Not ready for what's coming: Perceptions and preparedness of healthcare providers for adverse effects of climate change in Victoria, Australia

Not ready for what's coming: Perceptions and preparedness of healthcare providers for adverse effects of climate change in Victoria, Australia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Not ready for what's coming: Perceptions and preparedness of healthcare providers for adverse effects of climate change in Victoria, Australia Mikaela Misso, David Reser, Margaret Simmons This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6644033/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Anthropogenic global climate change (AGCC) is expected to drive an increase in frequency and severity of weather-related disasters, as well as aggravating existing medical conditions in vulnerable populations. Specific health related outcomes of AGCC include It is unclear however, how prepared healthcare practitioners (HCPs) are for the impending challenges that AGCC presents for health, or the extent to which pre-professional and professional training programs have incorporated formal instruction around the health effects of climate change. We employed a mixed methods study design, consisting of an online survey followed by semi-structured interviews with Victorian HCPs to address the following topics: perceptions of HCPs on AGCC; anticipated impacts AGCC will have on health and delivery of healthcare; level of preparation for possible adverse health impacts of AGCC; and opinions of climate-specific educational and professional development training. What emerged was that participants were aware of climate change (78%) and were highly concerned about its impacts on the health of the Victorian population. Over half of the participants indicated their current practices are not sufficient to tackle the anticipated adverse health impacts and a majority supported the introduction of climate change education (78%). Participants expressed a knowledge deficit, despite their self-initiated learning. A key finding of this study is that the majority of participating HCPs obtained their information about climate change exclusively or predominantly from mass media and social media outlets, as opposed to sources which would be favoured in an evidence-based approach (e.g. peer-reviewed literature). Our findings suggest that most HCPs are concerned about the adverse impacts of AGCC on the health of their patients. Despite the HCPs’ motivation to conduct self-initiated learning in the area, it is evident that the current education model does not provide a sufficient level of preparation. Given the likelihood of an increase in climate events and a concomitant increase in the severity of impacts on human health, it is likely that significant changes to the medical education curriculum will be necessary at both pre- and post- graduate levels. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction It is widely recognised that anthropogenic global climate change (AGCC) will impact human health, with large organisations such as the World Health Organization describing it as the “greatest threat to global health in the 21st century” (2, Pg 1). Probable changes include rising surface ocean temperatures and ocean acidification (3, 4); rising sea levels (5); a change in air and land quality (6); and an increased incidence of extreme weather events, including heat waves, extreme drought, wildfires, and floods (7, 8). Climate events pose multiple risks to human health, including disaster-related injury, heat- related health issues (9-14) and respiratory problems (15-20). The 2021 MJA-Lancet countdown report outlined the extensive health impacts of AGCC on the Australian population including heat-related health issues, injuries due to bushfires and floods, and an increased burden on the mental health of the population due to drought and bushfires (21). Adverse impacts of AGCC on human health will challenge healthcare practitioners (HCPs), as patient loads increase, and climate related injuries and disasters acutely strain healthcare resources. Adverse effects on public health and infrastructure, such as an increase in chronic respiratory disease incidence and damage to healthcare infrastructure during bushfires, are also likely (22-24). It is also foreseeable that the existing shortage of rural HCPs could be aggravated by the real and perceived hazards of living and working in AGCC-vulnerable communities, whereas early and continuing education surrounding the adverse impacts of AGCC on health could aid in preparing HCPs for their role in adaptation to, and mitigation of climate change effects. It is critical that we understand the health impacts of AGCC on health care delivery, and that we prepare HCPs to adapt to the changing health and safety needs of the Victorian population (21, 25). Multiple studies have shown that HCPs play a critical role in the response to AGCC (26-32), with special attention given to the HCP as educator and advocate for action by both HCPs and the healthcare system (33-36). Possible adaptation and mitigation strategies to address the varying impacts of AGCC are diverse and require support across sectors and disciplines (37-39). These strategies include education of HCPs and the public; sustainable energy sources; reducing wastage in the healthcare sector as well as climate event warning systems (40). This multidisciplinary approach is particularly important for the healthcare sector, as the health effects of AGCC are multifaceted and will require multiple disciplines, institutions, and policy makers to work together to adapt effectively (41, 42). As trusted professionals within the community (43-45), the role of the HCP in adapting to and mitigating the impacts of AGCC on health involves leading by example; education of patients; and advocating for the community. Understanding current HCP perceptions and opinions will facilitate the implementation of adaptation strategies and improve their effectiveness. Moreover, this understanding will aid in the process of constructing a practical and efficient AGCC curriculum for future HCPs. To date, little research has been conducted to appreciate the perceptions of HCPs of AGCC and its impact on population health or even whether they are ready to take on the possible role they have in adapting to and mitigating AGCC impacts on health. This study examined the perceptions of general practitioners, registered nurses, and nurse practitioners practicing in Victoria, Australia recruited by email and phone contact (see Methods). Australia is considered particularly vulnerable to the effects of climate change due to its topography, soil composition, atmospheric conditions, population distribution, and unique fauna. Recent temperature increases, altered rainfall and wildfire patterns, and oceanographic perturbances are attributable to or aggravated by AGCC (46,47). Past studies have indicated that a majority of HCPs believe that climate change will impact the health of their patients in various ways (48-52). Among rural GPs in New South Wales, Purcell and McGirr found general agreement that AGCC will have an adverse effect on the health of the populations they serve, and also that there was insufficient professional education available to deal with anticipated effects, especially with regard to locally available education resources (51). Moreover, most studies found that many of the practicing HCPs do not feel adequately prepared to educate patients or make changes in their practice to be more sustainable (49, 50). Methods This study utilised a triangulation mixed methods research design (53,54) to provide separate but complementary datasets which facilitated an interrogation of similarities and contradictions between the datasets (55-57). The study included a quantitative survey followed by a qualitative, semi-structured interview with open-ended questions. The mixed methods approach is an increasingly preferred methodology in healthcare literature, successfully utilised by other researchers on this topic (49, 58-61). Recruitment for the study was conducted using posters, word-of-mouth, contact with relevant professional organisations, and direct email contact to healthcare clinics and practitioners. A total of 531 clinics were contacted using email addresses sourced through health directories (62, 63). In total, 22 clinics agreed to distribute the recruitment email to their staff. In addition, four organisations, including Doctors for the Environment Australia (DEA) and the Australian Nursing and Midwifery Federation (ANMF), agreed to contact their constituents either via emails directly or through an advertisement in their newsletters. An additional 33 emails were sent directly to contacts referred by participants or study personnel. As there is no single or clear denominator for calculating response rate, it could not be determined for this study. All participants provided informed consent in advance of data collection, and all study procedures were approved by the Monash University Human Research Ethics Committee (study #27458). The survey consisted of 21 questions, and was conducted online using Qualtrics software (Qualtrics, Provo, UT, Version 09/2021, available at: https://www.qualtrics.com). The quantitative survey included demographic questions and investigated the perceptions of HCPs on AGCC, and their views about the impact of AGCC on healthcare delivery. Questions were aimed at understanding how prepared HCPs currently are for AGCC impacts; perceptions on the educational and professional development training requirements for AGCC and how their healthcare practice and patients might be affected. To determine the place of practice for participants, all participants were asked to describe their location based on the Accessibility/Remoteness Index of Australia (ARIA) (1). Semi-structured interviews were conducted with the intent of building upon the answers provided in the survey (64). As participants were interviewed, points of interest were explored which in some cases prompted new questions to be added or for original questions to be amended (64). Qualitative interviews were conducted via Zoom™ due to COVID-19 contact restrictions and for the convenience of participants. Qualitative data retrieved from interviewing participants was transcribed verbatim by the researchers and a Monash approved transcription service (SMARTdocs, https:// www.smartdocstranscriptionservices. com.au/) using the Zoom™ recordings. Responses to the survey questions were analysed using descriptive statistics (65-67). Ordinal data retrieved from the Likert scale questions were analysed using non-parametric statistical analyses and, where appropriate, Mann-Whitney U tests were utilised to assess the differences between demographic factors and answers to Likert scale questions. Analysis and graphing were conducted using Microsoft Excel and GraphPad Prism (V9.2.0 for Windows, GraphPad Software, San Diego, California USA, www.graphpad.com). A six-phase thematic analysis, as described by Clarke and Braun (64), was employed to analyse the qualitative interview data (68). Results A total of 41 survey responses were submitted, however, 14 were incomplete and therefore excluded from the study. 27 complete surveys were included, with 20 of those participants consenting to a qualitative interview. The regional distribution and demographics of participants are described in Table 1. The cohort had a relatively even distribution of metropolitan HCPs (48%) versus rural and regional HCPs (52%). Quantitative comparisons of survey responses were made according to demographic classifiers, profession, experience in clinical practice, and rurality, however, no differences between any classifiers were found ( Table 1). Table 1. Demographic characteristics of study participants. Demographic category Response options Number of participants % of intent-to- treat population** Preferred gender descriptor female 22 79 male 5 18 non-binary 1 4 Highest Degree Bachelor (Medicine 17 61 or Nursing) Doctor (Medicine or 2 7 Nursing) Other 9 32 Current Practice Registered Nurse 13 46 Nurse Practitioner 4 14 Doctor or specialist 11 39 physician Time since award of highest <7 13 46 degree (y)* 7 to 15 3 11 15+ 12 43 Length of practice* # <7 7 25 7 to 15 8 29 15+ 13 46 Practice location Urban Centre 13 46 Regional 13 46 Rural/Remote 2 7 Number of providers at primary < 10 5 18 workplace 11 to 20 8 29 21+ 15 54 *Due to an editing error, the blocking of categories allowed for overlap at the 7 year mark. Numbers reflect actual participant responses **Intent to treat N=28 participants. Data in text represent number of respondents to survey and/or follow up interviews as specified. # practice duration excludes career interruptions (e.g. prolonged leave) Thematic Analysis Analysis of qualitative interview results yielded three main themes, including: the practitioner’s level of knowledge of and concern for AGCC, the role of the HCP in adaptation and mitigation strategies and possible approaches and barriers to the implementation of AGCC education for HCPs. Practitioner Knowledge Survey responses suggest widespread recognition of AGCC, with 78% of participants indicating they were aware that AGCC is an issue (Figure 1A). A majority of participants indicated there would be adverse health impacts on the overall population due to AGCC in both five and ten years (74% and 95% respectively). Moreover, most participants indicated these adverse impacts would increase in severity from five to ten years in the future. For the adverse events in five and ten years respectively, the median Likert scale response increased from five (95% CI 5-6) to six (95% CI 6-7, Figure 1B). Most participants expressed concern for the potential impacts of AGCC on infectious disease (93%) and mental health (93%), with approximately half indicating mental health and infectious disease are a serious concern (48% for both, Figure 1C&D). Commensurate with the quantitative data, participants expressed considerable concern for AGCC in the qualitative interviews. Most participants (19/20) highlighted multiple concerns regarding the health impacts of AGCC, with several emphasising that it was a multifaceted issue. For example, one participant explained that the extent of the issue was “kind of hard to verbalise” (P8), while another indicated: “it’s quite a complex issue … with multi-layers … [where] everything is dependent upon everything" (P6). When participants reflected on how AGCC would impact their clinical practice, numerous health concerns were raised. These concerns included the severity of respiratory conditions and the increased burden of chronic and infectious diseases. One participant indicated that the “list can go on” (P4), demonstrating the extensive impacts perceived by HCPs on their patients’ health. Practitioner Preparedness Over half (52%) of the participants in quantitative surveys indicated they did not believe their current practices were sufficient to tackle the health impacts of AGCC (Figure 2A). This level of agreement suggests that most HCPs are aware that they could be doing more to mitigate the adverse health impacts of AGCC. Moreover, 93% of participants indicated they would be willing to implement changes to their practice (Figure 2B). This desire for change was reflected in the qualitative data, where some participants indicated that there was more their practice could be doing to mitigate the adverse health impacts of AGCC. Evidence from both the quantitative and qualitative arms of the study indicate there is a knowledge deficit among HCPs. Participants indicated a lack of formal AGCC instruction in their professional training, as well as a lack of formal support for any further professional development in the area: "I have had zilch … not surprising" (P4). Some participants mentioned that there may have been some discussion of AGCC within their formal training, however, this was not extensive nor applicable to the healthcare setting. One participant noted: “I feel like there were maybe the odd throw away lines in some lectures” (P3). Another participant expanded further, stating: there hasn’t really been any formal support … to explore or learn more about [AGCC] or have any kind of practical things that we can … take to the practice (P8). According to the quantitative data, the majority (59%) of participants indicated their highest level of training was self-initiated online research, while 19% indicated they had received no training at all (Figure 3A). In addition, 59% indicated the most influential sources of information on the health impacts of AGCC were mass media and social media, strongly suggesting that there is a dearth of peer-reviewed, high-quality resources in the information disseminated to HCPs regarding AGCC (Figure 3B). Consistent with the quantitative data, multiple participants indicated in the follow up interviews that their knowledge around AGCC resulted from self-initiated education, demonstrating that there is a deficit in HCP education. One participant indicated that their main source of information on AGCC was mass media, rather than professional or academic literature: I’m as aware of it as I am probably as a result of what I see in the media, not necessarily anything that I read professionally or [that] comes across my desk as a result of the job that I do (P9). Multiple participants in the qualitative interviews noted that their education on AGCC was due to self-initiated online research, as suggested in the quantitative data. Interestingly, one participant explained that the available online information was inconsistent, and they had to “[reinvent] the wheel” (P12) in order to create a centralised source of AGCC information and resources for other HCPs to take into their workplace. Another participant suggested that without interest in AGCC motivating self-driven education, there was minimal opportunity to learn about the topic: [Education] was probably more something if you had an interest in that… like the doctors for the environment Australia group or the … AMSA global health forum and code green and those sorts of things (P3) While another participant indicated that despite their interest they encountered difficulty accessing information around AGCC: "it’s something that I’d like to engage with a little bit better … but I always found it difficult to … access those spaces" (P8). The lack of accessible information was also noted by other participants: There's nothing available that I'm aware of, at the moment. Well, there might be something, I guess, out there but it's not a publicly or well-circulated thing (P16) Overall an ongoing theme of difficulty accessing climate information and a lack of formal training emerged from the qualitative data. Participant Opinion Regarding AGCC Education A clear consensus was expressed between participants regarding training for the health impacts of AGCC, with 78% agreeing that it should be included in the education of HCPs (Figure 4). Consistent with the quantitative data, all interviewed participants (20/20) responded positively to the prospect of implementing formal education for HCPs on the topic of AGCC and its impact on health. One participant pointed out that the concept of introducing education around AGCC is not new within the healthcare education field, specifically citing the Association of Medical Education in Europe (AMEE) Consensus Statement (69): this is not controversial – this is in big consensus statements from AMEE, on the importance of including climate change in health and medical education (P18). Participants suggested various educational aspects of AGCC that should be incorporated in the curriculum, including: education on the link between the environment and health; crisis management and care; managing surges of illness due to AGCC; risk management of chronic illness and medications in a changing climate; the impacts on the healthcare system and how to reduce them; and how to educate and advocate for patients in a changing environment. As one participant elucidated: [it is] widely recognised that climate change is the biggest health threat that we are currently facing, and it's important that all healthcare professionals are trained in understanding what the effects are; how to think about risk management for their patients; but also, to think about our professional responsibility for being leaders, cleaning up our own sector, and doing our best to make sure that [we are] not contributing more to the problems that we face (P18). Another participant concurred that AGCC and its effects should be part of the curriculum for HCPs: I think it’s actually imperative and it should be part of the curriculum for all nurses and other health professionals, to have a module on climate change and how it can affect the health of individuals, definitely (P23). Despite most participants providing potential solutions for the knowledge deficit within HCP education, a few expressed hesitancies about the introduction of specific AGCC education. This hesitancy did not stem from whether the education would be useful, but instead how it could be effectively implemented into the curriculum or professional development, as one participant reflected: To be honest, educational stuff is probably going to be a bit more limited at the moment other than talking about it in a more global population health sense of your local community, your country, the populace as a whole (P6). Another participant explained that such training and education would need to have practical relevance: “I’d have to see it as being more immediately relevant to my actual clinical practice and what I was doing” (P10). Further barriers to the wholesale implementation of AGCC education were expressed by some participants, including: resistance and scepticism from HCPs; space within the curriculum; time restrictions; lack of support from the healthcare system; immediate relevance to clinical practice; clinician engagement; and awareness of the link between action and benefit to public health. Barriers to the development and implementation of strategies to cope with AGCC, as suggested by participants, included the vulnerability of the healthcare system and the mental toll AGCC takes on HCPs. The healthcare system was considered to have a multifaceted vulnerability to AGCC due to environmental factors placing strain on the reliability of resources, including power supply water and sanitation. In addition, participants mentioned that climate events may interrupt supply chains; increase the burden of morbidity and place pressure on the healthcare system; cause infrastructure damage and general difficulties in providing care within a crisis. As one participant remarked: “the system doesn’t have any structures in place to deal with … a severe climate event” (P8). Lack of resilience and reliability in the healthcare system causes it to resort to a reactive response to AGCC, rather than developing innovations to better prepare for future adverse events. As one participant expressed: it is an issue that … at the moment we're not even necessarily being reactive to … we are being reactive to the effects of the issue (P2). Further, many participants suggested that the toll AGCC will take on HCPs as another barrier to preparation for AGCC. Some participants feared the difficulty of providing care within a crisis setting, with one participant reflecting: “how do you manage that situation if you can’t get to your clinic, [or] if you can’t write scripts if you don’t have access to your software?” (P4). As one participant explained, during the 2019-20 bushfire season, there were major impacts on the healthcare system, including mental and material?? implications for staff in the healthcare sector: [i]n those 2019 fires... that I told you about, [our professional organisation], all of a sudden ... [w]e had to send staff out to Corryong on the border with New South Wales because there were staff who had been stuck at that hospital for five days unable to get back to their families and homes (P12). Participants expressed the view that AGCC will have physical tolls on already overworked staff. These tolls include fear for the future, despair about the current situation and lack of emotional support due to separation from family. These comments suggest that the toll AGCC takes on the mental health of HCPs may act as a barrier to forward thinking and preparation for future impacts of AGCC. One participant reflected: you know, at the moment I'm facing the crisis that I'm dealing with at the moment and it’s harder to think beyond that ... it’s kind of hard to think of that as “ok, so you know that … [it has] been crap being a doctor in the pandemic [it] has been really hard … how do we stop this from happening again?” (P4). Despite these barriers, survey participants indicated a high degree of willingness to implement changes required to adapt to and mitigate the adverse impacts of AGCC on health (93%, Figure 2B). Overall, however, participants indicated they did not currently feel prepared for the health impacts of AGCC. In addition, most participants offered various suggestions for addressing these barriers and effectively implementing education across the healthcare sector. Specifically, participants suggested various solutions to poor HCP engagement, including leadership buy-in as well as keeping education concise and relevant to HCPs. One participant even suggested adding value to AGCC education for GPs to increase engagement with the topic, including Continuing Professional Development points: Certainly, it would be good for the climate change education to hold some value in terms of points, especially if it’s 40 points for doing a half-day workshop, which I think that’s pretty attractive. (P26). Participants also suggested creating an integrated educational approach, therefore addressing the issue of a ‘crowded curriculum’ (70). As research continues to broaden the scope of healthcare, the health care practitioner curriculums have expanded also. This produces a curriculum that attempts to teach a wide range of topics in a very short amount of time, resulting in students relying on short term memory in order to get through exams, thus preventing long-term understanding of the topics presented (71--73). One participant suggested: [o]ne of the objections is, the curriculum is already so full. Well don’t we need to be climate-ready practitioners? And the argument there really falls flat because it doesn’t have to be a separate module, it can be an integrated module (P12). Participant opinions on the positioning of AGCC education within HCP curriculum varied in the qualitative data. Most participants agreed that education should be implemented from the beginning of the HCPs training. However, the reasoning behind this starting point differed for participants. Some participants suggested that implementing training within the first few years of education allowed an effective basic introduction to the topic. Moreover, with AGCC education being placed before clinical practice training, HCPs would develop a more consistent and coherent knowledge base. In addition, some participants highlighted that implementing AGCC education at the beginning of their learning would result in standardised compulsory education for all healthcare students independent of the specialty chosen, as outlined by a participant who undertook medicine: [T]his is why, probably, medical school is the best way to … try and get it in because … regardless of where you end up you'll at least have some working knowledge on it (P8). Some doctors in the cohort expressed that early medical school is the most appropriate time to introduce AGCC education, in order to attract the highest engagement from students: [T]his should be taught early in medical school ... probably in the first couple [of] years, [be]cause once you move out you're going to clinical and everyone only cares about singular organs and don't give a shit about anything else (P6). However, while some participants agreed the AGCC education warranted introduction in the first few years of the curriculum, they indicated that it should be reinforced in postgraduate and specialty training, in order to ensure relevance to an individual’s practice. To maintain relevance, some participants suggested continuing education that matches the relevance and training level of the student or practitioner. It just depends how it's relevant to what they're learning at the time. … You can't talk to a first-year medical student about what type of anaesthetic gas they're supposed to be sourcing contracts … for that hospital. That's just not appropriate. But targeted for each person's stage and type of training, it is really important. P18 There was also variation in the reasoning behind having AGCC education as part of post- undergraduate or during specialist healthcare training; however, most participants mentioned relevance to the clinical practice of the HCP. Interestingly, some participants expressed concern for the legitimacy of the topic within the curriculum. Participants insisted they did not want AGCC to be a tokenistic form of education, with one participant expressing the importance of integration of the education across all levels of HCP training: “it's really important that climate change in health is not seen as a fringe population health issue that's tucked into one lecture on the side; it's important that it's integrated across all systems throughout all levels of education” (P18). Moreover, a few participants indicated that it would not be difficult to implement professional development into the current system. One participant suggested incorporating AGCC education into mandatory professional development for all HCPs: “I’m sure all health professionals have got compulsory competencies to take on, so it could be that" (P23). Other participants indicated education should be ongoing to increase engagement, as one suggested: “if you try to do too much at once people will lose interest’ there’s too much else going on” (P14). Interestingly, one participant indicated that the professional development post-graduation may be a more important location for AGCC training, as they considered the younger generation already has a greater knowledge base around AGCC: “the younger generation is probably actually already a lot more up to speed with things ... there actually won’t be as much gain or difference, in that they’re already a fairly high-level, and that maybe – it’s actually the GPs who are currently working as GPs who might be far behind … but then, I think it’s even more tricky, because at least at university, you have all the students there. You can have mandatory lectures and classes" (P26). Discussion Our results indicate that there are specific areas of need around health impacts of AGCC for the Victorian healthcare system and the training of its workforce. Participants in this study have indicated that despite their self-initiated education, their knowledge on the area is not extensive. This knowledge deficit indicates that independent education is not enough to prepare HCPs for the adverse health impacts of AGCC. Over half of participants (59%) within this study have indicated that they rely on mass media for information regarding the health impacts of AGCC. Similar proportions of HCPs utilising mass media sources for information were found by the Climate and Health Alliance ( 49 ) and Sustainability Victoria ( 48 ), further substantiating the call for formal education for HCPs. The lack of credibility and consistency in mass media as an educational tool for HCPs creates variation in the level of understanding, as indicated by the data in this study. Overall, the results of this study suggest that the current model of education for HCPs around the adverse health impacts of AGCC is insufficient and requires transformation, in order to prepare HCPs for the impending challenges of AGCC. It is vital that HCPs are trained not only on how to address the health impacts of AGCC, but also on how to deliver healthcare during crises. The extensive suggestions from participants on how to implement AGCC education for HCPs indicate that HCPs are aware of the actions required to manage and mitigate the effects of AGCC. Moreover, multiple suggestions were expressed enthusiastically, with some participants indicating the vital nature of their inclusion into the training for HCPs. This degree of emphasis reflects that HCPs consider AGCC as vital to their training, and that its inclusion is both imperative and feasible. One barrier to including AGCC education in HCP curriculums mentioned by multiple participants was the already dense programs of study. As discussed by Bell ( 75 ), perhaps the answer lies within building upon current learning objectives and competencies rather than adding more onto these crowded curriculums. Limited progress by both the healthcare system and HCPs in planning and implementation of modifications to clinical practices may be due to a lack of resources for HCPs and support from healthcare organisations, as reported by the Climate and Health Alliance ( 49 ). An additional subtle, but important effect of AGCC on health care provision, especially in rural and remote areas, is the impact of climate events on HCPs themselves. Those providers who live in remote areas are themselves vulnerable to the adverse effects of AGCC, including bushfires, floods, and changes in air and land quality. There is already evidence that such impacts are affecting HCPs' decisions to practice in rural and remote areas of Australia ( 76 ). This reluctance to practice rurally may add to the impetus for policy makers and hospital operators to account for AGCC in the workforce and care delivery strategies. Further research into the reasoning for this planning stagnation may enlighten policy makers on the barriers currently preventing HCPs from making changes to their clinical practice to mitigate the adverse health impacts of AGCC. This study provided an extensive understanding of HCP opinions on various aspects of AGCC. As a result, other key themes that emerged from qualitative data were not mentioned within this paper, however, are vital in understanding the impact of AGCC on patients and HCPs. These themes included the mental health toll of AGCC, the monetary cost associated with the impacts of AGCC and how it may impact access to healthcare as well as the unequal distribution of impacts due to AGCC based on socioeconomic groups, age and location. To properly explore the themes mentioned in this paper, these themes, while important, were removed so that they could be explored in greater detail in further publications. Limitations and Potential Sources of Variability The study is limited to a Victorian cohort, therefore, the opinions and perceptions of HCPs within the data could not be extrapolated to all Australian HCPs, as was the case in previous studies ( 49 ). Furthermore, as only doctors and nurses were included in the study, the data is limited in its ability to extrapolate to the entire HCP population. This study also had various sources of variability, mostly stemming from a lower than anticipated response rate. These sources of variability included minimal distribution within the range of participants in demographic classifiers for analysis, as well as a possible bias of opinions towards HCPs who feel strongly about AGCC. The observed lack of differentiation with respect to profession, years of experience, or rural/regional location could be due to the low participant numbers, or to a true absence of effect from any of these classifiers. Furthermore, it is plausible that the Covid-19 pandemic minimised participant interaction with the study due to HCPs being overworked or disinterested. Conclusions Victorian HCPs expressed high levels of concern regarding the health impacts of the impending climate crisis on the Australian population, and identified issues within current patients which could be attributed to or aggravated by AGCC. However, the main source of information about AGCC for the majority of participants was a combination of mainstream and social media, highlighting the need for discipline-relevant education on this topic. The knowledge deficit reported by participants indicates education regarding the link between AGCC and health should be introduced in both training and professional development curricula. As expressed by one participant, “[t]he way that you think Covid’s bad, there is a bigger pandemic out there. This is a tsunami coming. It’s not a little wave” (P17). Declarations Acknowledgements This study was conducted in part during the COVID-19 pandemic, which caused significant hardship to Victorian healthcare workers, and we gratefully acknowledge the participants who shared their time and insights during that crisis. The help and support of the Year A staff at Monash Rural Health-Churchill was indispensable for completion of this work. This study was reviewed in advance and approved by the Monash University Human Research Ethics Committee (study #27458, amended 31/5/23). We acknowledge the Gunnai-Kurnai people as the traditional owners of the land where MRH-C is located, and we recognise their Elders, past, present, and emerging. No external funding supported the work described in this report. The authors declare that they have no competing interests. No individually identifiable information is included in this report, thus, consent for publication beyond the informed consent for participation is not applicable. Funding declaration: No external funding was provided for this study. Author Contributions All authors have reviewed the submitted manuscript and consent to its publication. MM: Data collection and analysis, manuscript preparation DHR: Study design and supervision, data analysis, manuscript preparation and submission MS: Study design and supervision, data analysis, manuscript preparation References Department of Health and Aged Care. Measuring Remoteness: Accessibility/Remoteness Index of Australia (ARIA). Canberra, ACT: October; 2001. World Health Organisation [WHO]. WHO calls for urgent action to protect health from climate change – Sign the call2015 Available from: https://www.who.int/news/item/06-10-2015- who-calls-for-urgent-action-to-protect-health-from-climate-change-sign-the-call Gruber N. Warming up, turning sour, losing breath: ocean biogeochemistry under global change. Philos Trans Math Phys Eng Sci. 2011;369(1943):1980–96. Heinze C, Blenckner T, Martins H, Rusiecka D, Doscher R, Gehlen M et al. The quiet crossing of ocean tipping points. Proc Natl Acad Sci U S A. 2021;118(9). Wong TE, Bakker AMR, Keller K. Impacts of Antarctic fast dynamics on sea-level projections and coastal flood defense. Clim Change. 2017;144(2):347–64. Orru H, Ebi KL, Forsberg B. The Interplay of Climate Change and Air Pollution on Health. Curr Environ Health Rep. 2017;4(4):504–13. Intergovernmental Panel on Climate Change. Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press; 2021. Masson-Delmotte V, Zhai P, Pörtner H-O, Roberts D, Skea J, Shukla PR, Pirani A, Moufouma-Okia W, Péan C, Pidcock R, Connors S, Matthews JBR, Chen Y, Zhou X, Gomis MI, Lonnoy E, Maycock T, Tignor M, Waterfield T. Global Warming of 1.5°C. An IPCC Special Report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. 2018. Vaneckova P, Bambrick H. Cause-specific hospital admissions on hot days in Sydney, Australia. PLoS ONE. 2013;8(2):e55459. Trancoso R, Syktus J, Toombs N, Ahrens D, Wong KK, Pozza RD. Heatwaves intensification in Australia: A consistent trajectory across past, present and future. Sci Total Environ. 2020;742:140521. van der Linden N, Longden T, Richards JR, Khursheed M, Goddijn WMT, van Veelen MJ, et al. The use of an 'acclimatisation' heatwave measure to compare temperature-related demand for emergency services in Australia, Botswana, Netherlands, Pakistan, and USA. PLoS ONE. 2019;14(3):e0214242. Nitschke M, Tucker GR, Hansen AL, Williams S, Zhang Y, Bi P. Impact of two recent extreme heat episodes on morbidity and mortality in Adelaide, South Australia: a case-series analysis. Environ Health. 2011;10:42. Khalaj B, Lloyd G, Sheppeard V, Dear K. The health impacts of heat waves in five regions of New South Wales, Australia: a case-only analysis. Int Arch Occup Environ Health. 2010;83(7):833–42. Hansen AL, Bi P, Ryan P, Nitschke M, Pisaniello D, Tucker G. The effect of heat waves on hospital admissions for renal disease in a temperate city of Australia. Int J Epidemiol. 2008;37(6):1359–65. Borchers Arriagada N, Palmer AJ, Bowman DM, Morgan GG, Jalaludin BB, Johnston FH. Unprecedented smoke-related health burden associated with the 2019-20 bushfires in eastern Australia. Med J Aust. 2020;213(6):282–3. Howard ZL, Carlson SJ, Baldwin Z, Johnston F, Durrheim DN, Dalton CB. High community burden of smoke-related symptoms in the Hunter and New England regions during the 2019–2020 Australian bushfires. Public Health Res Pract. 2020;30(4). Nguyen HD, Azzi M, White S, Salter D, Trieu T, Morgan G, et al. The Summer 2019–2020 Wildfires in East Coast Australia and Their Impacts on Air Quality and Health in New South Wales, Australia. Int J Environ Res Public Health. 2021;18(7):3538. Walter CM, Schneider-Futschik EK, Knibbs LD, Irving LB. Health impacts of bushfire smoke exposure in Australia. Respirology. 2020;25(5):495–501. Campbell SL, Fox-Hughes PD, Jones PJ, Remenyi TA, Chappell K, White CJ et al. Evaluating the Risk of Epidemic Thunderstorm Asthma: Lessons from Australia. Int J Environ Res Public Health. 2019;16(5). Price D, Hughes KM, Thien F, Suphioglu C. Epidemic Thunderstorm Asthma: Lessons Learned from the Storm Down-Under. J Allergy Clin Immunol Pract. 2021;9(4):1510–5. Beggs PJ, Zhang Y, McGushin A, Trueck S, Linnenluecke MK, Bambrick H, et al. The 2021 report of the MJA-Lancet Countdown on health and climate change: Australia increasingly out on a limb. Med J Aust. 2021;215(9):390–e222. Wondmagegn BY, Xiang J, Dear K, Williams S, Hansen A, Pisaniello D, et al. Increasing impacts of temperature on hospital admissions, length of stay, and related healthcare costs in the context of climate change in Adelaide, South Australia. Sci Total Environ. 2021;773:145656. Hancock T. Healthcare in the Anthropocene: Challenges and Opportunities. Healthc Q. 2016;19(3):17–22. Beggs PJ. Climate change and allergy in Australia: an innovative, high-income country, at potential risk. Public Health Res Pract. 2018;28(4). Weaver HJ, Blashki GA, Capon AG, McMichael AJ. Climate change and Australia's healthcare system - risks, research and responses. Aust Health Rev. 2010;34(4):441–4. Howard C, Tcholakov Y, Holz C. The Paris agreement: charting a low-emissions path for a child born today. Lancet Planet Health. 2020;4(1):e4–6. Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Belesova K, Boykoff M, et al. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. Lancet. 2019;394(10211):1836–78. Woodward A. Climate change and the surgeon: what is the problem? Why is it so hard? What can be done? ANZ J Surg. 2019;89(11):1358–63. Sainsbury P, Charlesworth K, Madden L, Capon A, Stewart G, Pencheon D. Climate change is a health issue: what can doctors do? Intern Med J. 2019;49(8):1044–8. Spiby JGAHJ, Stott MGR. Ten practical actions for doctors to combat climate change. BMJ. 2008;336(7659):1507. Butterfield P, Leffers J, Vásquez MD. Nursing’s pivotal role in global climate action. BMJ. 2021;373:n1049. Sheffield PE, Durante KT, Rahona E, Zarcadoolas C. Emerging roles of health care providers to mitigate climate change impacts: a perspective from East Harlem, New York. Health Hum Rights. 2014;16(1):113 – 21. Maibach E, Miller J, Armstrong F, El Omrani O, Zhang Y, Philpott N, et al. Health professionals, the Paris agreement, and the fierce urgency of now. J Clim Change Health. 2021;1:100002. Maibach EW, Sarfaty M, Mitchell M, Gould R. Limiting global warming to 1.5 to 2.0 degrees C-A unique and necessary role for health professionals. PLoS Med. 2019;16(5):e1002804. Solomon CG, LaRocque RC. Climate Change - A Health Emergency. N Engl J Med. 2019;380(3):209–11. Foong LH, Huntley R. Communicating about climate change - Who is listening, who isn't and why: Implications for medical professionals. J Paediatr Child Health. 2021;n/a(n/a). Hime N, Vyas A, Lachireddy K, Wyett S, Scalley B, Corvalan C. Climate change, health and wellbeing: challenges and opportunities in NSW, Australia. Public Health Res Pract. 2018;28(4). Frumkin H, Hess J, Luber G, Malilay J, McGeehin M. Climate change: the public health response. Am J Public Health. 2008;98(3):435–45. McMichael AJ, Friel S, Nyong A, Corvalan C. Global environmental change and health: impacts, inequalities, and the health sector. BMJ. 2008;336(7637):191–4. Beggs PJ, Zhang Y, Bambrick H, Berry HL, Linnenluecke MK, Trueck S, et al. The 2019 report of the MJA-Lancet Countdown on health and climate change: a turbulent year with mixed progress. Med J Aust. 2019;211(11):490–e121. Blashki G. Climate change and the rural health workforce. Aust J Rural Health. 2008;16(1):1. Blashki G, Armstrong G, Berry HL, Weaver HJ, Hanna EG, Bi P, et al. Preparing health services for climate change in Australia. Asia Pac J Public Health. 2011;23(2 Suppl):S133–43. Elliott D. It’s a fact… scientists are the most trusted people in the world 2019.Available from: https://www.ipsos.com/en-au/its-fact-scientists-are-most-trusted-people-world. Roy Morgan Research. Roy Morgan Image of Professions Survey 2021: In a year dominated by COVID-19 - health professionals including Nurses, Doctors and Pharmacists are the most highly regarded; but almost all professions down from pre-pandemic. Image of Professions Survey [Internet]; 2021. Jackson DN, Peterson EB, Blake KD, Coa K, Chou WS. Americans' Trust in Health Information Sources: Trends and Sociodemographic Predictors. Am J Health Promot. 2019;33(8):1187–93. Hughes L. Climate change and Australia: key vulnerable regions. Reg Environ Change. 2011;11(Suppl 1):189–95. https://doi.org/10.1007/s10113-010-0158-9 . Head L, Adams M, McGregor HV, Toole S. Climate change and Australia. WIREs Clim Change. 2014;5:175–97. https://doi.org/10.1002/wcc.255 . Ibrahim JE, McInnes JA, Andrianopoulos N, Evans S. Minimising harm from heatwaves: a survey of awareness, knowledge, and practices of health professionals and care providers in Victoria, Australia. Int J Public Health. 2012;57(2):297–304. Climate and Health Alliance. Real, Urgent & Now Insights from health professionals on climate and health in Australia Melbourne. Victoria: Climate and Health Alliance; 2021. June 2021. Sustainability Victoria. Linking Climate Change and Health Impacts. Melbourne, Victoria: Sustainability Victoria. 2020 February 2020. Purcell R, McGirr J. Preparing rural general practitioners and health services for climate change and extreme weather. Aust J Rural Health. 2014;22(1):8–14. Wild K, Tapley A, Fielding A, Holliday E, Ball J, Horton G et al. Climate change and Australian general practice vocational education: a cross-sectional study. Fam Pract. 2022. Creswell JW, Fetters MD, Ivankova NV. Designing a mixed methods study in primary care. Ann Fam Med. 2004;2(1):7–12. Creswell JWPCV, Gutmann ML, Hanson WE. Advanced mixed methods research designs. Thousand Oaks. CA: SAGE; 2003. Powers of qualitative research. Nat Clim Change. 2021;11(9):717. Wisdom J, Creswell JW. Mixed Methods: Integrating Quantitative and Qualitative Data Collection and Analysis While Studying Patient-Centered Medical Home Models. PCMH Resource Center [Internet]. 2013. Available from: https://pcmh.ahrq.gov/page/mixed-methods-integrating- quantitative-and-qualitative-data-collection-and-analysis-while Irvine FE, Clark MT, Efstathiou N, Herber OR, Howroyd F, Gratrix L, et al. The state of mixed methods research in nursing: A focused mapping review and synthesis. J Adv Nurs. 2020;76(11):2798–809. Sarfaty M, Mitchell M, Bloodhart B, Maibach EW. A survey of African American physicians on the health effects of climate change. Int J Environ Res Public Health. 2014;11(12):12473–85. Sarfaty M, Bloodhart B, Ewart G, Thurston GD, Balmes JR, Guidotti TL, et al. American Thoracic Society member survey on climate change and health. Ann Am Thorac Soc. 2015;12(2):274–8. Sarfaty M, Kreslake J, Ewart G, Guidotti TL, Thurston GD, Balmes JR, et al. Survey of International Members of the American Thoracic Society on Climate Change and Health. Ann Am Thorac Soc. 2016;13(10):1808–13. Sarfaty M, Kreslake JM, Casale TB, Maibach EW. Views of AAAAI members on climate change and health. J Allergy Clin Immunol Pract. 2016;4(2):333–e526. Primary and Commmunity Health Directory [Internet]. Health.VIC. Available from: https://www2.health.vic.gov.au/primary-and-community-health/community-health/community-health- directory/?q=&ps = 10&s = relevance&i=&f = C9EDC6C2D7824AE59981B8885121815F&n=&e=&a=∾=&df=&dt=&l=&lq=. Find a Health Service. Healthdirect.gov.au; [Available from: https://www.healthdirect.gov.au/australian-health-services Clarke V, Braun V. Successful Qualitative Research: A Practical Guide for Beginners2013. Schrum ML, Johnson M, Ghuy M, Gombolay MC. Four Years in Review: Statistical Practices of Likert Scales in Human-Robot Interaction Studies. ArXiv. 2020;abs/2001.03231. Sullivan GM, Artino AR. Jr. Analyzing and interpreting data from likert-type scales. J Grad Med Educ. 2013;5(4):541–2. Jamieson S. Likert scales: how to (ab)use them. Med Educ. 2004;38(12):1217–8. Thomas DR. A General Inductive Approach for Analyzing Qualitative Evaluation Data. Am J Evaluation. 2016;27(2):237–46. Shaw E, Walpole S, McLean M, Alvarez-Nieto C, Barna S, Bazin K, et al. AMEE Consensus Statement: Planetary health and education for sustainable healthcare. Med Teach. 2021;43(3):272–86. The Crowded Medical Curriculum. JAMA. 2009;302(12):1373. McAllister M, Madsen W, Godden J, Greenhill J, Reed R. Teaching nursing’s history: A national survey of Australian Schools of Nursing, 2007–2008. Nurse Educ Today. 2010;30(4):370–5. Slavin S, D'Eon MF. Overcrowded curriculum is an impediment to change (Part A). Can Med Educ J. 2021;12(4):1–6. Diekelmann N, Smythe E. Covering Content and the Additive Curriculum: How Can I Use My Time with Students to Best Help Them Learn What They Need to Know? J Nurs Educ. 2004;43(8):341–4. Yammine K. The Current Status of Anatomy Knowledge: Where Are We Now? Where Do We Need to Go and How Do We Get There? Teach Learn Med. 2014;26(2):184–8. Bell EJ. Climate change: what competencies and which medical education and training approaches? BMC Med Educ. 2010;10(1):31. Pendrey CG, Quilty S, Gruen RL, Weeramanthri T, Lucas RM. Is climate change exacerbating health-care workforce shortages for underserved populations? Lancet Planet Health. 2021;5(4):e183–4. Additional Declarations No competing interests reported. Supplementary Files Appendix1surveyquestions.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6644033","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":460951277,"identity":"b13d5614-c0be-4968-b878-0beda6fc6ae6","order_by":0,"name":"Mikaela Misso","email":"","orcid":"","institution":"Monash Rural Health-Churchill, Health Sciences\u003c Monash University","correspondingAuthor":false,"prefix":"","firstName":"Mikaela","middleName":"","lastName":"Misso","suffix":""},{"id":460951278,"identity":"ff2b8c8b-8a87-4fca-b91f-e0479030d638","order_by":1,"name":"David Reser","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYDCCA0DEA2EyPgBTEkDMQ6QWZgOitcAUsEkQpYXv+BnDA28Y7snJt/c+q7pRcUdefnYD44O3bbi1SJ7JMTg4h6HY2ODMcbPbOWeeGW64c4DZcC4eLQYH0hIO8zAkJG6QSGO7ndt2mHGDRAKbNC8+LeefgbXUz5//jK0YqMV+/owE9t94tdxIPgDSksBwg42NGaglseFGAhszPi2SNx4fODjHIMFww5k0ZumcM4eTN9xIbJaccw63Fr7zic0f3lQkyMu3H2P8nFNx2Hb+jOSDH96U4dYCdR4Kj7GBkPpRMApGwSgYBQQAALQRV43ILNLcAAAAAElFTkSuQmCC","orcid":"","institution":"Monash Rural Health-Churchill, Health Sciences\u003c Monash University","correspondingAuthor":true,"prefix":"","firstName":"David","middleName":"","lastName":"Reser","suffix":""},{"id":460951279,"identity":"234f84ce-21e2-47f8-85e0-5175277245a7","order_by":2,"name":"Margaret Simmons","email":"","orcid":"","institution":"Monash Rural Health-Churchill, Health Sciences\u003c Monash University","correspondingAuthor":false,"prefix":"","firstName":"Margaret","middleName":"","lastName":"Simmons","suffix":""}],"badges":[],"createdAt":"2025-05-12 07:38:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6644033/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6644033/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83440187,"identity":"961d354a-5b0f-47d0-9f65-84ccf226d7b4","added_by":"auto","created_at":"2025-05-26 09:23:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":214148,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant knowledge regarding adverse health impacts of AGCC. A) current familiarity rating; B) predicted increase in AGCC health impact severity from 5-10 years of survey; C) degree of predicted mental health impact of AGCC; D) predicted AGCC impact on infectious disease spread and severity.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6644033/v1/0aa19f6af7e0d79871ed6058.png"},{"id":83439714,"identity":"652e4757-55f8-4dc2-99a1-d47ba150f434","added_by":"auto","created_at":"2025-05-26 09:15:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":164509,"visible":true,"origin":"","legend":"\u003cp\u003ePreparedness of HCP for AGCC impacts on practice. A) confidence in current practice (group or individual); B) Willingness to adjust practice to reflect likely AGCC impacts.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6644033/v1/adedf2416dc63e52bc963aee.png"},{"id":83439720,"identity":"b45d2a5c-6e64-450c-88fc-875186fedfc9","added_by":"auto","created_at":"2025-05-26 09:15:20","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":138069,"visible":true,"origin":"","legend":"\u003cp\u003eA) Educational background of study participants; B) Participants' information resources around health impacts of AGCC\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6644033/v1/9687fca9d26be9cffb7b26a3.png"},{"id":83440941,"identity":"5e1eae8f-09ad-430f-830b-5727886f2cc6","added_by":"auto","created_at":"2025-05-26 09:31:20","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":74366,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant rating of need for AGCC education during health care training.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6644033/v1/b8a573ff0181fb5972f2ea2d.png"},{"id":85035744,"identity":"f45b2fa4-69bd-4096-b69d-873f70380a62","added_by":"auto","created_at":"2025-06-20 08:23:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":925444,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6644033/v1/79d39df9-ccc0-42a0-b6c8-3be29c4b4c50.pdf"},{"id":83439721,"identity":"6923087e-0de8-4865-8988-baa46cde08d5","added_by":"auto","created_at":"2025-05-26 09:15:21","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":10750,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1surveyquestions.docx","url":"https://assets-eu.researchsquare.com/files/rs-6644033/v1/79241c01d14c2021c8d191fd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Not ready for what's coming: Perceptions and preparedness of healthcare providers for adverse effects of climate change in Victoria, Australia ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIt is widely recognised that anthropogenic global climate change (AGCC) will impact human health, with large organisations such as the World Health Organization describing it as the\u0026nbsp;\u0026ldquo;greatest\u0026nbsp;threat\u0026nbsp;to\u0026nbsp;global\u0026nbsp;health\u0026nbsp;in\u0026nbsp;the\u0026nbsp;21st\u0026nbsp;century\u0026rdquo;\u0026nbsp;(2,\u0026nbsp;Pg\u0026nbsp;1).\u0026nbsp;Probable\u0026nbsp;changes\u0026nbsp;include\u0026nbsp;rising surface ocean temperatures and ocean acidification (3, 4); rising sea levels (5); a\u0026nbsp;change in air and land quality (6); and an increased incidence of extreme weather events,\u0026nbsp;including heat waves, extreme drought, wildfires, and floods (7, 8).\u003c/p\u003e\n\u003cp\u003eClimate events pose multiple risks to human health, including disaster-related injury, heat- related health issues (9-14) and respiratory problems (15-20). The 2021 MJA-Lancet countdown report outlined the extensive health impacts of AGCC on the Australian population including heat-related health issues, injuries due to bushfires and floods, and an increased burden on the mental health of the population due to drought and bushfires (21). Adverse impacts of AGCC on human health will challenge healthcare practitioners (HCPs), as patient loads increase, and climate related injuries and disasters acutely strain healthcare resources. Adverse effects on public health and infrastructure, such as an increase in chronic respiratory disease incidence and damage to healthcare infrastructure during bushfires, are also likely (22-24). It is also foreseeable that the existing shortage of rural HCPs could be aggravated by the real and perceived hazards of living and working in AGCC-vulnerable communities, whereas early and continuing education surrounding the adverse impacts of AGCC on health could aid in preparing HCPs for their role in adaptation to, and mitigation of climate change effects. It is critical that we understand the health impacts of AGCC on health care delivery, and that we prepare HCPs to adapt to the changing health and safety needs of the Victorian population (21, 25).\u003c/p\u003e\n\u003cp\u003eMultiple studies have shown that HCPs play a critical role in the response to AGCC (26-32),\u0026nbsp;with\u0026nbsp;special\u0026nbsp;attention\u0026nbsp;given\u0026nbsp;to\u0026nbsp;the\u0026nbsp;HCP\u0026nbsp;as\u0026nbsp;educator\u0026nbsp;and\u0026nbsp;advocate\u0026nbsp;for\u0026nbsp;action\u0026nbsp;by\u0026nbsp;both\u0026nbsp;HCPs\u0026nbsp;and the healthcare system (33-36). Possible adaptation and mitigation strategies to address the varying impacts of AGCC are diverse and require support across sectors and disciplines (37-39). These strategies include education of HCPs and the public; sustainable energy sources; reducing wastage in the healthcare sector as well as climate event warning systems\u003c/p\u003e\n\u003cp\u003e(40). This multidisciplinary approach is particularly important for the healthcare sector, as\u0026nbsp;the health effects of AGCC are multifaceted and will require multiple disciplines, institutions,\u0026nbsp;and\u0026nbsp;policy\u0026nbsp;makers\u0026nbsp;to\u0026nbsp;work\u0026nbsp;together\u0026nbsp;to\u0026nbsp;adapt\u0026nbsp;effectively\u0026nbsp;(41,\u0026nbsp;42).\u0026nbsp;As\u0026nbsp;trusted\u0026nbsp;professionals within\u0026nbsp;the\u0026nbsp;community\u0026nbsp;(43-45),\u0026nbsp;the\u0026nbsp;role\u0026nbsp;of\u0026nbsp;the\u0026nbsp;HCP\u0026nbsp;in\u0026nbsp;adapting\u0026nbsp;to\u0026nbsp;and\u0026nbsp;mitigating\u0026nbsp;the\u0026nbsp;impacts\u0026nbsp;of AGCC on health involves leading by example; education of patients; and advocating for\u0026nbsp;the\u0026nbsp;community.\u0026nbsp;Understanding\u0026nbsp;current\u0026nbsp;HCP\u0026nbsp;perceptions\u0026nbsp;and\u0026nbsp;opinions\u0026nbsp;will\u0026nbsp;facilitate\u0026nbsp;the implementation of adaptation strategies and improve their effectiveness. Moreover, this\u0026nbsp;understanding will aid in the process of constructing a practical and efficient AGCC\u0026nbsp;curriculum\u0026nbsp;for\u0026nbsp;future\u0026nbsp;HCPs.\u003c/p\u003e\n\u003cp\u003eTo date, little research has been conducted to appreciate the perceptions of HCPs of AGCC\u0026nbsp;and its impact on population health or even whether they are ready to take on the possible\u0026nbsp;role they have in adapting to and mitigating AGCC impacts on health. This study examined\u0026nbsp;the\u0026nbsp;perceptions\u0026nbsp;of\u0026nbsp;general\u0026nbsp;practitioners,\u0026nbsp;registered\u0026nbsp;nurses,\u0026nbsp;and\u0026nbsp;nurse\u0026nbsp;practitioners practicing\u0026nbsp;in\u0026nbsp;Victoria,\u0026nbsp;Australia\u0026nbsp;recruited\u0026nbsp;by\u0026nbsp;email\u0026nbsp;and\u0026nbsp;phone\u0026nbsp;contact\u0026nbsp;(see\u0026nbsp;Methods).\u003c/p\u003e\n\u003cp\u003eAustralia is considered particularly vulnerable to the effects of climate change due to its topography, soil composition, atmospheric conditions, population distribution, and unique fauna. Recent temperature increases, altered rainfall and wildfire patterns, and oceanographic perturbances are attributable to or aggravated by AGCC (46,47). Past studies have indicated that a majority of HCPs believe that climate change will impact the health of their patients in various ways (48-52). Among rural GPs in New South Wales, Purcell and McGirr found general agreement that AGCC will have an adverse effect on the health of the populations they serve, and also that there was insufficient professional education available to deal with anticipated effects, especially with regard to locally available education resources (51). Moreover, most studies found that many of the practicing HCPs do not feel adequately prepared to educate patients or make changes in their practice to be more sustainable (49, 50).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study utilised a triangulation mixed methods research design (53,54) to provide separate but complementary datasets which facilitated an interrogation of similarities and contradictions between the datasets (55-57). The study included a quantitative survey followed by a qualitative, semi-structured interview with open-ended questions. The mixed methods approach is an increasingly preferred methodology in healthcare literature, successfully utilised by other researchers on this topic (49, 58-61).\u003c/p\u003e\n\u003cp\u003eRecruitment for the study was conducted using posters, word-of-mouth, contact with relevant professional organisations, and direct email contact to healthcare clinics and practitioners. A total of 531 clinics were contacted using email addresses sourced through health directories (62, 63). In total, 22 clinics agreed to distribute the recruitment email to their staff. In addition, four organisations, including Doctors for the Environment Australia (DEA) and the Australian Nursing and Midwifery Federation (ANMF), agreed to contact their constituents either via emails directly or through an advertisement in their newsletters. An additional 33 emails were sent directly to contacts referred by participants or study personnel. As there is no single or clear denominator for calculating response rate, it could\u003c/p\u003e\n\u003cp\u003enot be determined for this study. All participants provided informed consent in advance of data collection, and all study procedures were approved by the Monash University Human\u003c/p\u003e\n\u003cp\u003eResearch Ethics Committee (study #27458).\u003c/p\u003e\n\u003cp\u003eThe survey consisted of 21 questions, and was conducted online using Qualtrics software (Qualtrics, Provo, UT, Version 09/2021, available at: https://www.qualtrics.com). The quantitative survey included demographic questions and investigated the perceptions of HCPs on AGCC, and their views about the impact of AGCC on healthcare delivery. Questions were aimed at understanding how prepared HCPs currently are for AGCC impacts; perceptions on the educational and professional development training requirements for AGCC and how their healthcare practice and patients might be affected. To determine the place of practice for participants, all participants were asked to describe their location based on the Accessibility/Remoteness Index of Australia (ARIA) (1).\u003c/p\u003e\n\u003cp\u003eSemi-structured interviews were conducted with the intent of building upon the answers provided in the survey (64). As participants were interviewed, points of interest were explored which in some cases prompted new questions to be added or for original questions to be amended (64). Qualitative interviews were conducted via Zoom\u0026trade; due to COVID-19 contact restrictions and for the convenience of participants. Qualitative data retrieved from interviewing participants was transcribed verbatim by the researchers and a Monash approved transcription service (SMARTdocs, https:// www.smartdocstranscriptionservices. com.au/) using the Zoom\u0026trade; recordings. Responses to the survey questions were analysed using descriptive statistics (65-67). Ordinal data retrieved from the Likert scale questions were analysed using non-parametric statistical analyses and, where appropriate, Mann-Whitney U tests were utilised to assess the differences between demographic factors and answers to Likert scale questions. Analysis and graphing were conducted using Microsoft Excel and GraphPad Prism (V9.2.0 for Windows, GraphPad Software, San Diego, California USA, www.graphpad.com). A six-phase thematic analysis, as described by Clarke and Braun (64), was employed to analyse the qualitative interview data (68).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 41 survey responses were submitted, however, 14 were incomplete and therefore excluded from the study. 27 complete surveys were included, with 20 of those participants consenting to a qualitative interview. The regional distribution and demographics of participants are described in Table 1. The cohort had a relatively even distribution of metropolitan HCPs (48%) versus rural and regional HCPs (52%). Quantitative comparisons of survey responses were made according to demographic classifiers, profession, experience in clinical practice, and rurality, however, no differences between any classifiers were found ( Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1. Demographic characteristics of study participants.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDemographic category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResponse options\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber of participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e% of intent-to-\u003c/p\u003e\n \u003cp\u003etreat population**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePreferred gender descriptor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003enon-binary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHighest Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor (Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eor Nursing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDoctor (Medicine or\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNursing) Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCurrent Practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRegistered Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNurse Practitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDoctor or specialist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ephysician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTime since award of highest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003edegree (y)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 to 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLength of practice*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 to 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePractice location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUrban Centre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRegional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRural/Remote\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber of providers at primary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003e\u0026lt;\u003c/u\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eworkplace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 to 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Due to an editing error, the blocking of categories allowed for overlap at the 7 year mark.\u003c/p\u003e\n\u003cp\u003eNumbers reflect actual participant responses\u003c/p\u003e\n\u003cp\u003e**Intent to treat N=28 participants. Data in text represent number of respondents to survey and/or follow up interviews as specified.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e#\u003c/sup\u003epractice duration excludes career interruptions (e.g. prolonged leave)\u003c/p\u003e\n\u003cp\u003eThematic Analysis\u003c/p\u003e\n\u003cp\u003eAnalysis of qualitative interview results yielded three main themes, including: the practitioner’s level of knowledge of and concern for AGCC, the role of the HCP in adaptation and mitigation strategies and possible approaches and barriers to the implementation of AGCC education for HCPs.\u003c/p\u003e\n\u003cp\u003ePractitioner Knowledge\u003c/p\u003e\n\u003cp\u003eSurvey responses suggest widespread recognition of AGCC, with 78% of participants indicating they were aware that AGCC is an issue (Figure 1A). A majority of participants indicated there would be adverse health impacts on the overall population due to AGCC in both five and ten years (74% and 95% respectively). Moreover, most participants indicated these adverse impacts would increase in severity from five to ten years in the future. For the adverse events in five and ten years respectively, the median Likert scale response increased from five (95% CI 5-6) to six (95% CI 6-7, Figure 1B). Most participants expressed concern for the potential impacts of AGCC on infectious disease (93%) and mental health (93%), with approximately half indicating mental health and infectious disease are a serious concern (48% for both, Figure 1C\u0026amp;D).\u003c/p\u003e\n\u003cp\u003eCommensurate with the quantitative data, participants expressed considerable concern for AGCC in the qualitative interviews. Most participants (19/20) highlighted multiple concerns regarding the health impacts of AGCC, with several emphasising that it was a multifaceted issue. For example, one participant explained that the extent of the issue was “kind of hard to verbalise” (P8), while another indicated: “it’s quite a complex issue … with multi-layers … [where] everything is dependent upon everything\" (P6). When participants reflected on how\u003c/p\u003e\n\u003cp\u003eAGCC would impact their clinical practice, numerous health concerns were raised. These concerns included the severity of respiratory conditions and the increased burden of chronic and infectious diseases. One participant indicated that the “list can go on” (P4), demonstrating the extensive impacts perceived by HCPs on their patients’ health.\u003c/p\u003e\n\u003cp\u003ePractitioner Preparedness\u003c/p\u003e\n\u003cp\u003eOver half (52%) of the participants in quantitative surveys indicated they did not believe their current practices were sufficient to tackle the health impacts of AGCC (Figure 2A). This level of agreement suggests that most HCPs are aware that they could be doing more to mitigate the adverse health impacts of AGCC. Moreover, 93% of participants indicated they would be willing to implement changes to their practice (Figure 2B).\u003c/p\u003e\n\u003cp\u003eThis desire for change was reflected in the qualitative data, where some participants indicated that there was more their practice could be doing to mitigate the adverse health impacts of AGCC. Evidence from both the quantitative and qualitative arms of the study indicate there is a knowledge deficit among HCPs. Participants indicated a lack of formal\u003c/p\u003e\n\u003cp\u003eAGCC instruction in their professional training, as well as a lack of formal support for any further professional development in the area: \"I have had zilch … not surprising\" (P4). Some participants mentioned that there may have been some discussion of AGCC within their formal training, however, this was not extensive nor applicable to the healthcare setting.\u003c/p\u003e\n\u003cp\u003eOne participant noted: “I feel like there were maybe the odd throw away lines in some lectures” (P3). Another participant expanded further, stating: there hasn’t really been any formal support … to explore or learn more about [AGCC] or have any kind of practical things that we can … take to the practice (P8).\u003c/p\u003e\n\u003cp\u003eAccording to the quantitative data, the majority (59%) of participants indicated their highest level of training was self-initiated online research, while 19% indicated they had received no training at all (Figure 3A). In addition, 59% indicated the most influential sources of information on the health impacts of AGCC were mass media and social media, strongly suggesting that there is a dearth of peer-reviewed, high-quality resources in the information disseminated to HCPs regarding AGCC (Figure 3B). Consistent with the quantitative data, multiple participants indicated in the follow up interviews that their knowledge around AGCC resulted from self-initiated education, demonstrating that there is a deficit in HCP education.\u003c/p\u003e\n\u003cp\u003eOne participant indicated that their main source of information on AGCC was mass media, rather than professional or academic literature:\u003c/p\u003e\n\u003cp\u003eI’m as aware of it as I am probably as a result of what I see in the media, not necessarily anything that I read professionally or [that] comes across my desk as a result of the job that I do (P9).\u003c/p\u003e\n\u003cp\u003eMultiple participants in the qualitative interviews noted that their education on AGCC was due to self-initiated online research, as suggested in the quantitative data. Interestingly, one participant explained that the available online information was inconsistent, and they had to “[reinvent] the wheel” (P12) in order to create a centralised source of AGCC information and resources for other HCPs to take into their workplace. Another participant suggested that without interest in AGCC motivating self-driven education, there was minimal opportunity to learn about the topic:\u003c/p\u003e\n\u003cp\u003e[Education] was probably more something if you had an interest in that… like the doctors for the environment Australia group or the … AMSA global health forum and code green and those sorts of things (P3)\u003c/p\u003e\n\u003cp\u003eWhile another participant indicated that despite their interest they encountered difficulty accessing information around AGCC:\u003cbr\u003e \"it’s something that I’d like to engage with a little bit better … but I always found it difficult to … access those spaces\" (P8). The lack of accessible information was also noted by other participants:\u003c/p\u003e\n\u003cp\u003eThere's nothing available that I'm aware of, at the moment. Well, there might be something, I guess, out there but it's not a publicly or well-circulated thing (P16)\u003c/p\u003e\n\u003cp\u003eOverall an ongoing theme of difficulty accessing climate information and a lack of formal training emerged from the qualitative data.\u003c/p\u003e\n\u003cp\u003eParticipant Opinion Regarding AGCC Education \u003cbr\u003eA clear consensus was expressed between participants regarding training for the health impacts of AGCC, with 78% agreeing that it should be included in the education of HCPs (Figure 4). Consistent with the quantitative data, all interviewed participants (20/20) responded positively to the prospect of implementing formal education for HCPs on the topic of AGCC and its impact on health.\u003c/p\u003e\n\u003cp\u003eOne participant pointed out that the concept of introducing education around AGCC is not new within the healthcare education field, specifically citing the Association of Medical Education in Europe (AMEE) Consensus Statement (69):\u003c/p\u003e\n\u003cp\u003ethis is not controversial – this is in big consensus statements from AMEE, on the importance of including climate change in health and medical education (P18).\u003c/p\u003e\n\u003cp\u003eParticipants suggested various educational aspects of AGCC that should be incorporated in the curriculum, including: education on the link between the environment and health; crisis management and care; managing surges of illness due to AGCC; risk management of chronic illness and medications in a changing climate; the impacts on the healthcare system and how to reduce them; and how to educate and advocate for patients in a changing environment. As one participant elucidated:\u003c/p\u003e\n\u003cp\u003e[it is] widely recognised that climate change is the biggest health threat that we are currently facing, and it's important that all healthcare professionals are trained in understanding what the effects are; how to think about risk management for their patients; but also, to think about our professional responsibility for being leaders, cleaning up our own sector, and doing our best to make sure that [we are] not contributing more to the problems that we face (P18).\u003c/p\u003e\n\u003cp\u003eAnother participant concurred that AGCC and its effects should be part of the curriculum for HCPs:\u003c/p\u003e\n\u003cp\u003eI think it’s actually imperative and it should be part of the curriculum for all nurses and other health professionals, to have a module on climate change and how it can affect the health of individuals, definitely (P23).\u003c/p\u003e\n\u003cp\u003eDespite most participants providing potential solutions for the knowledge deficit within HCP education, a few expressed hesitancies about the introduction of specific AGCC education. This hesitancy did not stem from whether the education would be useful, but instead how it could be effectively implemented into the curriculum or professional development, as one participant reflected:\u003c/p\u003e\n\u003cp\u003eTo be honest, educational stuff is probably going to be a bit more limited at the moment other than talking about it in a more global population health sense of your local community, your country, the populace as a whole (P6).\u003c/p\u003e\n\u003cp\u003eAnother participant explained that such training and education would need to have practical relevance: “I’d have to see it as being more immediately relevant to my actual clinical practice and what I was doing” (P10). Further barriers to the wholesale implementation of AGCC education were expressed by some participants, including: resistance and scepticism from HCPs; space within the curriculum; time restrictions; lack of support from the healthcare system; immediate relevance to clinical practice; clinician engagement; and awareness of the link between action and benefit to public health.\u003c/p\u003e\n\u003cp\u003eBarriers to the development and implementation of strategies to cope with AGCC, as suggested by participants, included the vulnerability of the healthcare system and the mental toll AGCC takes on HCPs. The healthcare system was considered to have a multifaceted vulnerability to AGCC due to environmental factors placing strain on the reliability of resources, including power supply water and sanitation. In addition, participants mentioned that climate events may interrupt supply chains; increase the burden of morbidity and place pressure on the healthcare system; cause infrastructure damage and general difficulties in providing care within a crisis. As one participant remarked: “the system doesn’t have any structures in place to deal with … a severe climate event” (P8).\u003c/p\u003e\n\u003cp\u003eLack of resilience and reliability in the healthcare system causes it to resort to a reactive response to AGCC, rather than developing innovations to better prepare for future adverse events. As one participant expressed:\u003c/p\u003e\n\u003cp\u003eit is an issue that … at the moment we're not even necessarily being reactive to … we are being reactive to the effects of the issue (P2).\u003c/p\u003e\n\u003cp\u003eFurther, many participants suggested that the toll AGCC will take on HCPs as another barrier to preparation for AGCC. Some participants feared the difficulty of providing care within a crisis setting, with one participant reflecting: “how do you manage that situation if you can’t get to your clinic, [or] if you can’t write scripts if you don’t have access to your software?” (P4). As one participant explained, during the 2019-20 bushfire season, there were major impacts on the healthcare system, including mental and material?? implications for staff in the healthcare sector:\u003c/p\u003e\n\u003cp\u003e[i]n those 2019 fires... that I told you about, [our professional organisation], all of a sudden ... [w]e had to send staff out to Corryong on the border with New South Wales because there were staff who had been stuck at that hospital for five days unable to get back to their families and homes (P12).\u003c/p\u003e\n\u003cp\u003eParticipants expressed the view that AGCC will have physical tolls on already overworked staff. These tolls include fear for the future, despair about the current situation and lack of emotional support due to separation from family. These comments suggest that the toll AGCC takes on the mental health of HCPs may act as a barrier to forward thinking and preparation for future impacts of AGCC. One participant reflected:\u003c/p\u003e\n\u003cp\u003eyou know, at the moment I'm facing the crisis that I'm dealing with at the moment and it’s harder to think beyond that ... \u003cbr\u003eit’s kind of hard to think of that as “ok, so you know that … [it has] been crap being a doctor in the pandemic [it] has been really hard … how do we stop this from happening again?” (P4).\u003c/p\u003e\n\u003cp\u003eDespite these barriers, survey participants indicated a high degree of willingness to implement changes required to adapt to and mitigate the adverse impacts of AGCC on health (93%, Figure 2B). Overall, however, participants indicated they did not currently feel prepared for the health impacts of AGCC.\u003c/p\u003e\n\u003cp\u003eIn addition, most participants offered various suggestions for addressing these barriers and effectively implementing education across the healthcare sector. Specifically, participants suggested various solutions to poor HCP engagement, including leadership buy-in as well as keeping education concise and relevant to HCPs. One participant even suggested adding value to AGCC education for GPs to increase engagement with the topic, including Continuing Professional Development points:\u003c/p\u003e\n\u003cp\u003eCertainly, it would be good for the climate change education to hold some value in terms of points, especially if it’s 40 points for doing a half-day workshop, which I think that’s pretty attractive. (P26).\u003c/p\u003e\n\u003cp\u003eParticipants also suggested creating an integrated educational approach, therefore addressing the issue of a ‘crowded curriculum’ (70). As research continues to broaden the scope of healthcare, the health care practitioner curriculums have expanded also. This produces a curriculum that attempts to teach a wide range of topics in a very short amount of time, resulting in students relying on short term memory in order to get through exams, thus preventing long-term understanding of the topics presented (71--73). One participant suggested:\u003c/p\u003e\n\u003cp\u003e[o]ne of the objections is, the curriculum is already so full. Well don’t we need to be climate-ready practitioners? And the argument there really falls flat because it doesn’t have to be a separate module, it can be an integrated module (P12).\u003c/p\u003e\n\u003cp\u003eParticipant opinions on the positioning of AGCC education within HCP curriculum varied in the qualitative data. \u003cbr\u003eMost participants agreed that education should be implemented from the beginning of the HCPs training. However, the reasoning behind this starting point differed for participants. Some participants suggested that implementing training within the first few years of education allowed an effective basic introduction to the topic. Moreover, with AGCC education being placed before clinical practice training, HCPs would develop a more consistent and coherent knowledge base. In addition, some participants highlighted that implementing AGCC education at the beginning of their learning would result in standardised compulsory education for all healthcare students independent of the specialty chosen, as outlined by a participant who undertook medicine:\u003c/p\u003e\n\u003cp\u003e[T]his is why, probably, medical school is the best way to … try and get it in because\u003c/p\u003e\n\u003cp\u003e… regardless of where you end up you'll at least have some working knowledge on it (P8).\u003c/p\u003e\n\u003cp\u003eSome doctors in the cohort expressed that early medical school is the most appropriate time to introduce AGCC education, in order to attract the highest engagement from students:\u003c/p\u003e\n\u003cp\u003e[T]his should be taught early in medical school ... probably in the first couple [of] years, [be]cause once you move out you're going to clinical and everyone only cares about singular organs and don't give a shit about anything else (P6).\u003c/p\u003e\n\u003cp\u003eHowever, while some participants agreed the AGCC education warranted introduction in the first few years of the \u003cbr\u003ecurriculum, they indicated that it should be reinforced in postgraduate and specialty training, \u003cbr\u003ein order to ensure relevance to an individual’s practice.\u003c/p\u003e\n\u003cp\u003eTo maintain relevance, some participants suggested continuing education that matches the relevance and training level of the student or practitioner.\u003c/p\u003e\n\u003cp\u003eIt just depends how it's relevant to what they're learning at the time. … You can't talk to a first-year medical student about what type of anaesthetic gas they're supposed to be sourcing contracts … for that hospital. That's just not appropriate. But targeted for each person's stage and type of training, it is really important. P18\u003c/p\u003e\n\u003cp\u003eThere was also variation in the reasoning behind having AGCC education as part of post- undergraduate or \u003cbr\u003eduring specialist healthcare training; however, most participants mentioned relevance to the clinical practice of the HCP. Interestingly, some participants expressed concern for the legitimacy of the topic within the curriculum. Participants insisted they did not want AGCC to be a tokenistic form of education, with one participant expressing the importance of integration of the education across all levels of HCP training:\u003c/p\u003e\n\u003cp\u003e“it's really important that climate change in health is not seen as a fringe population health issue that's tucked into one lecture on the side; it's important that it's integrated across all systems throughout all levels of education” (P18).\u003c/p\u003e\n\u003cp\u003eMoreover, a few participants indicated that it would not be difficult to implement professional development into the current system. One participant suggested incorporating AGCC education into mandatory professional development for all HCPs: “I’m sure all health professionals have got compulsory competencies to take on, so it could be that\" (P23).\u003c/p\u003e\n\u003cp\u003eOther participants indicated education should be ongoing to increase engagement, as one suggested: “if you try to do too much at once people will lose interest’ there’s too much else going on” (P14). \u003cbr\u003eInterestingly, one participant indicated that the professional development post-graduation may be a more important location for AGCC training, as they considered the younger generation already has a greater knowledge base around AGCC:\u003c/p\u003e\n\u003cp\u003e“the younger generation is probably actually already a lot more up to speed with things ... there actually won’t be as much gain or difference, in that they’re already a fairly high-level, and that maybe – it’s actually the GPs who are currently working as GPs who might be far behind … but then, I think it’s even more tricky, because at least at university, you have all the students there. You can have mandatory lectures and classes\" (P26).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur results indicate that there are specific areas of need around health impacts of AGCC for the Victorian healthcare system and the training of its workforce. Participants in this study have indicated that despite their self-initiated education, their knowledge on the area is not extensive. This knowledge deficit indicates that independent education is not enough to prepare HCPs for the adverse health impacts of AGCC. Over half of participants (59%) within this study have indicated that they rely on mass media for information regarding the health impacts of AGCC. Similar proportions of HCPs utilising mass media sources for information were found by the Climate and Health Alliance (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e) and Sustainability Victoria (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e), further substantiating the call for formal education for HCPs. The lack of credibility and consistency in mass media as an educational tool for HCPs creates variation in the level of understanding, as indicated by the data in this study. Overall, the results of this study suggest that the current model of education for HCPs around the adverse health impacts of AGCC is insufficient and requires transformation, in order to prepare HCPs for the\u003c/p\u003e \u003cp\u003eimpending challenges of AGCC. It is vital that HCPs are trained not only on how to address the health impacts of AGCC, but also on how to deliver healthcare during crises.\u003c/p\u003e \u003cp\u003eThe extensive suggestions from participants on how to implement AGCC education for HCPs indicate that HCPs are aware of the actions required to manage and mitigate the effects of AGCC. Moreover, multiple suggestions were expressed enthusiastically, with some participants indicating the vital nature of their inclusion into the training for HCPs. This degree of emphasis reflects that HCPs consider AGCC as vital to their training, and that its inclusion is both imperative and feasible. One barrier to including AGCC education in HCP curriculums mentioned by multiple participants was the already dense programs of study.\u003c/p\u003e \u003cp\u003eAs discussed by Bell (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e), perhaps the answer lies within building upon current learning objectives and competencies rather than adding more onto these crowded curriculums.\u003c/p\u003e \u003cp\u003eLimited progress by both the healthcare system and HCPs in planning and implementation of modifications to clinical practices may be due to a lack of resources for HCPs and support from healthcare organisations, as reported by the Climate and Health Alliance (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). An additional subtle, but important effect of AGCC on health care provision, especially in rural and remote areas, is the impact of climate events on HCPs themselves. Those providers who live in remote areas are themselves vulnerable to the adverse effects of AGCC, including bushfires, floods, and changes in air and land quality. There is already evidence that such impacts are affecting HCPs' decisions to practice in rural and remote areas of Australia (\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e). This reluctance to practice rurally may add to the impetus for policy makers and hospital operators to account for AGCC in the workforce and care delivery strategies. Further research into the reasoning for this planning stagnation may enlighten policy makers on the barriers currently preventing HCPs from making changes to their clinical practice to mitigate the adverse health impacts of AGCC.\u003c/p\u003e \u003cp\u003eThis study provided an extensive understanding of HCP opinions on various aspects of AGCC. As a result, other key themes that emerged from qualitative data were not mentioned within this paper, however, are vital in understanding the impact of AGCC on patients and HCPs. These themes included the mental health toll of AGCC, the monetary cost associated with the impacts of AGCC and how it may impact access to healthcare as well as the unequal distribution of impacts due to AGCC based on socioeconomic groups, age and location. To properly explore the themes mentioned in this paper, these themes, while important, were removed so that they could be explored in greater detail in further publications.\u003c/p\u003e \u003cp\u003eLimitations and Potential Sources of Variability\u003c/p\u003e \u003cp\u003eThe study is limited to a Victorian cohort, therefore, the opinions and perceptions of HCPs within the data could not be extrapolated to all Australian HCPs, as was the case in previous studies (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Furthermore, as only doctors and nurses were included in the study, the data is limited in its ability to extrapolate to the entire HCP population.\u003c/p\u003e \u003cp\u003eThis study also had various sources of variability, mostly stemming from a lower than anticipated response rate. These sources of variability included minimal distribution within the range of participants in demographic classifiers for analysis, as well as a possible bias of opinions towards HCPs who feel strongly about AGCC. The observed lack of differentiation with respect to profession, years of experience, or rural/regional location could be due to\u003c/p\u003e \u003cp\u003ethe low participant numbers, or to a true absence of effect from any of these classifiers. Furthermore, it is plausible that the Covid-19 pandemic minimised participant interaction with the study due to HCPs being overworked or disinterested.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eVictorian HCPs expressed high levels of concern regarding the health impacts of the impending climate crisis on the Australian population, and identified issues within current patients which could be attributed to or aggravated by AGCC. However, the main source of information about AGCC for the majority of participants was a combination of mainstream and social media, highlighting the need for discipline-relevant education on this topic. The knowledge deficit reported by participants indicates education regarding the link between AGCC and health should be introduced in both training and professional development curricula. As expressed by one participant, \u0026ldquo;[t]he way that you think Covid\u0026rsquo;s bad, there is a bigger pandemic out there. This is a tsunami coming. It\u0026rsquo;s not a little wave\u0026rdquo; (P17).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThis study was conducted in part during the COVID-19 pandemic, which caused significant hardship to Victorian healthcare workers, and we gratefully acknowledge the participants who shared their time and insights during that crisis. The help and support of the Year A staff at Monash Rural Health-Churchill was indispensable for completion of this work. This study was reviewed in advance and approved by the Monash University Human Research Ethics Committee (study #27458, amended 31/5/23). We acknowledge the Gunnai-Kurnai people as the traditional owners of the land where MRH-C is located, and we recognise their Elders, past, present, and emerging. No external funding supported the work described in this report.\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests. No individually identifiable information\u0026nbsp;is\u0026nbsp;included\u0026nbsp;in\u0026nbsp;this\u0026nbsp;report,\u0026nbsp;thus,\u0026nbsp;consent\u0026nbsp;for\u0026nbsp;publication\u0026nbsp;beyond\u0026nbsp;the\u0026nbsp;informed\u0026nbsp;consent\u0026nbsp;for\u0026nbsp;participation\u0026nbsp;is\u0026nbsp;not\u0026nbsp;applicable.\u003c/p\u003e\n\u003cp\u003eFunding declaration: No external funding was provided for this study.\u003c/p\u003e\n\u003cp\u003eAuthor\u0026nbsp;Contributions\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAll authors have reviewed the submitted manuscript and consent to its publication.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eMM:\u0026nbsp;Data\u0026nbsp;collection\u0026nbsp;and\u0026nbsp;analysis,\u0026nbsp;manuscript\u0026nbsp;preparation\u003c/p\u003e\n\u003cp\u003eDHR:\u0026nbsp;Study\u0026nbsp;design\u0026nbsp;and\u0026nbsp;supervision,\u0026nbsp;data\u0026nbsp;analysis,\u0026nbsp;manuscript\u0026nbsp;preparation\u0026nbsp;and\u0026nbsp;submission\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;MS: Study design and supervision, data analysis, manuscript preparation\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDepartment of Health and Aged Care. Measuring Remoteness: Accessibility/Remoteness Index of Australia (ARIA). Canberra, ACT: October; 2001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organisation [WHO]. WHO calls for urgent action to protect health from climate change \u0026ndash; Sign the call2015 Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news/item/06-10-2015- who-calls-for-urgent-action-to-protect-health-from-climate-change-sign-the-call\u003c/span\u003e\u003cspan address=\"https://www.who.int/news/item/06-10-2015- who-calls-for-urgent-action-to-protect-health-from-climate-change-sign-the-call\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGruber N. Warming up, turning sour, losing breath: ocean biogeochemistry under global change. Philos Trans Math Phys Eng Sci. 2011;369(1943):1980\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeinze C, Blenckner T, Martins H, Rusiecka D, Doscher R, Gehlen M et al. The quiet crossing of ocean tipping points. Proc Natl Acad Sci U S A. 2021;118(9).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong TE, Bakker AMR, Keller K. Impacts of Antarctic fast dynamics on sea-level projections and coastal flood defense. Clim Change. 2017;144(2):347\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrru H, Ebi KL, Forsberg B. The Interplay of Climate Change and Air Pollution on Health. Curr Environ Health Rep. 2017;4(4):504\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIntergovernmental Panel on Climate Change. Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasson-Delmotte V, Zhai P, P\u0026ouml;rtner H-O, Roberts D, Skea J, Shukla PR, Pirani A, Moufouma-Okia W, P\u0026eacute;an C, Pidcock R, Connors S, Matthews JBR, Chen Y, Zhou X, Gomis MI, Lonnoy E, Maycock T, Tignor M, Waterfield T. Global Warming of 1.5\u0026deg;C. An IPCC Special Report on the impacts of global warming of 1.5\u0026deg;C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty. 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVaneckova P, Bambrick H. Cause-specific hospital admissions on hot days in Sydney, Australia. PLoS ONE. 2013;8(2):e55459.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrancoso R, Syktus J, Toombs N, Ahrens D, Wong KK, Pozza RD. Heatwaves intensification in Australia: A consistent trajectory across past, present and future. Sci Total Environ. 2020;742:140521.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Linden N, Longden T, Richards JR, Khursheed M, Goddijn WMT, van Veelen MJ, et al. The use of an 'acclimatisation' heatwave measure to compare temperature-related demand for emergency services in Australia, Botswana, Netherlands, Pakistan, and USA. PLoS ONE. 2019;14(3):e0214242.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNitschke M, Tucker GR, Hansen AL, Williams S, Zhang Y, Bi P. Impact of two recent extreme heat episodes on morbidity and mortality in Adelaide, South Australia: a case-series analysis. Environ Health. 2011;10:42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhalaj B, Lloyd G, Sheppeard V, Dear K. The health impacts of heat waves in five regions of New South Wales, Australia: a case-only analysis. Int Arch Occup Environ Health. 2010;83(7):833\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHansen AL, Bi P, Ryan P, Nitschke M, Pisaniello D, Tucker G. The effect of heat waves on hospital admissions for renal disease in a temperate city of Australia. Int J Epidemiol. 2008;37(6):1359\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorchers Arriagada N, Palmer AJ, Bowman DM, Morgan GG, Jalaludin BB, Johnston FH. Unprecedented smoke-related health burden associated with the 2019-20 bushfires in eastern Australia. Med J Aust. 2020;213(6):282\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoward ZL, Carlson SJ, Baldwin Z, Johnston F, Durrheim DN, Dalton CB. High community burden of smoke-related symptoms in the Hunter and New England regions during the 2019\u0026ndash;2020 Australian bushfires. Public Health Res Pract. 2020;30(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen HD, Azzi M, White S, Salter D, Trieu T, Morgan G, et al. The Summer 2019\u0026ndash;2020 Wildfires in East Coast Australia and Their Impacts on Air Quality and Health in New South Wales, Australia. Int J Environ Res Public Health. 2021;18(7):3538.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalter CM, Schneider-Futschik EK, Knibbs LD, Irving LB. Health impacts of bushfire smoke exposure in Australia. Respirology. 2020;25(5):495\u0026ndash;501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell SL, Fox-Hughes PD, Jones PJ, Remenyi TA, Chappell K, White CJ et al. Evaluating the Risk of Epidemic Thunderstorm Asthma: Lessons from Australia. Int J Environ Res Public Health. 2019;16(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrice D, Hughes KM, Thien F, Suphioglu C. Epidemic Thunderstorm Asthma: Lessons Learned from the Storm Down-Under. J Allergy Clin Immunol Pract. 2021;9(4):1510\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeggs PJ, Zhang Y, McGushin A, Trueck S, Linnenluecke MK, Bambrick H, et al. The 2021 report of the MJA-Lancet Countdown on health and climate change: Australia increasingly out on a limb. Med J Aust. 2021;215(9):390\u0026ndash;e222.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWondmagegn BY, Xiang J, Dear K, Williams S, Hansen A, Pisaniello D, et al. Increasing impacts of temperature on hospital admissions, length of stay, and related healthcare costs in the context of climate change in Adelaide, South Australia. Sci Total Environ. 2021;773:145656.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHancock T. Healthcare in the Anthropocene: Challenges and Opportunities. Healthc Q. 2016;19(3):17\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeggs PJ. Climate change and allergy in Australia: an innovative, high-income country, at potential risk. Public Health Res Pract. 2018;28(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeaver HJ, Blashki GA, Capon AG, McMichael AJ. Climate change and Australia's healthcare system - risks, research and responses. Aust Health Rev. 2010;34(4):441\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoward C, Tcholakov Y, Holz C. The Paris agreement: charting a low-emissions path for a child born today. Lancet Planet Health. 2020;4(1):e4\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatts N, Amann M, Arnell N, Ayeb-Karlsson S, Belesova K, Boykoff M, et al. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. Lancet. 2019;394(10211):1836\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoodward A. Climate change and the surgeon: what is the problem? Why is it so hard? What can be done? ANZ J Surg. 2019;89(11):1358\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSainsbury P, Charlesworth K, Madden L, Capon A, Stewart G, Pencheon D. Climate change is a health issue: what can doctors do? Intern Med J. 2019;49(8):1044\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpiby JGAHJ, Stott MGR. Ten practical actions for doctors to combat climate change. BMJ. 2008;336(7659):1507.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eButterfield P, Leffers J, V\u0026aacute;squez MD. Nursing\u0026rsquo;s pivotal role in global climate action. BMJ. 2021;373:n1049.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheffield PE, Durante KT, Rahona E, Zarcadoolas C. Emerging roles of health care providers to mitigate climate change impacts: a perspective from East Harlem, New York. Health Hum Rights. 2014;16(1):113\u0026thinsp;\u0026ndash;\u0026thinsp;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaibach E, Miller J, Armstrong F, El Omrani O, Zhang Y, Philpott N, et al. Health professionals, the Paris agreement, and the fierce urgency of now. J Clim Change Health. 2021;1:100002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaibach EW, Sarfaty M, Mitchell M, Gould R. Limiting global warming to 1.5 to 2.0 degrees C-A unique and necessary role for health professionals. PLoS Med. 2019;16(5):e1002804.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSolomon CG, LaRocque RC. Climate Change - A Health Emergency. N Engl J Med. 2019;380(3):209\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoong LH, Huntley R. Communicating about climate change - Who is listening, who isn't and why: Implications for medical professionals. J Paediatr Child Health. 2021;n/a(n/a).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHime N, Vyas A, Lachireddy K, Wyett S, Scalley B, Corvalan C. Climate change, health and wellbeing: challenges and opportunities in NSW, Australia. Public Health Res Pract. 2018;28(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrumkin H, Hess J, Luber G, Malilay J, McGeehin M. Climate change: the public health response. Am J Public Health. 2008;98(3):435\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcMichael AJ, Friel S, Nyong A, Corvalan C. Global environmental change and health: impacts, inequalities, and the health sector. BMJ. 2008;336(7637):191\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeggs PJ, Zhang Y, Bambrick H, Berry HL, Linnenluecke MK, Trueck S, et al. The 2019 report of the MJA-Lancet Countdown on health and climate change: a turbulent year with mixed progress. Med J Aust. 2019;211(11):490\u0026ndash;e121.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlashki G. Climate change and the rural health workforce. Aust J Rural Health. 2008;16(1):1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlashki G, Armstrong G, Berry HL, Weaver HJ, Hanna EG, Bi P, et al. Preparing health services for climate change in Australia. Asia Pac J Public Health. 2011;23(2 Suppl):S133\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElliott D. It\u0026rsquo;s a fact\u0026hellip; scientists are the most trusted people in the world 2019.Available from: https://www.ipsos.com/en-au/its-fact-scientists-are-most-trusted-people-world.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoy Morgan Research. Roy Morgan Image of Professions Survey 2021: In a year dominated by COVID-19 - health professionals including Nurses, Doctors and Pharmacists are the most highly regarded; but almost all professions down from pre-pandemic. Image of Professions Survey [Internet]; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJackson DN, Peterson EB, Blake KD, Coa K, Chou WS. Americans' Trust in Health Information Sources: Trends and Sociodemographic Predictors. Am J Health Promot. 2019;33(8):1187\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHughes L. Climate change and Australia: key vulnerable regions. Reg Environ Change. 2011;11(Suppl 1):189\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10113-010-0158-9\u003c/span\u003e\u003cspan address=\"10.1007/s10113-010-0158-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHead L, Adams M, McGregor HV, Toole S. Climate change and Australia. WIREs Clim Change. 2014;5:175\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/wcc.255\u003c/span\u003e\u003cspan address=\"10.1002/wcc.255\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIbrahim JE, McInnes JA, Andrianopoulos N, Evans S. Minimising harm from heatwaves: a survey of awareness, knowledge, and practices of health professionals and care providers in Victoria, Australia. Int J Public Health. 2012;57(2):297\u0026ndash;304.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClimate and Health Alliance. Real, Urgent \u0026amp; Now Insights from health professionals on climate and health in Australia Melbourne. Victoria: Climate and Health Alliance; 2021. June 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSustainability Victoria. Linking Climate Change and Health Impacts. Melbourne, Victoria: Sustainability Victoria. 2020 February 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePurcell R, McGirr J. Preparing rural general practitioners and health services for climate change and extreme weather. Aust J Rural Health. 2014;22(1):8\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWild K, Tapley A, Fielding A, Holliday E, Ball J, Horton G et al. Climate change and Australian general practice vocational education: a cross-sectional study. Fam Pract. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreswell JW, Fetters MD, Ivankova NV. Designing a mixed methods study in primary care. Ann Fam Med. 2004;2(1):7\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreswell JWPCV, Gutmann ML, Hanson WE. Advanced mixed methods research designs. Thousand Oaks. CA: SAGE; 2003.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePowers of qualitative research. Nat Clim Change. 2021;11(9):717.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWisdom J, Creswell JW. Mixed Methods: Integrating Quantitative and Qualitative Data Collection and Analysis While Studying Patient-Centered Medical Home Models. PCMH Resource Center [Internet]. 2013. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pcmh.ahrq.gov/page/mixed-methods-integrating- quantitative-and-qualitative-data-collection-and-analysis-while\u003c/span\u003e\u003cspan address=\"https://pcmh.ahrq.gov/page/mixed-methods-integrating- quantitative-and-qualitative-data-collection-and-analysis-while\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrvine FE, Clark MT, Efstathiou N, Herber OR, Howroyd F, Gratrix L, et al. The state of mixed methods research in nursing: A focused mapping review and synthesis. J Adv Nurs. 2020;76(11):2798\u0026ndash;809.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarfaty M, Mitchell M, Bloodhart B, Maibach EW. A survey of African American physicians on the health effects of climate change. Int J Environ Res Public Health. 2014;11(12):12473\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarfaty M, Bloodhart B, Ewart G, Thurston GD, Balmes JR, Guidotti TL, et al. American Thoracic Society member survey on climate change and health. Ann Am Thorac Soc. 2015;12(2):274\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarfaty M, Kreslake J, Ewart G, Guidotti TL, Thurston GD, Balmes JR, et al. Survey of International Members of the American Thoracic Society on Climate Change and Health. Ann Am Thorac Soc. 2016;13(10):1808\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarfaty M, Kreslake JM, Casale TB, Maibach EW. Views of AAAAI members on climate change and health. J Allergy Clin Immunol Pract. 2016;4(2):333\u0026ndash;e526.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrimary and Commmunity Health Directory [Internet]. Health.VIC. Available from: https://www2.health.vic.gov.au/primary-and-community-health/community-health/community-health- directory/?q=\u0026amp;ps\u0026thinsp;=\u0026thinsp;10\u0026amp;s\u0026thinsp;=\u0026thinsp;relevance\u0026amp;i=\u0026amp;f\u0026thinsp;=\u0026thinsp;C9EDC6C2D7824AE59981B8885121815F\u0026amp;n=\u0026amp;e=\u0026amp;a=∾=\u0026amp;df=\u0026amp;dt=\u0026amp;l=\u0026amp;lq=.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFind a Health Service. Healthdirect.gov.au; [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.healthdirect.gov.au/australian-health-services\u003c/span\u003e\u003cspan address=\"https://www.healthdirect.gov.au/australian-health-services\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarke V, Braun V. Successful Qualitative Research: A Practical Guide for Beginners2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchrum ML, Johnson M, Ghuy M, Gombolay MC. Four Years in Review: Statistical Practices of Likert Scales in Human-Robot Interaction Studies. ArXiv. 2020;abs/2001.03231.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSullivan GM, Artino AR. Jr. Analyzing and interpreting data from likert-type scales. J Grad Med Educ. 2013;5(4):541\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJamieson S. Likert scales: how to (ab)use them. Med Educ. 2004;38(12):1217\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas DR. A General Inductive Approach for Analyzing Qualitative Evaluation Data. Am J Evaluation. 2016;27(2):237\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaw E, Walpole S, McLean M, Alvarez-Nieto C, Barna S, Bazin K, et al. AMEE Consensus Statement: Planetary health and education for sustainable healthcare. Med Teach. 2021;43(3):272\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Crowded Medical Curriculum. JAMA. 2009;302(12):1373.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcAllister M, Madsen W, Godden J, Greenhill J, Reed R. Teaching nursing\u0026rsquo;s history: A national survey of Australian Schools of Nursing, 2007\u0026ndash;2008. Nurse Educ Today. 2010;30(4):370\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSlavin S, D'Eon MF. Overcrowded curriculum is an impediment to change (Part A). Can Med Educ J. 2021;12(4):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiekelmann N, Smythe E. Covering Content and the Additive Curriculum: How Can I Use My Time with Students to Best Help Them Learn What They Need to Know? J Nurs Educ. 2004;43(8):341\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYammine K. The Current Status of Anatomy Knowledge: Where Are We Now? Where Do We Need to Go and How Do We Get There? Teach Learn Med. 2014;26(2):184\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBell EJ. Climate change: what competencies and which medical education and training approaches? BMC Med Educ. 2010;10(1):31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePendrey CG, Quilty S, Gruen RL, Weeramanthri T, Lucas RM. Is climate change exacerbating health-care workforce shortages for underserved populations? Lancet Planet Health. 2021;5(4):e183\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6644033/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6644033/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAnthropogenic global climate change (AGCC) is expected to drive an increase in frequency and severity of weather-related disasters, as well as aggravating existing medical conditions in vulnerable populations. Specific health related outcomes of AGCC include It is unclear however, how prepared healthcare practitioners (HCPs) are for the impending challenges that AGCC presents for health, or the extent to which pre-professional and professional training programs have incorporated formal instruction around the health effects of climate change. We employed a mixed methods study design, consisting of an online survey followed by semi-structured interviews with Victorian HCPs to address the following topics: perceptions of HCPs on AGCC; anticipated impacts AGCC will have on health and delivery of healthcare; level of preparation for possible adverse health impacts of AGCC; and opinions of climate-specific educational and professional development training. What emerged was that participants were aware of climate change (78%) and were highly concerned about its impacts on the health of the Victorian population. Over half of the participants indicated their current practices are not sufficient to tackle the anticipated adverse health impacts and a majority supported the introduction of climate change education (78%). Participants expressed a knowledge deficit, despite their self-initiated learning. A key finding of this study is that the majority of participating HCPs obtained their information about climate change exclusively or predominantly from mass media and social media outlets, as opposed to sources which would be favoured in an evidence-based approach (e.g. peer-reviewed literature). Our findings suggest that most HCPs are concerned about the adverse impacts of AGCC on the health of their patients. Despite the HCPs\u0026rsquo; motivation to conduct self-initiated learning in the area, it is evident that the current education model does not provide a sufficient level of preparation. Given the likelihood of an increase in climate events and a concomitant increase in the severity of impacts on human health, it is likely that significant changes to the medical education curriculum will be necessary at both pre- and post- graduate levels.\u003c/p\u003e","manuscriptTitle":"Not ready for what's coming: Perceptions and preparedness of healthcare providers for adverse effects of climate change in Victoria, Australia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-26 09:15:15","doi":"10.21203/rs.3.rs-6644033/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"45c26983-1006-4b42-b583-7c2183cbdbc2","owner":[],"postedDate":"May 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-20T08:23:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-26 09:15:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6644033","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6644033","identity":"rs-6644033","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}