The Deadly Liver Mob (DLM) program is a peer-led health promotion program that aims to improve access to screening and treatment for blood borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians. In this paper, we used client and staff insights to explore the successes and challenges of implementing the DLM program according to the RE-AIM framework, which explores real-world implementation of interventions according to reach, effectiveness, adoption, implementation, and maintenance.Clients and staff were recruited through the DLM program. Semi-structured interviews were conducted with four Aboriginal and Torres Strait Islander and 11 non-Aboriginal or Torres Strait Islander health workers, as well as 33 Aboriginal and Torres Strait Islander clients of the program.Findings show the positive effects of the DLM program, in creating a culturally safe and sensitive environment for Aboriginal and Torres Strait Islander clients to access care. In particular, the employment of frontline Aboriginal and Torres Strait Islander workers to deliver the education was touted as one of the primary successes of the program, in enabling workers to build trust between clients and mainstream health systems, which has the flow on effect of encouraging clients to go through to screening. The use of the RE-AIM framework illustrates the challenges of implementing real-world interventions across various locations, such as the difficulties in delivering DLM in regional and remote areas due to covering large geographic areas with minimal public transport available.The data emphasise the need for interventions to be adaptable and flexible, altering elements of the program to suit local and community needs, such as by offering mobile and outreach services to enable access across regional and rural areas. The findings of this evaluation have been used to develop tools so that the learnings from DLM can be shared with others who may be hoping to implement DLM or other similar programs. This paper presents on qualitative data from a mixed-methods evaluation of the Deadly Liver Mob (DLM) program, a peer-driven, incentivised health promotion program, which first began as two pilot sites in 2013 and 2015 in New South Wales, Australia. The aim of the program is to provide a culturally safe, sensitive, and appropriate way to increase access of Aboriginal and Torres Strait Islander peoples to testing and treatment for blood borne viruses (BBVs) and sexually transmissible infections (STIs) at mainstream needle and syringe programs (NSP) and sexual health services. First, we provide a review of the data on rates of BBVs and STIs among Aboriginal and Torres Strait Islander communities, which provides the background context and rationale for the establishment of the DLM program. We then provide an overview of the DLM program model, before turning to the methods and findings from qualitative interviews with DLM clients and staff.Census data indicate that in 2021 there were approximately 812,728 Aboriginal and Torres Strait Islander people in Australia, representing 3.2% of the total population . Data alWard and colleagues  argue thOther individual and systemic barriers that may impede the access of Aboriginal and Torres Strait Islander peoples to primary health services include limited knowledge about BBVs and STIs, limited skills among health providers to effectively communicate with Aboriginal and Torres Strait Islander people about BBVs and STIs,The DLM program was introduced in 2013 as a pilot program in one publicly funded NSP, followed by a second pilot site in 2015. The program aimed to overcome systemic barriers to mainstream health care participation faced by Aboriginal and Torres Strait Islander communities by providing a culturally safe, sensitive, and appropriate pathway to engagement in the service. The DLM program is modelled from a program known as the Safe Injecting Cwiz (SIC), which was implemented in Western Sydney, New South Wales between 1998–2002, targeting people who injected drugs and were under the age of 25 years –23.The DLM program is for Aboriginal and Torres Strait Islander people, and Aboriginality is determined by the local Aboriginal and Torres Strait Islander DLM workers and in accordance with community principles. Additional eligibility criteria for the DLM program are that clients must have ever or currently inject drugs OR are classified as ‘at risk’ for injecting drug use, BBVs, or STIs. ‘At risk’ in the program is defined as people who have a prison history, unsafe tattoo, or that they are living with a person/people who inject drugs or who have/have had HCV. Aboriginal and Torres Strait Islander clients who enter the program are educated about viral hepatitis then offered screening and any relevant treatment for BBVs and STIs, as well as vaccination for hepatitis A (HAV) or hepatitis B (HBV). The program is unique in that it was developed, implemented, and evaluated in partnership with Aboriginal and Torres Strait Islander people, for Aboriginal and Torres Strait Islander people.At each stage of the program, clients are offered nominal incentives: education, recruitment of peers, screening, treatment for STIs, and vaccination for HAV and HBV  employed at the Centre for Social Research in Health, UNSW Sydney. Consent for interviews was obtained via telephone and clients were provided with a voucher to compensate them for their time. Interviews were audio-recorded and transcribed by a professional transcriber operating under a confidentiality agreement.Health staff who were involved in the development and implementation of the DLM program were also invited to take part in semi-structured interviews to speak about their experiences of the scale-up and implementation. Staff who were interviewed included frontline Aboriginal and Torres Strait Islander workers, program managers, and sexual health clinicians. Interviews with Aboriginal and Torres Strait Islander staff were conducted by Aboriginal researchers , while interviews with non-Aboriginal or Torres Strait Islander staff were conducted by a non-Aboriginal or Torres Strait Islander staff member from the Centre for Social Research in Health, UNSW Sydney. Staff were not provided with vouchers or monetary compensation. Interviews were audio-recorded and transcribed by the same professional transcriber as the client interviews.All potentially identifying information about staff and clients were removed from the transcripts. We analysed the transcripts in relation to the components of the RE-AIM framework, which are Reach, Effectiveness, Adoption, Implementation, and Maintenance. We were interested in exploring the perspectives of health staff and clients about the expansion of the program to new sites, including the ability to implement the program as intended, the positive and negative impacts of the program, and whether the program could be absorbed within the site as part of routine everyday practice. Following initial data analyses by the first author (EC), analyses and interpretation were workshopped with Aboriginal  and non-Aboriginal  authors. We only identify participants according to whether they are Aboriginal and Torres Strait Islander or non-Aboriginal or Torres Strait Islander, and staff or clients, due to the risk of identifying participants if we were to provide further information.The sample consisted of four Aboriginal and Torres Strait Islander and 11 non-Aboriginal or Torres Strait Islander health workers, as well as 33 Aboriginal and Torres Strait Islander clients of DLM. Health workers were involved in various elements of DLM, such as the development and implementation of the program, and delivery of the program, such as Aboriginal and Torres Strait Islander frontline workers and clinical staff providing sexual health screening.In relation to reach, we were interested in the ability of the DLM program to bring clients into the program. Elsewhere, we have outlined the numbers of clients entering and progressing through the DLM program , and herIt’s about your clients and the community and feeling safe and comfortable, to suss you out, know that they have come to talk to you on other things and they might do that, and then once they know that they feel safe and comfortable with you, then they’re more likely to go through the education and maybe even screening. The expectation is to be able to get as many Aboriginal mob coming through the door so that they can be screened and hopefully prevent like preventable illnesses and for us to be spreading the word in the community and accept within the community that it’s a safe place to come and have a yarn about their business. A culturally appropriate or safe program would be one that develops trust and respect between health systems, health workers, and Aboriginal and Torres Strait Islander peoples . To imprWe’ve got both a male and female Aboriginal sexual health worker and I believe having both was beneficial for the education and, you know, progressing people into screening following that education… I think it stems back to again in [this community], a bit of the men’s business, women’s business. Clients described that staff were friendly and non-judgemental, providing a safe space for them to discuss health concerns and injecting drug use history. As one client said, ‘Because they are nice to you and they don’t judge you and they just like tell you as it is sort of thing.’ (DLM client). Although this was not logistically possible at all sites, those sites that were able to employ both a male and female Aboriginal or Torres Strait Islander worker were seen as best practice in accordance with community principles.I think if you didn’t have the vouchers, no one would pull up and have the time to check themselves, you know. Yeah, that’s what I reckon, so it’s a good thing, because that will push them to come along. (DLM client)I reckon it’s a great incentive, the best one. It does encourage people you know, not only to get themselves sorted out, they can get a little bit of tucker [food] with the vouchers too and they can walk away and go, “I might have had a blood test, but I’m eating well tonight”. Some people can’t live right, eat right or can’t budget their money right and that voucher there, gives them that incentive to buy a bit of tucker. (DLM client)Vouchers are a big draw card. Some places were good, because some of the outreach places we worked at, once someone came in that knew about the vouchers and that, they went out and grabbed other people who came in and then they went out and grabbed more people, so that was a really good thing. The DLM program provides clients with incentives to progress through the program, from education, to screening, returning for results, and receiving any required HAV or HBV vaccination or treatment for STIs. Financial incentives have been shown by previous research to be effective in altering health behaviours and increasing uptake of health interventions, particularly in low- and middle-income countries –38. Alth[W]hat didn’t work was when trying to get them back for … because their phone numbers change and stuff like that, so it was trying to get them back for their results or they come in for their results. Many people we see don’t have telephones… that can be quite hard and a challenge for us [to follow up]. Health systems must overcome individual and systemic barriers to health care access for Aboriginal and Torres Strait Islander Australians .Getting it out there more, yeah more advertisement so that if something does come up, I tend to let people know and really I’d like to see more of them, yeah. It’s a good little thing. (DLM client)[I]t could be in other places, because some people don’t access this centre… I guess having various locations, because you know a place this big… So it would be good to have various locations within a place, more central where people have got to go in and do their business elsewhere could be you know close by for example like a Centrelink place maybe or a place where people go for you know business, their own business, shopping maybe. (DLM client)The second key barrier for reach was the ability to deliver and promote the program in regional and remote areas. For instance, in regional and remote areas, there may only be one site and travel distances to the site might be significant, which presented a barrier to clients if they did not have transport to the service. As one Aboriginal or Torres Strait Islander DLM worker described, ‘if they didn’t have transport, how could they actually get down to the venue to see me? So, there are a lot of struggles in terms of where people live and what sort of transportation they have and being out in the [remote area], even public transport is just almost non-existent.’ As will be described later, some sites ran outreach into regional and remote areas in order to increase the reach of the program, although this can come with its own challenges (such as ensuring clients are provided with results from BBV and STI screening). Some clients also believed that DLM should be run in multiple locations, to provide clients with options for where to attend. They also believed that running the program in high density sites, for instance close to Centrelink locations , would improve the reach of the program. Further, clients suggested that greater advertising could be done to more widely promote the program.I thought it was really good that they were educating people on how you can catch it and what you could catch it from and how you can treat it and where you can get it treated… So they gave me the confidence to be able to go and get treated and go and get the tests done and stuff like that and the liver function test and everything, so yeah. (DLM client)I think they are very nice, very open minded, never judgmental and they make you feel comfortable… And that’s what keeps me coming back and I feel comfortable with this and even just getting the blood taken, when I got the blood taken, that’s a big thing and just having that atmosphere in the room at the time, yeah, it’s a lot smoothing and helpful. (DLM client)It’s about your clients and the community and feeling safe and comfortable, to suss you out, know that they have come to talk to you on other things and they might do that, and then once they know that they feel safe and comfortable with you, then they’re more likely to go through the education and maybe even screening. The DLM program aims to increase access to testing and treatment of BBVs and STIs, including provision of education to clients on topics such as HCV and injecting equipment sharing. Elsewhere, we have described data on clients’ progression through the stages of the program . In inteWhile the focus of DLM is specifically on BBVs and STIs, Aboriginal and Torres Strait Islander workers described an additional benefit of their presence, which was that it could allow clients to speak about other health issues that they were facing. For sites with good connections with other mainstream health and social services, there were good referral pathways to ensure that clients could address these other needs. Due to political, cultural, and social determinants of health, Aboriginal and Torres Strait Islander communities face significant health disparities, including high prevalence of chronic health conditions such as diabetes, heart and liver disease, and cancer, contributing to a gap in mortality among Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander Australians . Thus, tI think having an Aboriginal person who is safe and comfortable without feeling pressured or judged or anything else, to be able to talk about stuff… The client will come up and once they start feeling comfortable with you, they are going to start talking about everything else and then before you know it, you actually try to work with them on all the other issues that are not yours, particularly in like that sort of community, being in a far, you know, what they call a rural/remote community… You try to do what you can, you try to make phone calls and maybe take them to the other service as a one-off to help build that relationship with that other service… We see it at a holistic level and if we can tap in and try to put that person to access those other services that are required. .I think it’s great. I mean whatever works really. That’s my overall impression is, is whatever works, works and you know some people might say that giving money is not the right way to go about things, but I disagree, I think if they can come in and they get a good meal that otherwise wouldn’t, then that’s a positive experience that they relate to health care in itself. The provision of incentives for participation in health programs is potentially divisive for some health staff. In the pilot program, some staff expressed concerns about the use of vouchers as ‘bribing’ clients to undergo education and screening . FollowiIt was more the education [than the incentives] and I think the people who were involved with it at the time, they were just really supportive, really open and more like a friend… Yeah, because they are just really nice, kind people that are kind hearted… Not judgmental at all you know, they will give you a cuppa, they will have a yarn with you. (DLM client)Definitely the incentives bring people in, but it’s not just … it doesn’t seem to be just the incentive because people want to be screened anyway once they’ve heard about it. I think too, family members that are perhaps Aboriginal and not injecting drug users, but they know somebody, so that attracts them to bring … interest to bring their family members or people they know to come and learn more about hepatitis C and be tested. Although incentives were considered to play an important role for getting clients into the service, staff also described that Aboriginal and Torres Strait Islander clients wanted to be involved irrespective of the incentives once word spread about the program. Thus, incentives were just a ‘bonus’  to clients becoming involved. Further, clients remained engaged in the program for other reasons beyond incentives, such as the relationships built with Aboriginal and Torres Strait Islander staff and the increased levels of trust in mainstream health system following their experiences with DLM. In particular, clients described coming back due to the relationships established with DLM workers, who were described as supportive and like a friend.[Y]ou get hit hard and fast… and then it’s more of a trickle effect because you have almost plateaued at who you can recruit for that site if that makes sense. [W]e saw lots of clients and they came back and I would say it was very successful, but obviously what we’ve found with time is that in some ways we started to our exhaust those numbers. Where metro sites had great success in seeing early and steep increases in the numbers of Aboriginal and Torres Strait Islander clients accessing the service, these numbers tended to plateau over time. Conversely, progress was slower in rural and regional sites. It’s important to carefully consider how ‘success’ is defined in programs such as DLM given contextual factors : for exa[I]f you don't have an Aboriginal sexual health or Deadly Liver Mob worker directly located near one of the clinics, it can be a little difficult to maintain engagement with the client to get them tested, so the part from recruiting into DLM from NSP to getting them across to the site for testing. Adoption is concerned with the settings in which the intervention is implemented, and the people who deliver the intervention . The DLM[T]he availability to deliver the clinics in a community setting, so from a hub, we have a community hub which is based out in where a lot of the Aboriginal people live in [social] housing, so obviously the need for an Aboriginal worker to go out and access community, so we would run that clinic from that hub, where I would go out, knock on doors, have a yarn and talk about the program and bring them back, … I think what worked well is being able to provide that clinic each week out there, so the mob knew where it was. [T]hey [DLM frontline workers] have done [some sites] to saturation with the occasional trickle you know what I mean, but not worthy of putting resources sitting there all day waiting for one punter a week you know what I mean? So I told them to go mobile to other sites… [We’re] getting really good results, but no doubt will hit saturation points there. Hence why we have decided that the people that we really need to get to are the ones that don't turn up at NSPs, so we think the mobile unit will be you know, will probably enhance access out at communities. [W]e’re going to have to find new ways of reaching out, so we’re just about to start a DLM program down at [a hospital]… and it’s got a clinical room and once our new worker is on board, we will be looking at having a DLM program down there, maybe twice a month with one of our nurses and we’re also looking at setting up in another NGO down there, so yeah, we’ve got hopes Staff also reflected on how they had to be innovative with their recruitment approaches, particularly once the initial increases seen following introduction of DLM began to stabilise over time. This included recruiting through Aboriginal and Torres Strait Islander festivals, men’s groups, and post-release from incarceration. One worker described the program as having ‘portability to enhance access’ , with potential to move around during NAIDOC  week, which celebrates the history and culture of Aboriginal and Torres Strait Islander peoples in Australia. The below excerpts highlight both the strategies that sites had already taken to improve Reach and diversify Adoption, as well as how sites were continuously brainstorming how to do so moving forward.Within the RE-AIM framework, the dimension of Implementation is partly concerned with whether staff deliver the program as originally planned or intended . To mainNow, another barrier that we sort of had but we managed to work our way around was when we first started talking about the incentives, the [mainstream supermarkets] sort of vouchers were the way we ended up going, but when we started doing more outreach, so again the location, for example, when they started doing the outreach once a month and we were offering the Deadly Liver Mob there, there’s no [mainstream supermarket] out that way, so we had to negotiate with the local [supermarket] to participate in the project. In designing and implementing the DLM program, all sites stressed the need to be flexible and adaptable, and to tailor the program to meet local community needs. This was in recognition that not all materials and strategies would work across all sites, particularly given the geographic spread across metro and regional and rural areas of the state. Thus, sites also needed to use local resources and referrals during education sessions, as well as make alterations to the program in circumstances where the original model was not working well. For example, metro sites were provided with incentives vouchers for mainstream supermarkets, however this was not appropriate for rural areas which did not have a nearby mainstream supermarket. For these areas, vouchers for other stores, such as smaller chain supermarkets, were provided.I think it’s a worthwhile reason. I know in other areas, they have possibly changed the incentive schedule because, you know, because cost of travel or the distance to travel was so much that the incentive wasn’t worth it for people. So, they’ve tried to make the incentive more of an incentive, you know what I mean, so that people will come back. Some sites also altered the incentive amounts that they were providing to clients. Although the overall maximum incentive amount remained the same, these sites provided a lower amount for education and a higher amount for screening and returning for results. This was due to drop off rates in people returning for screening and results for various reasons, such as travel distance , travel costs, and parking availability at the site. As one Aboriginal and Torres Strait Islander DLM worker noted, ‘It’s a very busy little street too during the day time… a lot of people get dropped off and run in and grab their [injecting equipment] really quick, so that’s why they weren’t sticking around.’ Thus, incentive amounts were varied to try to encourage clients to return given the importance of providing clients with screening and results.Probably the only difficulty for us is trying to sustain the gift vouchers. If we could somehow work out a way to sustain the gift voucher costs within our budget, I can see absolutely no reason why DLM shouldn’t keep continuing…. [The funding is] all coming out of this research program, but once the research is completed that would be something that I think we will have to build in and work out how to build that in. The other thing with DLM I think you really need to have Aboriginal workers… to be able to do it. The dimension of Maintenance is largely related to the sustainability of the intervention. This was a core concern for the DLM program, as the grant scheme for the evaluation funded the incentive vouchers for some of the sites for the duration of the evaluation period. Thus, there were concerns about the sustainability of the model beyond the life of the evaluation, when such funding would no longer be available. Staff suggested that services would need to find ways to sustain the incentive vouchers beyond the evaluation, and within their regular budget. It’s important to note that some sites covered the costs for incentive vouchers throughout the evaluation, and thus this aspect of sustainability was only of concern to those sites who had received funding assistance as part of the evaluation.I think the need is much greater than what we are able to meet at the moment… We know that all the area health services have limited budgets and yet Aboriginal health continues to be a priority both under Federal and State Governments, but still the money is just not being made available to demonstrate that they think it’s a priority. There were additional concerns about staffing, including recruitment, retention, as well as securing ongoing funding for a designated Aboriginal or Torres Strait Islander worker. For Aboriginal and Torres Strait Islander workers, they described the need for more identified Aboriginal and Torres Strait Islander positions, as well as permanent roles rather than short-term contracts. For instance, one Aboriginal or Torres Strait Islander worker described at the time of the interview being unsure whether their contract would be extended and whether they would have a job at that time. Despite Aboriginal and Torres Strait Islander people being a priority population within the national and state BBV and STI strategies –47, and We’ve had some staff changes over the time with the Aboriginal position… it’s tricky, it’s a reasonably small workforce that we can tap into and because we are also looking for somebody with project management skills as well as direct client skills. Throughout the evaluation, there were also disruptions to the implementation of the program due to staff changes or staff unavailability. To overcome some of these issues, in very rare cases, some sites had a non-Aboriginal or Torres Strait Islander staff member cover the DLM program. However, this was only to cover if the Aboriginal or Torres Strait Islander DLM worker was unavailable on the day that the DLM program was run and did not apply to circumstances where the staff member took a longer-term absence or had left the position. In instances where the DLM worker had left the position, DLM was not operational until a new Aboriginal or Torres Strait Islander worker was recruited to the position, which in some cases led to months where the program did not run. These disruptions were further exacerbated by the COVID pandemic, where DLM did not run for several months in any of the sites, particularly in 2021 when outbreaks extended to Aboriginal and Torres Strait Islander communities and staff were required to assist in COVID-related activities.And every community is different, every mob is different, what works in one might not work in another, but it definitely has to be more flexible. I think DLM should be broadened.… I don’t DLM should just be for NSP. I think scaling up of DLM should be across liver clinics, NSP and sexual health services. I think you would get a lot greater compliance with education, testing and diagnosis and treatment if it was across all three. Given many of the challenges faced by DLM, which have been detailed in the preceding sections, staff stressed the importance of the DLM model being adaptable and flexible. For instance, Aboriginal and Torres Strait Islanders described how every community is different, and the program may need to be adapted to meet the needs of each local community. The benefit of the program was the ability for it to be mobile, with staff able to conduct outreach into communities. However, Aboriginal and Torres Strait Islander workers were cognisant that much more could be done. Both Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander staff indicated that more could be done to address BBVs and STIs in communities, such as by undertaking dried blood spot testing (and ensuring that the frontline staff were trained to do so), advertising the program more widely, doing greater outreach, and broadening the delivery of the program beyond NSPs and sexual health to liver clinics and other settings. Further, as one Non-Aboriginal or Torres Strait Islander worker noted, ‘the potential would be taking the existing model as it works and trying to increase that geographically to the areas where that’s not happening at the moment.’[W]e ripped off the methodology, thank you very much, with a view to looking at broader issues around diabetes, smoking and anxiety I guess you could also adapt and apply it for many different things. You know, obviously at the moment it’s STI’s, BBI centred, but you could have exactly the same model for diabetes, you know chronic care, other chronic care issues like heart disease, smoking, those sorts of things, there’s no reason it has to stay just within that small realm of BBI’s and STI’s, especially since we know unfortunately so many of the clients who we see here, have got many complex comorbidities in health. Beyond BBVs and STIs, staff suggested that the DLM model could be broadened to address a range of chronic health conditions that disproportionately affect Aboriginal and Torres Strait Islander communities. In some instances, the DLM model was used to inform the development of other programs run by the sites. This has allowed for the continuation of the intervention, albeit not necessarily in the original form it was intended. For instance, one site used learnings from DLM to inform the development of a broader intervention for Aboriginal and Torres Strait Islander clients on a range of health issues. Some of the learnings from DLM included having a designated Aboriginal or Torres Strait Islander worker, how or where clients would be recruited from, and how clients could be followed up over time. This should not be viewed as a failure of the program, but rather show the potential for an intervention such as this to be scaled up and implemented to address a broader range of health concerns.This paper uses DLM staff and client insights to reflect on how the DLM program applies to each of the dimensions of the RE-AIM framework for interventions. RE-AIM is a useful framework when examining interventions, given that it provides the opportunity to examine how the intervention was intended to be implemented against the messy, real-world implementation of programs. Our findings illustrate this point in relation to mainstream NSP and sexual health services. The DLM program was originally designed to be run at two pilot sites, with the NSP and sexual health services closely co-located, to facilitate referral pathways for BBV and STI screening and treatment. However, when scaled up and expanded across several new sites, our findings highlight the need for adaptability and flexibility of the program to suit the local context and community needs. For instance, new sites did not necessarily have co-located NSP and sexual health services and required solutions (such as transporting clients) to this disjoint between education and screening in order to ensure a smooth referral pathway. In another example, new sites were faced with challenges like travel distances  and parking difficulties, resulting in the site running outreach programs and altering the incentive payment amounts provided to clients to try to encourage clients to return for screenings, results, and vaccination or STI treatment. Sites also faced other challenges such as ensuring clients returned to progress through the program, such as to receive their results. This challenge may be resolved in future with the development of effective point-of-care testing for BBVs and STIs (see ).Despite the challenges of scaling up and implementing the program, the findings documented in this paper highlight the numerous benefits of the DLM program in facilitating relationships between Aboriginal and Torres Strait Islander people and mainstream health services. Having frontline Aboriginal and Torres Strait Islander workers was seen by staff and clients to be critical in creating a culturally appropriate and safe environment and attempting to rebuild trust in mainstream health systems. The initial introduction by Aboriginal and Torres Strait Islander workers was perceived as engendering positive first interactions with mainstream health services , which could encourage clients to return for repeat health interactions in future beyond engagement in the program. Further, incentivising engagement in a health promotion program may be considered to be controversial for some, however, our data show that such incentives are effective in at least getting clients to first attend the service. It is the relationships built with health workers, however, which sustain their attendance over and above these incentives. As we have demonstrated here and elsewhere , 30, theThis study is limited by the self-selecting sample of DLM clients and staff. Originally, we intended to recruit a range of clients from the service, including those who had dropped off at various stages of the DLM program or those who refused to participate in the program. Ultimately, we were unable to engage these clients, and thus their perspectives were not included in this research. Future iterations of the program and evaluation should seek to obtain broader perspectives of the program to examine barriers to engagement in DLM and opportunities for improvement.https://www.deadlylivermob.org). The findings from this paper and others  [By documenting the challenges (and positive outcomes) from implementing the DLM program, we hope to share the learnings from these nine sites with others who may be considering implementation of DLM or other similar programs targeted at Aboriginal and Torres Strait Islander communities. To further assist those who may be interested in implementing DLM, we have developed an implementation toolkit with further resources and templates to guide this process (see  review) , 49 show


Numerous studies have demonstrated that exposure to caregiver intimate partner violence (IPV) can have cascading negative impacts on children that elevate the risk of involvement in dating abuse. This cascade may be prevented by programs that support the development of healthy relationships in children exposed to IPV. This paper describes the results of a study of the web-based adaptation of an evidence-based dating abuse prevention program for IPV-exposed youth and their maternal caregivers. Core information and activities from an evidence-based program, Moms and Teens for Safe Dates, were adapted to create the web-based program (e-MTSD), which comprises 1 module for mothers only and 5 modules for mother-adolescent dyads to complete together.The primary objective of this study was to evaluate the feasibility and acceptability of the e-MTSD program and the associated research processes. We also examined the practicability of randomizing mothers to receive SMS text message reminders and an action planning worksheet, which were intended to support engagement in the program.Mothers were recruited through community organizations and social media advertising and were eligible to participate if they had at least one adolescent aged 12 to 16 years of any gender identity who was willing to participate in the program with them, had experienced IPV after their adolescent was born, and were not currently living with an abusive partner. All mothers were asked to complete the program with their adolescent over a 6- to 8-week period. Participants were randomized to receive SMS text message reminders, action planning, or both using a 2×2 factorial design. Research feasibility was assessed by tracking recruitment, randomization, enrollment, and attrition rates. Program feasibility was assessed by tracking program uptake, completion, duration, and technical problems, and acceptability was assessed using web-based surveys.Over a 6-month recruitment period, 101 eligible mother-adolescent dyads were enrolled in the study and were eligible for follow-up. The median age of the adolescent participants was 14 years; 57.4% (58/101) identified as female, 32.7% (33/101) identified as male, and 9.9% (10/101) identified as gender diverse. All but one mother accessed the program website at least once; 87.1% (88/101) completed at least one mother-adolescent program module, and 74.3% (75/101) completed all 6 program modules. Both mothers and adolescents found the program to be highly acceptable; across all program modules, over 90% of mothers and over 80% of adolescents reported that the modules kept their attention, were enjoyable, were easy to do, and provided useful information.Findings suggest the feasibility of web-based delivery and evaluation of the e-MTSD program. Furthermore, average ratings of program acceptability were high. Future research is needed to assess program efficacy and identify the predictors and outcomes of program engagement. Numeroun of IPV , may be n of IPV ,4. Furthn of IPV .The MTSD program comprises a series of booklets with activities for mothers and their 12- to 16-year-old adolescents to complete together that are designed to foster a family environment that protects against adolescent dating violence. A randomized controlled trial (RCT) of the MTSD program conducted in 2012 found that the program was effective in increasing family cohesion and preventing dating abuse among youth with high, but not low, levels of IPV exposure . The resTo address these dissemination and implementation barriers, we developed a web-based MTSD (e-MTSD) program . In addiThe overarching goal of this study was to determine whether the e-MTSD program was appropriate for further testing. This study has 3 main objectives. First, we examined the feasibility of the research process used to evaluate the program. Limited research has sought to evaluate programs for caregiver-adolescent dyads using web-based recruitment, assessment, and program-delivery methods. Therefore, a better understanding of the practicality of the proposed research processes may inform future evaluation efforts. Second, we assessed the acceptability and feasibility of the e-MTSD program. Acceptability was defined as participants’ “emotional and cognitive responses to the program” . FeasibiMother-adolescent dyads were recruited for the study via social media posting and information dissemination through community agencies  and educational institutions  that work with or provide services to mothers and IPV survivors. Mothers residing in the United States were eligible to participate if they (1) had at least one 12- to 16-year-old child of any gender identity who lived with them at least part of the time; (2) had experienced IPV at some point in their lives after at least one of their 12- to 16-year-old children was born; (3) were not currently living with an abusive partner; (4) were able to read and speak English; (5) had access to an internet-enabled device; and (6) were able to receive SMS text messages. Mothers who had more than one age-eligible child were asked to select 1 child to participate in the study together with them.Recruitment materials were directed at mothers of children aged 12 to 16 years. Recruitment messages were positive and gain framed, focused on the benefits of the program for “helping mothers prepare teenagers to engage in healthy relationships.” Messages explicitly stated that the program was developed for mothers or maternal caregivers who had experienced domestic violence in the past and had a 12- to 16-year-old adolescent. We used a multimethod recruitment plan that included a range of outlets . Study advertisements directed individuals interested in participating in a link where they could complete a web-based prescreening questionnaire and provide contact information and permission to be contacted. In addition, materials included the study phone number, email, and web address for a recruitment website that included more information about the study procedures and directed interested individuals to the eligibility screener link. The research staff reviewed prescreening questionnaires and attempted to schedule a study orientation via telephone with mothers who were screened as potentially eligible and provided consent to be contacted. Mothers who were contacted by phone were administered a standard set of questions to confirm eligibility, and those who were eligible were provided with study details and asked to confirm their interest in enrollment. All study communications  were conducted with potentially eligible or enrolled mothers. The research staff did not collect contact information or directly communicate with potentially eligible or enrolled adolescents. Mothers who indicated that they were interested in enrolling were sent an electronic consent form to complete as well as an electronic assent for their adolescent to review and complete. Once the consent and assent forms were completed, mothers were sent a link to a baseline survey to complete as well as a link to a separate baseline survey for their adolescent to complete. Eligible mother-adolescent dyads who completed the baseline surveys were enrolled in the study.Mothers who logged into the e-MTSD program were directed to view a brief onboarding video explaining the program and then complete the Getting Started module, which is designed to prepare and motivate mothers to complete the program with their adolescent. At the completion of the Getting Started module, mothers were instructed to complete the remaining 5 program modules together with their adolescent. These modules included information and interactive activities designed to increase mother-adolescent positive communication about healthy and unhealthy relationships and reduce the adolescent’s risk of experiencing dating violence. All mothers who enrolled in the study were asked to complete all 6 modules of the e-MTSD program together with their adolescent over a 6-week period, with a 2-week grace period allowed for families who were unable to comply with this schedule . One week before losing access to the program (day 49), all participants were sent an email and SMS text message reminder that their access to the program was going to expire. For additional details on the e-MTSD program development process, content, and structure, see the study protocol paper .All enrolled mothers, regardless of group assignment, were provided information on how to access and log in to the program via email and were sent a welcome text directly from the web-based program. In addition, mother-adolescent dyads were randomized to 1 of 4 “adherence support” groups (conditions): text reminders only (TR), action planning only (AP), text reminders plus action planning (TRAP), or low adherence support (LA). We randomly assigned participants to conditions to determine whether it was feasible to deliver different combinations of support to participant dyads in anticipation of potentially testing the main and interactive effects of different supports on engagement outcomes  in a future RCT.All mother participants who had been sent onboarding information and who did not log in to the program and complete Getting Started (the mothers-only module) received up to 3 reminders via text 3, 7, and 10 days after enrollment. These reminders prompted mothers to log in and offered technical support if needed. Mothers could text back in response to these reminders to solicit technical support by logging in to or navigating the program. All mother participants who had not completed the program 49 days after enrollment were sent a notification that their access to the program would end in 7 days and were offered technical support if needed.”) and offer technical support. Mothers assigned to the AP and TRAP conditions were provided with a modified version of the onboarding information that asked them to complete a brief electronic form before logging into the program that prompted them to make an “action plan” for where and when they would complete the program and identify how they would overcome barriers to engaging with the program.Mother participants in the TR and TRAP conditions received up to 8 tailored messages at fixed intervals. Messages 1, 2, and 3 were sent 3, 7, and 10 days after the onboarding information and welcome text were sent. Messages 4 through 8 were sent every 7 days thereafter until the program was finished. Reminders were tailored based on whether the dyad was on track with respect to the recommended completion rate of 1 module per week. Those who were on track or ahead of schedule were sent a congratulatory message. Those who were behind schedule received messages that aimed to motivate engagement . Informed consent was obtained from maternal caregivers, and assent was obtained from adolescent participants. All study communications were with maternal caregivers and not directly with adolescents. Mothers were asked to ensure their adolescent’s privacy when completing the web-based surveys. All data were collected and stored using secure servers, and data were deidentified before analysis. Participants were compensated with a US $30 gift card upon completion of baseline, program completion, and completion of follow-up surveys .Mother and adolescent participants completed brief module acceptability surveys, which were embedded in the e-MTSD program at the end of each program module (n=6 surveys). In addition, participants completed web-based surveys at baseline and at two additional assessment points: (1) immediately after program completion or, if the program was not completed during the exposure window, 56 days after enrollment (postprogram survey) and (2) 90 days after enrollment (follow-up survey). Questions within the postprogram survey were tailored depending on (1) how much of the program had been completed and (2) adherence support group assignment. Specifically, participant dyads who had not completed the program were asked about barriers that may have prevented them from engaging with the program. Mother participants assigned to the text reminder and action planning condition were asked about the helpfulness of these adherence supports.e-MTSD is designed for participants to move sequentially in a forward progression through 6 modules with the ability to return to completed content. To track program use, we assigned a number to each page in the program sequence (n=107) and classified each page as providing an introductory video, an interactive activity, information only, or a module completion survey. Web paradata on program use were collected for all participants who logged into the program (n=100) and included three variables: (1) the participant’s identification number; (2) the visited URL, which corresponded to a page number in the program sequence; and (3) the date and time the page was accessed. There were 13,170 data points in the use database for all the participants. The mean by participant was 131.7 . There were 4473 duplicate page views . We used this database to create indicators of program uptake, use, and duration (described in subsequent sections).Mother participants reported their relationship with the adolescent participating in the study with them, age, self-identified race and Hispanic ethnicity, highest level of education, whether they were currently living with a partner, and whether they had ever petitioned for a domestic violence protective order. To assess family financial stress, mother participants were asked, “Thinking about the next month, how worried are you that you and your family will have difficulty with having enough to eat?” . ResponsAdolescent participants reported their age, self-identified race, Hispanic ethnicity, gender identity , sexual We calculated the recruitment rate as the average number of potentially eligible participants  recruited per month. The enrollment rate was calculated as the percentage of participant dyads confirmed eligible (via telephone screen) who enrolled in the study . The randomization rate was calculated as the proportion of enrolled participants who were correctly randomized to an adherence support condition. Retention rate was calculated as the percentage of participants eligible for follow-up who completed the postprogram and follow-up surveys.We assessed the delivery of SMS text messages via the program completion survey by asking participants in the SMS text message support conditions whether they had or had not received SMS text message reminders to complete the program. Delivery of action planning was assessed by calculating the proportion of mother participants assigned to the AP and TRAP conditions who completed the action planning form.For the baseline survey, which was the longest survey used in this study, we assessed the following: (1) the percentage of missing data for each item in the survey, (2) the percentage of missing items for each respondent, and (3) the time taken to complete the survey.We defined program uptake using two indicators: (1) the proportion of enrolled participants who logged in to the program at least once and (2) the proportion of enrolled participants who completed module 1, indicating that the participant mother had started the program with their adolescent.Program use was operationalized as the percentage of modules completed, and program completion was operationalized as whether a participant had completed all program modules. A module was coded as completed if the participant was recorded as having visited all the unique pages in the module.Following previous research, we operationalized duration as the overall time spent to complete a module and the full program . e-MTSD Technical problems were assessed in each module completion survey via a question that asked whether participants had experienced technical problems using or accessing the website and via an open-ended follow-up question asking what technical problems occurred.Primary indicators of acceptability cover each of the domains specified in the Theoretical Framework of Acceptability, including affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy . ResponsIn the postprogram survey for mothers, participants assigned to the TR and TRAP conditions were asked how helpful the SMS text reminders were for them to do the program with their adolescent. We coded responses such as “very helpful” and “somewhat helpful” as 1 and responses such as “not at all helpful” and “not very helpful” as 0. In addition, participants were asked if they felt that the number of SMS text messages received was “too many,” “just the right number,” or “too few.” Participants who were assigned to the AP and TRAP conditions were asked how helpful or not helpful it was to make the action plan before completing the program. We coded responses such as “very helpful” and “somewhat helpful” as 1 and responses such as “not at all helpful” and “not very helpful” as 0.The characteristics of mother  and adolNearly all mother participants  reported that they were the participating adolescents’ biological or adoptive mother. Approximately 9.9% (10/101) reported that their highest level of education was high school or less and 24.8% (25/101) reported being somewhat or very worried about their family having enough to eat in the next month. Most mother participants  reported that they had petitioned for a domestic violence protective order, 94.1% (95/101) reported having experienced psychological IPV, 84.2% (85/101) reported that they had experienced physical IPV, and 65.3% (66/101) reported that they had experienced sexual IPV.The median age of the adolescent participants was 14 years, and age was approximately evenly distributed across the age range in the sample (12-16 years). Approximately 17.8% (18/101) of adolescent participants reported their race and ethnicity as non-Hispanic Black or African American, 14.9% (15/101) reported as Hispanic or Latino 46.5% (47/101) reported as non-Hispanic White; and 20.8% (21/101) reported as non-Hispanic multiracial or “other” race. Approximately one-third  of the adolescents identified as male; 57.4% (58/101) identified as female; and 9.9% (10/101) identified as “other” gender identity. Most  adolescents self-reported their sexual identity as “straight or heterosexual”; 12.9% (13/101) reported their sexual identity as bisexual; 4% (4/101) identified as gay or lesbian; and 11.9% (12/101) identified as “other.” See the note in In the baseline surveys for mothers and adolescents, there were 45 and 90 items, respectively, for which data were missing for at least one respondent . Of these items, nearly all (>90%) were missing for only 1 or 2 respondents in both the mother and adolescent surveys. One item, which was the same item on both surveys, had more substantial missing data (n=12 missing adolescent and n=8 missing mother observations). In both surveys, this item involved the use of a “slider” to enter responses. Previous research has shown that sliders produce more incomplete data than clickable radio buttons in previous research (Funke 2016). At the participant level, nearly all (88% for both mothers and adolescents) of the 43 adolescents and 41 mothers had missing data on 1 or 2 items. One adolescent participant had more substantial missing data . The baseline survey completion time was assessed for 46 mother and 38 adolescent participants; the median time to complete the survey was 22 minutes for mothers and 25 minutes for adolescents.χ2=1.8, n=101; P=.61). Among those who completed the full program, the median time to program completion was 146 minutes (approximately 2.5 hours). Modules 1, 2, and 3 each took a median time of approximately 28 minutes to complete; the Getting Started module and modules 4 and 5 were shorter, with median completion times of 16, 17, and 18 minutes, respectively.The proportion of participants who reported experiencing technical problems with the program after each module  differed across modules (range 3%-16%), with the greater proportion of participants reporting problems after completing modules with more activity pages . A review of open-ended responses to each module completion survey identified a set of specific issues  raised by multiple respondents that should be reviewed and addressed before subsequent evaluation of the program  indicated that the messages were helpful for reminding them to do the program with their adolescent and 92% (36/39) reported that the number of messages received was “just right.” Two mothers reported that the number of SMS text messages was “too many,” and 1 mother reported that the number of messages was “too few.” Of the 50 participants who were assigned to the AP and TRAP conditions, 76% (n=38) completed an action plan. Just over half  of the mothers assigned to the AP and TRAP conditions who completed the postprogram survey (n=43) reported that making an action plan was “very helpful” to them in completing the program; 28% (n=12) reported that it was “somewhat helpful”; and 14% (n=6) reported that it was “not very helpful”; no one reported that it was “not at all helpful.”This study examined and found support for the feasibility and acceptability of a web-based family-based dating abuse prevention program for adolescents who have been exposed to IPV. This study has several key findings. First, it is feasible to (1) recruit IPV-exposed adolescent study participants and their maternal caregivers using a multipronged promotion strategy targeted at potentially eligible participant mothers and (2) evaluate program impacts among mothers and adolescents using web-based surveys (research process feasibility). Second, it is feasible for mothers and their adolescents to access and complete the program via a web-based platform (program feasibility). Third, a high proportion of mother and adolescent participants found the program content to be acceptable and agreed that the program impacted targeted learning outcomes (program acceptability). The results also suggest the need to address technical problems identified with the functionality of the program and potential revisions to the program content. We discuss these main findings, including their implications for future e-MTSD program development and evaluation research, in detail in subsequent sections.Findings indicate the practicability of using the recruitment procedures used in this study in future research examining the efficacy of the e-MTSD program. We were able to recruit and fully enroll approximately 18 eligible mother-adolescent dyads per month over a 6-month period, and the enrollment rate was only slightly lower than that achieved in the RCT of MTSD, which enrolled an average of 22 mother-adolescent pairs per month over an 18-month period using a recruitment strategy that relied principally on advertising through domestic violence coalitions and mass transit systems in 2 cities . It is nThe convenience sample enrolled in this study includes some groups that are over- or underrepresented compared with the national data. Specifically, the national data suggest that our study population of mothers was more highly educated than the national average. In 2020, the proportion of people aged ≥25 years in the United States who had at least a bachelor’s degree was 38%, compared with 50% in this study . In termRates of enrollment and retention for this study were in line with or higher than those reported in other studies of web-based family-based programs, suggesting the practicability of our procedures for consent and data collection -31. NotaThe rates of program completion were higher than those reported for the RCT of the MTSD booklets, supporting the feasibility of web-based delivery of program content. Specifically, 75% of families in this study completed all 6 program modules, whereas only 62% of families completed the last program booklet in the MTSD RCT ,31. For On average, both mothers and adolescents rated the program as highly acceptable across a range of indicators. Nearly all mother participants (98%) reported that the program taught them how to help their teenager avoid dating abuse, a key learning outcome, and 100% of mothers reported that they would use information from the program in the future. When examining ratings across modules, the findings suggested that ratings were slightly lower for module 2 than for the other modules, particularly for indicators tapping into the affective attitude dimension of acceptability. Therefore, future iterations of the program should consider how to make the content of this module more engaging and enjoyable for adolescents. Additional issues to address include technical problems related to program navigation  and glitches with specific activities.Despite a robust field of study of dating violence interventions that use traditional forms of delivery, the field of digital health interventions for the prevention of relationship violence is only just emerging . This st


The suicide rate in the elderly population is the highest of all ages in Korea. Suicide prevention programs specialized in the elderly are scarce.We evaluated the effect of the suicidal prevention program named “Nae-an-ae” (means to love oneself), which was specifically designed for the conditions of the community dwelling elderly.The subjects were those who agreed to participate in the Nae-an-ae program among those evaluated as suicide high-risk groups according to the 2021 Jeollanam-do Mental Health Survey. The program consisted of five sessions of simple activities that could be practiced in daily life along with knowledge transfer through education on emotion recognition, stress management, sleep and relaxation, pain and exercise, and depression. This program was conducted by social workers or nurses working at each local community mental health and welfare center. We evaluated the Geriatric Depression Scale-Short Form Korean Version (GDS-SF), suicidal ideation, satisfaction with life scale (SWLS) and brief resilience scale (BRS) which were measured before and after the program and compared them with the control group.A total of 276 participated in the program, 226 were in the control group. In the program participating group, the frequency of suicidal ideation was significantly decreased from 36.2% to 11.6% after the program. GDS-SF, SWLS and BRS were significantly decreased in active group than control group.Image:Image 2:Image 3:These findings showed that “Nae-an-ae” program was found to affect not only the control of suicide risk factors such as depression but also positive factors such as life satisfaction and resilience.None Declared


Ergosterol is a component of the cell membrane of mycorrhizal fungi and is frequently used to quantify their biomass. Arbuscular mycorrhizal (AM) fungi and ectomycorrhizal (ECM) fungi establish a symbiotic relationship with a respective host plant. Several methods are currently employed for quantification of ergosterol; however, these utilise a series of potentially hazardous chemicals with varying exposure times to the user. The present comparative study aims to ascertain the most reliable method to extract ergosterol whilst limiting hazard exposure to the user. Chloroform, cyclohexane, methanol and methanol hydroxide extraction protocols were applied to a total of 300 samples of root samples and a further 300 growth substrate samples across all protocols. Extracts were analysed via HPLC methodologies. Chromagraphic analysis showed chloroform-based extraction procedures produced a consistently higher concentration of ergosterol in both root and growth substrate samples. Methanol hydroxide, without the addition of cyclohexane, produced a very low concentration of ergosterol, with a reduction of quantified ergosterol of between 80 and 92 % compared to chloroform extractions. Hazard exposure was greatly reduced following the chloroform extraction protocol when compared with other extraction procedures. All generated data are provided within the paper.Ergosterol extractions typically employ methanol hydroxide as one of the main solvents. Inflated ergosterol quantification, and fungal biomass via equation transformation, can result from corrosive damage to plant cells. Therefore, alternative methods must be investigated. Furthermore, user exposure to hazardous chemicals, as well as overall length of the procedure, is greater than other solvent-based ergosterol extraction procedures carried out in the present study. Chloroform ergosterol extraction was seen to require the shortest period of user exposure to hazardous chemicals as well as the shortest extraction processing time. Chloroform extractions also were able to produce a greater quantity of ergosterol from the same samples as those subjected to methanol hydroxide extraction. This may suggest a chemical reaction between methanol hydroxide and ergosterol that reduces the quantity of the compound able to be extracted.Both arbuscular mycorrhizal (AM) and ectomycorrhizal (ECM) fungi form close symbiotic relationships with a host plant, and aid in the acquisition of soil nutrients provided to their host . AM fung28H44O) is a phytosterol consisting of three double bonded carbon atoms throughout the molecule and a beta-hydroxyl group  and two AM fungi-supporting species  were grown under controlled conditions  and grown in 50 % perlite and 50 % vermiculite as growth substrate with the addition of 50 g J Arthur Bowers multipurpose compost as a mycorrhizal inoculum. Watering was carried out once per week to a total volume of 100 ml, along with a source of liquid nutrient (BabyBio) applied to each plant every 4 weeks diluted as per the manufacturer’s instructions. Plants were sampled at 6 months post-germination where a maximum mass of 15 g of growth substrate (n=300 per ergosterol extraction protocol per plant species) and 1 g of root tissue (n=300 per ergosterol extraction protocol per plant species) was taken and stored at −20 °C until ergosterol extraction could be performed.Plant growth of two ECM fungi-supporting species . Post hoc t testing further revealed that MeOH had a significantly negative impact on ergosterol extraction  reducing the overall quantity extracted, whilst chloroform had a significantly increased impact on the extraction of ergosterol   .Construction of an ergosterol standard curve, via HPLC, indicated a retention time of 6.8 min . ComparaP=0.005, d.f.: 2,9, F value: 4.04, F critical: 4.25, single-factor ANOVA). Due to the flow rate of the fume cupboard being used for all extraction procedures, monitoring of localized volatile hazards was consistently recorded at 0 ppm.The total duration of the procedure is given in The present comparison of methodologies has been able to show a large range in quantified ergosterol from the same samples by using four extraction procedures. Method comparisons indicated a consistently greater degree of extracted ergosterol, proportional to fungal biomass via equation 1, via a chloroform protocol compared to the other three extraction procedures used. MeOH extractions were seen to produce consistently low fungal biomass  regardleet al. [et al. [Fungal biomass, shown in et al.  utilizes [et al.  reports  [et al. , AM funget al. [et al. [The use of methanol alone for the extraction of ergosterol has been utilized by several investigations with a range of success . The maiet al.  placed s [et al.  found thTypically, MeOH ergosterol extractions are coupled with cyclohexane to increase the concentration of the extracted ergosterol as seen in et al. [et al. [et al. [The employed chloroform/methanol ergosterol extraction procedure has several advantages over the other methods ued, including a single reaction tube, reduced equipment requirement, small volumes of solvent, and comparatively shorter extraction times  comparedet al.  provide  [et al.  experime [et al.  dried thIt is acknowledged that all chemicals employed in the extraction of ergosterol are highly hazardous and pose a risk to the user, such as being corrosive and/or flammable. All extractions were carried out in a fume cupboard to reduce exposure to the user, as well as keeping a ToxiRAE Pro PID near the user to monitor volatile vapours released from the procedure. This was aided by keeping the lowest required volumes of each extractant chemical within the workspace of the fume cupboard. Such hazards, however, have to be balanced by the degree of reliably in extracting ergosterol from the sample. To this effect, the present comparison of methods would suggest the use of a chloroform extraction procedure for both root and growth substrate samples as this is also the procedure minimizing the overall duration of potential exposure to the user . It is n