Prevention and Management of Long Term Conditions

Description and Aims

This stream is a response to the challenge of long-term conditions to health and health care services.   These conditions include diabetes, cardiovascular disease, asthma and chronic obstructive lung disease, cancer and mental illness.  They commonly occur as multi-morbidities.   The aim is conduct research in the community which informs improvement in health care and programs which aim to prevent and manage these conditions.

Key Current Research Areas


The program focuses on improving interventions to address the behavioural risk factors (especially Smoking, Nutrition, Alcohol and Physical activity) as well as physiological risk factors such as obesity and cardiovascular risk in primary health care.  This uses the 5As framework (ask/assess, advise, agree and assist, arrange), approaches tailored to health literacy levels and use of wearable technology and social media.


This program focuses on a patient centred approach based on the Chronic Care model and includes teamwork, information and communication systems (including e-health), self-management support and community resources.  This is the focus of work on diabetes, cardiovascular disease, asthma, COPD, cancer, mental illness and multi-morbidity.

Key Partners

This research is conducted in partnership with primary health networks and local health districts along with other groups including Aboriginal Health organisations.

Stream lead

Mark Harris leads the stream. 



Mental Health Literacy Training and Education for the primary health workforce

CPHCE is working with a consortium (Swinburne, University, University of Newcastle and North Coast PHN) to develop education and training materials to improve mental health literacy responsiveness in primary care and specialist health settings. This project is a component of the Health Literacy Initiative that is being managed by the Mental Health Commission of NSW.

Pathways to Preventive Care for People with Severe Mental Illness

The project will focus on the experiences and perspectives of PWSMI and what has helped or enabled them to establish and maintain a positive relationship with a GP. This information will assist with further research and codesign of an intervention to improve access to preventive health care for PWSMI.

Preventing chronic disease in patients with low health literacy using e-health in general practice.

Preventing chronic disease in patients with low health literacy using e-health in general practice.

This is a cluster randomised controlled trial of the effectiveness of an intervention which uses accessible and interactive information technology to support general practice nurses to better communicate with patients with low health literacy, to help them use information, set priorities, navigate referral and maintain behaviour change.

Understanding barriers to the provision of pre-travel preventative health advice to migrant Australians in primary care in the post-COVID era

International travellers are a primary factor in the spread of infectious diseases across borders and have been instrumental in spreading SARS-CoV-2 around the world. Diasporic people who travel back to their countries of origin to visit friends and relatives (VFR travellers) are at increased risk of acquiring a range of infectious diseases during travel, compared to other travellers. Pre-travel assessment and advice is an important opportunity to address VFR issues regarding health beliefs, health behaviours, current health status and pre-existing conditions.

General Practitioners (GPs) are an important source of pre-travel advice for travellers. An Australian population-based survey found that almost 90% of travellers used their general practitioner for travel health advice (1). Despite this, there has been little published research on the practice of travel medicine in primary care in Australia or internationally(2, 3) and few address the provision of travel medicine advice to migrant Australians travelling to visit friends and relatives (4). A 2012 study of GPs in migrant-rich suburbs of Sydney found a lack of awareness of the need for pre-travel health assessment of migrant Australians, particularly among migrant GPs (4). Further research is needed to identify barriers to care among a more generalisable sample of Australian GPs.

Traveller behaviour may differ in the post-COVID era and the practice of travel medicine is likely to change. Understanding GP knowledge, and perception of travel risks and barriers to the provision of advice is important, with previous research indicating a need for directed education and awareness of the need for opportunistic targeting of VFR travellers (5). 

A cross-sectional survey of GPs practicing in Australia will be conducted. GPs will be sampled from the AMA Medical Directory of Australia database. Depending on contact details, GPs will be emailed a link to an online survey or posted a hard-copy survey and invited to participate.




Barriers and facilitators to use of the asthma 3+ visit plan

The Asthma 3+ Visit Plan is an initiative of the National Asthma Council to promote organized care of asthma in general practice. This study explores barriers and facilitators to Asthma 3+ Visit Plan in general practice.

Better Management of Weight in General Practice (BMWGP)

Socioeconomically disadvantaged adults are both more likely to be obese and have lower levels of health literacy. This trial evaluated the implementation and effectiveness of primary care nurses acting as prevention navigators to support obese patients with low health literacy to lose weight.

Centre Obesity Management and Prevention Research Excellince in Primary Health Care

Centre Obesity Management and Prevention Research Excellince in Primary Health Care

COMPaRE-PHC has conducted a program of that aims to inform primary health care policy and practice in the prevention and management of obesity in disadvantaged populations across Australia.

Community Health Risk Factor Management Research Project

This study aims to increase the capacity of community health services to address chronic disease risk factors of smoking, nutrition, alcohol and physical activity as part of their normal clinical work.




No projects found.