Background General practitioners (GPs) are in a unique position for community detection and manag... more Background General practitioners (GPs) are in a unique position for community detection and management of mild cognitive impairment (MCI). However, adequate knowledge, attitudes, and practice (KAP) are prerequisites for fulfilling such a role. This study aims to assess the MCI-related KAP of GPs in Shanghai, China. Methods An online survey was conducted on 1253 GPs who were recruited from 56 community health centres (CHCs) in Shanghai between April and May 2021. Knowledge (8 items), attitudes (13 items), and practice (11 items) were assessed using a scale endorsed by a panel of multidisciplinary experts. An average summed score was calculated and transformed into a score ranging from 0 to 100 for knowledge, attitudes, and practice, respectively. Adjusted odds ratios (AORs) were calculated for potential predictors of higher levels of KAP scores (with mean value as a cutoff point) through logistic modelling. The mediating role of attitudes on the association between knowledge and prac...
Background Research shows tobacco plain packaging (TPP) is effective in reducing the attractivene... more Background Research shows tobacco plain packaging (TPP) is effective in reducing the attractiveness of tobacco products, effectiveness of tobacco packaging and increases the impact of health warnings. Since Australia introduced TPP in 2012, several other countries have adopted similar legislation, and more have begun preparations for introducing it. Turkey first announced its intention to proceed with TPP in 2011, however prior to the eventual passage of legislation in December 2018 there were many false starts and delays. This study (conducted in 2018 before TPP legislation was passed in Turkey) explored the barriers and facilitators to introducing legislation. Methods A qualitative study design was employed using a single case study approach. Publicly available documents relevant to TPP in Turkey were analysed and interviews with key informants from academics, bureaucrats in government ministries and non-government organisations (NGOs) were conducted in 2018. Results Barriers such...
Objective: Social support plays a critical role in the detection and management of mild cognitive... more Objective: Social support plays a critical role in the detection and management of mild cognitive impairment (MCI). However, socioeconomic inequalities exist in both social support and health care services. Our study aimed to compare the level of social support received by MCI patients in comparison with those without MCI and to determine its link with income. Methods: Secondary data analyses were performed. Social support was measured using the Duke Social Support Index (DSSI) and satisfaction ratings. Multivariate logistic regression models were constructed to determine the associations of personal income and MCI with social support after adjustment for variations in the sociodemographic and health characteristics of the respondents. The multiplicative and additive interaction effects of income and MCI were further examined through introducing the MCI*Income variable to the regression models and using the relative excess risk due to interaction (RERI) analysis, respectively. Resul...
Background General practitioners (GPs) play a critical role in community detection and management... more Background General practitioners (GPs) play a critical role in community detection and management of mild cognitive impairment (MCI). Although adequate knowledge is essential, healthcare practice is shaped by many factors, both intrinsic and extrinsic. This study aimed to test the mediating effect of perceived extrinsic barriers on the associations between knowledge, attitudes and intended practice of GPs in community detection and management of MCI. Methods A cross-sectional study was conducted through an online survey of 1253 GPs sampled from 56 community health centres (CHCs) in Shanghai in 2021. Perceived extrinsic barriers were rated on a five-point Likert scale for patient engagement, working environment, and system context, respectively. A summed score was generated subsequently for each domain ranging from 0 to 100, with a higher score indicating higher barriers. The mediating effect of perceived extrinsic barriers (second-order) and the moderation effects of training and pa...
Background Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive agei... more Background Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive ageing and overt dementia, with amnesic MCI (aMCI) being the dominant subtype. This study aims to synthesise the prevalence results of MCI and aMCI in community-dwelling populations in China through a meta-analysis and systematic review. Methods The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol. English and Chinese studies published before 1 March 2020 were searched from ten electronic bibliographic databases. Two reviewers screened for relevance of the studies against the pre-defined inclusion and exclusion criteria and assessed the quality of the included studies using the Risk of Bias Tool independently. A random-effect model was adopted to estimate the prevalence of MCI and aMCI, followed by sub-group analyses and meta-regression. Sensitivity and publication bias tests were performed to verify the robustness of the meta-analyses. ...
the International Journal of Person-Centered Medicine, Sep 11, 2012
ABSTRACT Following the adoption of a regional policy framework on people-centred healthcare (PCHC... more ABSTRACT Following the adoption of a regional policy framework on people-centred healthcare (PCHC), WHO (Western Pacific Regional Office) initiated a project to examine what indicators might be used to monitor progress of national health systems towards people-centred healthcare. Following a desk review of existing indicator sets, further consultation was undertaken to consider how an indicator set might be determined and what strategies might be used to test their value at the national level. The PCHC National Indicators Project found that conceptual difficulties in using indicator sets developed by a provider-oriented health system and for other purposes. There were also expected gaps in obtaining useful indicators from the perspectives of patients, families and communities. Nevertheless, respondents in the consultation indicated that a participatory process at the national level, with collaboration across countries, may be helpful in refining and testing indicators as well as providing the feedback necessary to drive health system change.
Transformative forces such as increasing connectivity, innovation of technologies with far-reachi... more Transformative forces such as increasing connectivity, innovation of technologies with far-reaching capabilities, industrialisation, urbanisation and increasing population growth and mobility are interacting to escalate the tempo of change in the early 21st century. New patterns of risk and opportunity for population health are surfacing. Making policy, strategy and decisions in this context is replete with uncertainties. As an aid to reducing uncertainty and exploring policy options, futures studies have been used by many governments, organisations and researchers. Utilisation of futures studies in health policy has not been well researched, limiting understanding of its potential applications, benefits and restrictions. This study explored the question: How and why are futures studies used in health policy making, by developing case studies around three policy reviews in Australia, United Kingdom and United States of America. The initiatives were framed in terms of ten to 20 year ...
Australia has a longstanding history of promoting health through programs that reflect the princi... more Australia has a longstanding history of promoting health through programs that reflect the principles of the Ottawa Charter and recognising the importance of social determinants of health. Health promotion programs are delivered by a wide range of organisations, in a wide range of settings and sectors for, or with, multiple groups. Since the mid-1980s aspects of infrastructure and capacity for health promotion, such as human and financial resources, have been put in place including the establishment of health promotion foundations via tobacco hypothecation. Following neo-liberal reforms in the 1990s, however, government policies have increasingly focused more narrowly on specific diseases and risk factors. Chronic disease has become the new banner under which health promotion, social determinants and efforts to address health inequalities fit. While the importance of social determinants is often recognised within and outside the health sector, health promotion practitioners are seld...
Background General practitioners (GPs) are in a unique position for community detection and manag... more Background General practitioners (GPs) are in a unique position for community detection and management of mild cognitive impairment (MCI). However, adequate knowledge, attitudes, and practice (KAP) are prerequisites for fulfilling such a role. This study aims to assess the MCI-related KAP of GPs in Shanghai, China. Methods An online survey was conducted on 1253 GPs who were recruited from 56 community health centres (CHCs) in Shanghai between April and May 2021. Knowledge (8 items), attitudes (13 items), and practice (11 items) were assessed using a scale endorsed by a panel of multidisciplinary experts. An average summed score was calculated and transformed into a score ranging from 0 to 100 for knowledge, attitudes, and practice, respectively. Adjusted odds ratios (AORs) were calculated for potential predictors of higher levels of KAP scores (with mean value as a cutoff point) through logistic modelling. The mediating role of attitudes on the association between knowledge and prac...
Background Research shows tobacco plain packaging (TPP) is effective in reducing the attractivene... more Background Research shows tobacco plain packaging (TPP) is effective in reducing the attractiveness of tobacco products, effectiveness of tobacco packaging and increases the impact of health warnings. Since Australia introduced TPP in 2012, several other countries have adopted similar legislation, and more have begun preparations for introducing it. Turkey first announced its intention to proceed with TPP in 2011, however prior to the eventual passage of legislation in December 2018 there were many false starts and delays. This study (conducted in 2018 before TPP legislation was passed in Turkey) explored the barriers and facilitators to introducing legislation. Methods A qualitative study design was employed using a single case study approach. Publicly available documents relevant to TPP in Turkey were analysed and interviews with key informants from academics, bureaucrats in government ministries and non-government organisations (NGOs) were conducted in 2018. Results Barriers such...
Objective: Social support plays a critical role in the detection and management of mild cognitive... more Objective: Social support plays a critical role in the detection and management of mild cognitive impairment (MCI). However, socioeconomic inequalities exist in both social support and health care services. Our study aimed to compare the level of social support received by MCI patients in comparison with those without MCI and to determine its link with income. Methods: Secondary data analyses were performed. Social support was measured using the Duke Social Support Index (DSSI) and satisfaction ratings. Multivariate logistic regression models were constructed to determine the associations of personal income and MCI with social support after adjustment for variations in the sociodemographic and health characteristics of the respondents. The multiplicative and additive interaction effects of income and MCI were further examined through introducing the MCI*Income variable to the regression models and using the relative excess risk due to interaction (RERI) analysis, respectively. Resul...
Background General practitioners (GPs) play a critical role in community detection and management... more Background General practitioners (GPs) play a critical role in community detection and management of mild cognitive impairment (MCI). Although adequate knowledge is essential, healthcare practice is shaped by many factors, both intrinsic and extrinsic. This study aimed to test the mediating effect of perceived extrinsic barriers on the associations between knowledge, attitudes and intended practice of GPs in community detection and management of MCI. Methods A cross-sectional study was conducted through an online survey of 1253 GPs sampled from 56 community health centres (CHCs) in Shanghai in 2021. Perceived extrinsic barriers were rated on a five-point Likert scale for patient engagement, working environment, and system context, respectively. A summed score was generated subsequently for each domain ranging from 0 to 100, with a higher score indicating higher barriers. The mediating effect of perceived extrinsic barriers (second-order) and the moderation effects of training and pa...
Background Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive agei... more Background Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive ageing and overt dementia, with amnesic MCI (aMCI) being the dominant subtype. This study aims to synthesise the prevalence results of MCI and aMCI in community-dwelling populations in China through a meta-analysis and systematic review. Methods The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol. English and Chinese studies published before 1 March 2020 were searched from ten electronic bibliographic databases. Two reviewers screened for relevance of the studies against the pre-defined inclusion and exclusion criteria and assessed the quality of the included studies using the Risk of Bias Tool independently. A random-effect model was adopted to estimate the prevalence of MCI and aMCI, followed by sub-group analyses and meta-regression. Sensitivity and publication bias tests were performed to verify the robustness of the meta-analyses. ...
the International Journal of Person-Centered Medicine, Sep 11, 2012
ABSTRACT Following the adoption of a regional policy framework on people-centred healthcare (PCHC... more ABSTRACT Following the adoption of a regional policy framework on people-centred healthcare (PCHC), WHO (Western Pacific Regional Office) initiated a project to examine what indicators might be used to monitor progress of national health systems towards people-centred healthcare. Following a desk review of existing indicator sets, further consultation was undertaken to consider how an indicator set might be determined and what strategies might be used to test their value at the national level. The PCHC National Indicators Project found that conceptual difficulties in using indicator sets developed by a provider-oriented health system and for other purposes. There were also expected gaps in obtaining useful indicators from the perspectives of patients, families and communities. Nevertheless, respondents in the consultation indicated that a participatory process at the national level, with collaboration across countries, may be helpful in refining and testing indicators as well as providing the feedback necessary to drive health system change.
Transformative forces such as increasing connectivity, innovation of technologies with far-reachi... more Transformative forces such as increasing connectivity, innovation of technologies with far-reaching capabilities, industrialisation, urbanisation and increasing population growth and mobility are interacting to escalate the tempo of change in the early 21st century. New patterns of risk and opportunity for population health are surfacing. Making policy, strategy and decisions in this context is replete with uncertainties. As an aid to reducing uncertainty and exploring policy options, futures studies have been used by many governments, organisations and researchers. Utilisation of futures studies in health policy has not been well researched, limiting understanding of its potential applications, benefits and restrictions. This study explored the question: How and why are futures studies used in health policy making, by developing case studies around three policy reviews in Australia, United Kingdom and United States of America. The initiatives were framed in terms of ten to 20 year ...
Australia has a longstanding history of promoting health through programs that reflect the princi... more Australia has a longstanding history of promoting health through programs that reflect the principles of the Ottawa Charter and recognising the importance of social determinants of health. Health promotion programs are delivered by a wide range of organisations, in a wide range of settings and sectors for, or with, multiple groups. Since the mid-1980s aspects of infrastructure and capacity for health promotion, such as human and financial resources, have been put in place including the establishment of health promotion foundations via tobacco hypothecation. Following neo-liberal reforms in the 1990s, however, government policies have increasingly focused more narrowly on specific diseases and risk factors. Chronic disease has become the new banner under which health promotion, social determinants and efforts to address health inequalities fit. While the importance of social determinants is often recognised within and outside the health sector, health promotion practitioners are seld...
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Papers by Dr Sally Fawkes