Reflecting on 2021 for the Australian Journal of Primary Health

The past year has been a difficult one for health services and systems, including primary health care; arguably the most challenging in the post-war era. The COVID-19 pandemic has continued to dominate everyone’s lives, and publication of this issue of the Australian Journal of Primary Health (AJPH) coincides with the second anniversary of the second documented case of COVID-19 in a human. This year has been characterised by a shift from 2020s’ uncertainty and a lack of knowledge, to a better understanding of how COVID-19 is transmitted, the spread of new variants of concern, a rapid population-wide vaccination rollout, and COVID-19 becoming endemic. Primary health care mobilised on an unprecedented scale, as a workforce and as a system, to respond to these changes. Community-based health services have had an essential role proactively engaging with diverse communities and consumers to encourage testing and vaccination.

The past year has also seen significant changes in academic publishing. There has been an emphasis on rapid dissemination of research findings during the pandemic, increasing the prominence of pre-publication manuscripts and reinforcing the need for timely peer review. There has been a significant increase in the volume of manuscripts submitted, including to the AJPH.

At the same time, it is more difficult than ever to find peer reviewers for submitted articles. There has been a significant increase in the pressures on people’s time, through their paid jobs, but also because of juggling caring responsibilities during multiple lockdowns. Many people have been redeployed to support health systems and organisations to respond to the COVID-19 pandemic. The Australian Government’s decision to not provide any financial support to universities during the pandemic has led to thousands of jobs being lost across the sector over the past year, with more losses likely to come. Precarious employment has become even more entrenched and fewer people are in jobs that include service to the profession as part of their roles. This leads to fewer people being able to undertake reviews at the time we need high-quality peer review most.

However, there are causes for hope. CSIRO Publishing has considerably extended and expanded its Read & Publish agreements (CAUL 2021; CSIRO Publishing 2021). From next year, AJPH joins these Read & Publish agreements, meaning Open Access publication without author publication charges to researchers at participating institutions. Corresponding authors from these institutions do not need to do anything, as eligibility will be flagged post-acceptance based on their email address or Ringgold ID. With a growing number of agreements in place, we hope this will make a major contribution to enhancing the accessibility of primary healthcare research to researchers, practitioners, and the public.

This issue of the AJPH covers significant topics of relevance to current and future primary health care. Several articles deal with the importance of knowledge and attitudes in influencing access to care and outcomes for people, as well as reporting on interventions to address these. Mazza et al. (2021) report on a qualitative study of general practitioners’ understanding and engagement with telehealth-at-home abortion providers. Parker and colleagues (2021) investigate the attitudes of health professionals to an online support tool for carers of people at the end of their lives. Hammarberg and Stocker (2021) evaluate the impact of an online learning module for nurses and midwives on understanding about preconception health. Ding et al. (2021) describe the findings of a qualitative study exploring the attitudes and experiences of general practitioners and sexual health physicians when asked to remove long-acting reversible contraceptives. Moore et al. (2021) report on a systematic review of websites educating consumers on complex regional pain syndrome, with specific reference to the comprehensiveness and accuracy of the information presented. Godbee and colleagues (2021) describe a Massive Open Online Course on dementia prevention and the attitudes of participants to the role that primary healthcare professionals should play in reducing risk of dementia.

Several of the papers in this issue describe innovative models of care and the challenges faced in implementing these. The evolving role of practice nurses in providing medical abortion in Australia is discussed by Moulton et al. (2021). Beales et al. (2021) describe the potential role of specialist physiotherapists in managing persistent musculoskeletal pain. Dennis and colleagues (2021) discuss the lack of meaningful integration of allied health into primary healthcare teams, and how the lack of supportive policy and funding arrangements undermines efforts to manage chronic conditions in primary health care at scale. Missen et al. (2021) present the findings of a mixed methods study on the impacts of a day rehabilitation program that incorporates gardening.

Two papers focus on oral health, and attitudes, behaviours and subsequent choices consumers make. Trinh et al. (2021) present findings on the factors that influence consumers’ choices when accessing oral health services. Tuncer and Darby (2021) describe survey findings examining people with diabetes’ understandings of, and attitudes to, periodontal health. This important study highlights the importance of increasing both patients’ and health professionals’ understanding of the relationship between oral health and diabetes.

Refugee health is examined in Saberi and colleagues’ (2021) qualitative study of young Hazara people who have been refugees, which describes the practical, conceptual, and health literacy barriers that are encountered by people from this group when seeking access to care. Au et al. (2021) correspond regarding the need for further and sustained research on models of specialist service delivery for people who have been refugees.

Finally, Brennan et al. (2021) investigate levels of anxiety and fear among people attending a COVID-19 outpatient testing service in Sydney, Australia. Given its focus on COVID-19, this paper has been made open access under a CC BY licence. This is possible because CSIRO Publishing has joined with publishers worldwide to make COVID-19-themed papers Open Access, thereby supporting rapid and wide communication of research outcomes (STM 2020).

The papers in this issue demonstrate the breadth of scope of the AJPH and encompass research that was undertaken both before and during the COVID-19 pandemic. This issue also reflects the work undertaken by our hard-working reviewers, Associate Editors, and CSIRO Publishing’s editorial staff during the past couple of stressful years. People’s commitment to high-quality primary healthcare research remains strong, even though individually they are under pressure. This journal would not be possible without their efforts in 2021, and we appreciate their contributions and ongoing support. And finally, thank you to our subscribers and readers; we hope that you have enjoyed reading the AJPH over the past year and we look forward to 2022.

Ben Harris-Roxas, Associate Editor, AJPH

Virginia Lewis, Editor-in-Chief, AJPH

Jenny Macmillan, Executive Officer, AJPH