Optimal early childhood development is an international priority. Risks during pregnancy and early childhood have lasting effects because growth is rapid. We are testing whether a complex intervention addressing multiple modifiable risks: maternal nutrition, mental health, parenting capabilities, infant health and development and gender-based violence, is effective in reducing deficient cognitive development among children aged two in rural Vietnam.
The Learning Clubs intervention is an evidence-based program combining perinatal stage-specific information, learning activities and social support. It comprises 20 modules, in 19 accessible, facilitated groups for women at a community centre and one home visit. Content has been translated and culturally adapted for Vietnam and acceptability and feasibility established in pilot testing. This is, to our knowledge, the first trial to address eight risks to the early development of children in a multicomponent intervention in a resource-constrained setting.
Each of the program's 19 community-based facilitated group sessions provides mothers, fathers, and grandparents with access to learning activities, educational DVDs, and social support. The program's effectiveness is being investigated in a cluster randomised controlled trial in rural Vietnam.
We have partnered with the Research and Training Centre for Community Development (RTCCD)-Vietnam, University of Melbourne, Burnet Institute, and UNICEF for this project, which is funded by the National Health and Medical Research Council (NHMRC).
Learning Clubs to improve women’s health & infant’s health and development in Vietnam: a cluster randomised controlled trial to inform transition to scale
Fisher J, Luchters S, Tran TD, Le M, Nguyen T, Tran T, Tran H, Biggs B, Hanieh S, Nguyen V
Grand Challenges Canada is supported by the Canadian Government to fund Bold Idea with Big Impact. One of their initiatives, Saving Brains, supports promising programs to improve the development of young children in resource-constrained settings throughout the first 1000 days of a child's development.
The Learning Clubs program has been selected by Grand Challenges Canada for support. They are providing funds to match the National Health and Medical Research Council funding to evaluate the economic impacts of the program, and to undertake additional analyses to identify how Learning Clubs works and what is needed to take it to scale in Vietnam. Grand Challenges Canada is providing active support to assist us to take the program to scale once the trial has been completed.
Fisher, J., Nguyen, T., Tran, T.D., Tran, H., Tran, T., Luchters, S., Hipgrave, D., Hanieh, S. and Biggs, B.A., 2019. Protocol for a process evaluation of a cluster randomized controlled trial of the Learning Club intervention for women's health, and infant's health and development in rural Vietnam. BMC health services research, 2019; 19(1), p.511.
Addressing an unrecognised public health problem in Vietnam: a clustered randomised controlled trial of the culturally adapted Resourceful Adolescent Program (RAP-V) to improve adolescent mental health
Tran T, Nguyen H, Fisher J, Shochet I, Holton S
There are no national policies or programs for adolescent mental health in Vietnam, despite prevalence rates of up to 29% for youth mental health problems. We aim to improve the mental health of Vietnamese adolescents by establishing whether a cultural adaptation of the evidence-based Resourceful Adolescent Program (RAP) is effective in preventing symptoms of depression and suicidal behaviours.
Established in 1996, RAP was developed to build resilience and promote positive mental health in teenagers. RAP is widely used in over 3000 schools in Australia and has been successfully introduced in over 15 other countries. This adaptation will provide essential evidence for integration of RAP into school-based programs in Vietnam.
We have partnered with the Hanoi School of Public Health (Vietnam), and the Queensland University of Technology for this research, which is funded under a joint initiative of the National Health and Medical Research Council (NHMRC) in Australia and NAFOSTED in Vietnam.
Experiences of heart and lung transplantation in Australia: creating a pre- and post-transplant resource
Kirkman M, Stubber C
People who need a lung, heart, or heart and lung transplant not only have life-threatening conditions but are also aware that their only chance of survival depends on a fellow human’s death. These are highly emotionally-arousing circumstances. Access to accounts of the experiences of transplant recipients can reduce distress and improve the mental health and wellbeing of potential and recent recipients, but there is little opportunity in Australia to learn from those who are living with transplanted organs. The known benefits of learning from peers include feeling less alone, being better informed, knowing what to ask clinicians, and insight into managing such difficult procedures.
We are developing an online resource as an outcome of our video-recorded research with organ recipients. We plan that this resource will be of benefit to people contemplating organ transplantation, organ recipients, their families and friends, and professionals working with recipients and prospective recipients. This project is funded by the Grenet Foundation.
Latrobe Valley early parenting – What Were We Thinking
Fisher J, Rowe H
What Were We Thinking (WWWT) is a carefully researched, evidence-based set of materials and activities designed to promote confidence and reduce distress in parents with a first baby.
WWWT is a two-session program, designed to be offered at local health centres, appropriately constructed as safe environments for parents and infants. It is intended to be conducted four to six weeks postpartum, at a time that is convenient to parents, and facilitated by an experienced maternal and child health or early childhood nurse.
This project involves the provision of course materials, face-to-face training, implementation and post-training support for 30 maternal and child health (MCH) nurses in the Latrobe Valley and the delivery of WWWT to parents attending all first-time parenting groups (FTPG) in the Latrobe Valle.
We have partnered with the Victorian Government Department of Education and Training, City of Latrobe, Shire of Baw Baw, and the Shire of Wellington for this project, which is funded by Department of Education and Training.
Contributing to optimal mental health for older women in Australia: a multiple methods research program
Fisher J, Kirkman M, Tran TD, Hammarberg K
We aim to learn from older women about their understanding of what contributes to or hinders their mental health and wellbeing. The goal of this research is to improve mental health and wellbeing of older women in Australia.
Mental health is a state of wellbeing in which people can use their skills and capabilities, to adapt to the demands of daily life, experience mutually gratifying relationships, and contribute to the community, including through productive work. It is much more than the absence of illness.
Most research has focused on understanding severe or common mental disorders. The factors that interact to foster good mental health, including in later life, are much less well elucidated. In a recent analysis of data gathered from older women over several decades, we found three paths reflecting women’s mental health: stable good health, stable poor health, and declining from good to poor. We are now consulting older women about these results to seek their perspectives on what enhances and damages women’s mental health as they age. We have partnered with The Jean Hailes Foundation for this project, which is funded by the Liptember Foundation.
Tran TD, Hammarberg K, Ryan J, Lowthian J, Freak-Poli R, Owen A, Kirkman M, Curtis A, Rowe H, Brown H, Ward S, Britt C, Fisher J. Mental health trajectories among women in Australia as they age. Aging & Mental Health 2019, 23(7):887-896, DOI: 10.1080/13607863.2018.1474445
Improving child health and development in resource-constrained settings: a multi-component study to inform policy and more effective interventions
Tran TD (Fisher J is the Mentor)
Worldwide, over 200 million children under five years of age do not reach their potential because they are stunted and have compromised cognitive, motor, and social-emotional development, setting them on poor lifetime trajectories.
This project will extend knowledge about the effects of social determinants on child malnutrition and compromised development in low-and middle-income countries (LMICs) to inform policy and the development of targeted, effective interventions in disadvantaged groups worldwide.
The first component, a secondary analysis of The UNICEF Multiple Indicator Cluster Surveys conducted in ~ 60 LMICs, will describe the trends in the prevalence of child malnutrition in LMICs in the last 15 years.
The second, a secondary analysis of a longitudinal study in four LMICs which follows up a cohort of 8,000 children from one to 15 years of age, will examine the trajectories of child growth and development in this timeframe. It will determine the effects of factors at child, parental, family, community and country levels on the trajectories of child growth and development.
The last component is a cluster-randomised controlled trial in Vietnam to evaluate the impact of Learning Clubs for women and Infants; a structured universal program we have developed on the health of women and the health and development of their infants. This project is funded by the National Health and Medical Research Council (NHMRC).
Tran TD, Biggs B, Holton S, Nguyen H, Hanieh S, Fisher J. Co-morbid anaemia and stunting among children of pre-school age in low- and middle-income countries: a syndemic. Public Health Nutrition 2019, 22(1), 35–43, DOIs: 10.1017/S136898001800232X
Tran TD, Luchters S, Fisher J. Early childhood development: impact of national human development, family poverty, parenting practices and access to early childhood education. Child: Care, Health & Development 2017, 43 (3), 415–426 DOI: 10.1111/cch.12395.
Fisher J, Tran T, Luchters S, Tran TD, Hipgrave D, Hanieh S, Tran H, Simpson J, Nguyen T, Le M, Biggs B-A. Addressing multiple modifiable risks through structured community-based Learning Clubs to improve maternal and infant health and infant development in rural Vietnam: protocol for a parallel group cluster randomised controlled trial. BMJ Open 2018, 8:e023539. DOI:10.1136/bmjopen-2018-023539 https://bmjopen.bmj.com/content/8/7/e023539
Clinician-level Quality Indicator Reports: A qualitative research project to understand views of clinicians receiving and not receiving these reports
Kirkman M, Evans S, Heathcote P, Fisher J, Millar J, Mark, S, Currow D, Frydenberg M, Khadra M
The Prostate Cancer Outcome Registry-Australia and New Zealand (PCOR-ANZ) was established to monitor the quality of care provided by contributing hospitals and clinicians to patients with prostate cancer. Quality indicators were developed through a consensus process as tools to measure quality of care and, since 2012, the Prostate Cancer Outcome Registry-Victoria (PCOR-Vic) has provided Quality Indicator Reports six-monthly to clinicians and hospitals. These reports provide to contributing sites and clinicians a summary of the patterns of care of patients they are managing and specifies their individual performance relative to others. The PCOR-Vic and the PCOR-ANZ Steering Committees have sought guidance on how best to manage those who fall outside the ‘normal’ range of quality indicators (defined as two standard deviations below the mean). Given the many reasons why a hospital or clinician might register outside the normal range, management needs to be sensitive and responsible. The aim of this research is to understand how urologists respond to reports of the quality of care and how potential ‘outlier’ activity could be best be communicated. Urologists in Australia and New Zealand will be consulted to ascertain their views and advice.
Postnatal mental health problems among women are associated with morbidity, reduced social participation, impaired infant development and family functioning, and constitute an Australian public health priority. Universal primary care health services (Maternal and Child Health and General Practice) are at the forefront of promotion, prevention and early intervention for postnatal mental health. However, they are under-resourced for these roles, and the two sectors are organisationally segregated.
Health service reform to increase consistency of care and service integration, supporting a comprehensive stepped-care model of prevention, early intervention and treatment, is required.
What Were We Thinking (WWWT) is an evidence-informed, effective, acceptable, psycho-educational model of postnatal care that addresses known but neglected risks for mental health at this phase of life. It is non-stigmatising, and facilitates clinician professional development, parent skill-building, and identification of, and early intervention for, mental health problems. The Department of Health and Human Services Victoria has commissioned Rowe and Fisher to implement WWWT in the Latrobe Valley (2018-2020).
The Flagship will leverage this project to bring implementation science experts and consumers together with key government, primary care and community health partners to translate and scale up successful implementation of the reform. The Theoretical Domains Framework will guide investigation of stakeholder perspectives about required modifications and how to achieve and measure change in barriers and enablers for implementation. The Flagship outcome will be rigorously-evaluated, practical, implementation tools, specifically for consumers, clinicians, and health services. The tools will support WWWT scale-up across Victoria, and will be readily transferrable to implementation of other complex interventions and health settings.
This project is being led by Global and Women's Health's Dr Heather Rowe for Gippsland Women's Health (GWH). The project is funded through the 2019 Monash Partners Medical Research Future Fund (MRFF) Rapid Applied Research Translation funding round.
Projects on which Global and Women’s Health is a partner
SPHERE – The Centre of Research Excellence in Sexual and Reproductive Health for Women: achieving better outcomes through primary care
Mazza D, Fisher J, Taft A, Black K, Lucke J, Hass M, Hussainy S, McGeechan K, Norman W
SPHERE aims to both improve women’s access to critical sexual and reproductive health services and improve pregnancy outcomes. The multidisciplinary investigator team will also study task-sharing by health workers in primary care and evaluate whether this and other new models of care align with patient preferences and are cost effective.
SPHERE’s aim is to address the issue of sexual and reproductive health through broad collaboration between researchers, healthcare providers, health service delivery organisations, policymakers, peak bodies for women’s health in Australia, and consumers. Monash University is specifically investigating pre-conception health within this project.
SPHERE brings together the leading Australian researchers in sexual and reproductive health for women in primary care and pre-eminent international researchers in this field.
Led by the Department of General Practice, Monash University, other partners include: Global and Women’s Health, Monash University, LaTrobe University, University of Sydney, University of Technology Sydney, University of British Columbia, Canada. This project is funded by the National Health and Medical Research Council (NHMRC).
Centre of Research Excellence on Women and Non-communicable Disease (CRE WaND): prevention and detection
Mishra G, Hickey M, Dobson A , Gannon B, Doust J, Fisher J, Cicuttini F, Huxley R, Tooth L, Brown H
Non-communicable diseases (NCD) – such as cardiovascular disease – are now leading causes of mortality and morbidity among women, both globally and in Australia. This Centre of Research Excellence shifts the focus of women’s health from reproductive and maternal health to encompass the risk of NCDs. We are examining how the risk factors that women face combine to influence NCDs across life and aim to quantify the impacts on health services used. We are exploring how best to transform current approaches for preventing NCDs among women.
Led by The University of Queensland, other project partners include: Monash University, the University of Melbourne, Bond University Limited, The Jean Hailes Foundation, La Trobe University, and Deakin University. The project is funded by the National Health and Medical Research Council (NHMRC).
Centre of Research Excellence in childhood adversity and associated depression and anxiety
Hiscock H, Jorm A, Goldfeld S, Fisher J, Eastwood J, Reupert A, Sanci L, Yap M, Dalziel K, Eapen V
Through this Centre of Research Excellence, we aim to prevent depression, anxiety problems and suicidality by reducing the occurrence of adverse childhood experiences. With our multi-disciplinary, multi-site team, we will develop practitioner and policy makers documents showing which experiences are associated with depression, anxiety problems and suicidality and how best to manage them. We will then use this evidence to develop and test new ways of helping families facing these experiences.
This project is being led by the Centre for Community Child Health at the Royal Children's Hospital Melbourne, and project partners include: Monash University, the University of Melbourne, South Western Sydney Local Health District, and the University of New South Wales. The project is funded by the National Health and Medical Research Council (NHMRC).
Preventing postnatal depression in new mothers using telephone peer support: a randomised controlled trial
Forster D, McLachlan HL, Dennis CL, Nicholson J, Shafiei T, Shiell A, Nguyen C, Nguyen T, Adams C, Grimes H, Fisher J, Petschel P
Unfortunately, depression in women who have recently had a baby is a very common occurrence. More than 53,000 new mothers in Australia are affected by depression each year. The condition can lead to serious adverse consequences for a mother’s health and the health of her infant and family. Effective strategies to prevent and reduce maternal depression are therefore needed. We are testing whether support by telephone from other mothers (peer volunteers) helps in women at increased risk of depression at four weeks postpartum.
Monash University is supporting this project, which is being led by the Judith Lumley Centre at LaTrobe University, and the Royal Women’s Hospital. The project is funded by the National Health and Medical Research Council (NHMRC).
Provision of a perinatal depression online support tool
Milgrom J, Smith T, Fisher J, Rowe H, Michelmore J, Kavanagh D
MindMum is an App designed to assist expectant and new mothers by providing effective strategies to improve mood, strengthen relationships and help women to feel supported and confident in becoming a mum.
We aim to obtain qualitative information about users’ experience of the MindMum app, including factors that would lead them to download and continue to use this and similar apps for a sufficient amount of time to allow treatment benefits to occur. We aim to ascertain quantitative ratings of the MindMum application on the user version of the Mobile Application Rating Scale (MARS), and on the Components Perceived Usefulness Questionnaire.
This project is being led by the Parent-Infant Research Institute, and project partners include: Monash University, Queensland University of Technology, Perinatal Anxiety & Depression Australia (PANDA), and The Jean Hailes Foundation. This project is funded by the Australian Government Department of Health.
Safe Families multi-component qualitative research study – Solomon Islands
Trembath A, Greenwood K, Fulu E, Fisher J, Lees S, Dicker K, Puiahi D, Honda T, Tran T
The Solomon Islands has one of the highest rates of family violence in the world. Safe Families is the first long-term, intensive, locally-developed community mobilisation-based violence prevention program to be implemented in Solomon Islands.
We aim to evaluate the implementation of the Safe Families intervention, and to understand the processes of change to harmful social norms that drive family and sexual violence in two provinces in the Solomon Islands.
We would like to better understand and describe the context-specific responses of individuals, communities and agencies to the Safe Families model for violence prevention in the Solomon Islands, in order to inform optimisation and scale-up of the intervention. We also aim to advance our understanding of how to conduct research on violence against women that is ethical, safe and rigorous in the context of small, geographically-disparate island communities where violence is relatively normalised.
Led by Oxfam Australia, other partners include Monash University and the Equality Institute. The project is funded by the World Bank’s Sexual Violence Research Initiative.
The World Health Organization (WHO) recommends universal distribution of anaemia control iron supplements or iron-containing multiple micronutrient powders (MMPs), with the goal of restoring developmental potential, health and wellbeing. However, it is increasingly uncertain whether universal iron interventions are a safe, beneficial and cost-effective public-health strategy in children in low-income (especially malaria endemic) settings. There is an urgent need to quantify the magnitude of benefit in functional outcomes from these interventions.
Although nearly half of the world's young children are anaemic, evidence regarding the best approaches to correct this problem is limited. New data even suggests that the conventional approaches (iron supplements, multiple micronutrient powders) may be harmful. We will perform the definitive trial to confirm the existence and magnitude of any benefit (and harm) from these interventions in young Bangladeshi children. This trial will inform global policy on anaemia control.
This University of Melbourne is leading this project, and has partnered with Monash University, University of Sydney, International Center for Diarrhoeal Disease Research, Bangladesh, Burnet Institute, and the University College London (UCL). This project is funded by the National Health and Medical Research Council (NHMRC).
Your Fertility: Supporting Reproductive Choices is an evidence-based national fertility health promotion and infertility prevention program which addresses primary and secondary prevention of infertility. The program promotes awareness of the factors that affect fertility and reproductive outcomes and the benefits of positive health behaviours for reproductive health.
Your Fertility is funded by the Commonwealth Government and delivered by the Fertility Coalitions, a collaboration between the Victorian Assisted reproductive Treatment Authority (VARTA), Robinson Research Institute, Healthy male, Jean Hailes for Women’s Health and Monash University.