While water is renewable, only a finite amount of it is available. Rapid urbanization, industrial development, and growth in food demand contribute to the shortage of freshwater in many countries. The limited availability of surface water and its uneven distribution in time and space has increased the dependence on groundwater (GW) in Punjab. Its irrigation development is characterized by excessive extraction of GW to meet the crop water requirements for ensuring the country’s self-reliance in food. GW development guided by populist political pronouncements has contributed to serious environmental and ecological concerns. The paper, using the GW resource estimation methodology-2015, assesses the net annual replenish able GW availability (21.58 billion cubic meters) and GW extraction (35.78 billion cubic meters), and thus a stage of GW extraction of 166%. It analyses the impact of continuous GW mining on the long-term behaviour of water table. Considering the declining availability of surface water under climate change, it is a high time to study the emerging GW scenario more scientifically and prescribe a policy framework for the future.

Background: Physical inactivity is a leading risk factor for chronic disease. Brief physical activity counselling delivered within healthcare systems has been shown to increase physical activity levels; however, implementation efforts have mostly targeted primary healthcare and uptake has been sub-optimal. The Brief Physical Activity Counselling by Physiotherapists (BEHAVIOUR) trial aims to address this evidence-practice gap by evaluating (i) the effectiveness of a multi-faceted implementation strategy, relative to usual practice for improving the proportion of patients receiving brief physical activity counselling as part of their routine hospital-based physiotherapy care and (ii) effectiveness of brief physical activity counselling embedded in routine physiotherapy care, relative to routine physiotherapy care, at improving physical activity levels among patients receiving physiotherapy care. Methods: Effectiveness-implementation hybrid type II cluster randomised controlled trial with embedded economic evaluation, qualitative study and culturally adapted patient-level outcome measures. The trial will be conducted across five hospitals in a local health district in Sydney, Australia, with a lower socioeconomic and culturally diverse population. The evidence-based intervention is brief physical activity counselling informed by the 5As counselling model and behavioural theory, embedded into routine physiotherapy care. The multi-faceted strategy to support the implementation of the counselling intervention was developed with key stakeholders guided by the Consolidated Framework for Implementation Research and the Capabilities, Opportunities, Motivation-Behaviour (COM-B) theoretical model, and consists of clinician education and training, creating a learning collaborative, tailored strategies to address community referral barriers, team facilitation, and audit and feedback. Thirty teams of physiotherapists will be randomised to receive the multi-faceted implementation strategy immediately or after a 9-month delay. Each physiotherapy team will recruit an average of 10 patients (n=300) to collect effectiveness outcomes at baseline and 6 months. The primary effectiveness outcome is self-reported planned physical activity using the Incidental and Planned Exercise Questionnaire, and the primary implementation outcome is reach (proportion of eligible new physiotherapy patients who receive brief physical activity counselling). Secondary effectiveness and implementation outcomes will also be collected. Discussion: This project focuses on physiotherapists as health professionals with the requisite skills and patterns of practice to tackle the increasing burden of chronic disease in a high-risk population. Trial registration: ANZCTR, ACTRN12621000194864. Registered on 23 February 2021.

Physical activity counselling has demonstrated effectiveness at increasing physical activity when delivered in healthcare, but is not routinely practised. This study aimed to determine (1) current use of physical activity counselling by physiotherapists working within publicly funded hospitals; and (2) influences on this behaviour. A cross-sectional survey of physiotherapists was conducted across five hospitals within a local health district in Sydney, Australia. The survey investigated physiotherapists’ frequency of incorporating 15 different elements of physical activity counselling into their usual healthcare interactions, and 53 potential influences on their behaviour framed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model. The sample comprised 84 physiotherapists (79% female, 48% 90% indicating their patients lacked financial and transport opportunities. These findings confirm that physical activity counselling is not routinely incorporated in physiotherapy practice and help to identify implementation strategies to build clinicians’ opportunities and capabilities to deliver physical activity counselling.

Telerehabilitation is an appealing service delivery option for optimising recovery. Internationally, the equity of telerehabilitation services for people from culturally and linguistically diverse (CALD) backgrounds has been questioned. Using a 31-item survey, our study explored the access, readiness and willingness of 260 patients receiving allied health services from a large tertiary health service located in Sydney, Australia, to use telerehabilitation for adults. Overall, 72% patients reported having access to technology, 38% met our readiness criteria and 53% reported willingness to engage in telerehabilitation. There were no differences in access, readiness and willingness to engage in telerehabilitation between patients from CALD and non-CALD backgrounds. Age was the only factor that influenced access (OR = 0.94, 95% CI 0.90 to 0.97), readiness (OR = 0.95, 95% CI 0.92 to 0.98) and willingness (OR = 0.97, 95% CI 0.95 to 1.00) to engage in telerehabilitation. Past experience of telerehabilitation was related to willingness (OR = 2.73, 95% CI 1.55–4.79) but not access (OR = 1.79, 95% CI 0.87 to 3.68) or readiness (OR = 1.90, 95% CI 0.93 to 3.87). Our findings highlight the importance of ensuring positive patient experiences to promote ongoing willingness to use telerehabilitation. Efforts are needed to improve patients’ digital health literacy, especially patients from older age groups, to ensure equitable engagement in telerehabilitation services.

Telerehabilitation is an appealing service delivery option for optimising recovering. Internationally, the equity of telerehabilitation services for people from culturally and linguistically diverse (CALD) backgrounds has been questioned. Using a 31-item survey, our study explored the access, readiness, and willingness of 260 patients to use allied health telerehabilitation services for adults receiving interventions from a large tertiary health service located in Sydney, Australia. Overall, 72% patients reported having access to technology, 38% met our readiness criteria, and 53% reported willingness to engage in telerehabilitation. There were no difference in access, readiness and willingness to engage in telerehabilitation between patients from CALD and non-CALD backgrounds. Age was the only factor that influenced access, readiness and willingness to engage in telerehabilitation. Past experience of telerehabilitation was related to willingness, but not access or readiness. Findings highlight the importance of ensuring positive patient experiences to promote ongoing willingness to use telerehabilitation. Efforts are needed to improve patients’ digital health literacy, especially patients from older age groups, to ensure equitable access to telerehabilitation services.

Type 2 Diabetes Mellitus (T2DM) presents a major public health challenge globally, disproportionately affecting Indian migrants who are vulnerable to diabetes-related complications due to cultural, linguistic and systemic barriers that can limit access to timely and effective care. Health literacy is a key determinant of T2DM management, yet its association with medication adherence in this population remains underexplored. This study investigates the association between performance-based (objectively assessed) and self-reported (subjectively assessed) health literacy and medication adherence among Indian migrants with T2DM, while accounting for a range of demographic, socioeconomic and health-specific factors. A cross-sectional study design was employed. Participants (n = 309) were recruited through multicultural health services, and hospital diabetes clinics across Greater Western Sydney, a socioeconomically and culturally diverse area of Sydney, NSW, Australia. Eligible participants self-identified as Indian, were aged 18 years or older, had been diagnosed with T2DM for at least one year, and were currently prescribed diabetes medication. Data were collected via a structured survey and analysed using multivariate logistic regression. Low health literacy was prevalent among Indian migrants, with over 67.6% demonstrating low performance-based health literacy and 62.5% reporting low self-reported health literacy. Approximately 68.9% of participants had low medication adherence. Lower medication adherence was significantly and positively associated with lower health literacy, both performance-based (adjOR=9.14, 95%CI: 4.24-19.72; p = <0.001) and self-reported (adjOR=12.45, 95%CI: 4.55-34.10; p = <0.001). Key predictors of medication adherence included health literacy, private health insurance, BMI, glucose level, comorbidities and social support. Models differed slightly depending on the type of health literacy assessed. Health literacy plays an important role in diabetes self-management for Indian migrants. These findings highlight the need for culturally tailored interventions that address both health literacy support - such as improving understanding of medical information and navigating healthcare systems - and social or family support systems that influence health behaviours and decision-making.