Strategic Health Research Program

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Strategic HealthResearch Program

• Briefing Session 1 SASP Priorities
• 17 October 2007

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Kaurna Introduction

• We would like to acknowledge this land that we
  meet on today is the traditional Lands for the
  Kaurna people and that we respect their spiritual
  relationship with their country. We also
  acknowledge the Kaurna people as the custodians
  of the greater Adelaide region and that their
  cultural and heritage beliefs are still as
  important to the living Kaurna people today.

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Overview

• Part 1 Overview of Program

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Introduction

• Second funding round of SHRP.
• SHRP represents a paradigm shift from research
  funded under broad priority areas to a program
  where researchers are invited to respond to
  specific topics and questions (a targeted
  approach similar to commissioned research)

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Two main SHRP Strategies

• Two major strategies
• 1. User Driven research against priorities,
  topics and questions identified by the
  Department
• (applicants should consider SHRP as seed
  funding for topics which also have national
  relevance).
• 2. Leveraging research against Departmental
  priorities which provides more scope for
  researcher flexibility (not part of this call
  for research).

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Why this approach?

• We need to adopt strategies where there is
  focussed use of limited resources through a
  greater level of specificity within the
  prioritisation process. (Many good ideas but not
  everything can be funded)
• The universities approach the Dept for research
  topics. SHRP provides opportunities for
  university researchers to obtain funding under
  topics of mutual interest, but initially
  identified by the Dept.

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Collaboration

• Greater emphasis on research collaborations in
  three ways
• On the research undertakings themselves
• ie research team collaborations
• - Collaborations with policy makers/practiti
  oners
• Theme groups

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Why research collaboration?

• These collaborations aim to
• Co-produce research with policy/practitioners
  (research)
• Build SA strength and capacity across multiple
  research paradigms on SASP topic areas e.g.
  Healthy Weight
• Help to position SA researchers competitively
  nationally
• Build stronger multidisciplinary responses to
  complex research topics

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SHRP Priorities

• Priorities - revised to take account of the
  updated (2007) SASP and new directions for SA
  Health.
• Revision process was undertaken with selected
  end users of research (policy and decision
  makers) across the health system.
• As with the previous SHRP round, the priority
  setting process has been designed to generate
  research which has the capacity to be applied
  across the health system in a range of settings.
• Linkage and exchange underpins this process for
  better translation of research into policy and
  practice.

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SHRP Priorities

• Themes for 2007
• Psychological wellbeing
• Equal or lower than the Australian average for
  psychological distress by 2014 (SASP Target 2.7)
• Smoking
• Reduce the percentage of young cigarette smokers
  by 10 percentage points between 2004 and 2014.
  (SASP Target 2.1)
• Healthy weight
• Increase the proportion of South Australians 18
  and over with healthy weight by 10 percentage
  points by 2014 (SASP Target 2.2)
• Healthy life expectancy
• Increase the healthy life expectancy of South
  Australians by 5 for males and 3 for females by
  2014. (SASP Target 2.4)

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Cross cutting issues/approaches

• SHRP designed to address the priorities from the
  perspective of
• Health inequality or achieving health equity
• Prevention early intervention
• Population focus
• This year a focus on some clinical areas that
  impact on policy
• Responds to the broader question How do we get
  the greatest leverage for improving health and
  wellbeing across the SASP targets?

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Structure of SHRP

• Two core research streams
• Research Synthesis secondary research to
  address short term health system priorities
  where there are information shortfalls (only one
  topic in 2007-2008)
• New Research primary research to address longer
  term SASP relevant health priorities.

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SHRP does not fund

• Dental/Medical research
• Basic research
• Projects which do not address the SHRP 2007-2008
  Research Topics and Questions or do not align
  with the intent of the guidelines.
• Applications which exceed the stipulated funding
  levels under each research stream.
• Bio-technology research

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SHRP does not fund

• Retrospective funding of research projects.
• Capital items (e.g. computers, equipment).
• Projects requiring ongoing funding from the
  Department of Health, top ups to existing
  research etc.
• Attendance at seminars or conferences, unless
  integral to the research transfer strategy.

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2006-2007 Data

• Registrations of Interest 55
• Expressions of Interest 25
• Invitations to submit Full App. 11
• Submissions received 10
• Projects funded 7

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Research Funded in 2006-2007

• Preventing infant deaths in Aboriginal and
  teenage women in South Australia Chief
  Investigator Philippa Middleton, Discipline of
  Obstetrics and Gynaecology, CYWHS.
• Effective strategies to reduce the costs of
  overweight and obesity to SA Chief
  investigators Prof Christian Gericke and A/Prof
  John Moss, Department of Public Health, Adelaide
  University.
• Socio-economic status and overweight/obesity
  supply of and access to (un) healthy food. Chief
  Investigators A/Prof John Coveney and A/Prof
  Paul Ward, Department of Public Health, Flinders
  University.
• Psychological Distress in the South Australian
  adult population Chief Investigator Mr John
  Glover, Director, Public Health Information
  Development Unit (PHIDU), Adelaide University.

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Research Funded in 2006-2007

• Assessment of the Determinants and Epidemiology
  of Psychological Distress (ADEPD) Study. Chief
  Investigator Prof Helen Winefield Professor of
  Psychology, University of Adelaide and Cathy
  Chittleborough, Senior Epidemiologist, Population
  Research and Outcome Studies Unit, Department of
  Health
• Resilience and the mental health and wellbeing
  of farm families experiencing climate variation
  in South Australia Chief Investigator Dr. Debra
  King, National Institute for Labour Studies
  (NILS), Flinders University, in collaboration
  with A/Prof Colin McDougall, Department of Public
  Health, Flinders University.
• Exploring resilience and coping in relation to
  smoking within 'at risk' populations Chief
  Investigators Dr George Tsourtos and A/Prof Paul
  Ward, Department of Public Health, Flinders
  University.
• Indigenous Smoking Scoping Study Urbis

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What kind of research do we want

• Collaborative research with multi d teams of
  researchers and policy or practitioners (may
  mean new collaborations)
• Projects that directly address the topic and
  questions (some questions may need refinement but
  the original intention must be maintained)
• Research synthesis prepared to present the
  information in useable formats for use across the
  health system and develop innovative
  methodologies for the synthesis task

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We Will

• Promote collaborations to avoid competing
  proposals and duplication of topics (Ultimately
  it is researcher responsibility to do this)
• Researchers must show a willingness at the
  beginning of the process to talk to each other to
  discuss topics and how to collaborate

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Aboriginal Research

• Research team consist of 1 Aboriginal CI, if
  possible
• Community or key Stakeholder participation
• High level of collaboration but relevant to the
  topic
• Builds capacity
• Consistent with NHMRC Aboriginal Research
  Guidelines
• Deals with health equity
• Consistency with the Iga Warta Agreement
• Non Aboriginal researchers must be willing to be
  open to cultural perspective of Aboriginal peers

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Funding Levels

• Research Synthesis up to 120Kpa (GST Exc), for
  projects 6-12 months duration
• New Research up to 150Kpa (GST Exc), for
  projects up to 3 years duration
• These are the maximum funding levels for each
  stream. Applicants seeking maximum amounts must
  be able to justify clearly why funding is needed.
  
• Applications exceeding these levels will be
  automatically rejected.

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Application Process Key Dates

• SHRP has a 3 stage application process
• Registration intention to submit an EOI for the
  SHRP 07-08 funding round
• Due Date 22 October 2007
• Expression of Interest used to outline
  methodology and scope of research. 4 weeks
  allocated.
• Due Date 5 November 2007
• Full Application those successful at EOI stage
  will be invited to submit a full application. 9
  weeks allocated.
• Due Date 21 January 2008
• All research must start within 6 weeks of
  notification

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Aboriginal New Research Projects

• Registration intention to submit an EOI for the
  SHRP 07-08 funding round
• Due Date 22 October 2007
• Expression of Interest used to outline
  methodology and scope of research. 4 weeks
  allocated.
• Due Date 3 December 2007
• Full Application those successful at EOI stage
  will be invited to submit a full application. 9
  weeks allocated.
• Due Date 14 April 2008
• Extended timelines are important allow time to
  develop collaborations and linkages with
  Aboriginal contacts and the community.

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Assessment Process

• Applicants must address all headings in the
  application forms and selection criteria.
• Assessment through a panel (with relevant mix of
  expertise), and full proposals peer reviewed,
  plus DH policy input
• While peer review comments will be important,
  final decision to be made by the Chief Executive

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Guidelines

• Two sets of Guidelines have been produced for the
  07-08 funding round.
• Represent the separation of SASP General Health
  and Health Systems Research topics.
• All key information is included in the
  Guidelines. Interested applicants must read and
  familiarise themselves with all components of the
  relevant Guidelines.
• Further clarification (if needed) may be obtained
  from the SHRP team if Guidelines are unclear.

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Website

• Website contains
• Guidelines (and all documents)
• Application Forms
• Selection criteria
• Indicative timelines
• Relevant resources and DH policy documents
• http//www.health.sa.gov.au/shrp

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Contact Details

• Website http//www.health.sa.gov.au/shrp
• Email shrp_at_health.sa.gov.au
• Phone [phone] 6431

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Research Topics

• Part 2 Research Topics

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Psychological Health Wellbeing

• What are the most effective mental health
  interventions for Aboriginal children and
  adolescents? A Research Synthesis
• The Research Problem
• There is a gap in regard to the availability of
  a comprehensive analysis of the types of
  interventions for policy makers and planners that
  have been used across Australian settings to
  prevent and manage mental health difficulties
  amongst Aboriginal children and youth, and
  promote mental health and wellbeing. Examples of
  interventions should include, but not limited to
  the following

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Psychological Health Wellbeing

• home and school based programs
• interventions that address specific behavioural
  problems and conditions (e.g. depression, self
  harm, substance misuse and suicide)
• community based interventions
• mental health interventions within the juvenile
  justice system
• those which have an emphasis on building
  resilience and wellbeing in Aboriginal children
  and young people and
• programs which encourage healthy lifestyle
  choices.
• It is acknowledged that a proportion of these
  interventions are unlikely to have been
  evaluated, and therefore evidence for their
  effectiveness will not be known.
• Maximum timeframe is 6 months.
• A synthesis of research and literature (including
  grey literature)
• is required. This should cover Canadian, US, NZ
  Australian
• literature.

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Aboriginal Smoking

• Topic 1 Reducing Smoking in the Aboriginal
  Health and Education Workforce
• The Research Problem
• The rates of smoking must be lowered in order to
  reduce high rates of mortality and morbidity and
  to break the cycle of ongoing chronic disease and
  early deaths Aboriginal people experience
  compared with the non Aboriginal population.
• Evidence to date is lacking.

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Aboriginal Smoking

• Aboriginal (Health and Education) Workers Could
  they be a starting point for the design of
  interventions which can be built upon in other
  settings?
• Aboriginal Workers are a unique group for
  attention in this research as they usually have
  the benefits of employment and education. They
  may also work in settings which are impacted by
  recent changes to smoking legislation in South
  Australia and work in environments where quitting
  is encouraged. They may also have a unique role
  in influencing smoking cessation or smoking
  avoidance in others.
• Simple behavioural programs and nicotine patches
  could be part of the solution but not the whole
  solution. Given that very little is known about
  successful interventions for Aboriginal people
  this group represents a good starting point from
  whom to learn more about smoking behaviour within
  Indigenous communities and how to appropriately
  support them in quitting.

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Mental Illness Smoking

• Smoking Cessation for people who are mentally ill
  and on Clozapine
• Clinical impact
• The pharmacokinetics of clozapine and smoking are
  not always certain, while the clinical impact of
  the pharmacokinetics is even less certain.
• Case reports have shown that smokers who stop
  smoking may run into clinical difficulties by,
  effectively, overdosing on their medication.
  Some such case reports need to be treated with
  scepticism, while others are instructive and lead
  to the need for close clinical management.
• Beyond case studies, there have been no
  longitudinal studies which have examined people
  taking anti psychotics who start or stop smoking.
  Thus there is no evidence to guide a judgement on
  how rare or common problems are.

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Mental Illness Smoking

• Links with the Tobacco and Mental Illness Project
• The Tobacco and Mental Illness Project is running
  smoking cessation programmes for people with
  severe and disabling mental illness at mental
  health clinics across Adelaide. Over 500 people
  have been involved in these programs to date.
• Why does the Department want this study
  undertaken?
• The limited understanding of the clinical
  implications of the interaction of smoking
  cessation and clozapine levels is a barrier to
  people with mental illness getting appropriate
  support to address their smoking.
• i Wan, Hei (Carlos), Impact of smoking
  cessation on medication levels and safety of
  clozapine. Unpublished literature review,
  University of South Australia.

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Mental Illness Smoking

• The effectiveness of high dose nicotine
  replacement therapy among heavy smokers who have
  mental illness
• The rate of tobacco smoking amongst people with
  mental illness is very high and many smoke
  heavily. Nicotine Replacement Therapy (NRT) has
  been shown to reduce the symptoms of nicotine
  withdrawal and increase cessation rates. Higher
  doses of NRT and a combination of NRT types (for
  example, patch and gum together) have been shown
  to be more effective for heavy smokers. There is
  limited information about the safety and
  effectiveness of higher doses of NRT for people
  with mental illness who want to stop smoking
  tobacco.

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Mental Illness Smoking

• Why does the Department want to know about this
  problem?
• Although higher doses of NRT have been shown to
  be effective for heavy smokers in the general
  community, there is a lack of evidence of the
  safety and effectiveness of the use of higher
  doses of NRT for people living with severe and
  disabling mental illness.

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Healthy Weight

• Marketing of unhealthy foods
• growing recognition of the prevalence of
  unhealthy food advertising on television directed
  at children.
• less attention to date on how the food industry
  is engaging young consumers through media other
  than television. With the expansion of the
  internet and mobile phone SMS, opportunities
  exist to market and sell unhealthy and junk
  foods
• non-broadcast media are relatively unregulated
  in Australia, and present an opportunity for the
  food industry to expand advertising strategies to
  consumers, and present a problem for public
  health authorities attempting to curb the
  overweight and obesity epidemic.

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Marketing Unhealthy Foods

• The Research Problem
• The extent to which the food industry is using
  non-broadcast media (but not internet) to promote
  their products to young consumers in South
  Australia and across Australia more widely is
  unknown. The extent to which the non-broadcast
  media influences young people is also unknown.
• currently national research in progress exploring
  the use of the internet to promote food products
  - this will not be part of the analysis.

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Marketing Unhealthy Foods

• The non-broadcast media of interest includes the
  following categories
• Place e.g. vending machines, sporting and
  outdoor events, and supermarkets.
• Public relations e.g. sponsorship of television
  programs, sporting events, fund-raising
  activities, and establishing and donating money
  to charity.
• Promotions e.g. premium offers, celebrity
  endorsements, the use of cartoon characters,
  health and nutrient claims, and product
  placements.
• Print media e.g. magazines and newspapers.

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Marketing Unhealthy Foods

• Behaviours surrounding food requests
• Actual consumption of food.
• study would complement existing research in the
  area, some of which is being undertaken by the
  Cancer Council of NSW, and would provide data
  that could inform the development of public
  health policy and regulations to promote healthy
  weight and reduce rates of overweight and obesity
  in South Australia.
• As well as a comprehensive analysis of
  advertising in South Australia across the range
  of media listed above, SA Health seeks a better
  understanding of the influence and impact of such
  media on young consumers across the following
  areas
• Attitudes and beliefs regarding food
• Food preferences

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Regulatory Agenda Healthy Weight

• Determining a feasible regulatory agenda for
  healthy weight relevant to the South Australian
  context
• The Problem
• To progress thinking around this topic, further
  research and analysis is needed to identify
  feasible and priority options to shape a
  legislative approach to reduce overweight and
  obesity and promote healthy weight in South
  Australia.
• The Office of Recreation and Sport has undertaken
  a detailed review of government policy, planning
  and regulation that impacts on physical activity.
  This is under consideration and does not need to
  be repeated, however it will be essential to
  ensure a complementary approach
• The Department of Health conducted a literature
  review in 2006 exploring a range of approaches
  (including legislative) being used to impact the
  obesity epidemic, however, this work needs to be
  extended.
• New research is required which can provide the
  following
• A detailed examination of existing legislation
  (Acts, regulations) at a State and Commonwealth
  level (where relevant) that may have a bearing on
  good nutrition and healthy weight

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Regulatory Agenda-Healthy Weight

• An analysis of potential points of intervention
  within this legislation that would be likely to
  promote good nutrition and healthy weight
• What amendments or revisions could be introduced
  to existing legislation, or the introduction of
  new legislation, to promote good nutrition and
  healthy weight, including an exploratory analysis
  of the likely impacts of such revisions on other
  sectors (this should include positive and
  negative impacts). These could also be
  prioritised according to likely degree of impact
  on the problem
• An exploration of the political feasibility of
  any legislative changes discussed.
• On the basis of the above, an examination of what
  a regulatory framework might look like for South
  Australia, including appropriate recommendations
• An outline of what steps would be needed to gain
  appropriate support and consensus across
  Government and non-Government sectors to bring
  about legislative reform in line with the
  recommendations provided by this research.

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Healthy Life Expectancy Cancer Prevention

• Cervical Cancer Screening
• Need to better define women who are at risk of
  being under-screened and who, thus, risk
  potentially pre-cancerous high-grade cervical
  abnormalities remaining undetected. There is
  also a requirement to establish evidence based
  effective interventions aimed at improving
  cervical cancer screening rates for the target
  age range overall and for sub-populations of
  women. An understanding of at risk women is
  currently limited by a lack of routinely
  collected data on some variables of interest
  including ethnicity.
• Why does the Department want to know about this
  problem?
• Research which better defines women at risk of
  under-screening and research which establishes
  effective interventions can be utilised by the
  SA Cervix Screening Program to improve
  participation by SA women in the National
  Cervical Screening Program.

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Cancer Prevention

• Bowel Cancer Screening
• The implementation of the National Bowel Cancer
  Screening program requires further work in SA
  particularly in regard to defining screening
  pathways to achieve the best outcomes for
  clients. Exploration of how screening is provided
  could be explored such as the use of web based
  tools. Additionally, attention needs to be given
  to whether people from low socio-economic groups
  are effectively involved in the SA bowel
  screening program. There is significant scope
  within this research topic to explore avenues
  which ensure adequate uptake and monitoring of
  the SA bowel cancer screening program. In
  addition, research associated with bio-active
  foods and bowel cancer prevention may be
  undertaken.

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Cancer Prevention

• Prostate Cancer Prevention and Early Detection
• Prostate cancer testing does not have a
  population based screening test available due to
  the uncertainties in regard to benefits and
  adverse side effects of the Prostatic Specific
  Antigen (PSA) test. Research applications that
  further test the efficacy of PSA testing or other
  prostate cancer prevention measures are invited.

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Cancer Prevention

• The role of Bio-active foods in cancer prevention
• A significantly under-researched area is the role
  of food as an active agent in cancer prevention.
  South Australian researchers are well placed to
  build on current efforts relating to the role of
  bio-active foods in cancer prevention.
• Due to the exploratory nature of this work
  research applications are invited which allow
  researchers to develop their own research
  questions.
• It is preferable that one team of researchers
  (with inter-university representation where
  relevant) supports the development of people
  capacity as well as the research capability in
  this area.
• In the longer term this strategy will allow SA
  researchers to undertake a programmatic approach
  to their work that positions them competitively
  at the national and international level.