Ms Natasha Noble
School of Medicine and Public Health
- Phone:(02) 40420652
Natasha is a Research Assistant with the Health Behaviour Research Collaborative in the School of Medicine and Public Health. Natasha has worked as a Research Assistant with this group for over seven years. In 2017, Natasha was awarded a PhD in Behavioural Science in Relation to Medicine. Natasha's thesis explored the prevalence and clustering of health risk factors among people attending Aboriginal Community Controlled Health Services, as well as the feasibility of electronic screening of health risks and the health risk intervention preferences of people attending these services.
Natasha has previously worked across a range of projects including exploring barriers to the delivery of optimal dementia care for General Practitioners and geriatricians, and perceived preparation of patients for breast cancer surgery. Natasha is currently involved in several projects exploring optimal care for pre-diagnostic and early breast cancer and the application of telehealth to support breast cancer surgery patients, and the delivery of dementia care in Indigenous healthcare settings.
- Doctor of Philosophy, University of Newcastle
- Bachelor of Psychology (Honours), University of Newcastle
- Indigenous health
- health behaviour
- health risk factors
- public health
Fields of Research
|111701||Aboriginal and Torres Strait Islander Health||10|
|111799||Public Health and Health Services not elsewhere classified||60|
|119999||Medical and Health Sciences not elsewhere classified||30|
Faculty Medal: Faculty of Science and Information
Faculty of Science and Information Technology, The University of Newcastle | Australia
Best RHD confirmation presentation award
Faculty of Health and Medicine, University of Newcastle
For publications that are currently unpublished or in-press, details are shown in italics.
Journal article (19 outputs)
Noble N, Mackenzie L, Carey M, Proietto A, Sanson-Fisher R, Walker G, Silcock J, 'Cross-sectional survey to inform the development of a telehealth support model: a feasibility study for women undergoing breast cancer surgery.', Pilot and Feasibility Studies, 5 1-7 (2019) [C1]
Freund M, Hobden B, Deeming S, Noble N, Bryant J, Sanson-Fisher RW, 'Reducing alcohol-related harm in Australia: a simple data-based tool to assist prioritization of research and health care delivery in primary care', Family practice, 36 473-478 (2019) [C1]
© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org. INTRODUCTION: The detection of harmf... [more]
© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: email@example.com. INTRODUCTION: The detection of harmful alcohol use and the delivery of brief advice in primary care are less than optimal. Given limited health care resources, deciding where best to allocate funding to optimize health outcomes is imperative. A simple data-based tool could be useful when access to specialist health economic advice is unavailable. This study aimed to examine the utility of a simple data-based calculator to facilitate priority setting in general practice for reducing alcohol-related harm. METHODS: A simple algorithm was developed within Microsoft Excel to allow comparison of hypothetical intervention scenarios that aimed to increase detection and brief advice for harmful alcohol use in general practice. The calculator accommodated varying implementation costs, size of effect and reach for each scenario created. The incremental costs of the intervention scenarios, the incremental number of successes (i.e. abstinence or drinking at safe levels) and the incremental costs-effectiveness ratio (ICER) were calculated for each hypothetical scenario and compared with a usual care scenario. RESULTS: In the hypothetical scenarios modelled, increasing both the detection of harmful alcohol consumption and the provision of brief advice produced the greatest number of incremental successes above baseline. Increasing detection alone produced fewer incremental successes but was the most cost-effective approach, as indicated by the lowest ICER. DISCUSSION: The data-based calculator provides a simple method of exploring reach and cost-effectiveness outcomes without the need for any specific skills. Although this approach has limitations, the calculator can be used by decision makers to guide intervention planning.
Noble N, Paul C, Walsh J, Wyndham K, Wilson S, Stewart J, 'Concordance between self-report and medical records of preventive healthcare delivery among a sample of disadvantaged patients from four aboriginal community controlled health services', BMC Health Services Research, 19 (2019) [C1]
© 2019 The Author(s). Background: This cross-sectional study aimed to explore, among a sample of patients attending one of four Aboriginal Health Services (ACCHSs), the degree of ... [more]
© 2019 The Author(s). Background: This cross-sectional study aimed to explore, among a sample of patients attending one of four Aboriginal Health Services (ACCHSs), the degree of concordance between self-report and medical records for whether screening for key healthcare items had ever been undertaken, or had been undertaken within the recommended timeframe. Methods: Across the four ACCHSs, a convenience sample of 109 patients was recruited. Patients completed a self-report computer survey assessing when they last had preventive care items undertaken at the service. ACCHS staff completed a medical record audit for matching items. The degree of concordance (i.e. the percentage of cases in which self-reports matched responses from the medical record) was calculated. Results: Concordance was relatively high for items including assessment of Body Mass Index and blood pressure, but was substantially lower for items including assessment of waist circumference, alcohol intake, physical activity, and diet. Conclusions: Reliance on either patient self-report or medical record data for assessing the level of preventive care service delivery by ACCHSs requires caution. Efforts to improve documentation of some preventive care delivery in medical records are needed. These findings are likely to also apply to patients in other general practice settings.
Mansfield E, Noble N, Sanson-Fisher R, Mazza D, Bryant J, 'Primary Care Physicians' Perceived Barriers to Optimal Dementia Care: A Systematic Review.', The Gerontologist, (2018)
Olver I, Carey M, Boyes A, Hall A, Noble N, Bryant J, et al., 'The timeliness of patients reporting the side effects of chemotherapy.', Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 26 3579-3586 (2018) [C1]
Sanson-Fisher RW, Noble NE, Searles AM, Deeming S, Smits RE, Oldmeadow CJ, Bryant J, 'A simple filter model to guide the allocation of healthcare resources for improving the treatment of depression among cancer patients', BMC CANCER, 18 (2018) [C1]
Regan T, Paul C, Ishiguchi P, D Este C, Koller C, Forshaw K, et al., 'Comparison of two sources of clinical audit data to assess the delivery of diabetes care in aboriginal communities', International Journal of Environmental Research and Public Health, 14 (2017) [C1]
Carey M, Boyes A, Noble N, Waller A, Inder K, 'Validation of the PHQ-2 against the PHQ-9 for detecting depression in a large sample of Australian general practice patients', Australian Journal of Primary Health, 22 262-266 (2016) [C1]
© La Trobe University 2016. There is increasing interest in the use of brief screening tools to improve detection of depression in the primary care setting. The aim of the present... [more]
© La Trobe University 2016. There is increasing interest in the use of brief screening tools to improve detection of depression in the primary care setting. The aim of the present study was to compare the accuracy of the two-item Patient Health Questionnaire (PHQ-2) against the nine-item Patient Health Questionnaire (PHQ-9) for detecting depression among general practice patients. A cross-sectional sample of 3626 adults attending 12 Australian general practices was recruited. Participants completed the PHQ-2 and PHQ-9 via a touchscreen computer. Depression was defined as a PHQ-9 score =10. The area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value were calculated. The PHQ-2 had good overall accuracy relative to the PHQ-9 for discriminating between cases and non-cases of depression, with an AUC of 0.92 (95% confidence interval 0.90-0.93). The PHQ-2 threshold of =3 was the best balance between sensitivity (91%) and specificity (78%) for detecting possible cases of depression. For clinical use, the optimal threshold was =2, with only 2% of possible cases missed.
Paul C, Tzelepis F, Bisquera A, Noble N, Wiggers J, 'Just how high-risk are ongoing smokers? Exploring clusters of health risk behaviours among current and ex-smokers.', Prev Med, 93 70-75 (2016) [C1]
Noble N, Paul C, Sanson-Fisher R, Turon H, Turner N, Conigrave K, 'Ready, set, go: a cross-sectional survey to understand priorities and preferences for multiple health behaviour change in a highly disadvantaged group', BMC HEALTH SERVICES RESEARCH, 16 (2016) [C1]
Noble N, Paul C, Turon H, Oldmeadow C, 'Which modifiable health risk behaviours are related? A systematic review of the clustering of Smoking, Nutrition, Alcohol and Physical activity ('SNAP') health risk factors', Preventive Medicine, 81 16-41 (2015) [C1]
© 2015 Elsevier Inc. Objective: There is a growing body of literature examining the clustering of health risk behaviours, but little consensus about which risk factors can be expe... [more]
© 2015 Elsevier Inc. Objective: There is a growing body of literature examining the clustering of health risk behaviours, but little consensus about which risk factors can be expected to cluster for which sub groups of people. This systematic review aimed to examine the international literature on the clustering of smoking, poor nutrition, excess alcohol and physical inactivity (SNAP) health behaviours among adults, including associated socio-demographic variables. Method: A literature search was conducted in May 2014. Studies examining at least two SNAP risk factors, and using a cluster or factor analysis technique, or comparing observed to expected prevalence of risk factor combinations, were included. Results: Fifty-six relevant studies were identified. A majority of studies (81%) reported a 'healthy' cluster characterised by the absence of any SNAP risk factors. More than half of the studies reported a clustering of alcohol with smoking, and half reported clustering of all four SNAP risk factors. The methodological quality of included studies was generally weak to moderate. Males and those with greater social disadvantage showed riskier patterns of behaviours; younger age was less clearly associated with riskier behaviours. Conclusion: Clustering patterns reported here reinforce the need for health promotion interventions to target multiple behaviours, and for such efforts to be specifically designed and accessible for males and those who are socially disadvantaged.
Noble NE, Paul CL, Turner N, Blunden SV, Oldmeadow C, Turon HE, 'A cross-sectional survey and latent class analysis of the prevalence and clustering of health risk factors among people attending an Aboriginal Community Controlled Health Service', BMC Public Health, 15 (2015) [C1]
© 2015 Noble et al. Background: Indigenous Australians are a socially disadvantaged group who experience significantly poorer health and a higher prevalence of modifiable health b... [more]
© 2015 Noble et al. Background: Indigenous Australians are a socially disadvantaged group who experience significantly poorer health and a higher prevalence of modifiable health behaviours than other Australians. Little is known about the clustering of health risks among Indigenous Australians. The aims of this study were to describe the clustering of key health risk factors, such as smoking, physical inactivity and alcohol consumption, and socio-demographics associated with clusters, among a predominantly Aboriginal sample. Methods: Participants (n = 377) attending an Aboriginal Community Controlled Health Service (ACCHS) in regional/rural New South Wales, Australia, in 2012-2013 completed a self-report touch screen health risk survey. Clusters were identified using latent class analysis. Results: Cluster 1 ('low fruit/vegetable intake, lower risk'; 51 %) consisted of older men and women; Cluster 2 ('risk taking'; 22 %) included younger unemployed males with a high prevalence of smoking, risky alcohol, and illicit drug use. Cluster 3 ('inactive, overweight, depressed'; 28 %) was characterised by younger to mid aged women likely to have experienced emotional or physical violence. Conclusions: If future research identifies similar stable clusters of health behaviours for this population, intervention approaches targeting these clusters of risk factors should be developed and tested for Aboriginal and Torres Strait Islander Australians.
Noble N, Paul C, Conigrave K, Lee K, Blunden S, Turon H, et al., 'Does a retrospective seven-day alcohol diary reflect usual alcohol intake for a predominantly disadvantaged Australian aboriginal population', Substance Use and Misuse, 50 308-319 (2015) [C1]
© 2015 Informa Healthcare USA, Inc. Background: Alcohol disproportionately affects socially disadvantaged groups including Aboriginal and Torres Strait Islander Australians. Metho... [more]
© 2015 Informa Healthcare USA, Inc. Background: Alcohol disproportionately affects socially disadvantaged groups including Aboriginal and Torres Strait Islander Australians. Methods to assess alcohol intake for disadvantaged communities need to be able to capture variable or episodic drinking. The ability of a seven-day diary to capture typical consumption for a predominantly Aboriginal sample has not been assessed. Objective: One aim of this paper was to examine agreement between a seven-day retrospective diary and 'usual' drinking assessed by a modified version of the Alcohol Use Disorders Identification Test question 3 (AUDIT-3m; two questions). Other aims were to describe drinking patterns as reported in the seven-day diary. Method: In 2012, consecutive adults attending an Aboriginal Community Controlled Health Service completed a cross-sectional health risk survey on a touch screen laptop (n = 188). Alcohol consumption questions included the retrospective diary and AUDIT-3m. Agreement was assessed using weighted kappa analysis. Results: There was good agreement between the two measures of consumption; however, the AUDIT-3m questions identified more current drinkers. Respondents who were drinkers (54%) tended to consume large amounts per drinking occasion: almost half (46%) of diary completers reported nine or more standard drinks on at least one occasion in the last week. Conclusions: The seven-day diary did not adequately capture variability in alcohol consumption common among this sample. Although the AUDIT-3m appeared acceptable, alternative approaches to assess usual or risky alcohol consumption, such as asking about specific drinking occasions, or allowing participants to respond in non-standard drink sizes, also need to be considered for indigenous and other disadvantaged communities.
Carey M, Noble N, Mansfield E, Waller A, Henskens F, Sanson-Fisher R, 'The role of ehealth in optimizing preventive care in the primary care setting', Journal of Medical Internet Research, 17 (2015) [C1]
Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion... [more]
Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion of the world's morbidity and mortality burden. General practitioners (GPs) play a key role in identifying and managing modifiable health risk behaviors. However, these are often underdetected and undermanaged in the primary care setting. We describe the potential of eHealth to help patients and GPs to overcome some of the barriers to managing health risk behaviors. In particular, we discuss (1) the role of eHealth in facilitating routine collection of patient-reported data on lifestyle risk factors, and (2) the role of eHealth in improving clinical management of identified risk factors through provision of tailored feedback, point-of-care reminders, tailored educational materials, and referral to online self-management programs. Strategies to harness the capacity of the eHealth medium, including the use of dynamic features and tailoring to help end users engage with, understand, and apply information need to be considered and maximized. Finally, the potential challenges in implementing eHealth solutions in the primary care setting are discussed. In conclusion, there is significant potential for innovative eHealth solutions to make a contribution to improving preventive care in the primary care setting. However, attention to issues such as data security and designing eHealth interfaces that maximize engagement from end users will be important to moving this field forward.
Noble N, Paul C, Carey M, Blunden S, Turner N, 'A randomised trial assessing the acceptability and effectiveness of providing generic versus tailored feedback about health risks for a high need primary care sample', BMC Family Practice, 16 (2015) [C1]
© 2015 Noble et al. Background: Tailored feedback has been shown to be effective for modifying health risk behaviours and may aid the provision of preventive care by general pract... [more]
© 2015 Noble et al. Background: Tailored feedback has been shown to be effective for modifying health risk behaviours and may aid the provision of preventive care by general practitioners (GPs). However, provision of tailored patient feedback for vulnerable or socially disadvantaged groups is not well explored. The aims of this study were to examine the acceptability and effectiveness of providing generic compared to tailored feedback on self-reported health risk behaviours among a high need sample of people attending an Aboriginal Community Controlled Health Service (ACCHS). Methods: Participants attending two ACCHSs in regional New South Wales completed a touch screen health risk survey and received either generic or tailored health risk feedback. Participants were asked to complete an exit survey after their appointment. The exit survey asked about feedback acceptability and effectiveness. Self-reported ease of understanding, relevance and whether the generic versus tailored feedback helped patients talk to their GP was compared using Chi-square analysis; The mean number of survey health risks talked about or for which additional actions were undertaken (such as provision of lifestyle advice or referral) was compared using t-tests. Results: Eighty seven participants (36 % consent rate) completed the exit survey. Tailored feedback was rated as more relevant and was more likely to be shown to the participant's GP than generic feedback. There was no difference in the mean number of health risk topics discussed or number of additional actions taken by the GP by type of feedback. Conclusions: Tailored and generic feedback showed no difference in effectiveness, and little difference in acceptability, among this socially disadvantaged population. Completing a health risk survey and receiving any type of feedback may have overwhelmed more subtle differences in outcomes between the generic and the tailored feedback. Future work to rigorously evaluate the longer-term effectiveness of the provision of tailored health risk feedback for Aboriginal Australians, as well as other high need groups, is still needed. Trial Registration: Australian New Zealand Clinical Trials Registry ANZCTRN12614001205628. Registered 11 November 2014.
Sanson-Fisher RW, D'Este CA, Carey ML, Noble N, Paul CL, 'Evaluation of Systems-Oriented Public Health Interventions: Alternative Research Designs', ANNUAL REVIEW OF PUBLIC HEALTH, VOL 35, 35 9-27 (2014) [C1]
Paul CL, Bryant J, Turon H, Brozek I, Noble N, Zucca A, 'A narrative review of the potential for self- tanning products to substitute for solaria use among people seeking a tanned appearance', PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE, 30 160-166 (2014) [C1]
Noble NE, Paul CL, Carey ML, Sanson-Fisher RW, Blunden SV, Stewart JM, Conigrave KM, 'A cross-sectional survey assessing the acceptability and feasibility of self-report electronic data collection about health risks from patients attending an Aboriginal Community Controlled Health Service', BMC MEDICAL INFORMATICS AND DECISION MAKING, 14 (2014) [C1]
Carey ML, Noble NE, Sanson-Fisher RW, Mackenzie LJ, 'Identifying psychological morbidity among people with cancer using the Hospital Anxiety and Depression Scale: Time to revisit first principles?', Psycho-Oncology, 21 229-238 (2012) [C1]
|Show 16 more journal articles|
Conference (4 outputs)
Mackenzie L, Noble N, Carey M, Proietto A, Sanson-Fisher R, Walker G, Silcock J, 'Cross-Sectional Survey to Inform the Development of a Telehealth Support Model for Women Undergoing Breast Cancer Surgery', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2017)
Noble N, Paul C, Turner N, Turon H, Blunden S, 'PREVENTIVE SCREENING FOR CANCER AMONG PEOPLE ATTENDING AN ABORIGINAL COMMUNITY CONTROLLED HEALTH SERVICE', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2014) [E3]
Noble N, Paul C, Carey M, Sanson-Fisher R, Blunden S, Stewart J, Conigrave K, 'ASSESSING THE ACCEPTABILITY AND FEASIBILITY OF SELF-REPORT ELECTRONIC DATA COLLECTION ABOUT HEALTH RISKS FROM PATIENTS ATTENDING AN ABORIGINAL MEDICAL SERVICE', ANNALS OF BEHAVIORAL MEDICINE (2013)
Noble N, Paul C, Carey M, Sanson-Fisher R, Blunden S, Stewart J, Conigrave K, 'PREVALENCE OF MULTIPLE HEALTH RISK FACTORS AMONG PATIENTS ATTENDING AN ABORIGINAL MEDICAL SERVICE', ANNALS OF BEHAVIORAL MEDICINE (2013)
|Show 1 more conference|
Grants and Funding
|Number of grants||2|
Click on a grant title below to expand the full details for that specific grant.
20121 grants / $39,324
Multiple substance use, mental health and other health risk behaviours among patients of Aboriginal Medical Services: Patient priorities for change and preferences for models of support. $39,324
Aboriginal and Torres Strait Islander Australians have disproportionately high levels of alcohol, tobacco and illicit drug use and depression, with these risk factors often occurring alongside additional health risk factors such as overweight/obesity, lack of physical activity, and poor diet.
This project aimed to obtain an Aboriginal and Torres Strait Islander patient perspective about how risk factors might be best addressed holistically by Aboriginal Medical Services (AMSs). Patients attending an AMS were asked to complete an iPad touch screen survey while waiting for their appointment. The survey assessed each patient’s health risk behaviours and their preferred approach to addressing their specific health risk profile. Patients were also asked about willingness, priorities and preferences for addressing health risk factors, who should deliver services, and how these services should be coordinated and located.
Results of this study provide a unique perspective about priorities and processes for the management of multiple health risks among patients of Aboriginal Medical Services.
Funding body: NSW Ministry of Health
|Funding body||NSW Ministry of Health|
Prof Christine Paul, L/Prof Rob Sanson-Fisher, A/Prof Mariko Carey, Dr Jamie Bryant, Dr Natasha Noble, Mr Steven Blunden, Prof Kate Conigrave
|Scheme||MENTAL HEALTH AND DRUG & ALCOHOL OFFICE (MHDAO)|
|Type Of Funding||Other Public Sector - State|
20111 grants / $34,490
Acceptability and feasibility of providing feedback to ACCHO patients and their GPs about patients’ risky alcohol, tobacco and drug use$34,490
Substance use and cardiovascular disease (CVD) are the main contributors to disproportionately high mortality and morbidity among Indigenous Australians. Risk factors such as alcohol misuse, tobacco use, high body mass and physical inactivity are significant modifiable contributors. Screening for these risk factors among the Indigenous population is poor and delivery of interventions targeting these modifiable risk behaviours is far from complete. This study examines the feasibility and acceptability of electronically collecting and feeding back health risk data to Indigenous patients and their GPs. Electronic self-report patient data would include drug use (alcohol, tobacco and illicit), depression, CVD risk factors and cancer screening. Whether feedback prompts discussion or action (e.g. screening tests, referral) will also be assessed. The project will provide data for the development of a larger, multi-faceted intervention to improve management of substance use and CVD risks for Indigenous patients, with the potential to be implemented in ACCHOs across
Funding body: NSW Ministry of Health
|Funding body||NSW Ministry of Health|
Associate Professor Mariko Carey, Associate Professor Kate Conigrave, Dr Jessica Stewart, Laureate Professor Robert Sanson-Fisher, Mr Steve Blunden, Professor Christine Paul; Dr Natasha Noble
|Scheme||Drug and Alcohol Council Research Grants Program|
|Type Of Funding||Other Public Sector - State|
Ms Natasha Noble
Health Behaviour Research Group
School of Medicine and Public Health
Faculty of Health and Medicine
|Room||HMRI W4 Desk: 099|
|Location||HMRI Lot 1 Kookaburra Circuit New Lampton Heights 2305