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TWO years into the COVID-19 pandemic, it is clear that evidence from research continues to be an important contributor to policy-making. The speed of change of the virus and the complex balance required in response has demonstrated the critical value of research expertise across clinical, public health and health services fields. We are now starting to see an assessment of the positive impacts of that research expertise across the breadth and scale of the response.
In New South Wales, the government acted early in the pandemic to support research, providing an additional $25 million in funding to establish the COVID-19 Research Program in April 2020. The program was set up to give policymakers the evidence they need to minimise the health and social impacts of the pandemic, including by tracking the mental wellbeing of the population, the effectiveness of new models of care and the changing genetic composition of the virus. Late in 2021, the NSW Government published an interim report on the achievements of this program to date.
Although an interim report, the findings are nevertheless revealing, because they show the breadth of the impact achieved by the research community. Impacts have been recorded across five “domains of benefit”: contribution to knowledge generation, contribution to policy and programs, contribution to clinical care, contribution to community and health outcomes, and contribution to economic benefits.
Two examples of projects undertaken as part of the NSW Government COVID-19 Research Program by the Sax Institute and its partners illustrate new and effective ways of generating information, particularly with respect to older Australians and the Indigenous community.
COVID-19 impacts in older populations
In one project funded by the COVID-19 Research Program, the 45 and Up Study – which has tracked the health of more than a quarter of a million older NSW people for the past 15 years – is revealing important insights into the population effects of COVID-19. As part of the COVID Insights project, study participants are being regularly surveyed to offer a real-time snapshot of their health and wellbeing during the COVID-19 pandemic. The greater risk profile seen in older people means the 45 and Up Study cohort is an ideal base for such research, more than justifying the overhaul of the study’s usual processes required to allow a rapid generation of results.
The Sax Institute and NSW Health developed a coproduction approach to the project that included working closely with clinical and policy groups, along with a group of research collaborators to identify priority survey themes and questions. More than 61 000 participants completed surveys during 2020–2021, with more than 140 000 surveys completed by the end of November 2021. Topics ranged from the pandemic’s impact on health, loneliness, lifestyle, physical activity, diet, sleep, alcohol use and access to health services as well as experiences with telehealth, vaccination and more. Data from the surveys are being made available to researchers and policymakers and are being used to fill important information gaps in the decision making process.
Importantly, through the 45 and Up Study’s longitudinal design and routine linkage to important datasets, such as the Pharmaceutical Benefits Scheme, the Medicare Benefits Schedule and hospital data, researchers can examine the different trajectories of participants’ health over time, including how the COVID-19 pandemic has changed patterns of health service utilisation and affected longer term health outcomes.
The evaluation report notes the contribution from this research, acknowledging that it has resulted in new knowledge generation and has created “rapid information on the health and social impacts of COVID-19 and related restrictions from 61 000 NSW residents”. Public interest has also been high, with a NSW Health tweet linking to a story about the 45 and Up Study project resulting in more than 40 000 views.
The latest survey, which involved 30 000 people and was carried out late in 2021, features questions on missed health care and mental health. It shows that around 16% of respondents missed or delayed a health care appointment in the previous month, and 65% of those hadn’t subsequently sought another appointment. Over 20% cited fear of COVID-19 infection as a reason for missing appointments. Around a third of those surveyed said their mental health had worsened due to the pandemic, up from 10% in a survey carried out earlier in the year.
These and other survey results will be used into the future to understand the ongoing effect of the COVID-19 pandemic on the health and wellbeing of the population.
COVID-19 and the Indigenous community
An important community in Australia’s COVID-19 response are health workers in Aboriginal Community Controlled Health Services (ACCHS). They are the focus of a separate, Indigenous-led project aiming to measure and support the social and emotional wellbeing of health care workers in Indigenous communities during the pandemic. The work of ACCHS staff is particularly critical in this time of pandemic, as their services have played a pivotal role in providing holistic care to their communities, including leading the local COVID-19 testing and vaccine response.
This research – involving several ACCHS working in collaboration with the Sax Institute – will for the first time describe the social and emotional wellbeing needs of health care workers in urban, regional and remote NSW. Using culturally adapted tools, yarning circles and self-reported information on the impacts of COVID-19, the project is capturing important data over an 18-month period. At the same time, ACCHS staff are being invited to participate in programs designed to build skills to support their social and emotional wellbeing, which has been particularly impacted by the challenges of the pandemic and the pressure of dealing with heightened levels of distress in the community.
Early, as yet unpublished findings have documented major shifts in the work and work practices of ACCHS staff as they support their communities through different phases of the pandemic. They have identified concern among health care workers and their community around the risk of infection, and high levels of community distress during times of peak infection. Most staff have reported high levels of job satisfaction and resilience, along with relatively low levels of emotional exhaustion, despite the challenges of dealing with the pandemic. A smaller but significant group, however, are more severely challenged by the impact of COVID-19 and require additional support. These early findings, together with analyses to come on areas of greatest need and the effectiveness of interventions, are being made immediately accessible to ACCHS to improve service planning and programs both locally and across the state.
These and the many other research projects detailed in the interim evaluation report show how the NSW and Australian research sectors have responded to generate new knowledge to support the pandemic response. As new COVID-19 variants emerge and our response to managing the pandemic evolves, it will continue to be critical that evidence from research informs our approach.
Dr Martin McNamara is Deputy CEO of the Sax Institute.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.