Cutting chronic disease risks and improving program uptake

Chronic diseases such as cardiovascular disease and cancer can be prevented with the right early intervention. Through his research, Professor Luke Wolfenden is working to reduce the risks with targeted health programs and multi-system change.

“My research program is focused on chronic disease prevention,” says Luke. “Specifically, how can we reduce chronic disease risks in the community to prevent the onset of chronic disease in later life?”

It’s an area of research that has interested Luke ever since his PhD days when he was part of a smoking cessation program for patients at John Hunter Hospital in Newcastle.

His goal is to increase the number of disease-free years lived. To achieve this, he focuses on improving health behaviours, such as physical activity and diet, while reducing risk factors like tobacco and excessive alcohol use.

Making programs easier to implement

Luke explains that a significant problem in the scientific process is too little of the research that is undertaken has an impact on public and community health.

“It takes 17 years for just 14 per cent of health innovations to be integrated into routine health policy and practice. This means investment in research isn’t adequately benefiting the community.”

Because of this, his work is about undertaking research that better meets the needs of health policy makers, practitioners, and make implementing health initiatives easier.

“It’s about developing and testing strategies that can improve the likelihood those programs are integrated and implemented into the routine practice of organisations that can host prevention programs.”

Host organisations include community services such as hospitals and primary care clinics, schools, childcare providers and sporting clubs.

Luke’s work involves building partnerships with these end users and organisations like the Ministry of Health.

“We’ve recently received significant grants to explore how we can help reorient and strengthen the capacity of these agencies to better use evidence, enabling them to learn faster and conduct the research they need to improve their programs and services,” says Luke.

“What we want is for these systems to conduct the research necessary to improve the implementation and delivery of chronic disease prevention programs and services.”

This approach contrasts with traditional models where research is undertaken by a University and then needs to be transferred to, and considered relevant by agencies like a Department of Health for it to be used in their decision making about health policy or programs.

E-cigarette use in teens

A specific project Luke is working on involves undertaking global synthesis of the evidence base around preventing e-cigarette use among adolescents—work that’s being funded by the Medical Research Future Fund.

This project involves routinely reviewing the literature to find people who are investigating the effects of interventions to prevent vaping.

“Once we find out who they are and the work they’re doing, we invite them into a global collaboration and encourage them to use a core set of outcome measures to evaluate their programs and to share their data.”

This creates an opportunity for a global data set enabling comparison of the effects of different vaping prevention efforts internationally to help us identify those that may be most effective and to inform how they can be further improved.”

From this data set, they can then generate evidence around vaping prevention for governments and other prevention agencies. As soon as the evidence of effective interventions exists, they can send it to the relevant agencies for policies to be developed.

“This is much more impactful than waiting for those programs to finish, only then to find out we can’t compare findings of studies because they’ve used different outcomes,” he continues.

Luke and his team are also running parent- and child-focused text-based interventions for vaping prevention, aiming to integrate them seamlessly into existing telephone support services like Quitline.

Tackling unhealthy lunchbox snacks

Another of Luke’s current research projects is focused on healthy eating in schools.

Working with Associate Professor Rachel Sutherland, and several agencies across Australia, including Queensland, NSW, Victoria and South Australia, he and his team are developing ways to better implement a healthy lunchbox program called ‘Swap It’ in schools.

“Swap It is a free, evidence-based program for primary schools. A core component of it involves sending discreet messages to parents making suggestions to replace unhealthy snacks with healthier ones,” says Luke.

“For example, we might recommend popcorn instead of a packet of chips.”

This work has the potential to influence millions of school lunches provided to children each week.

Boosting physical activity in schools

A further research project, developed in collaboration with Associate Professor Nicole Nathan, focuses on improving the implementation of a physical activity policy in schools.

The intervention helps schools enforce the mandatory minimum time for organised physical activity. While the curriculum requires 120 –150 minutes, depending on the school sector, most schools struggle to meet this standard.

“We have several support strategies in place, including training, prompts, and scheduling assistance, to ensure children receive adequate structured physical activity each week."

This was similar to another of Luke’s projects that looked at physical activity in childcare centres. A project that found the most effective thing to get kids moving was simply more outside time.

Guidance for learning health systems

Luke is also developing a guidance document for the World Health Organization to support healthcare institutions and other organisations where knowledge-generation processes are embedded into daily clinical practice, otherwise known as learning health systems.

“The document will provide instruction for the health systems to develop processes and procedures to better use data and inform their decision-making and improve the impact of their programs and interventions.”

This work isn’t related to a particular content area or health problem. Rather, it’s about strengthening health systems and could be applied to address a range of health challenges.

The impact of implementation efforts

Luke’s broad spectrum of work is having an impact locally and globally.

A lot of his evidence synthesis work has been used to shape international policy. This has included evidence reviews for the Food and Agricultural Organisation of the United Nations around the sorts of policies and programs that can work to improve the consumption of fruits and vegetables.

He’s also published a series of technical reports for the World Health Organisation (WHO) around tobacco control and e-cigarette use, which has also shaped global policy.

Additionally, Luke helped develop ‘Good Sports,’ an alcohol management and accreditation program for community sports clubs. Now implemented across Australia, in almost 12,000 clubs and reaching over 3 million Australians.

His work in improving the implementation of nutrition guidelines for childcare services led to federal funding for a national rollout, impacting thousands of centres and influencing millions of meals each year.

Luke and his team also serve as service consultants to state governments and prevention agencies, leading the development and evaluation of a range of streams of the ‘Good for Kids’ child obesity prevention initiatives that underpinned the architecture of the $79 million investment in child obesity and prevention by the NSW Government as part of the Healthy Children Initiative.

Overall, Luke’s work has significantly shaped the development of community-based programs.

Satisfaction in application

“What I enjoy most about my research is the applied nature of it”, says Luke.

“We do a lot of work with end-user organisations to address and solve problems that have been priority problems experienced in the community. Because it’s very applied, it means the work we do actually improves health policy. “

“It’s incredibly exciting and rewarding to walk into my kids’ childcare services, schools, or sports clubs and see the programs I’ve developed being implemented. I can see the positive impact I'm having on the health and wellbeing of the community."

Luke’s research moving forward will focus on strengthening health service systems, including how they use data, govern, develop and improve the workforce and collaborate.

If we can do those things, he shares, we can then create more sustainable systems that benefit peoples’ lives beyond an individual project or program.