Australia’s dominant food system encourages the overconsumption of foods detrimental for human and planetary health. Despite this, Australia has limited policies to reduce the burden of disease and protect the environment. Political donations from the food industry may contribute to policy inertia on this issue. We aimed to explore the extent of political donations made by the food industry in Queensland and investigate the timing of public health nutrition policies in relation to these donations.We collected publicly declared political donations data in Queensland, Australia, as it has the most transparent donation records. Policy data were sourced from the Australian National and Queensland State Parliaments, and consultations from the Australian and New Zealand Ministerial Forum on Food Regulation.Queensland, Australia.Not applicable.The Liberal National Party (LNP) received 68 % of all donations, with most immediately preceding the 2017 and 2020 state elections. The Australian Labor Party, despite forming government for the time period under study, received only 17 % of total donations. Most donations were given by the meat industry, followed by the sugar industry. Few policies exist to protect and improve human and planetary health, with limited associations with political donations for most industries except sugar.Industry preference for the LNP, particularly as most donations coincided with election periods, may be due to the party’s emphasis on minimal state involvement in economic and social affairs. The relationship between industry donations and policies is not clear, partly due to the limited number of policies implemented overall. Typical Australian diets are characterised by low intakes of fruits, vegetables and whole grains, and excessive consumption of red/processed meat and ultra-processed foods,3. Consequently, Australians have high rates of diet-related non-communicable diseases accounting for an estimated 87 % of deaths annually. This non-communicable disease ‘epidemic’ has significant economic and social ramifications, with costs of approximately $120 billion (AUD) annually due to a loss of productivity and well-being. Poor dietary patterns are not only a leading risk factor for Australia’s burden of disease but also contribute to various forms of environmental degradation, including greenhouse gas emissions, resource depletion and biodiversity loss,7.Despite providing large quantities of safe food and economic benefits, Australia’s dominant industrialised food system creates a consumptogenic food environment that promotes poor dietary patterns. Most policy actions that have been implemented are voluntary rather than mandatory, including food reformulation targets and a front-of-pack labelling system, or have involved consumer education,9. Unsurprisingly, the food and beverage corporations that may be impacted by such policy have resisted and opposed more severe and mandatory policy proposals,10.To attenuate these issues, comprehensive, multi-sectoral policy actions are needed to reduce the availability and affordability of food that is detrimental for human and planetary health. However, to date, Australia has limited policy actions regarding food to reduce non-communicable disease rates and protect the environment,11. Such strategies include conducting public relations campaigns for corporate social responsibility initiatives; utilising lobbyists and media communications; creating strategic public–private alliances; pursuing litigation; creating front groups and providing political donations. The provision of political donations is a strategy that is particularly well-suited to the commercial sector in that they are often well-resourced in comparison to public-health focused organisations. Previous research suggests that political donations from harmful commodity industries, including fossil fuels, tobacco and gambling, influence policymaking by creating favourable market conditions for those industries and potentially eroding the democratic process–16. It is important to note that here we refer to segments of the food industry that financially benefit from food and beverages that, in currently consumed quantities, are detrimental to human health, rather than the food industry as a whole.Strategies used by parts of the private sector to promote their interests and the consumption of harmful products have contributed to Australia’s political inertia regarding public health nutrition issues–14. Though political donations from the tobacco industry are no longer accepted by The Australian Liberal or Labor Parties, others including The National Party and Independents parliamentarians do still accept such donations. However, the prevalence and impact of political donations from the food industry are under investigated. Documents analysed in 2013 and 2014 demonstrate donations of $55 000 from Coca-Cola to Australian political parties, while a major Australian supermarket chain donated more than $35 000. However, a systematic examination of food industry donations has not been conducted in Australia, nor has the association between these political donations, political events and relevant policy outcomes been established.In Australia, substantial donations have been made to political parties from harmful commodity industries, ranging from $1 million donated by the tobacco industry (2005–2015) to $7 million from the alcohol industry. Similar reporting requirements occur in most states. Comparatively, the state of Queensland requires donation disclosure for gifts above $1000 and is the only state with real-time reporting (donations are publicly disclosed within 7 d of receipt). To date, no studies have used this dataset to investigate donations from the food industry to political parties, including who they are donating to and the potential implications this may have on policy outcomes. Therefore, we aim to explore the extent of political donations made by the food industry in Queensland and investigate the timing of public health nutrition policies in relation to these donations.One reason for this literature gap is that the process of reporting political donations within Australia is far from fully transparent. At the federal level, only donations to political parties that exceed $13 800 are required to be formally recorded. These donations are then made public on an annual basis, including the donor’s name, recipient and donation amount.To analyse the value of political donations made by the food industry in Queensland and their potential relationship with public health nutrition policy, we collected three types of data: (i) publicly declared political donations in Queensland; (ii) legislation tabled in the Australian National Parliament, the Queensland State Parliament and (iii) consultations from the Australian and New Zealand Ministerial Forum on Food Regulation (Forum). The Forum is responsible for setting the food policy framework for Australia and consists of health and agriculture ministers from the states and territories, and the Australian and New Zealand governments. We downloaded all donations published from 1st January 2016 to 30th November 2021 as a Microsoft Excel (V.2108) spreadsheet. Available information for each donation included the donor’s name, the recipient, the date of the donation and the donation value. Due to a change in reporting practices, additional information including the donor electorate and donor address was available for entries prior to 2019 only. In the Australian context, an electorate is defined as a specific geographical area represented by one member of parliament.We chose to analyse political donations (henceforth referred to as donations) made in Queensland as it is the only Australian state with real-time reporting. Data were collected from the electronic disclosure system on the Electoral Commission of Queensland websiteQueensland, farm, sugar, cattle, meat, salt, food and drink’), determined iteratively by scoping relevant literature and Government Hansard transcripts, were searched along with donor information to increase the number of donors we could identify. Donations were included if we were able to determine the donor’s identity, and if the donor pertained to any of the three groups of the food sector hierarchy sourced from the Australian Institute of Health and Welfare (AIHW) . Key terms (including ‘W) Table .. For our analysis, we have classified each donation by political party, rather than individual candidates. For example, if a Liberal party candidate received a donation, we categorised this as a donation for the Liberal party. Only donations to four key political parties in Queensland were included in the analysis, as these parties are deemed to have the highest level of influence in policymaking in Queensland due to their large proportion of seats in parliament. We did not include the Australian Greens in our analysis due to their policy on not accepting alcohol donations and a lack of donations from the food industry to this party. A description of each party ideology, expanded upon from Russell et al., is shown in Table To avoid misrepresentation and overestimation of results, we excluded entries where there was any uncertainty about the identity and nature of the donor. Donations from unions were also excluded, as these organisations predominantly advocate for employment-related matters, such as wages and working conditions, which falls beyond the scope of this study. This was supplemented with food regulation consultations from the Forum, sourced from their website. All consultations, bills and acts initiated between 2016 and 2021 were included in the analysis if they related to public health nutrition. Here, we define public health nutrition as a population-based focus on health promotion, food and nutrition systems, wellness maintenance and primary prevention.To determine potential government policy actions that may have been influenced by donations, we conducted a purposive search of the Bills and Acts recorded on the Queensland State and Commonwealth Government’s Parliamentary website. State election dates were identified via the Queensland Parliament websiteAfter screening the donations data, donors were coded by sector type based on the AIHW groups Table . If an oDetails from relevant bills and acts tabled in the Queensland State and Australian National parliaments and in Forum consultations were extracted and categorised in a Microsoft Excel spreadsheet. Categories included the name of the proposed legislation/consultation, the date initiated or assented to, a description of content, the party that tabled it (if applicable) and its status. Relying on the expertise of the authors in food and nutrition policy, food systems and corporate political activity, we undertook a double coding of all policies to determine which group, if any, where most likely to benefit from the policies. Any conflicts were resolved through team discussion. We then organised the data chronologically to synthesise the policies with the political donations data from the seven industries who gave the most money between 2016 and 2021. Descriptive statistics and graphical outputs to represent the data were generated using Microsoft Excel.Of the 12 661 publicly declared political donations recorded between January 2016 and November 2021 in Queensland, 526 were made by 212 unique representatives of the food industry, totalling $2 113 093. These donations were declared under the names of large local organisations, trans-national corporations, small private businesses and individuals. Donations ranged in value from $40 to $60 000. The Liberal National Party (LNP) received 68 % of all donations ($1 451 991), while the ALP received 17 % ($358 270), Katter’s Australian Party (KAP) received 14 % ($285 833) and One Nation received <1 % ($17 000) . There were also notable peaks in donations to the LNP between May and July in 2016–2020, corresponding with Budget Week and Estimate Committee Hearing Week . These two events are important to capture as Queensland’s Members of Parliament discuss how they will allocate the federal budget given to the State, examine their Ministerial Portfolio statements and discuss how they will spend the allocated budget within their department.Peaks in money donated to the LNP, KAP and One Nation occurred immediately preceding state elections , followed by processors 27 %) and the retail sector (20 %) . These industries donated to all parties, although the LNP, KAP and One Nation mostly received donations from the meat industry . Most money donated to the ALP was from the sugar industry . The produce, seafood, nut, non-alcoholic beverage and dairy industry only donated to the LNP. Comparatively, the egg industry only donated to the ALP.Most donations were given by the meat industry $1 056 733, 50 %), followed by the sugar industry   of the food industry donors donated only once between 2016 and 2021, seventy-two donated ten or less times and seven donated more than 10 times. Nineteen donated to multiple political parties, though mostly to the LNP and ALP. Only one donor (the Pioneers Cane Grower Organisation) donated to all political parties.The highest aggregated donation overall ($233 333) was made to KAP by a relative of the party head who co-owns a cattle farm in Queensland. This donor also had the highest frequency of donations in the time period under study. The second largest donor  had an aggregated donation of $171 800, given almost exclusively to the LNP. Over half (Sugar Industry (Arbitration for Mill Owners and Sugar Marketing Entities) Amendment Bill and the Labelling of sugars on packaged foods and drinks consultation, and immediately following the tabling of the Competition and Consumer Sugar Industry Code Bill.Details of each act, bill and consultation related to food, including the name, description, who introduced the legislation (if applicable), the outcome and the date of this outcome, are shown in Table . In addition to their conservative ideology, the National Party faction of the LNP was established to represent and protect farmers. The bias displayed by Australia’s food industry in favour of a conservative party could demonstrate a ‘conservative partisanship’ strategy. This approach is typically adopted by industries facing hostile regulation, as conservative governments tend to advocate for the preservation of existing social and economic structures. Furthermore, the inclusion of the National Party in the LNP may in part explain the high value of donations from the agriculture sector.In this study, we aimed to explore the extent of political donations made by the food industry in Queensland and investigate the timing of public health nutrition policies in relation to these donations. Our results suggest that the LNP is the preferred political party for the food industry in Queensland. Of Australia’s two primary parties, the LNP is more conservative and has a greater emphasis on minimal state involvement in economic affairs. Industries donate in a bipartisan manner to gain access to regulators regardless of who is in power. For example, we found that the sugar industry, one of Queensland’s most lucrative crops, donated approximately equally to both the ALP and LNP. Globally, sugar is an increasingly politicised crop, with a growing focus on the impact of added sugars to the global burden of disease. In the time period captured in this study, four bills and one consultation specifically relating to sugar were introduced. Interestingly, we saw a division between sugarcane growers and processors. Growers were more likely to follow the trend of agricultural organisations and individuals donating to the LNP, while processors were more likely to donate to the ALP. A potential reason for this disparity could include proposed regulation from the ALP to protect the Great Barrier Reef against environmental harms from sugar processing. Although this pattern of donating was observed in our study, it was not as prevalent as the ‘conservative partisanship’ strategy.In contrast, a ‘pragmatic’ strategy of bipartisan hedging in political donations is more likely to be adopted by industries that are already regulated, or for whom regulation is ‘inevitable’Our policy mapping demonstrates that there were limited legislated policies or consultations in Queensland and Nationally between 2016 and 2021 to improve human and planetary health. Most of the legislation that was implemented related to issues of agricultural processes rather than decreasing the consumptogenic nature of the food supply or the environment. It was therefore difficult to ascertain whether political donations impacted the outcome of any specific bill or act tabled in the period under study. Though there was limited association between increased industry donations and relevant policies for most industries, donations from the sugar industry, the second biggest donator, coincided with three potential policies. However, none of these polices or consultations resulted in legislative action. It is not possible from our study to explain the influence that these donations had on policy outcomes, as there are limited data, though donations may have been a contributing factor in preventing the progression of policies and consultations that could negatively impact the sugar industry.. The cost of running election campaigns in Australia is rising, including the advertising of a party’s political agenda to try and gain electoral support,35. Increasing costs encourage a reliance on external funding, including via political donations,34,35, which account for 30–50 % of political party income,35.The limited implementation of evidence-based policy suggests that part of the apparent influence of the food industry in Queensland is their ability to keep public health issues off the political agenda. Instead, most donations, particularly those given to the LNP, were received immediately preceding the 2017 and 2020 state elections, with donations significantly lower in non-election years. This is comparable to research of Australian political donations overall,13,17. These donations may be provided with the hope that industry ideologies and commercial interests will be represented by their preferred political party,30,34,35. Donations can influence the policymaking process by facilitating increased access to politicians and consequently, allowing representatives from the harmful commodities sector to develop long-term relationships with these decision makers,15,34,36. Research suggests that industry representatives who donate multiple times within a year are more likely to have meetings or contact with politicians,34. This gives commercial entities the opportunity to talk about industry-related issues or gain a ‘sympathetic hearing’, which may potentially influence a political outcome,36. Meeting with big or frequent donors can be a way politicians express gratitude and secure donations for future elections,35.Our findings mirror historical trends in donations from the tobacco and alcohol industries, which increase during federal election periods and preceding political discussions and decisions for regulatory reforms. Consequently, the relationship between government and the meat industry has been largely interdependent and symbiotic. Policy interests have largely focused on maintaining production and consumption of meat, despite the growing environmental concerns associated with greenhouse gas emission outputs, water and land use and reduced agrobiodiversity. Industry representative groups, like Meat and Livestock Australia, receive substantial levies from government, as well as agricultural subsidies of over $200 million/year. At the time of writing, no major party at either Federal or State level has taken any health or environmental policy position in relation to the impact of meat production. The targeting of LNP, KAP and One Nation is likely due to the majority seats held in rural electorates, where cattle farming and meat processing plants are run and employed by sizeable portions of these populations.Most donations overall, and to the LNP, KAP and One Nation, were provided by the meat industry. The meat industry – particularly beef, sheep and goat meat – is one of Australia’s largest sources of economic revenue and is a major export commodity to the Asia-Pacific region, generating around $18 billion in revenue each year. Politicians may hesitate to implement policies that could jeopardise these economic resources. The prioritisation of economic interests in policymaking over public health and sustainability is well documented. Furthermore, regulating the food industry may have limited social license as a voting issue, could lead to issues with trade agreements and goes against the continuing pressures to support personal choice and to promote personal responsibility,43. Advocacy from public health organisations can encourage major parties to give up harmful industry funding, as evidenced by major political parties no longer accepting donations from the tobacco industry. These findings have important implications for policy regarding transparency and integrity in the future. We would encourage restrictions on the size of donations that can be made to political parties, as well as developing a standardised process for political donations transparency between states and at a national level. To expand upon the analysis presented in this paper, future research should consider the course of a bill over time, including suggested amendments; industry lobbying for each policy issue and if/how the content of a finalised bill differs from when it was initially tabled.Other than sugar and meat, there was a lack of declared donations from harmful commodity industries, including alcohol and ultra-processed food corporations. Though our results demonstrate that such industries are not donating to political parties in the state of Queensland, future research should investigate their donations in other states and at the national level. One reason these industries may not be donating to political parties is their size and subsequent economic power. The food industry is one of the highest employing sectors in the state and contributes substantially to Queensland’s economy. Of particular concern is the Australian Electoral Commissions publication of political donations, which can have an 18-month gap between the date of a donation and the information release. We acknowledge that many factors are involved in policymaking and political donations are only one aspect of this. Therefore, our findings regarding associations between donations and policy outcomes need to be considered in this complex policymaking environment. There may also be other policy that was not captured in our food-related search, particularly regarding the trade, agriculture and economic policies. Further, while Queensland donation data are generally considered high quality, it was difficult to determine the exact identity of some donors as limited detail was provided in the disclosure statements, leading to potential underestimations in our analysis.This is the first Australian study to measure political donations from the food industry in Queensland, and the first to map these donations against relevant legislation to assess potential relationships. Our study was limited by the analysis of only one state, rather than multiple state or national political donations. This choice was made due to the lack of real-time donation data and the quality of donations data nationally and in other states. Delayed reporting of political donations and poor limited data common is common in AustraliaThe LNP was the preferred political party for the food industry in Queensland. This is potentially because it is the more conservative of Queensland’s two major parties, with an emphasis on minimal state involvement in economic affairs and preservation of existing social and economic structures. Donations were not regularly correlated with policies or consultations for most industries, rather they mostly preceded state elections. However, we found limited policy implemented overall to reduce food industry harms on human and planetary health, with most legislation related to issues of agricultural processes rather than decreasing the consumptogenic nature of the food supply or environment. Most donations were from the meat and sugar industries. Both industries may face regulatory intervention in the future given the relationship between these commodities and health and environmental outcomes.


Capacitive sensors are essential to promoting modernization and intelligence in agriculture. With the continuous advancement of this sensor technology, the demand for materials with high conductivity and flexibility is rapidly increasing. Herein, we introduce liquid metal as a solution for the in-site fabrication of high-performance capacitive sensors for plant sensing. As a comparison, three pathways have been proposed for the preparation of flexible capacitors inside plants, as well as on their surfaces. Specifically, concealed capacitors can be constructed by directly injecting liquid metal into the plant cavity. Printable capacitors are prepared via printing Cu-doped liquid metal with better adhesion on plant surfaces. A composite liquid metal-based capacitive sensor is achieved by printing liquid metal on the plant surface and injecting it into the interior of the plant. While each method has limitations, the composite liquid metal-based capacitive sensor provides an optimal trade-off between signal capture capability and operability. As a result, this composite capacitor is chosen as a sensor for monitoring water changes within plants and demonstrates the desired sensing performance, making it a promising technology for monitoring plant physiology. Therefore, increasing the productivity of food per unit area is another viable option. Precision agriculture, a modern agricultural production system that utilizes information and knowledge management, is dedicated to applying information technology to the whole process of crop production to achieve maximum agricultural productivity and is an effective way to achieve sustainable agriculture with high quality, high yield, low consumption, and environmental protection. Therefore, precise agriculture has gained considerable attention in recent years [With the world’s population rapidly growing, food security has become one of the major challenges for humanity. In order to solve this problem, expanding the area under cultivation for food is a straightforward way of doing this, but it often results in the destruction of forests and grasslands, which is detrimental to environmental protection. Especially in the current situation of global warming and excessive COnt years ,2,3.To achieve precision agriculture, various sensing technologies are being used for plant sensing and monitoring. Resistive and capacitive sensors are used to acquire data during plant growth ,5,6. ComTo address this challenge, liquid metal was recently selected as a plant sensing material for its excellent biocompatibility ,10, highThe water spinach used in our experiments was purchased from an agricultural market and grown in nutrient soil under natural light at room temperature. The plants were watered once a week and received fertilizer when they were first planted. Bamboo comes from gardens on campus. The liquid metal used for injection was EGaInSn, which consists of 68 wt% gallium, 22 wt% In, and 10 wt% Sn. EGaInSn is made by adding a certain proportion of weighed metal components into the glass and heating it to 200 °C for about an hour until all the metals are melted into liquid. After the liquid metal was injected, a wire was just inserted into the needle hole, and then it was fixed by silicone rubber. The other hole for degassing was also sealed by silicone rubber. It took 24 h for the silicone rubber to become totally solid. To achieve the printing of EGaInSn, 1 μm Cu nanoparticles were added into EGaInSn via stirring EGaInSn and Cu nanoparticles for 30 min in air. The instrument used is a mechanical stirrer with a speed of 600 r/min. To demonstrate that the liquid metal printed on the plant surface can serve as common patch electrodes, we first tried to fabricate it on Venus fly traps. To obtain a liquid metal printed electrode with a specific shape, we first designed the shape of printed electrodes in Solidworks, and the mold composed of PDMS was then obtained by 3D printing. The mass ratio of PDMS to curing agent is 10:1. The PDMS mask was then pasted to the fly trap, and the liquid metal was brushed onto the surface by line drawing pens. After that, a kind of silica gel line was brushed into the surface of liquid metal as an insulating layer. Finally, we measured the capacitance with a LCR digital bridge capacitance resistance measuring instrument . The frequency chosen for the water content test experiment was 1 kHz.In previous studies, capacitive sensors were usually placed on the surface of the plant, which is easy to manipulate and controllable. In this study, we placed one or two electrodes of the capacitive sensor inside the plant by injection, based on the principle of plant injectable electronics . To achiThree types of capacitive sensors can be obtained, depending on the position in which the liquid metal electrode plate is located c. The elTo achieve the injectable capacitor within the plant, liquid metal needs to be injected into the cavity of the plant. Fortunately, the liquid metal used in this study is a eutectic gallium-indium-tin alloy (EGaInSn), which has about twice the viscosity of water  and exhiaC) is reflected by the reactance of the whole equivalent circuits. To better illustrate this issue, the circuit model can be simplified, which is depicted by the following formula:f is frequency. Hence, with the current frequency going up, the tested capacitance should go down, which is in agreement with the experimental results. Besides, the measuring error of the capacitance can be regarded as spurious impedance illustrated in series or parallel. Depending on the level of spurious impedance, different test modes are selected. When the impedance is large, the parallel equivalent capacitance (Cp) is suitable, while, when the impedance is small, the series equivalent capacitance (SC) should be preferred. Here, given the relatively high impedance of the plant tissue, Cp was chosen to reflect the characteristics of capacitors, which can be used to reflect the variation in plant growth conditions. As a comparison, water spinach was also selected. The study further tested the performance of the capacitor inside the bamboo. As illustrated in In addition to injectable liquid metal capacitors within plants, printable liquid metal capacitors have also been prepared on the surface of the plant. The success of this fabrication method relies heavily on the effectiveness of the liquid metal printable electrodes in capturing signals from the plants. To ensure this, we conducted an experiment using a flycatcher as a model organism. The liquid metal was first printed onto the surface of the flycatcher, and then the plant was stimulated to observe any changes. The goal was to test whether the printed electrodes could effectively capture this typical biological event. Further research is necessary to enhance the durability of these sensors and minimize their vulnerability to external factors. Therefore, combining the advantages of the above two strategies, here we propose a liquid metal-based composite capacitive sensors via printing liquid metal on the surface of plants and injecting liquid metal into the cavity of plants. The structure diagram of such composite capacitors is shown in L is the height of the cylinder, R is the exradius, and r is the inner radius. It can be seen that the change in capacitor size and the variations in the dielectric constant of the inter-pole dielectric affect the capacitance value. Additionally, it is known from the previous discussion that the dielectric constant variation of plant tissues is mainly related to the water content. Therefore, the change in the value of the plant-related capacitor can be a good indicator of the water changes within the plant.As a demonstration of the application, such a composite capacitor is used to test the water content inside the plant. Water is an indispensable substance for plant growth and plays a highly important role in the physiological health of plants ,20. BesiTo ensure that the water content is represented as much as possible by the capacitance value of the capacitor, bamboo with very little change in shape during the water loss process was selected. In summary, we have successfully constructed three types of liquid metal capacitive sensors, both on the surface and inside of plants, by printing and injection. Injectable or transplanted capacitors are realized by injecting liquid metal into the plant’s interior, which effectively characterizes and monitors the tissue situations inside the plant. While the capacitance values measured by liquid metal capacitors printed on the surface of liquid metal are significantly smaller than those measured by injectable capacitors, they are superior in their ease of handling, controllability, and ability to effectively respond to plant-specific tissue conditions. By combining the above two strategies, we injected and printed liquid metal into the interior and surface of the plant, respectively, thus realizing a composite capacitive sensor. This capacitor displays a larger capacitance value than the printed capacitor, while its maneuverability is greatly increased by the need for only one pole plate to be injected into the plant. Furthermore, based on this obtained composite capacitive sensor, we successfully monitored the water loss process of bamboo, demonstrating its potential application value. In conclusion, it is believed that liquid metal-based capacitive sensors hold significant promise in the field of plant sensing and monitoring.


Despite the dramatic increase in opioid-related deaths in recent years, global access to treatment remains poor. A major barrier to people accessing Medication-assisted treatment of the opioid use disorder (MOUD) is the lack of providers who can prescribe and monitor MOUD. According to the World Drug Report, more young people are using drugs compared with previous generations and people in need of treatment cannot get it, women most of all. Nurse prescribers have the potential to enhance both access and treatment outcomes. Nurse prescribing practices do, however, vary greatly internationally. The aim of this scoping review is to explore nurse prescribing practices for MOUD globally with a view to informing equitable access and policies for people seeking MOUD.This scoping review was informed by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews (PRISMA-ScR). Electronic searches from 2010 to date were conducted on the following databases: PsycInfo, PubMed, Embase, and CINAHL. Only studies that met the eligibility criteria and described nurse prescribing policies and/or behaviours for MOUD were included.A total of 22 articles were included in the review which found several barriers and enablers to nurse prescribing of MOUD. Barriers included legislation constraints, lack of professional education and training and the presence of stigmatizing attitudes. Enablers included the presence of existing supportive services, prosocial messaging, and nurse prescriber autonomy.The safety and efficacy of nurse prescribing of MOUD is well established, and its expansion can provide a range of advantages to people who are dependent on opiates. This includes increasing access to treatment. Nurse prescribing of MOUD can increase the numbers of people in treatment from ‘hard to reach’ cohorts such as rural settings, or those with less financial means. It holds significant potential to reduce a wide range of harms and costs associated with high-risk opiate use. To reduce drug-related death and the global burden of harm to individuals, families, and communities, there is an urgent need to address the two key priorities of nurse prescriber legislation and education. Both of which are possible given political and educational commitment. Worldwide, drug use has led to about 500,000 deaths in 2019, with over 70% of these being related to opioids, and more than 30% of those deaths caused by overdose [Nurse prescribers for MOUD have the potential to enhance access to treatment and treatment outcomes. However, nurse prescribing practices vary greatly internationally as do levels of education and certification. In the North American region (USA and Canada), the highest level of advanced practice for nurses is certified nurse practitioners. The countries that currently have well to moderately developed nurse practitioner roles included in workforce planning are Australia, Canada, Finland, Ireland, the Netherlands, New Zealand, the United Kingdom , and the USA .In other countries, there may be varying levels of practice, but many are informal roles based on need and experience. Standardization of the nurse role in MOUD may be important to achieve the goal of reducing preventable deaths. However, as a critical first step, the aim of this scoping review is to explore nurse prescribing practices for MOUD globally. Findings will inform the need to develop and implement policy and to integrate guidelines for practice internationally.A scoping review, as defined by Arksey and O’Malley , is a meThis review used a population, exposure, outcomes (PEOS) framework to assess the eligibility of the studies  refers to a type of advanced practice registered nurse (APRN) and is used interchangeably with the title of advanced nurse practitioner (ANP) and advanced registered nurse practitioner (ARNP), although the preferred legal term varies by area. To become an APRN, individuals must obtain either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP). In the USA, the 2016 Comprehensive Addiction and Recovery Act (CARA) allowed NPs to begin prescribing MOUD . The legNew MOUD NPs in the USA, i.e., NPs who are legally allowed to prescribe opioids to treat OUD, are prescribing to more patients than doctors and therefore, providing much-needed treatment , especiaAccording to research by Andrilla and colleagues , NPs areA recent study highlighted that there is a need for ongoing learning resources and support for NP practice . ParticiNPs identified lack of adequate expertise in working with MOUD patients as a barrier. The structure of NP education was also found to be discouraging as NPs felt that they received little addiction training and no methadone education as part of their initial training. Addiction studies are also seen as a niche area requiring specialized and difficult knowledge , and thin = 21) over 7 months [The study by Carroll evaluated the implementation of NP led MOUD clinics and found that the pilot programme increased MOUD access by 34%  per capita. Non-OTP facilities offering any MOUD were also significantly associated with higher uptake .Methods of recruiting and promoting uptake can have a significant influence on NPs. Domino and colleagues conducted a study to evaluate the use of three methods to recruit NPs in the OUD workforce . Three tRural NPs reported facing more resistance from their practice partners in comparison with urban NPs . This waThis section highlights the negative attitudes of prescribers towards people who are dependent on opiates and social stigma. It also highlights the perceived complexity of MOUD prescribing, e.g., chronic health issues, risk of violence, drug use and diversion of prescribed medication.A study in Canada found that personal beliefs of NPs often pose a barrier to providing treatment, for example, views such as patients with OUD deserve less care than other patients , this waAndrilla and colleagues reported that NPs identified lack of specialty backup for complex patients as a key barrier to their practice . Bates aThe safety and efficacy of nurse prescribing of MOUD is well established, and its expansion can provide a range of advantages to people who are dependent on opiates. This includes increasing access to treatment, but nurse prescribing of MOUD can increase the numbers of people in treatment from ‘hard-to-reach’ cohorts such as those in rural settings, or those with less financial means , 34. Thiat all [The studies included in this review, although mostly from the USA, are reflective of the European context, in that the development of nurse prescribing of MOUD is subject to the efforts made within each jurisdiction to progress it. There are significant variations across regions in terms of levels of training, autonomy and scope of practice and indeed whether nurse prescribing of MOUD happens at all . For exaat all . In thisat all . Given tat all , it is iat all . Developat all .To build on current success, the expansion of NP of MOUD also requires ‘whole-systems’ support. In the first instance, this should start with passing the necessary legislation to allow nurse prescribing to take place . SecondlA key strength of this review is that it focuses on the role of NPs in providing MOUD treatment. Nurse prescribing practices across the globe for MOUD vary greatly internationally as do levels of education and certification. Nurse prescribers for MOUD have the potential to enhance access to treatment and treatment outcomes, and this review highlights the enablers and barriers to NPs role in MOUD treatment. The scoping review method provides a rigorous and transparent method for mapping key research areas. To ensure rigor and credibility in the process, the scoping review was conducted according to the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist and the literature was cross-checked and validated by all authors. In relation to the limitations of the review, it is important to note that the majority of literature that was yielded in the review was mainly from the US which limits the generalizability of the findings. Another limitation of this study is that a grey literature search was not conducted. While scoping reviews have rigorous methods, it is a rapid form of mapping research areas and as a result, may have missed some important papers.how nurse prescribing of MOUD has been developed, its effectiveness in each context is well established and there is ample evidence of appropriate strategies that can be used to support it. Nurse prescribing of MOUD can be further enhanced through the provision of targeted education and institutional support for nurse prescribers. Overall, the potential for nurse prescribing of MOUD to improve existing treatment and to provide treatment where there is none available is clear. In many jurisdictions, this potential has been realized by legislators and planners, but further realization and expansion of nurse prescribing of MOUD is required globally.Medication-assisted treatment for opiate use is a cost-effective and widely utilized approach which facilitates both harm reduction and recovery, but it is not always accessible to those who require it the most. Despite some inconsistencies in


All World Mental Health (WMH) Surveys apply high standards of data quality. To date, most of the published quality control (QC) procedures for these surveys were in relation to face-to-face interviews. However, owing to the social restrictions that emerged from the COVID-19 pandemic, telephone interviews are the most effective alternative for conducting complex probability-based large-scale surveys.In this paper, we present the QC system implemented in the WMH Qatar Survey, the first WMH Survey conducted during the COVID-19 pandemic in the Middle East. The objective of the QC process was to acquire high data quality through the reduction of random errors and bias in data collection.The QC design and procedures in this study were adapted to the telephone survey mode in response to the COVID-19 pandemic. We focus on the design of the QC indicator system and its implementation, including the investigation process, monitoring interviewers’ performance during survey fielding and applying quality-informed interventions.The study team investigated 11,035 flags triggered during the 2 waves of the survey data collection. The most triggered flags were related to short question administration duration and multiple visits to the same survey questions or responses. Live monitoring of the interviews helped in understanding why certain duration-related flags were triggered and the interviewing patterns of the interviewers. Corrective and preventive actions were taken against interviewers’ behaviors based on the investigation of triggered flags per interviewer and live call monitoring of interviews. Although, in most cases, the interviewers required refresher training sessions and feedback to improve their performance, several interviewers discontinued work because of low productivity and a high number of triggered flags.The specific QC procedures implemented in the course of the WMH Qatar Survey were essential for successfully meeting the target number of interviews (N=5000). The QC strategies and the new indicators customized for telephone interviews contributed to the flag investigation and verification process. The QC data presented in this study shed light on the rigorous methods and quality monitoring processes in the course of conducting a large-scale national survey on sensitive topics during the COVID-19 pandemic. Survey quality is determined by the accuracy, reliability, and validity of data . MeasureTo date, WMH Surveys have been conducted in >30 nations, including Arab countries such as Lebanon, Iraq, and Saudi Arabia -14. SchoIn the Middle East, large-scale mental health surveys rarely report the implementation of QC measures or procedures. However, scholars recommend the adoption of efficient QC tools and the development of strong teams to manage QC procedures as a priority ,20. To dIn this paper, we describe how we created and implemented a QC system for the first national mental health survey in Qatar, the WMH Qatar Survey, which is also one of the first studies in the WMH Survey consortium conducted using CATI technology during the COVID-19 pandemic. The QC design and procedures in our study were also adapted to the CATI mode of data collection. In other parts of the world, a study investigating the prevalence of suicidal thoughts and behaviors in the Spanish adult general population during the first wave of COVID-19 also used the CATI survey mode , whereasThis study provides an overall framework for implementing similar QC procedures in future large-scale population surveys, including the WMH Surveys using the CATI methodology. First, we briefly present information on the sampling design and fieldwork operations and procedures. Then, we discuss in detail the design of the QC system, implementation of quality indicators, flags investigation process, interviewers’ performance monitoring, and QC-informed interventions implemented during the fielding of the survey. At the time of writing this paper , the production and the QC process were in the final phase.This paper aims to (1) describe the design of the QC system adapted to the CATI mode of data collection, (2) discuss the QC measures that have been implemented to detect errors in data collection and prevent practices that do not follow the study protocol, and (3) provide a framework for developing QC systems and procedures in future large-scale population surveys.The target population of this study included Arab adults aged ≥18 years living in Qatar during the survey reference period . To reach this population, the Social and Economic Survey Research Institute (SESRI) worked with local cellular phone providers to develop a cellular phone frame. A probability sample was drawn from this frame by using the listed dialing technique. The proportion of adults with a cellular phone in Qatar is approximately 98% and it was determined by a SESRI statistician for the National Omnibus Survey conducted in 2018. A sample drawn from this type of frame was expected to have excellent coverage and representation of the target population. Because the target population could not be completely identified in the frame, we had to oversample certain groups of phone numbers that were likely to belong to the target population. This oversampling was also important to avoid sampling nonworking phone numbers. The sampled phone numbers were released for interviewing in batches to ensure that the complete call procedures were followed for all phone numbers. The phone calls were made at different times during the day and on different days of the week to maximize the chances of making contact with potential respondents.The fieldwork team and data collection played an essential role in the QC process. The interviewers recruited for this study were trained on the survey administration protocol and data capture software. In the following sections, we present details of the training and data collection procedures, including the software used and the changes in the phone interviewing approach necessitated by the COVID-19 pandemic.In interviewer-administered surveys, the training is considered an important part of the QC . ConductA total of 3 teams were involved in the training process: the research team, the CATI laboratory team, and the IT team at SESRI, Qatar University. The training materials included frequently asked questions sheet to support answering the respondents’ questions and concerns regarding the study. The respondent booklet contained survey response options, whereas the interviewer booklet listed scenarios and instructions for the interviewers’ reviews and references, as well as scripts that were used during the practical part of the interviewers’ training. During the training sessions, the interviewers were familiarized with the questionnaire, including diagnostic and nondiagnostic modules of the CIDI. The importance and aims of the study were highlighted, as well as media coverage of the study. General interviewing techniques  were also covered by the CATI laboratory team during the training, in addition to the study’s interviewing protocol and guidelines. The training also covered information about the importance of adherence to the ethical standards of scientific research, including informed consent and confidentiality. The IT team demonstrated the use of Blaise software (CBS Statistics) for entering data and trained the interviewers on IT-related procedures. Participants in the training program who had the best performance on the scored tasks during the training were selected to become interviewers in the WMH Qatar study.The CATI team comprised a manager, an assistant data collection specialist, 6 supervisors, and 42 interviewers. The interviewers worked 1 of 2 shifts  every day of the week from Sunday to Saturday.CATI is a telephone interviewing method in which interviewers use an electronic device, specifically a tablet, with Blaise data entry client software to read the survey script and enter the information collected and with Cisco Communicator software (Cisco Systems) to make the calls . The surThe data collected were automatically sent in real time to the SESRI central server using the Case Management System (Cisco Systems). Because of Coronavirus restrictions, interviewers conducted their activities from home. Remote work required each interviewer to connect to the Global Protect Virtual Private Network   to ensurBecause of the restrictions imposed on face-to-face interviews during the COVID-19 pandemic, it was decided to move CATI survey operations to a distributed CATI mode, as opposed to a centralized call center. In this data collection mode, because interviewers worked from home, they tended not to adhere to their working hours. Furthermore, supervisors were not able to directly monitor interviewers as they worked. To fill this gap, the SESRI IT team developed an app called CATI Time Tracker that allowed interviewers to log their work activities and breaks throughout their working shifts, which were accessible to CATI managers and supervisors. The CATI Time Tracker app also facilitated shift management and interviewer evaluations for supervisors, as well as provided technical support. The data generated through the app were fed into the QC database, which were used to monitor predefined QC indicators during the data collection phase of the study.This study was approved by Qatar University Institutional Review Board. The Research Ethics Approval Number is QU-IRB 1219 EA/20. As the survey was conducted using the telephone mode of interviewing, verbal informed consent to participate was obtained from all study participants. To safeguard against potential risks of participation, standard research protocols and the Health Insurance Portability and Accountability Act were followed. All respondents were assigned anonymous study codes for identification, and only aggregate data were used.The QC database mentioned above was a key component of the QC indicator system (QCIS), which transformed, integrated, and aggregated data into tables that store information on various indicators, allowing updates on the progress of data collection through visualizations used by the QC team to investigate the performance of the interviewers. To holistically comprehend the QC system, we present and discuss in this section the components of QCIS, modifications implemented to adapt the QC process to the phone interviewing mode, and the metrics and indicators, also called flags, that the QC team refers to when investigating, monitoring, and correcting interviewers’ performance and behavior.The data collected by the interviewers and paradata were categorized into different sources that were fed into the QC system. Through different schedules of frequency processing, quality indicators objectively measured the efficiency of the essential segments of data collection. Quality indicators were vital in the QC process because they offered the possibility of rapid insight into the quality of the collected data, the performance of the interviewers, and their patterns related to their performance with time .QCIS was developed by the SESRI IT team for the WMH Qatar study. The foundation of the QC tool was initially established for the CAPI survey mode in collaboration with the University of Michigan team. Switching to CATI mode involved major changes to the QC tool implemented by the SESRI IT team; these changes are presented below. In developing the QC tool, the SESRI IT team identified variables for QC indicator flags, created scripts to generate the indicator flag, designed a schema to store flag information and desired aggregated data, designed a periodic QC indicator processor to update the flag data in the Master QC, and developed sample charts and tables to use as visualizations of the QC indicators.Data coming from different sources were loaded into the QC database. Before the pandemic, when the interviewing mode was face-to-face, the QC infrastructure had the following sources: CATI audit trail (ADT), Sample Management System, and Blaise Response Data CIDI. These sources were processed into the QC database, and using the SQL analysis service to transform and the server analysis services tabular model to aggregate, the indicators were reported through charts, tables, and graphs on the Power Business Intelligence  dashboard. The structural changes implemented by the SESRI IT team because of the new mode of interviewing involved the addition of 3 new sources: Cisco call detail records (CDR), CATI Time Tracker, and Master Project Repository. Moreover, the server analysis services model was removed, and the data extraction transformation and loading process was integrated within the QC database .For a better understanding of the raw data fed into the QC database, a brief description of the data sources will provide insights into the information used for developing indicators. The 6 data sources are explained as follows:CATI ADT was generated by the Blaise software as interviewers went through the interview. ADT data were parsed daily and included information on Blaise sessions, all activities in survey fields, including start and end timestamps, and keystrokes. This information was used when flagging for survey time–related QC indicators.The Sample Management System used a call scheduler, which was responsible for scheduling telephone numbers in the day batch, making the cases available to the interviewers at the scheduled time.Blaise response data were also consumed by the QC system, including the start and end timestamps of the call, call outcome, appointment details, case status, respondent type, and gender. The Blaise data were collected in near real time (delays of a few seconds or minutes) and were vital for performing QC and for monitoring the progress of the study.CDR data provided a record of all calls that have been made or received by users of the Cisco Call Manager system and were useful for tracking call activity and monitoring sessions. CDR data were collected by SESRI, filtered to keep only outgoing calls from SESRI phone numbers, and transformed to extract details such as call start and end timestamps, duration of the call, correct phone number, and monitoring sessions that occurred during the call, if any.The CATI Time Tracker was also an important source that provided details about interviewers’ activities. The Time Tracker helped the data collection agents keep track of how each interviewer’s workday was distributed on different predefined activities such as calling, shift preparation, and technical support. These data were compared with the agent’s Blaise activity to check for underreporting or overreporting of work hours.The Master Project Repository was a database that served as the basis for the payroll system. It included data such as phases of studies conducted by SESRI, employee details, agents participating in each study and their roles, past payment details, and history of agent employment.These data sources underwent preprocessing, including filtering, parsing, and reshaping. This was done daily through special scripts and run using TeamCity (JetBrains) software. After preprocessing, the data were loaded into the QC database, which further transformed, integrated, and aggregated data into tables that stored information on dials, interviewer activities, values for different metrics and indicators, and the status of cases. This process was done using a series of specialized procedures that ran consecutively on SQL Server Management Studio  and initThe visualizations on the Power BI dashboard were based on indicators that have been attentively selected and implemented to reflect the requirements of the phone interviewing mode. The SESRI IT team and the research team met regularly to discuss the indicators required for the new mode of interviewing.short average interview length flag. The country’s cultural setting was also considered when determining the cutoff values for some of the flags. For example, prayer time affected the cutoff values used for the long question field time and long interview length flags. The pilot phase of the study provided an important opportunity to further test and adjust these values before the survey production phase.The Michigan team assisted in the implementation of these modified flags. After reassessing the old indicators for the CAPI mode, a few of the face-to-face mode indicators were kept with new cutoffs, and new indicators were developed by the SESRI IT team and displayed on the Power BI dashboard . The iniTo facilitate flag identification by each team, the indicators were categorized into CIDI-related indicators, duration-related indicators, IT indicators, and operational indicators. This categorization allowed each team to focus on the flags assigned for review and verification. In addition, the IT team developed new metrics to verify whether the interviewers were adhering to their working hours and to collect monitoring details . This waAfter discussing with the research team, the IT team, prioritized the information to be displayed on the first page of the Power BI dashboard. This provided a summary of the progress of interviewers that the field operations and the research teams were able to access in a fast way. The overall number of completed interviews per hour and the total duration of all Cisco calls were implemented on the dashboard, as well as a chart of the percentages of long and short completed interviews. Other indicators displayed on the main page were total sample size, sampled cases, total completed interviews, completed interviews per day, total number of interviewers, number of active interviewers per day, total number of dials, number of dials per day, disposition summary, and respondent type and gender .z score flags.Other tabs in the Power BI dashboard include visualizations of dispositions, overall performance, Cisco call details, interviewer activity, evaluation, and appointments. Another page containing all the flags by the interviewer provided a holistic perspective on the overall performance of the interviewers and enabled the users to filter the information by date, interviewer, category, and type of flags, including the flags calculated for a period of 2 weeks, called All the mentioned flags and metrics were displayed on the Power BI dashboard via graphs, charts, tables, and other infographics. The Power BI dashboard was customized for the WMH Qatar study, which helped the research team maintain oversight of survey progress and adherence to the protocol. The indicators were automated and updated daily, enabling live updates on productivity and interviewers’ performance in the field.List of flagsHigh number of completesShort question field timeShort stem question field timeHigh percentage of short field timeShort interview lengthLong interview lengthShort average interview lengthHigh number of negative stemsMultiple field visitsMultiple stem-field visitsLow prevalence rateLong question field timeLong treatment lengthMetrics developed by the Social and Economic Survey Research Institute IT teamMonitoredMonitoring time per caseMonitoring time per interviewerBlaise survey timeBlaise adjusted total timeBlaise treatment timeCisco calling timeAverage after call work timeDials per hourNumber of completions per hourAdjusted number of completions per hourDiscrepancy in reported working timeAudit trail section lengthBlaise timeout bug flagFor the WMH Qatar Survey, QC procedures included automated procedures applied to the collected data through the QC tool, manual verification and investigation of the indicators, prioritizing and filtering the most concerning flags, monitoring the performance of the interviewers, evaluating performance and progress, and applying corrective and preventive measures to improve interviewers’ performance. The composition of the QC team and the details of each QC procedure are presented as follows.The QC research team was formed of the QC supervisor who oversaw the QC process from the research side and investigated the flags, another flag investigator from the IT team, and 4 phone monitors in charge of evaluating the interviewers during the interviews. Moreover, 5 supervisors from the CATI laboratory monitored and evaluated the interviewers.The process of reviewing the flags served 4 main objectives: (1) obtaining information about the interview , (2) providing information about the overall data quality of the survey , (3) detecting and preventing data falsification, and (4) improving interviewer performance by reinforcing the requirements to fall into specific parameters.z scores), a task was created for the IT team to check and resolve the flag issue. If there were no technical issues identified, the flags were compiled in an Excel (Microsoft Corporation) sheet with details, notes, and comments and presented to the entire QC research team during biweekly meetings. It was crucial to prioritize and filter the flags according to their level of gravity. The flag investigator determined, based on the findings of the examination, whether a flag was concerning or not. If a flag was concerning, it was reassigned to the monitoring team in the Planner for further investigation. In addition to assigning flags to the Planner, the QC supervisor sent an email at the end of each biweekly meeting with a list of interviewers who required further monitoring and evaluation of their skills. Then, the monitoring team observed the interviewers, added notes and actions in the Planner, and reassigned the task to the QC supervisor to review the added notes. If the explanations and actions were satisfactory, the task was recorded as completed, and the dashboard was updated with the task status.Several steps pertained to the verification and investigation processes . The QC Monitoring allowed us to investigate further suspicious patterns of interviewers’ behaviors and aided us in understanding why certain flags were triggered. The QC staff monitored the progress of the survey activities. Most WMH Surveys recommended 1 monitor for every 8 to 10 experienced interviewers . The monThe interviews were monitored live (not recorded) by members of the research team and CATI laboratory supervisors using the Cisco Finesse software (Cisco Systems). The monitors looked for specific anomalies according to the concerning flags assigned by the QC supervisor in the Planner. For instance, if an interviewer was flagged for having a short question field time, the phone monitor observed the reading speed and verified whether this particular interviewer was reading the questions verbatim as per the protocol or not.The entire duration of all dials made by the interviewers was 9767 hours. We defined dial duration as a telephone connection that starts when the respondent answers the incoming phone call. The monitoring duration accounted for 6.01% (586/9767) of the total duration of dial time. Looking at the completed cases only, 12.08% (543/4496) of them were monitored for at least 15 minutes. Approximately 21% (944/4496) of the completed cases were monitored for at least several minutes (including the cases monitored for <15 min and >15 min).The monitoring team evaluated the interviewers by scoring their skills on the Power BI dashboard and CATI Time Tracker. The following skills were evaluated: probing techniques, dealing with objections and refusals, ability to persuade participants to participate in the survey, typing speed, project knowledge and the ability to answer questions and concerns, and reading the question verbatim without extra explanation or personal opinions. The interviewers’ working hours and the number of completed interviews were also verified. Each skill was scored on a scale from 0 (lowest) to 5 (highest). Monthly and biweekly vouchers were offered to interviewers who adhered to the study protocols, triggered fewer flags, and showed progress after receiving feedback.Monitoring notes revealed that most of the flagged interviewers were reading the questionnaire in a rapid manner, skipping words, pronouncing words unclearly, and providing interpretations. Such behaviors required both preventive and corrective measures to reinforce the importance of interviewing protocols and guidelines. The preventive actions included refresher sessions, observing the interviewer’s performance for anomalies, reminding the interviewers to follow fieldwork protocols, and using the interviewer booklet for clarifications. Corrections were made by supervisors and phone monitors by contacting the interviewers to provide feedback and instructions. In case of lack of improvement, further action was taken by the CATI laboratory manager by sending a final warning to the interviewers who failed to show any progress.From the beginning of fielding until the moment of writing this paper, the QC team investigated the flags, focusing on the low prevalence rate, negative stems, number of completed interviews per day, and duration of the interview and questions. The team investigated 11,035 flags triggered during the 2 waves of survey production.multiple stem-field visits flag . A high percentage of multiple visits by interviewers was observed for the stem questions in the stressful experiences module , depression module , and worry and anxiety module . With a cutoff of 1 visit per stem question, most stem questions were visited 2 times  and 3 times . The highest number of stem-field visits was 13 for a question in the stressful experiences module.Out of the total number of 1926 flags of multiple field visits for nonstem questions , the higThe QC team investigated multiple field visits for stem and nonstem questions, focusing on whether the interviewers were changing to negative answers to minimize the duration of the interview. In most cases, the answers were not modified, and when interviewers were monitored or contacted to provide explanations, it was found that respondents wanted to revisit the questions because they did not understand them. Other motives, such as call interruptions, rapid entry of the option before respondents finalized answering, and respondent’s request to go back to a module at the beginning of the survey, explained revisiting questions. Another motive was the sensitive nature of some questions in these modules, which may have prompted the readdressing of questions. This finding also explains why the module with the most multiple field visits (stem and nonstem) is the stressful experiences module, which contained questions about traumatic situations, including sexual harassment and rape.The short question field time was the second most triggered flag . The research team tested the questionnaire and verified which questions were <3 seconds by default and eliminated those from the questions to be flagged. Upon further monitoring, the interviewers who read the questions in <3 seconds and were flagged, we found that they were reading the questions in a rapid manner, skipping words, selecting the option before the respondent gave a final answer, and even not reading verbatim but using their own words. Corrective actions for such behavior included reinforcing instructions through SMS text messages or phone calls by a member of the monitoring team. An example of a corrective message to the interviewer was as follows: read the questions clearly at a medium speed , read the full answer options if applicable, and record the answer after the respondent’s response, not while still talking. Some of the preventive actions included the supervisor and the monitoring team keeping an eye on a particular interviewer’s performance for anomalies, as well as reminding the interviewers to follow the necessary fieldwork protocols.z score for positive prevalence and <−1.5 Z score for negative prevalence. The average value was 0.43 (SD 0.11). The highest negative prevalence flag was −2.64 (SD 0.16), whereas the highest positive prevalence flag was 2.47 (SD 0.17). In total, only 21 flags were triggered for the negative prevalence indicator, where the cases included in the calculations had no disorders, and 26 flags were triggered for the positive prevalence flag, where cases had many disorders. When investigated and correlated with other flags, some interviewers with a high negative prevalence also had short interviews and short questions. These interviewers were further investigated and monitored to determine if they were developing certain patterns when interviewing, and corrective actions were taken. Interviewers with high positive prevalence flags exhibited greater skills in convincing the respondents to disclose their mental health disorders.The prevalence flag indicated whether the cases had disorders or not. The prevalence flag accounted for both positive and negative values calculated for a period of 2 weeks and a cutoff of >+1.5 short interview length and long interview length flags were monitored. It was found that, in the case of short interviews, the interviewers were reading at a fast pace, but clearly, while those with long interviews were either having technical issues and interruptions, respondents who provided detailed answers or comments, interviewers reading the questionnaire slowly, or breaks requested by the respondent. In the case of a break for >7 minutes, the case was flagged with long question field time, which was investigated by tracing the duration of the reported working time, Cisco calling time, ADT time, and Blaise time. In addition, we verified the question where the interviewer was at during the long pause and whether the interviewer left any remarks for that respective question. Some interviewers left notes saying that the respondent took a short break to pray (as Muslims pray 5 times each day) or attend to domestic tasks. In cases where no explanation was provided for a break, the monitoring team observed the interviewers and took corrective actions.Most of the short and long interviews were just a few minutes shorter than the cutoff values. The interviewers who cumulated a high number of high number of completed interviews and with high percentage of short field time (>30% of short questions within 1 interview) were found to have the short question field time and short interview length flags as well. However, in many instances, the interviewers flagged with a high number of completed cases per day were completing cases at the second or third attempt. This finding meant that previous interviewing sessions were conducted before for the same cases that completed the modules of the survey.Some of the cases flagged with short average interview length flag, the average interview length was calculated for each interview every 2 weeks. If the z score for this type of flag was ≤−2, then the interviewer was flagged. We only had 14 short average interview length flags. This finding was largely because of the long nature of the WMH Survey, in which the average interview length was 94 minutes for the long version and 64 minutes for the short version.In the case of On the basis of the investigation of triggered flags per interviewer, monitoring, corrective and preventive actions were taken. Although, in most cases, interviewers required refresher training sessions and feedback to improve their performance, several interviewers discontinued work owing to low productivity and a high number of triggered flags.high number of completes flags were triggered. After an in-depth investigation and based on the collected data, we found that some interviewers were working extra hours, completing more interviews, and being flagged without taking these factors into consideration. After accounting for extra hours, the number of these flags decreased from 85 to 18 .Developing new flags involved determining appropriate cutoffs adapted for the telephone interviewing mode. This was challenging because the previous phone interviews conducted at SESRI were not based on long and complex questionnaires, as was the case for the WMH Qatar Survey. In this regard, some flags required additional calculations to reflect various factors affecting the predetermined values. For instance, after 3 weeks into production, we discovered that many Microsoft Planner posed some difficulties at the start of the survey production phase in relation to documenting the flag investigation process, monitoring observations, and assigning corrective interventions. We initially allocated each flag a task on the Planner. This led to hundreds of tasks generated on a daily basis in the Planner, making it logistically impossible to review and prioritize the flags triggered. We decided to organize the tasks per interviewer instead and to generate weekly frequency for the flags triggered most often  rather than daily frequency.To mitigate the challenges faced during the design, implementation, investigation, and verification phases, the QC team proposed innovative solutions and experimental stages to address various factors affecting the survey QC process. Being one of the first studies in the WMH Survey consortium conducted using CATI mode during the COVID-19 pandemic, no prior evidence was available on how to incorporate QC procedures within these complex surveys. Available, but limited, literature from other parts of the world in relation to using CATI surveys  and web QC procedures were essential in conducting the WMH Qatar phone survey in the context of the COVID-19 pandemic. The IT team, the CATI laboratory team, and the research team collaborated to develop strategies to conduct and manage the QC procedures. Switching from the CAPI mode to CATI mode required a complete transformation of the previously established QC system. Initially, the CATI laboratory was based on a centralized call center, and because of the COVID-19 outbreak, the operations had to be switched to a decentralized call center. Various programs were introduced, such as CATI Time Tracker, developed by the SESRI IT team, to accommodate the requirements of phone surveying. Microsoft Planner was also used to provide justifications and document the actions taken by the research team and the CATI laboratory team.Developing new indicators customized for the phone mode of surveying enhanced the QC process. The flag investigation and verification of the interviewers’ performance shed light on how the interviewers conducted the telephone interviews and the QC standards followed during the data collection phase of the WMH Qatar Survey.Feasible methods of QC are a high priority for institutions and individuals conducting studies that involve data collection of sensitive and costly population-based surveys. QC measures may present a challenge for remote monitoring of interviewers’ performance. Our efforts to design and implement a survey QC system attempted to solve some of the challenges related to the phone mode of interviewing, especially when conducted remotely for large-scale and costly surveys. We also attempted to build a prototype of the QC system for phone interviewing that can be further used in our local research community. Our findings will help shape future QC procedures in similar studies in which a probability sample is designed under conditions of necessity. This is relevant for survey practice today more than ever because of the increasing demand to collect more quality data at a lower cost and its implications for health policies.


Intensified cleaning protocols to maintain a safe environment during the pandemic caused an increase in the use of disinfectants. The use of cleaning products in safer conditions by mothers is one of the important practices that will reduce the risk of household accidents.  The aim of research was determine the practices of mothers about the safe use of cleaning and disinfectant products in the COVID-19.  Data were collected by online survey among 255 mothers of the children 0-6 age from April and July 2021. Percentage, mean and chi-square tests were used to evaluate the data.  It was reported that the amount of cleaning product usage (69%) increased significantly, 26.3% of the mothers store the products in a locked cabinet and 29.4% use the product in the recommended amount. It was detected 28.7% of the mothers use disinfectants close to children. It was detected that 37.6% of the families were exposed to cleaning and disinfectant products. There was not significant difference between exposure situations and maternal age, education, employment status.  It can be suggested that health workers should organize screening and training programs for the community about safe cleaning and disinfection practices. Since the home and surrounding environment are basic living area for the children between 0 and 6 years of age, home accidents are particularly important for this age group. Home accidents are ignored unless they cause an injury that requires intervention in children. However, frequent minor injuries may also address serious injuries. Majority of home accidents is preventable. Therefore, it is important to reduce the risk factors that lead to accidents in the home environment . It was determined that the coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus may be transmitted through droplets and by touching the mouth, nose and eyes after contact with contaminated surfaces . Proper This is a cross-sectional and descriptive study. The universe of the study consisted of mothers of the children between 0 and 6 years of age living in different regions of Turkey, and the sample of the study consisted of 255 mothers who volunteered to participate in the study and whose questionnaires were sent online using the snowball sampling method. It was calculated in the power analysis that 234 mothers could be included when the effect size was taken as 0.19 according to the accident rates seen in children in the literature  the signThe question form for mothers’ use of home cleaning and disinfectant products during COVID-19 pandemic were used in the research.The Question Form for Mothers’ Use Of Home Cleaning And Disinfectant Products During COVID-19 Pandemic: This form which was prepared by the researchers in line with the literature , , . Since hCleaning products should be stored in their own packages. In this study, 9.8% of the mothers stated that they transferred their cleaning products to different containers such as bottles and glasses. However, this may cause mixing of cleaning products with drinks and food, and poisoning of small children in particular. Silva et al.  and GollThe fast transmission of the pandemic and causing death increase the health concerns of individuals, cause them to store cleaning materials and take more precautions regarding hygiene, cleaning and contact . The CDCThe CDC states that disinfection of objects and surfaces that are commonly touched after cleaning is important to reduce the risk of COVID-19. In our study, almost half of the mothers stated that they did not clean the dirty surfaces with a detergent before disinfection, and this indicates that they did not perform a proper disinfection process. Furthermore, since more than half of the mothers do not consider electronic items such as toys, electric switches, keyboards, remote controls which are frequently used during the pandemic as surfaces that need to be cleaned and disinfected frequently, this may cause virus transmission through these objects. Similarly, it was detected in a study conducted in Iran during the pandemic period that most of the participants have usually disinfected surfaces such as mobile phones, kitchen, bathroom, and toilet; however, this rate was limited for computers . It was detected in our study that approximately two of every five households were exposed to cleaning and disinfectant products during the pandemic, and mothers as well as their children at and below six years of age were most frequently exposed in these households. It was reported that exposure is most common by skin contact and inhalation of the product, less frequent by ingestion and eye contact. Koksoy Vayisoglu & Oncu  reportedIt was determined in our study that maternal age, education, employment status and the number of children living at home did not affect the exposure. However, it is stated in the literature that exposure to corrosive substances as a home accident is more common in societies with lower education levels. Gollu et al.  stated tBehaviors such as use of cleaning products more than recommended on the label, mixing different products are stated as hazardous behaviors. Mixing bleach with vinegar or ammonia releases chlorine and chloramine gases that may cause severe damage on the lung tissue . The useCDC recommends reading the instructions for use prior to the cleaning and disinfection, using protective equipment such as gloves and goggles, and ventilating the environment during the procedure . The useAnother hazardous behavior is the use of household cleaning products in inadequate areas. In this study, almost of the mothers used these products for hand and skin cleaning; however, a limited number of them used such products for food cleaning purposes such as gargling or adding bleach to the irrigation water of fruits and vegetables. Similarly, the previous studies conducted during the pandemic reported that these practices which have a higher risk are carried out in homes , 22]..22].The limitations of the present study include the inability to conduct a personal survey with parents and their children, since the research was conducted in a certain time period and the pandemic continued at the time of the study. Furthermore, another limitation is that only parents with online access were able to participate in the study. Therefore, it is recommended to make arrangements to include mothers/fathers with no/limited internet access in future studies. It was detected that the knowledge of the mothers on the safe use of cleaning and disinfectant products is insufficient and they are involved in hazardous practices that will adversely affect the health of themselves, their children and other family members. Safe cleaning and disinfection practices protect the health of the children and reduce the risk of exposure, not only during the pandemic, but at all times. Accordingly, it may be suggested that healthcare workers, especially nurses, should organize training programs by using innovative strategies  and scanning the whole society about safe cleaning and disinfection practices. It is recommended that nurses working in pediatrics plan regular training on parents of children between 0 and 6 years of age about protection from home accidents and raising awareness.The authors declare that they have no competing interests.We thank the mothers who participated in this study.th Forensic Nursing Congress” (16–18 May 2022) This study was presented as a oral presentation at the “International 6Approval was obtained from the Ethics Committee of the Institute of Health Sciences of a University (No. 2021/04-13).This study was not financially supported. 0000-0001-5803-0059Emine Güdek Seferoglu: 0000-0002-8677-0414Ümran Çevik Güner: