Dr Alice Grady
Postdoctoral Research Fellow
School of Medicine and Public Health
- Phone:(02) 4924 6310
Turning health research into action
Dr Alice Grady is using implementation science and new technology to translate public health research into real-world benefits for the community.
Improving public health requires robust research—but that’s just the beginning. Dr Alice Grady is using new technologies, such as web-based programs, to put evidence into practice in a way that is effective, sustainable and can be scaled up to reach more people. By turning research into action, Alice is helping to prevent chronic diseases and create healthier communities.
“To impact lives, we need to implement evidence-based practices that help to improve people’s health behaviours and prevent chronic disease. Digital interventions, such as online programs and phone apps, are a promising and potentially cost-effective solution.
“Technology has the ability to overcome geographical barriers, with minimal investment, to help more people benefit from evidence-based health practices.”
Improving children’s nutrition
Alice is particularly interested in improving children’s health and nutrition through clever online systems.
One of her collaborative projects successfully developed a web-based program—titled feedAustralia—to help over 50 childcare services across NSW adhere to the required dietary guidelines for children. Carried out in partnership with research institutes and health service providers, the evaluation of feedAustralia was a winner at both the 2018 Hunter New England Excellence Awards and the 2018 NSW Health Awards. The innovative program has gained national attention, garnering $1.2 million in funding support from the Commonwealth Department of Health to be expanded nationwide.
While public health research continues to uncover answers and new hope for communities, our knowledge of how to successfully implement the research findings in a meaningful and scalable way remains limited. Alice’s research explores the barriers and enablers to rolling out effective health interventions—helping quality programs and research benefit more people.
“Poor implementation of evidence-based practices in community and healthcare systems can significantly hinder local, state and national efforts to prevent chronic disease, such as childhood obesity.
“By researching how to implement interventions well, we can increase the public health impact considerably.”
Alice’s research is contributing to global impact. Over the past few years, she has collaborated internationally with prominent evidence-driven organisations such as the Cochrane Collaboration and Word Health Organization. Her work has been published in renowned journals such as The Medical Journal of Australia, been presented at 22 national and international conferences, and received more than $330,000 in funding.
In 2018, Alice was invited to further hone her research and academic skills as a participant in the ThinkWell Early and Mid-Career Women’s Development Program, facilitated through the University of Newcastle’s Faculty of Health and Medicine's Gender Equity Committee.
“The program was a strategic step towards achieving my career: to become an independent research leader in the prevention of chronic disease via the dissemination and implementation of evidence-based practices within community settings.”
Alongside her research, Alice also supervises PhD students with the University, allowing her a valuable opportunity to pass on her knowledge and expertise.
Dr Alice Grady is a behavioural scientist and postdoctoral research fellow with the University of Newcastle. Her research aims to prevent chronic disease by putting robust evidence into practice within healthcare and community settings, such as schools, childcare services and more. To do this, Alice’s research draws on the benefits of digital health interventions—such as smart phone apps—that allow evidence to be translated in a way that is easily understood by the public and can be upscaled to reach more people.
Alice completed a Bachelor of Psychology in 2009 and a PhD in behavioural science in 2016. Her PhD research examined barriers to the implementation of best-practice stroke care in Australia. During her candidature, Alice worked as a research assistant at the Priority Research Centre for Health Behaviour, under the supervision of Laureate Professor Rob Sanson-Fisher, before moving into the role of postdoctoral research fellow with the Hunter New England Population Health Research Group.
Alice has broad experience in individual patient and applied health services research. Her current research is more niche, focusing on implementing and evaluating interventions to improve child nutrition. This includes leading a system-level randomised controlled trial examining the effectiveness of a web-based intervention to help over 50 childcare services across NSW adhere to dietary guidelines. She was also recently awarded a Hunter Children's Research Foundation grant for a pilot trial assessing the potential impact of an online intervention to improve child dietary intake in childcare.
Alice is a Public Health Early Career Researcher representative for Hunter Medical Research Institute Early and Mid-Career Researcher Steering Committee, and Hunter Cancer Research Alliance Symposium Committee representative for implementation science. She is also a member of multiple national and international societies, including the Australasian Society for Behavioural Health and Medicine, and International Society of Behavioural Nutrition and Physical Activity.
- Doctor of Philosophy, University of Newcastle
- Bachelor of Psychology, University of Newcastle
- Child health
- Chronic disease
- Early childhood
- Evidence-based health care
- Health research
- Implementation science
- Population health
- Public health
- English (Mother)
Fields of Research
|111799||Public Health and Health Services not elsewhere classified||50|
For publications that are currently unpublished or in-press, details are shown in italics.
Journal article (36 outputs)
Grady A, Dodds P, Jones J, Wolfenden L, Yoong S, 'Prevalence of night sleep duration, sleep quality and sleep hygiene practices among children attending childcare services in New South Wales, Australia', JOURNAL OF PAEDIATRICS AND CHILD HEALTH, 55 59-65 (2019)
Yoong SL, Grady A, Seward K, Finch M, Wiggers J, Lecathelinais C, et al., 'The Impact of a Childcare Food Service Intervention on Child Dietary Intake in Care: An Exploratory Cluster Randomized Controlled Trial.', Am J Health Promot, 33 991-1001 (2019)
Pond N, Finch M, Sutherland R, Wolfenden L, Nathan N, Kingsland M, et al., 'Cluster randomised controlled trial of an m-health intervention in centre-based childcare services to reduce the packing of discretionary foods in children's lunchboxes: study protocol for the ' SWAP IT Childcare' trial', BMJ OPEN, 9 (2019)
Mansfield E, Bryant J, Carey M, Turon H, Henskens F, Grady A, 'Getting the right fit: Convergence between preferred and perceived involvement in treatment decision making among medical oncology outpatients.', Health Science Reports, 2 e101 (2019) [C1]
Jones J, Wolfenden L, Grady A, Finch M, Bolsewicz K, Wedesweiler T, Yoong SL, 'Implementation of continuous free play schedules in Australian childcare services: A cross-sectional study.', Health Promot J Austr, (2019)
Grady A, Stacey F, Seward K, Finch M, Jones J, Yoong SL, 'Menu planning practices in early childhood education and care - factors associated with menu compliance with sector dietary guidelines.', Health Promot J Austr, (2019)
Razak LA, Jones J, Clinton-McHarg T, Wolfenden L, Lecathelinais C, Morgan PJ, et al., 'Implementation of policies and practices to increase physical activity among children attending centre-based childcare: A cross-sectional study.', Health Promot J Austr, (2019)
Paul C, D'Este C, Ryan A, Jayakody A, Attia J, Oldmeadow C, et al., 'Staff perspectives from Australian hospitals seeking to improve implementation of thrombolysis care for acute stroke', SAGE OPEN MEDICINE, 7 (2019)
Finch M, Seward K, Wedesweiler T, Stacey F, Grady A, Jones J, et al., 'Challenges of Increasing Childcare Center Compliance With Nutrition Guidelines: A Randomized Controlled Trial of an Intervention Providing Training, Written Menu Feedback, and Printed Resources', American Journal of Health Promotion, 33 399-411 (2019)
© The Author(s) 2018. Purpose: To assess the effectiveness of an intervention including training, provision of written menu feedback, and printed resources on increasing childcare... [more]
© The Author(s) 2018. Purpose: To assess the effectiveness of an intervention including training, provision of written menu feedback, and printed resources on increasing childcare compliance with nutrition guidelines. Design: Parallel group randomized controlled trial. Setting: Hunter New England region, New South Wales, Australia. Participants: Forty-four childcare centers that prepare and provide food on-site to children while in care. Intervention: The intervention was designed using the Theoretical Domains Framework, targeted managers, and cooks and included implementation strategies that addressed identified barriers. Measures: Outcomes included the proportion of menus providing food servings (per child) compliant with overall nutrition guideline recommendations and each individual food group assessed via menu assessments. Cook knowledge of recommendations, intervention acceptability, adverse events, and barriers were also assessed via questionnaires with cooks and managers. Analysis: Logistic regression models, adjusted for baseline values of the outcome. Results: At baseline and follow-up, zero centers in the intervention and control groups were compliant with the overall menu guidelines or for the vegetable and meat food groups. Follow-up between-group differences in compliance for discretionary (33.3 vs 5, P =.18), dairy (41.7 vs 15, P =.16), breads and cereals (8.3 vs 10 P = 1.00), and fruit (16.7 vs 10, P =.48) were all nonsignificant. Relative to the control group, intervention centers showed a significantly greater increase in percentage of cooks with correct knowledge for vegetable servings (93.3 vs 36.4, P =.008). Conclusion: Although the application of the theoretical framework produced a broader understanding of the determinants of menu compliance, due to the complexity of guidelines, limited follow-up support, lower training uptake, and low intervention dose, the intervention was not effective in supporting the practice change required.
Finch M, Stacey F, Jones J, Yoong SL, Grady A, Wolfenden L, 'A randomised controlled trial of performance review and facilitated feedback to increase implementation of healthy eating and physical activity-promoting policies and practices in centre-based childcare', IMPLEMENTATION SCIENCE, 14 (2019) [C1]
Yoong SL, Grady A, Stacey F, Polimeni M, Clayton O, Jones J, et al., 'A pilot randomized controlled trial examining the impact of a sleep intervention targeting home routines on young children's (3-6 years) physical activity.', Pediatric obesity, 14 e12481 (2019) [C1]
Carey M, Bryant J, Zucca A, Hall A, Grady A, Dilworth S, Peek K, 'How well do cancer survivor self-classifications of anxiety, depression and stress agree with a standardised tool? Results of a cross-sectional study.', PloS one, 14 (2019) [C1]
Wolfenden L, Reilly K, Kingsland M, Grady A, Williams CM, Nathan N, et al., 'Identifying opportunities to develop the science of implementation for community-based non-communicable disease prevention: A review of implementation trials', Preventive Medicine, 118 279-285 (2019) [C1]
© 2018 Implementation of interventions in community organisations such as schools, childcare centres, and sporting clubs are recommended to target a range of modifiable risks of n... [more]
© 2018 Implementation of interventions in community organisations such as schools, childcare centres, and sporting clubs are recommended to target a range of modifiable risks of non-communicable diseases. Poor implementation, however, is common and has contributed to the failure of non-communicable disease interventions globally. This study aimed to characterise experimental research regarding strategies to improve implementation of chronic disease prevention programs in community settings. The review used data collected in three comprehensive systematic reviews undertaken between August 2015 and July 2017. Randomised controlled trials, including cluster design, and non-randomised trials with a parallel control group were included. The data were extracted to describe trial characteristics, implementation strategies employed, implementation outcomes and study quality. Of the 40 implementation trials included in the study, unhealthy diet was the most common risk factor targeted (n = 20). The most commonly reported implementation strategies were educational meetings (n = 38, 95%), educational materials (n = 36, 90%) and educational outreach visits (n = 29, 73%). Few trials were conducted ¿at-scale¿ (n = 8, 20%) or reported adverse effects (n = 5, 13%). The reporting of implementation related outcomes; intervention adoption (n = 13, 33%); appropriateness (n = 11, 28%); acceptability (n = 8, 20%); feasibility (n = 8, 20%); cost (n = 3, 8%); and sustainability (n = 2, 5%); was limited. For the majority of trials, risk of bias was high for blinding of study personnel/participants and outcome assessors. Testing of strategies to improve implementation of non-communicable disease prevention strategies in community settings, delivered ¿at-scale¿, utilising implementation frameworks, including a comprehensive range of implementation outcomes should be priority areas for future research in implementation science.
Yoong SL, Nathan N, Reilly K, Sutherland R, Straus S, Barnes C, et al., 'Adapting implementation strategies: a case study of how to support implementation of healthy canteen policies', Public Health, 177 19-25 (2019) [C1]
© 2019 The Royal Society for Public Health Objectives: Although evidence-based interventions (EBIs) and effective strategies to implement them exist, they cannot be used by policy... [more]
© 2019 The Royal Society for Public Health Objectives: Although evidence-based interventions (EBIs) and effective strategies to implement them exist, they cannot be used by policy makers and practitioners if they do not align with end users¿ needs. As such, adaptations to EBIs and implementation approaches are likely to occur to increase ¿fit¿ with end users¿ capacity. This article describes an approach undertaken by a population health service delivery unit in one Australian state to develop an adapted implementation strategy to support the implementation of the mandatory healthy canteen policy (EBI) to all schools located in the service delivery region. Study design: This is a case study of adapting an intervention to improve implementation of the healthy canteen policy. Methods and results: This is a six-step pragmatic, empirically driven approach. The steps include (i) adapt, where appropriate, the EBI to facilitate implementation; (ii) identify end users¿ capacity for implementation; (iii) identify opportunities to adapt the implementation interventions while preserving meaningful intervention impact; (iv) undertake program adaptation; (v) develop training and resources to support delivery of implementation strategies and; (vi) evaluate the adapted intervention. This article describes the application of these steps by the authors to develop an adapted support strategy consistent with end users¿ needs. Conclusions: This study provides some guidance on how to adapt implementation support approaches particularly when EBIs cannot be adapted. Future empirical research providing guidance on making practical adaptation decisions are needed.
Grady A, Wolfenden L, Rissel C, Green S, Reilly K, Yoong SL, 'Effectiveness of a dissemination strategy on the uptake of an online menu planning program: A controlled trial', Health Promotion Journal of Australia, (2018)
© 2018 Australian Health Promotion Association Issue addressed: Online systems offer opportunities to provide effective, ongoing support to childcare services to implement dietary... [more]
© 2018 Australian Health Promotion Association Issue addressed: Online systems offer opportunities to provide effective, ongoing support to childcare services to implement dietary guidelines. The study aimed to assess the effectiveness of a dissemination strategy on childcare service: (i) adoption; and (ii) use of an online menu planning program designed to increase compliance with dietary guidelines. Methods: A nonrandomised controlled trial was conducted with long day care services across Australia. All services received an email invitation to access an online evidence-based menu planning program. Services in the intervention also received training, telephone contact and provision of a portable computer tablet to encourage program adoption and use. Outcomes were assessed at the 6-month follow-up using analytics data recorded by the online program. Outcomes included the proportion of services having accessed the program (adoption) and the proportion of services with a current menu entered in the program (use as intended). Results: Twenty-seven interventions and 19 control services took part. At the 6-month follow-up, 100% vs 58% of services had adopted the online menu planning program (OR: 14.67, 95% CI: 2.43-infinity; P¿<¿0.01) and 41% vs 5% of services had a current menu entered in the program (OR: 9.99, 95% CI: 1.01-534.57; P¿<¿0.01) in the intervention and control arms respectively. Conclusions: This study highlights the need for strategies to support adoption and use of an online menu planning program in childcare services if the potential benefits of such a program are to be achieved. Future research should explore the effectiveness of differing strategies to increase adoption and use of online programs at scale. So what?: Strategies to support childcare service uptake and use of online programs are required in order for the potential public health benefits of such technologies to be realised.
Wolfenden L, Goldman S, Stacey FG, Grady A, Kingsland M, Williams CM, et al., 'Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity.', Cochrane Database Syst Rev, 11 CD012439 (2018) [C1]
Grady A, Seward K, Finch M, Fielding A, Stacey F, Jones J, et al., 'Barriers and Enablers to Implementation of Dietary Guidelines in Early Childhood Education Centers in Australia: Application of the Theoretical Domains Framework.', Journal of nutrition education and behavior, 50 229-237.e1 (2018) [C1]
Reilly K, Nathan N, Grady A, Wu JHY, Wiggers J, Yoong SL, Wolfenden L, 'Barriers to implementation of a healthy canteen policy: A survey using the theoretical domains framework', Health Promotion Journal of Australia, (2018)
© 2018 Australian Health Promotion Association Issue addressed: Improving implementation of school healthy canteen policies requires a comprehensive understanding of implementatio... [more]
© 2018 Australian Health Promotion Association Issue addressed: Improving implementation of school healthy canteen policies requires a comprehensive understanding of implementation barriers. Therefore, the aim of this study was to assess a range of barriers, as reported by canteen managers, using a quantitative survey instrument developed based on a theoretical framework. Methods: A cross sectional survey of primary school canteen managers from the Hunter New England region of New South Wales was conducted of eligible schools in the study region identified as having an operational canteen. Survey items assessed canteen manager employment status, canteen characteristics and potential barriers to healthy canteen policy implementation, aligned to the 14 domains of the theoretical domains framework via a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The mean domain scores of canteen managers were calculated, less than four indicating the canteen manager considered the domain was a barrier. Canteen managers were also asked to provide the current canteen menu for audit by a dietitian. Results: Of the 184 participants, 20% (n¿=¿36) were assessed as having menus compliant with the state policy. The five most common domains identified as potential barriers to policy implementation were behavioural regulation (n¿=¿117, 65%), skills (n¿=¿105, 57%), beliefs about capabilities (n¿=¿100, 55%), reinforcement (n¿=¿95, 52%) and goals (n¿=¿95, 52%). Canteen managers who reported optimism as a barrier had significantly lower odds of having a menu compliant with the state policy (OR¿=¿0.39; 95% CI 0.16-0.95, P¿=¿0.038). Conclusions: This study provides further evidence of perceived and actual barriers that canteen managers face when attempting to implement a healthy canteen policy, and highlights the need to address differences in canteen characteristics when planning implementation support. So what?: For public health benefits of nutrition policies within schools to be realised, the barriers to implementation need to be identified and used to help guide implementation support strategies.
Clinton-McHarg T, Janssen L, Delaney T, Reilly K, Regan T, Nathan N, et al., 'Availability of food and beverage items on school canteen menus and association with items purchased by children of primary-school age', Public Health Nutrition, 21 2907-2914 (2018) [C1]
© The Authors 2018Â. Objective To (i) describe the proportion of foods and beverages available on school canteen menus classified as having high ('green'), moderate (&ap... [more]
© The Authors 2018Â. Objective To (i) describe the proportion of foods and beverages available on school canteen menus classified as having high ('green'), moderate ('amber') or low ('red') nutritional value; (ii) describe the proportion of these items purchased by students; and (iii) examine the association between food and beverage availability on school canteen menus and food and beverage purchasing by students.Design A cross-sectional study was conducted as part of a larger randomised controlled trial (RCT).Setting A nested sample of fifty randomly selected government schools from the Hunter New England region of New South Wales, Australia, who had participated in an RCT of an intervention to improve the availability of healthy foods sold from school canteens, was approached to participate.Subjects School principals, canteen managers and students.Results The average proportion of green, amber and red items available on menus was 47·9, 47·4 and 4·7 %, respectively. The average proportion of green, amber and red items purchased by students was 30·1, 61·8 and 8·1 %, respectively. There was a significant positive relationship between the availability and purchasing of green (R 2=0·66), amber (R 2=0·57) and red menu items (R 2=0·61). In each case, a 1 % increase in the availability of items in these categories was associated with a 1·21, 1·35 and 1·67 % increase in purchasing of items of high, moderate and low nutritional value, respectively.Conclusions The findings provide support for school-based policies to improve the relative availability of healthy foods for sale in these settings.
Wolfenden L, Nathan NK, Sutherland R, Yoong SL, Hodder RK, Wyse RJ, et al., 'Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease', COCHRANE DATABASE OF SYSTEMATIC REVIEWS, (2017) [C1]
Seward K, Finch M, Yoong SL, Wyse R, Jones J, Grady A, et al., 'Factors that influence the implementation of dietary guidelines regarding food provision in centre based childcare services: A systematic review', Preventive Medicine, 105 197-205 (2017) [C1]
© 2017 Children attending centre based childcare services consume as much as two thirds of their daily dietary requirements while in care. However, such services often fail to pro... [more]
© 2017 Children attending centre based childcare services consume as much as two thirds of their daily dietary requirements while in care. However, such services often fail to provide foods that are consistent with guideline recommendations. Developing strategies to improve childcare service adherence to menu dietary guidelines requires a comprehensive understanding of factors that may impede or promote implementation. The primary aim of this systematic review is to describe factors (barriers and facilitators) that may influence the implementation of menu dietary guidelines regarding food provision in centre-based childcare services and to map these factors to a theoretical framework. Over 7000 citations were identified from all sources. Duplicate abstracts were removed and selection criteria applied. Twelve studies (1994¿2015) were included in the review. Dual data extraction was conducted and the reported factors were synthesised using the theoretical domains framework (TDF). Barriers and facilitators identified in qualitative studies were classified into 8 and 10 of the 14 TDF domains. Barriers and facilitators reported in quantitative studies covered 6 and 3 TDF domains respectively. The most common domain of which both barriers and facilitators to the implementation of menu dietary guidelines were identified was ¿environmental context and resources¿. This is the first study that comprehensively assesses literature to identify factors that influence the implementation of menu dietary guidelines in childcare services utilising a theoretical framework. Findings provide guidance to support researchers and policy makers design strategies to improve menu dietary guideline implementation and, as such have the potential to improve food provision in care.
Stacey FG, Finch M, Wolfenden L, Grady A, Jessop K, Wedesweiler T, et al., 'Evidence of the Potential Effectiveness of Centre-Based Childcare Policies and Practices on Child Diet and Physical Activity: Consolidating Evidence from Systematic Reviews of Intervention Trials and Observational Studies', Current Nutrition Reports, 6 228-246 (2017) [C1]
Grady A, Carey M, Bryant J, Sanson-Fisher R, Hobden B, 'A systematic review of patient-practitioner communication interventions involving treatment decisions', Patient Education and Counseling, 100 199-211 (2017) [C1]
© 2016 Elsevier Ireland Ltd Objectives To examine the: 1) methodological quality of interventions examining strategies to improve patient-practitioner communication involving trea... [more]
© 2016 Elsevier Ireland Ltd Objectives To examine the: 1) methodological quality of interventions examining strategies to improve patient-practitioner communication involving treatment decisions; 2) effectiveness of strategies to improve patient-practitioner communication involving treatment decisions; and 3) types of treatment decisions (emergency/non-emergency) in the included studies. Methods Medline, PsychINFO, CINAHL, and Embase were searched to identify intervention studies. To be included, studies were required to examine patient-practitioner communication related to decision making about treatment. Study methodological quality was assessed using Cochrane's Effective Practice and Organisation of Care risk of bias criteria. Study design, sample characteristics, intervention details, and outcomes were extracted. Results Eleven studies met the inclusion criteria. No studies were rated low risk on all nine risk of bias criteria. Two of the three interventions aimed at changing patient behaviour, two of the five practitioner directed, and one of the three patient-practitioner directed interventions demonstrated an effect on decision-making outcomes. No studies examined emergency treatment decisions. Conclusions Existing studies have a high risk of bias and are poorly reported. There is some evidence to suggest patient-directed interventions may be effective in improving decision-making outcomes. Practice implications It is imperative that an evidence-base is developed to inform clinical practice.
Grady A, Carey M, Oldmeadow C, Bryant J, Mazza D, Sanson-Fisher R, 'GP detection of health risk factors among general practice patients at risk of primary and secondary stroke', Family Practice, 32 336-342 (2015) [C1]
© The Author 2015. Published by Oxford University Press. All rights reserved. Background. People with a history of stroke or heart disease are at increased risk of future stroke; ... [more]
© The Author 2015. Published by Oxford University Press. All rights reserved. Background. People with a history of stroke or heart disease are at increased risk of future stroke; therefore, identification of risk factors by GPs is critical. Objectives. To compare the following among general practice patients with and without a history of stroke or heart disease: (i) self-reported prevalence rates of lifestyle risk factors; (ii) accuracy of GP detection of patient-reported risk factors and (iii) average proportion of patient-reported risk factors detected by GPs. Methods. Consecutive patients attending a participating general practice clinic were invited to participate in a cross-sectional touchscreen survey assessing lifestyle risk factors in 2010-11. The GP of each consenting patient completed a corresponding survey assessing the patient's risk factors. Demographic characteristics of patients and GPs were obtained. Results. Data from 51 GPs and 564 patients were analysed. Patients without a history of stroke or heart disease reported significantly higher rates of smoking (12%) and risky alcohol consumption (56%) than patients with a history of stroke or heart disease (6% and 36%, respectively). Low sensitivity of GP detection of risk factors was found for all risk factors for all patients. Patients with a history of stroke or heart disease have a significantly higher mean proportion of risk factors detected by their GP compared to patients without a history of stroke or heart disease (P = 0.00). Conclusion. Given low sensitivity and specificity of GP detection of risk factors among patients, alternate methods of identification are needed. Research is required to determine strategies to facilitate secondary care of patients with a history of stroke or heart disease by GPs.
Zucca AC, Sanson-Fisher RW, Waller A, Carey M, Grady A, Mackenzie L, 'Life expectancy discussions in a multisite sample of Australian medical oncology outpatients', MEDICAL JOURNAL OF AUSTRALIA, 203 (2015)
Grady AM, Bryant J, Carey ML, Paul CL, Sanson-Fisher RW, Levi CR, 'Agreement with evidence for tissue Plasminogen Activator use among emergency physicians: A cross-sectional survey', BMC Research Notes, 8 (2015) [C1]
© 2015 Grady et al. Background: Emergency department staff play a crucial role in the triage of stroke patients and therefore the capacity to deliver time-dependent treatments suc... [more]
© 2015 Grady et al. Background: Emergency department staff play a crucial role in the triage of stroke patients and therefore the capacity to deliver time-dependent treatments such as tissue Plasminogen Activator. This study aimed to identify among emergency physicians, (1) rates of agreement with evidence supporting tissue Plasminogen Activator use in acute stroke care; and (2) individual and hospital factors associated with high agreement with evidence supporting tissue Plasminogen Activator use. Methods: Australian fellows and trainees of the Australasian College for Emergency Medicine were invited to complete an online cross-sectional survey assessing perceptions of tissue Plasminogen Activator use in acute stroke. Demographic and hospital characteristics were also collected. Results: 429 Australasian College for Emergency Medicine members responded (13% response rate). Almost half (47.2%) did not agree with any statements regarding the benefits of tissue Plasminogen Activator use for acute stroke. Perceived routine administration of tissue Plasminogen Activator by the head of respondents' emergency department was significantly associated with high agreement with the evidence supporting tissue Plasminogen Activator use in acute stroke. Conclusions: Agreement with evidence supporting tissue Plasminogen Activator use in acute stroke is not high among responding Australian emergency physicians. In order for tissue Plasminogen Activator treatment to become widely accepted and adopted in emergency settings, beliefs and attitudes towards treatment need to be in accordance with clinical practice guidelines.
Zucca AC, Sanson-Fisher RW, Waller A, Carey M, Grady A, Mackenzie L, 'Life expectancy discussions in a multisite sample of australian medical oncology outpatients', Medical Journal of Australia, 203 405.e1-405.e7 (2015) [C1]
© 2015 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved. Objectives: The study examined: 1) the proportion of patients who received their preferred level of informat... [more]
© 2015 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved. Objectives: The study examined: 1) the proportion of patients who received their preferred level of information about life expectancy; and 2) sociodemographic, clinical and psychological factors associated with patients¿ perceptions of whether they received too little, too much, or the right amount of information about life expectancy. Design: Cross-sectional survey. Setting: Eleven large Australian medical oncology treatment centres. Participants: A total of 1431 medical oncology outpatients participated (81% consent rate). Eligible patients were approached between September 2012 and May 2014. Main outcome measures: Patients indicated whether the information about life expectancy they received aligned with their preferences. Results: Almost one in four patients (24%) received too little information, 4% received too much, and 50% received all the information they wanted; 22% of patients neither wanted nor received information about life expectancy. Patients were more likely to receive too little information if they were not in remission (odds ratio [OR], 1.77), did not know their cancer stage at diagnosis (OR, 3.64), or were anxious (OR, 1.48) or depressed (OR, 1.48). Patients had greater odds of receiving too much information if they were younger (OR, 1.45), had more advanced cancer (OR, 2.01) or did not know their cancer stage at diagnosis (OR, 4.42). Conclusions: That fact that 28% of cancer patients did not receive their desired level of information about life expectancy highlights the difficulties associated with discussing this sensitive topic. To ensure that life expectancy discussions correspond with patient preferences, clinicians should routinely ask patients whether they want to know this information, in what format, and at which level of detail.
Waller A, Carey M, Mazza D, Yoong S, Grady A, Sanson-Fisher R, 'Patient-reported areas for quality improvement in general practice: A cross-sectional survey', British Journal of General Practice, 65 e312-e318 (2015) [C1]
©British Journal of General Practice. Background: GPs are often a patient's first point of contact with the health system. The increasing demands imposed on GPs may have an i... [more]
©British Journal of General Practice. Background: GPs are often a patient's first point of contact with the health system. The increasing demands imposed on GPs may have an impact on the quality of care delivered. Patients are well placed to make judgements about aspects of care that need to be improved. Aim: To determine whether general practice patients perceive that the care they receive is 'patient-centred' across eight domains of care, and to determine the association between sociodemographic, GP and practice characteristics, detection of preventive health risks, and receipt of patient-centred care. Design and setting: Cross-sectional survey of patients attending Australian general practice clinics. Method: Patients completed a touchscreen survey in the waiting room to rate the care received from their GP across eight domains of patient-centred care. Patients also completed the Patient Health Questionnaire (PHQ-9) and self-reported health risk factors. GPs completed a checklist for each patient asking about the presence of health risk factors. Results: In total1486 patients and 51 GPs participated. Overall, 83% of patients perceived that the care they received was patient-centred across all eight domains. Patients most frequently perceived the 'access to health care when needed' domain as requiring improvement (8.3%). Not having private health insurance and attending a practice located in a disadvantaged area were significantly associated with perceived need for improvements in care (P<0.05). Conclusion: Patients in general practice report that accessibility is an aspect of care that could be improved. Further investigation of how indicators of lower socioeconomic status interact with the provision of patient-centred care and health outcomes is required.
Carey M, Yoong SL, Grady A, Bryant J, Jayakody A, Sanson-Fisher R, Inder KJ, 'Unassisted detection of depression by GPs: Who is most likely to be misclassified?', Family Practice, 32 282-287 (2015) [C1]
© The Author 2015. Published by Oxford University Press. All rights reserved. Background. Meta-analyses indicate 50% of cases of depression are not detected by GPs. It is importan... [more]
© The Author 2015. Published by Oxford University Press. All rights reserved. Background. Meta-analyses indicate 50% of cases of depression are not detected by GPs. It is important to examine patient and GP characteristics associated with misclassification so that systems can be improved to increase accurate detection and optimal management for groups at risk of depression. Objective. To examine patient and GP characteristics associated with GP misclassification of depression for patients classified by the Patient Health Questionnaire-9 as depressed. Methods. A cross-sectional study within general practices in two states of Australia. GPs completed a one-page paper and pencil survey indicating whether they thought each patient was clinically depressed. Patients completed a computer tablet survey while waiting for their appointment to provide demographic information and indicate depression status. Chi-square analyses were used to determine whether patient and GP characteristics were associated with a false-negative and false-positive result. The probability of misclassification was modelled using Generalized Estimating Equations to account for clustering of patients. Results. Fifty GPs from 12 practices participated. GPs completed surveys for 1880 patients. Younger patients aged 25-44, and those with a health care card were less likely to have a false-negative assessment. Patients with 0-3 GP visits in the past 12 months, and those with private health insurance were less likely to have a false-positive assessment. GPs who worked five sessions or fewer per week were more likely to make false-positive assessments.
Paul CL, Levi CR, D'Este CA, Parsons MW, Bladin CF, Lindley RI, et al., 'Thrombolysis ImPlementation in Stroke (TIPS): Evaluating the effectiveness of a strategy to increase the adoption of best evidence practice - protocol for a cluster randomised controlled trial in acute stroke care', Implementation Science, 9 (2014) [C3]
Background: Stroke is a leading cause of death and disability internationally. One of the three effective interventions in the acute phase of stroke care is thrombolytic therapy w... [more]
Background: Stroke is a leading cause of death and disability internationally. One of the three effective interventions in the acute phase of stroke care is thrombolytic therapy with tissue plasminogen activator (tPA), if given within 4.5 hours of onset to appropriate cases of ischaemic stroke.Objectives: To test the effectiveness of a multi-component multidisciplinary collaborative approach compared to usual care as a strategy for increasing thrombolysis rates for all stroke patients at intervention hospitals, while maintaining accepted benchmarks for low rates of intracranial haemorrhage and high rates of functional outcomes for both groups at three months.Methods and design: A cluster randomised controlled trial of 20 hospitals across 3 Australian states with 2 groups: multi- component multidisciplinary collaborative intervention as the experimental group and usual care as the control group. The intervention is based on behavioural theory and analysis of the steps, roles and barriers relating to rapid assessment for thrombolysis eligibility; it involves a comprehensive range of strategies addressing individual-level and system-level change at each site. The primary outcome is the difference in tPA rates between the two groups post-intervention. The secondary outcome is the proportion of tPA treated patients in both groups with good functional outcomes (modified Rankin Score (mRS <2) and the proportion with intracranial haemorrhage (mRS =2), compared to international benchmarks.Discussion: TIPS will trial a comprehensive, multi-component and multidisciplinary collaborative approach to improving thrombolysis rates at multiple sites. The trial has the potential to identify methods for optimal care which can be implemented for stroke patients during the acute phase. Study findings will include barriers and solutions to effective thrombolysis implementation and trial outcomes will be published whether significant or not.Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12613000939796. © 2014 Paul et al.; licensee BioMed Central Ltd.
Grady A, Bryant J, Carey M, Paul C, Sanson-Fisher R, 'Enablers of the implementation of tissue plasminogen activator in acute stroke care: A cross-sectional survey', PLoS ONE, 9 (2014) [C1]
© 2014 Grady et al. Objective: To assess emergency physicians' perceptions of individual and system enablers to the use of tissue Plasminogen Activator in acute stroke.Method... [more]
© 2014 Grady et al. Objective: To assess emergency physicians' perceptions of individual and system enablers to the use of tissue Plasminogen Activator in acute stroke.Method: Australian fellows and trainees of Australasian College for Emergency Medicine completed a 57-item online survey assessing enablers to implementation of evidence-based practice across six domains: knowledge, skills, modelling, monitoring, feedback, and maintenance. Demographic and workplace characteristics were obtained. Descriptive statistics were calculated to describe demographic and workplace characteristics of responders, and survey responses. Each domain received an overall score (%) based on the number of responders agreeing with all items within the domain.Results: A total of 429 (13%) Australasian College for Emergency Medicine members responded. 17.7% of respondents reported they and/or their workplace met all knowledge-related enablers, however only 2.3% had all skill-related enablers in place. Of respondents who decide which patients receive tissue Plasminogen Activator treatment, 18.1% agreed that all maintenance-related enablers are in place at their hospital, compared to 6.6% for those who do not decide which patients receive tissue Plasminogen Activator treatment. None of the respondents had all items in place cross all domains.Conclusions: Even when allowing for the low response rate, it seems likely there is a lack of individual and system enablers supporting the implementation of bestpractice stroke care in a number of Australian hospitals. Quality improvement programs could target all domains, particularly the skills-training and feedback emergency physicians receive, to aid implementation of tissue Plasminogen Activator treatment for acute stroke.
Grady A, Carey M, Sanson-Fisher R, 'Assessing awareness of appropriate responses to symptoms of stroke', Patient Education and Counseling, 95 400-405 (2014) [C1]
Objective: The study explored (1) the level of awareness, and associates of greater awareness, of the appropriate action to take in response to stroke symptoms; and (2) actions ta... [more]
Objective: The study explored (1) the level of awareness, and associates of greater awareness, of the appropriate action to take in response to stroke symptoms; and (2) actions taken in response to potential stroke symptoms, among general practice patients. Methods: Patients attending general practice clinics in New South Wales, Australia completed a paper and pencil survey. Results: 308 participants returned the survey. 76% indicated they would call an ambulance within 10. min for 'difficulty speaking or understanding others, with blurred vision (in one eye), and face, arm or leg weakness or numbness (on one side of the body)'. Having a first degree relative with a history of stroke was significantly associated with greater awareness of the appropriate action to take in response to stroke symptoms. Of those reporting they had experienced 'dizziness, loss of balance or an unexplained fall' 80% did not call an ambulance at the time of experiencing this symptom. Conclusion: There appears to be high awareness of the appropriate response to take for stroke symptoms among this sample, however this does not translate into actions when individuals experience a potential stroke symptom. Practice implications: Education campaigns should be targeted towards individuals without a family history of stroke. © 2014 Elsevier Ireland Ltd.
Grady A, Carey M, Bryant J, Sanson-Fisher R, 'Recruitment of healthcare specialists', EMA - Emergency Medicine Australasia, 26 516-517 (2014) [C3]
Yoong SL, Carey M, Sanson-Fisher R, Grady A, 'A systematic review of behavioural weight-loss interventions involving primary-care physicians in overweight and obese primary-care patients (1999-2011).', Public Health Nutrition, 16 2083-2099 (2013) [C1]
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Conference (5 outputs)
MacKenzie L, Kelly M, Lawson S, Grady A, McSkimming A, Kelly B, Waller A, 'Perceptions and Enablers of Psychosocial Care Guideline Implementation in a Radiation Oncology Setting: A Pilot Study', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2017)
Yoong S, Grady A, Wiggers J, Flood V, Rissel C, Wolfenden L, 'A Randomized Controlled Trial of an Online Menu Planning Intervention to Improve Childcare Service Adherence to Dietary Guidelines', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2017)
Grady A, Seward K, Finch M, Stacey F, Jones J, Wolfenden L, Yoong S, 'Theory-Informed Assessment of Barriers and Enablers to Implementation of Dietary Guidelines in Childcare Centers', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2017)
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Grants and Funding
|Number of grants||5|
Click on a grant title below to expand the full details for that specific grant.
20192 grants / $23,238
Implementation of a web-based initiative to improve childare service healthy eating policies and practices$19,438
Funding body: Hunter New England Local Health District NSW Health
|Funding body||Hunter New England Local Health District NSW Health|
Luke Wolfenden, Alice Grady, Nicole Nathan, Courtney Barnes, Karen Gillham, Jannah Jones, Tameka McFayden, Christophe Lecathelinais, Penny Reeves
|Scheme||HNE Improvement Grants|
|Type Of Funding||Other Public Sector - Local|
Funding body: Hunter Cancer Research Alliance
|Funding body||Hunter Cancer Research Alliance|
|Scheme||HCRA travel grant|
|Type Of Funding||Not Known|
20181 grants / $25,000
Pilot cluster randomised controlled trial assessing the potential impact of an online intervention to improve child dietary intake in childcare$25,000
Funding body: Hunter Medical Research Institute
|Funding body||Hunter Medical Research Institute|
|Project Team||Doctor Alice Grady, Doctor Serene Yoong, Associate Professor Luke Wolfenden, Doctor Nicole Nathan, Miss Courtney Barnes|
|Type Of Funding||C3120 - Aust Philanthropy|
20171 grants / $137,500
Funding body: Healthy Australia Ltd
|Funding body||Healthy Australia Ltd|
|Project Team||Doctor Alice Grady, Doctor Serene Yoong, Associate Professor Luke Wolfenden, Dr Luke Wolfenden, Professor John Wiggers, Ms Meghan Finch|
|Type Of Funding||C3111 - Aust For profit|
20111 grants / $91,440
Patient and Clinician Treatment Decisions in Acute Stroke: Strategies to increase adherence to clinical guidelines.$91,440
Funding body: Australian Postgraduate Award
|Funding body||Australian Postgraduate Award|
|Scheme||Australian Postgraduate Award|
|Type Of Funding||Not Known|
Number of supervisions
|Commenced||Level of Study||Research Title||Program||Supervisor Type|
|2019||PhD||Creating Healthy Environments to Support Children’s Healthy Eating and Physical Activity in the Family Day Care Setting||PhD (Public Health & BehavSci), Faculty of Health and Medicine, The University of Newcastle||Co-Supervisor|
|2019||PhD||Creating Healthy Environments to Support Children’s Healthy Eating and Physical Activity in the Family Day Care Setting||Behavioural Science, University of Newcastle, Australia||Co-Supervisor|
|2018||PhD||Improving the Dietary Intake of Children in Centre-Based Child Care Services in NSW, Australia||PhD (Behavioural Science), Faculty of Health and Medicine, The University of Newcastle||Co-Supervisor|