DLM was supported by a larger evaluation project initially planned to run for three years from to extended into because of COVID disruptions to service provision with the expectation that a significant amount of time was required for a program of this type to become institutionalised as routine programming and supported by management.

While DLM was supported for a three-year evaluation, there were factors that significantly impacted operations. Data collected in team meetings and via the issues register were used to map interruptions to service such as not having an Aboriginal and Torres Strait Islander worker available to conduct DLM for a period.

The final period of DLM evaluation overlapped with the start of the COVID pandemic. Given the vulnerabilities of Aboriginal and Torres Strait Islander communities to COVID [ 32 ], many non-essential health services were suspended in this period, including DLM operations.

While the COVID epidemic stabilised in NSW during the latter part of , numerous outbreaks occurred across including a lockdown exceeding three months making the stabilisation of DLM programs difficult to assess. We also note that the principles of DLM were adapted for use in non-Aboriginal and Torres Strait Islander communities who could benefit from connection to HCV education, testing, and treatment via needle and syringe programs [ 33 ].

Evaluation of real-world programs which are designed to improve the health of marginalised groups requires a careful design with a sensitive and flexible research apparatus.

This meant, for example, negotiating a waiver of consent to use routinely collected data that can be messy and vary across settings, using qualitative data to explore the detail of program delivery and acceptability, and using linked data to explore clinical outcomes of the program with necessary delays and quality issues to navigate.

This evaluation design also necessitated close engagement between researchers and those involved in program delivery as we sought to understand the various ways in which sites implemented DLM. However, this engagement brings a richness to the evaluation process and its outputs, particularly in the design of a toolkit to enable others to implement this program as efforts to improve the health of Aboriginal and Torres Strait Islander people must continue, and critically engage with the key barriers that have produced such stark inequities in health over centuries of colonisation.

Local Health Districts LHDs manage any public hospitals and health services within defined geographical areas in NSW. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework.

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Download references. This research was funded by a National Health and Medical Research Council Partnership Grant and by the NSW Ministry of Health.

Funding and in-kind contributions were also provided by participating sites. The authors wish to acknowledge the contributions of everyone who was involved in DLM over the years, including but not limited to listed alphabetically by surname : Clayton Anderson, Jade Christian, Margaret Crowley, John de Wit, Basil Donovan, Brian Doyle, Peter Emeana, Gary Gahan, Kim Grant, Jennifer Heslop, Max Hopwood, Kendall Jackman, Aunty Clair Jackson, Franklin John-Leader, Stevie Kemp, Catherine Kostovski, Jade Lane, Jo Lenton, Wendy Machin, Lou Maher, Julie Page, Kate Pearce, Syl Phillips-Ayre, Ann Ryan, Felicity Sheaves, Edmund Silins, Trevor Slattery, Kerri-Anne Smith, Larissa Smyth, Annabelle Stevens, Victor Tawil, Donna Tilley, Bev Tyson, James Vernon, Aunty Estelle Wade, Andrew Walden, Melinda Walker, James Ward, and David Webb.

Thanks to Kerryn Drysdale and Morgan Richards for their work in developing the DLM toolkit. Thanks also to Ron Horwood original artwork , Aunty Clair Jackson logo image , Emma Hicks logo image and digitisation for development of the DLM logo.

Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Kensington, NSW, , Australia. Needle and Syringe Program, Mount Druitt Community Health Centre, Western Sydney Local Health District, Sydney, NSW, , Australia.

Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, , Australia. Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, , Australia.

Byron Central Hospital, Mid North Coast and Northern NSW Local Health District, Byron Bay, NSW, , Australia. Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, NSW, , Australia.

Centre for Population Health, Ministry of Health, St Leonards, NSW, , Australia. Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, , Australia. Kirby Institute, UNSW Sydney, Sydney, NSW, , Australia.

Needle and Syringe Program, Western NSW Local Health District, Dubbo, NSW, , Australia. Broken Hill Community Centre, Far West Local Health District, Broken Hill, NSW, , Australia. You can also search for this author in PubMed Google Scholar. CT obtained the grant funding and conceived of the original evaluation.

CT wrote the first draft of the manuscript. All authors contributed to and approved the final manuscript. Correspondence to Carla Treloar. This project has ethics approval from South Eastern Sydney LHD Ethics Committee and the Aboriginal Health and Medical Research Council Ethics Committee.

Site-specific approvals were also obtained from the LHDs governing each of the DLM sites. The authors declare that some authors of this paper have been involved in the development and implementation of the DLM program. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is licensed under a Creative Commons Attribution 4. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Reprints and permissions. Treloar, C. et al. Evaluating a complex health promotion program to reduce hepatitis C among Aboriginal and Torres Strait Islander peoples in New South Wales, Australia: the Deadly Liver Mob.

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Skip to main content. Search all BMC articles Search. Download PDF. Download ePub. Abstract The Deadly Liver Mob DLM is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians, and was introduced in response to the disproportionate number of Aboriginal and Torres Strait Islander Australians who are impacted by blood borne viruses BBVs and sexually transmitted infections STIs.

Why was DLM started? What is DLM? The aims of the DLM program are to: Raise awareness about HCV, including transmission risk factors and treatment options; Increase access to BBV and STI testing and treatment by Aboriginal and Torres Strait Islander people; and Provide a point of entry to other health services for Aboriginal and Torres Strait Islander people.

Program logic as foundational to evaluation Robust and high-quality evaluation frameworks are built upon and examine the causal assumptions of the intervention [ 3 , 30 ].

Program logic for Deadly Liver Mob. Full size image. Designing the evaluation of a complex health promotion program In designing the DLM evaluation framework, we used insights from the RE-AIM model [ 1 ] and from the model developed by the UK Medical Research Council for process evaluations of complex interventions [ 3 ].

Is this a complex intervention? Staffing the evaluation The research funds from the NHMRC enabled the establishment of an independent evaluation team based at the Centre for Social Research in Health at UNSW Sydney.

The RE-AIM framework for evaluating DLM The five dimensions of the RE-AIM framework were designed to guide more comprehensive evaluations of public health programs designed for wide-scale and real-world implementation, such as in busy services operating without the support of a research infrastructure.

One study found that taking a cranberry supplement for six months improved hepatic steatosis, or fatty liver, in people with NAFLD.

But more studies are needed to determine whether this effect can be replicated in humans. Making these berries a regular part of your diet is a good way to help make sure your liver is supplied with the antioxidants it needs to stay healthy.

Grapes , especially red and purple grapes, contain various beneficial plant compounds that may benefit liver health. More studies are needed before taking grapeseed extract to promote liver health can be recommended.

Prickly pear Opuntia ficus-indica is a popular type of edible cactus. People commonly consume the fruit and its juice. It has long been used in traditional medicine as a treatment for the following conditions:.

A study found that the extract of this plant might help manage symptoms of a hangover. Prickly pear might also protect the liver from alcohol toxicity, with its anti-inflammatory and antioxidant properties.

More human studies are needed, especially using prickly pear fruit and juice rather than extract. But studies so far have demonstrated that prickly pear positively affects the liver.

Beetroot juice is a source of nitrates and antioxidants called betalains. Animal studies have shown that beet juice may help reduce oxidative damage and inflammation of the liver.

However, while animal studies look promising, more studies are needed to confirm the benefits of beetroot juice on human liver health. Cruciferous vegetables are known for their high fiber content and distinctive taste.

Studies suggest that cruciferous vegetables contain certain compounds that alter the detoxification process and protect against harmful compounds. In a study , mice that were fed broccoli developed fewer tumors or fatty liver disease than the mice in the control group.

Though human studies are limited, cruciferous vegetables look promising as a beneficial food for liver health. Nuts are rich in several key nutrients , including:. These nutrients are responsible for several health benefits. A study found a diet higher in nuts to be associated with a reduced risk of NAFLD.

While more high quality studies are needed, preliminary data points to nuts being an important food group for liver health. Fatty fish contain omega-3 fatty acids , which are healthy fats that help reduce inflammation and have been associated with a lower risk of heart disease.

A analysis found that omega-3 fatty acids helped lower liver fat and triglycerides in those with NAFLD or nonalcoholic steatohepatitis. While consuming omegarich fatty fish appears to be beneficial for your liver, adding more omega-3 fats to your diet is not the only thing to consider.

The ratio of omega-3 fats to omega-6 fats is also important. Most people exceed the intake recommendations for omega-6 fats , which are found in many plant oils and butter. So, in addition to adding more heart-healthy omega-3 fats to your diet, it may also be a good idea to reduce your intake of omega-6 fats that promote inflammation.

Olive oil is considered a healthy fat because of its many health benefits, including positive effects on the heart and metabolic health. It also positively affects the liver. According to a study from , following a Mediterranean diet rich in olive oil could be associated with a reduced risk of fatty liver in older adults.

Several other studies have found similar effects of olive oil consumption in humans, including less fat accumulation in the liver and improved blood levels of liver enzymes.

Fat accumulation in the liver is part of the first stage of liver disease. Including more nutrient-dense foods in your diet is a simple but effective way to improve the health of your liver. This is because many foods contain compounds like antioxidants , which can support liver health by reducing inflammation, easing oxidative stress, and preventing cell damage.

Some foods are also high in fiber , which can help promote weight management and ensure that your liver is functioning properly. Additionally, other foods may contain nutrients like protein or healthier fats, which could be beneficial for the treatment or prevention of other conditions associated with liver disease , such as diabetes.

In addition to making changes to your diet, you can take several other to keep your liver healthy. A few examples include :. Many foods contain specific compounds or antioxidants that have been shown to support liver function.

A few examples include grapefruit, blueberries, cranberries, fatty fish, olive oil, and cruciferous vegetables like broccoli or Brussels sprouts. Consuming certain foods in excess is associated with an increased risk for NAFLD.

You should try to limit your intake of the following foods to help keep your liver healthy:. In particular, some studies in humans and animals suggest that green tea , coffee , and beetroot juice may help promote liver function.

The 11 foods listed above have demonstrated beneficial effects on the liver. These benefits include the following:. Incorporating these foods into your diet is a natural and healthy way to help keep your liver functioning at its best.

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