Public perceptions of harms and benefits of increasing alcohol venue trading hours: a deliberative focus group study

The role of place in cultivating artistic practice, communities and audiences is well established and the economic, social and cultural benefits that flow from this are becoming better understood. By contrast, the factors impacting and influencing access to these places is poorly theorised. This paper identifies and examines these factors as they apply to live music in Australia, through a qualitative survey of live music patrons and venues. We compare the themes identified from our data with existing theories of access in the arts, with a particular focus on the ways in which place-based music scenes may encourage or exclude participation. We address the question of how access affects participation within these scenes, as well as how access might be improved.

ABSTRACTIntroductionThe night-time economy comprises various sectors, including hospitality, transportation and entertainment, which generate substantial revenues and contribute to employment opportunities. Furthermore, the night-time economy provides spaces for leisure activities, cultural expression and social interaction. On-trade alcohol premises (places where consumers can buy and consume alcohol such as bars, pubs, clubs and restaurants) are a significant component of this night-time economy, functioning as focal points for socialising, entertainment and cultural events. However, when on-trade alcohol premises stay open later at night, this can be associated with negative public health impacts including increased alcohol consumption, intoxication, assaults, injuries and burden on public services including ambulance call outs, hospitalisations and increased impacts on criminal justice services. The evidence on the societal impact of policies to ‘later’ trading hours for bars and clubs in the night-time economy is limited. This protocol details the design of an economic evaluation of policy to later trading hours for bars and clubs in the night-time economy alongside the ELEPHANT study (National Institute for Health and Care Research (NIHR) Public Health Research, ref:129885).Methods and analysisThe research design is an economic evaluation alongside a natural experiment within the ELEPHANT study carried out in Glasgow and Aberdeen. The economic evaluation has been designed to identify, measure and value prospective resource impacts and outcomes to assess the costs and consequences of local policy changes regarding late night trading hours for bars and clubs. A number of economic evaluation frameworks will be employed. A cost-effectiveness analysis (CEA) is appropriate for assessing the effectiveness of complex interventions when the impacts of policy are measured in natural units. Therefore, a CEA will be conducted for the primary consequence, alcohol-related ambulance call-outs, using a health service sector perspective. Since this outcome is essentially a cost, the CEA will also be reported as a cost-analysis. A cost-consequence analysis will also be performed for the primary and secondary consequences including all ambulance call-outs and reported crimes to evaluate the full economic impacts of later trading hours for bars and clubs in the night-time economy. The analysis will be conducted from a wider societal perspective, including health sector, criminal justice system, business and third sector perspectives and will be in line with the recent National Institute for Health and Care Excellence guidance and recommendations.Ethics and disseminationThe economic evaluation of the ELEPHANT study will be conducted using secondary data. Thus, no ethical approval is required for this economic evaluation. However, ethical approval for the ELEPHANT study has been granted from the University of Stirling’s General Research Ethics Committee, and prior consent has also been obtained from the participants, if involved. The results of this study will be disseminated through peer-reviewed publications in journals and national and international conferences.

In March 2004, two important documents on alcohol policy were published by the British government. One is an Alcohol Harm Reduction Strategy for England (UK Cabinet Office 2004). This document has received more attention, but is arguably of less import. As we shall see, what it offers is a recipe for ineffectiveness at the national level. The second document, the kind which only a lawyer could love, is entitled Draft Guidance issued under Section 182 of the Licensing Act 2003 (UK Ministry of Culture, Media & Sport 2004). The consequences of this document are likely to be much more serious for public health and safety, as it is intended to eviscerate any possibility of effective action on alcohol issues at the local level. In the same month, then, the Blair government has managed to accomplish not only a missed chance at the national level but also a thoroughgoing neutralization of local powers to control the alcohol market in the interests of public health and safety. This deliberate effort to disable the public interest applies directly only to parts of the United Kingdom, but it is of wider significance. As will be discussed, the same government also holds important powers for the whole of the United Kingdom, and there is nowhere else to look for policy decisions on such matters. Further, the UK government has an important voice in the European Union, and in this context has generally sided, as in the Strategy, with British alcohol industry interests at the expense of public health and safety. More generally, in an international context the effort is worth holding up to the light for detailed examination as a textbook case of how industry interests can be brought to bear, through an ideologically friendly central government, to thwart local efforts to deal with the problems which enthusiastic and unchecked alcohol marketing can bring at the street level. In 1998, the government of the United Kingdom stated that it was ‘preparing a new strategy on alcohol’ (UK Department of Health 1998, §9.14), and the next year added that ‘we expect to publish our strategy . . . early in the year 2000’ (UK Department of Health 1999, §2.23). In 2003, a PowerPoint presentation entitled the Interim Analytical Report was published on the web (UK Cabinet Office, 2003). As noted, the strategy has now finally been published (UK Cabinet Office 2004). Prepared by the Prime Minister's Strategy Unit, the strategy carries a foreword signed by Tony Blair himself. Although originally billed to be a National Strategy, the final document is a strategy only for England. This presumably partly covers any embarrassment from the fact that, by the time it appeared, every other part of the United Kingdom, including the Isle of Man, already had its alcohol or its drug and alcohol strategy. The downshifting of focus may also reflect that the strategy, as we shall discuss, largely avoids recommending any measures (such as changes in excise tax or in blood–alcohol level for drink-driving) which would require action at a broader level than England. This begs the question of the need still for an alcohol strategy for the United Kingdom, covering the aspects of alcohol policy which can be enacted only by the UK government. Both England and the rest of the United Kingdom are in trouble with respect to alcohol. The Interim Analytical Report and the Strategy itself each document this as best they can, given the spotty nature of available British statistics of alcohol consumption and alcohol-related harms. A further accounting can be found in a recent report from the Academy of Medical Sciences (2004; it should be noted that I was a member of that report's working group). The Strategy's proposals for how to respond to a bad and worsening situation can best be described as bathetic. If one takes the listing at the back of Alcohol—No Ordinary Commodity (Babor et al. 2003), for instance, where preventive measures are ranked roughly on the evidence of their effectiveness, there is an almost total correspondence between the measures proposed in the Strategy's recommendations and the measures which are ranked in the listing as ‘ineffective’. They are all there in the Strategy: school education, voluntary advertising codes, even a half-hearted discussion of alternative entertainment for youth. Conversely, the Strategy eschews almost all the strategies ranked as ‘effective’. For those from the effective end of the list which it does advocate—for instance, brief interventions in primary health care—no new resources are provided, and the problem of actually getting health workers to conduct brief interventions (Roche & Freeman 2004) is not addressed. Concerning drink-driving, the one concrete initiative mentioned is a designated-driver publicity campaign run by an alcohol industry group; again the Strategy chooses a measure for which there is no evidence of effectiveness. The Strategy mentions that the United Kingdom's blood alcohol limit of 0.08% is among the highest in Europe, but does not broach the idea of reducing the limit to 0.05% to match most of the rest of Europe, nor other effective measures such as intensive random breath-testing. Again, the Strategy steers away from any measure with a reasonable track-record of effectiveness. The Strategy acknowledges that ‘there is a clear association between price, availability and consumption’ (p. 23). However, it eschews any proposals either on excise taxes or on controls of availability, with the explanation that ‘our analysis showed that the drivers of consumption are much more complex than merely price and availability’. While this statement is true (although no back-up analysis for it is offered), it is irrelevant: that the aetiology of emphysema is more complicated than just cigarette smoking is not an argument against doing something about the smoking. The Strategy also mentions ‘evidence [which] suggested that using price as a key lever risked major unintended side-effects’. No such evidence is given, but presumably potential rises in cross-channel purchases and smuggling are what is meant. A discussion of these issues would have been a good opportunity to raise the issue of whether the United Kingdom should attempt to change EU rules on alcohol in the Single Market which undercut public health. Indeed, an indication of the parochial quality of the Strategy is that the European Union (EU) is mentioned only once (in connection with seeking permission from the EU to require warning labels on alcoholic beverage containers; p. 33). After implying that price and availability policies would be unpopular, the Strategy offers its capping argument for looking away from price and availability: ‘measures to control price and availability are already built into the system’ (p. 23). The idea the Strategy can thus ignore a whole arena of action because it is ‘already built into the system’ is a breathtaking contradiction with the Strategy's general thrust, which points out how fragmented alcohol issues are between government departments, with ‘no clear focus for policymaking’ (p. 82). A document cannot be accepted seriously as taking ‘a strategic approach to addressing alcohol issues’ (p. 82) if it rules out of consideration some of the most effective available strategies. Having offered its arguments for steering away from price and availability, the Strategy continues: ‘So we believe that a more effective strategy would be to provide the industry with further opportunities to work in partnership with the government to reduce alcohol-related harm’ (p. 23). No evidence is offered of why this would be ‘a more effective strategy’; again, the evaluation research literature would not support the belief. My reading of the sentence is that it must have been written with a wink, essentially as a statement that ‘our political masters decided that the Strategy's approach would be to work with the alcohol beverage industry, and vetoed recommendations on matters like price and availability which would upset the industry’. This reading of the sentence is supported by the most ludicrous item in the Strategy—the model of actors and responsibilities for reducing harms from drinking (pp. 24–25). Three sets of actors are named. The first are ‘individuals and families’, who are responsible through ‘their own choices about what they and those for whom they are responsible drink, where and how’, including being responsible for actions while intoxicated. The third actor is ‘government’, which is responsible for informing consumers, ‘supporting those who suffer adverse consequences’, protecting others from the drinker, ‘ensuring a fair balance between the interests of all stakeholders’ and ‘providing the right strategic framework’. Also mentioned is ‘protecting against harms caused by the supply of alcohol where appropriate, and for regulating to the minimum necessary to achieve this’. (One can guess which qualifiers in this sentence were insisted upon by industry interests.) Between the individual and family and the government is another actor, the ‘Alcoholic drinks industry’, which is assigned responsibilities for giving accurate information and warning about consequences of drinking, for ‘supplying its products in a way which minimizes harm’ and for working with national agencies and local partners. So much for civil society. No other intermediate actor is mentioned in the chart, whether professions, institutions, voluntary associations or—notably—local governments. There is simply the individual drinker or family, the government and the alcoholic beverage industry. It is a telling and indeed a rather totalitarian picture, and an utterly inadequate representation of reality in a complex society such as the United Kingdom. As noted, in the same month another major British alcohol policy document was released, the Draft Guidance issued under Section 182 of the Licensing Act 2003 (UK Ministry of Culture, Media & Sport 2004). This document was also the result of a long process of consideration. In May 2001, the Home Office published its proposals on alcohol licensing ‘reform’ (UK Home Office 2001), the culmination of a review and consultation process dating back to 1998. A notable feature was a provision to eliminate any national closing hours for pubs and nightclubs. After an intervening election, legislation based on the proposals was finally passed in 2003. The Draft Guidance, which must be passed by Parliament, begins the process of actually implementing the new legislation. After the election, responsibility for alcohol licensing matters was transferred to the Ministry of Culture, Media and Sport. This transfer, which of course further fragmented government responsibility for alcohol matters, has tended to provide the industry with a more reliable governmental ally (alcohol licensing falls under the ‘tourism’ section of the ministry's portfolio). A 2002 speech by the Culture Secretary to an alcohol trade group, for instance, essentially promised that the reforms would increase alcohol sales: ‘the reforms would be good for the economy, opening the way to new and more diverse markets, providing new investment opportunities and creating new employment’ (UK Ministry of Culture, Media & Sport 2002). A major change in the new licensing law is the abolition of the centuries-old system of ‘licensing justices’ and their replacement by a licensing committee drawn from the local elected council. This can be seen as a positive change in terms of governance and accountability, making the licensing authorities responsible to the community which elects them. However, this is precisely what has greatly worried alcohol industry interests, which fear that such local authorities may be less co-optable: ‘They have a vested interest in the people that vote for them’, a board member of the Restaurant Association complained (Restaurant industry speaks out . . . 2002). As troubles with drinking in the core city area have increased, a number of British municipal governments have become activist in their licensing policies, and some have been looking to charge the trade for the extra policing, street-cleaning and late-night transport that later closing hours would require (BISL hits out . . . 2002). The trade became worried that the shift in structure might mean a more restrictive rather than a weakened licence regime, including in some places a reduction rather than an increase in opening hours. The task for industry interests, thus, has been to lobby the central government to impose severe constraints on what actions local licensing boards can take, in the form of ‘guidance’ from the central government on how the boards can act. The March 23 document gives evidence of the trade's very considerable success in this effort. From the perspective of an outsider, the result is astonishing. The instructions on what may and may not be carried out are, after all, directed at local councillors who have presumably been elected to their positions as people of experience and judgement. It is hard to imagine such an audience anywhere taking kindly to the tone of the guidance, which in its admonitions sometimes reads as if directed at fractious kindergarteners. As for the substance, the consistent intent is to tie the hands of any local regulation. First of all, the document is firm on the limits of the legitimate uses of the licensing power, which are limited to ‘the prevention of crime and disorder; public safety; the prevention of public nuisance; and the prevention of children from harm’ (p. 15). ‘There is no power for the licensing authority to attach a condition [to the licence] which is merely aspirational: it must be necessary. For example, conditions may not be attached which relate solely to the health of customers rather than their direct physical safety’ (p. 65). ‘The public safety objective [of licensing] is concerned with the physical safety of the people using the relevant premises and not with the public health, with is dealt with in other legislation’ (p. 92). Secondly, licensing authorities are enjoined to look no further than the door of the premises in question in terms of causal chains which might result in conditions on the licence. ‘Conditions attached to licences cannot seek to manage the behaviour of customers once they are beyond the direct management of the licence holder and his staff or agents’ (p. 90). ‘Conditions [on licences] relating to public nuisance caused by the antisocial behaviour of customers once they are beyond the control of the licence holder . . . cannot be justified . . . Beyond the vicinity of the premises, these are matters for personal responsibility of individuals under the law’ (p. 95). Thus, also, ‘noise from customers in the street beyond the premises cannot be taken into account’ by police in considering a temporary closure of premises (p. 123). Thirdly, licensing authorities may not impose conditions which affect the prerogatives of licencees as employers. ‘No conditions relating to the management competency of designated premises supervisors should normally be attached to premises licences . . . It will normally be the responsibility of the premises licence holder as an employer, and not the licensing authority, to ensure that managers appointed at the premises are competent and appropriately trained and licensing authorities must ensure that they do not stray outside their powers and duties’ (p. 91). Fourthly, existing licences are to be treated essentially as an inalienable property right, which must be protected from ‘frivolous or vexatious’ complaints (p. 66) or even regular compliance checks—characterized dismissively in terms of a ‘culture of annual inspections’ (p. 35). This applies even to provisional licences issued prior to construction or alteration of premises, even though ‘a great deal of time may pass’ (p. 70) before the premises are opened. ‘It will be important for investment and employment opportunities’ that no new complaints are considered when the premises actually open (p. 70). While licensing authorities are allowed to adopt ‘special policies relative to cumulative impact’ which restrict the granting of new on-premises licences in a designated area, ‘cumulative impact’ may only be taken into account when a new licence or change in an existing one is being considered; it cannot be taken into account even in a review of an existing licence (p. 66). Such policies ‘should never be used as a ground for revoking an existing licence [even] when relevant representations are received about problems with those premises’ (p. 26). Fifthly, licensing authorities should not interfere with the free operation of the market. The old criterion of ‘need’ used by the licensing justices is no longer a legitimate consideration. ‘ “Need” concerns the commercial demand for another pub or restaurant or hotel. This is not a matter for the licensing authority . . . “Need” is a matter for planning committees and the market’ (p. 23). Sixthly, citizen input concerning problems from a prospective or current licence is strictly limited. The requirement for advertising that an application has been is limited to one on the premises (p. only and but also are to be from consideration for example, which would have been when the application for the licence was first and which were by of the prior of a provisional licence (p. It is that the on whether a is thus not to be considered be to staff of the licensing committee (p. This that political is as an of decisions on considering a ‘should not be on the of any political which would a approach to the This may be for councillors complaints from their own (p. and all, the is in For instance, on of it in general that and be allowed to alcohol at any time which they to The document in the British government that and early closing are ‘a key of and when of customers are to premises This in the of the research literature (Babor et al. 2003, and experience . . 2002). opening in for instance, in police in and in The police work was more the but this a change in police shift to the new work at et al. 2002). One to the problem of when the pubs at the same it would might be closing licensing authorities should also not seek to closing by for closing . . . In the this would only to the current of and . . . with a of . . . and would not be necessary to the licensing The general should be to support later opening that customers for a longer (p. 82). I found for a the of the document ‘licensing authorities should not closing for (p. this would a key of the 2003 (p. 26). are licensing authorities allowed to reduce opening hours in the to the new licensing regime, even in the case of premises with permission to open for hours. the even more ‘a licensing authority is from conditions . . . which would have the of opening hours to more limited hours than the current (p. the other any idea of the public responsibilities as a of public to be ‘there is no . . . to open for the . . . for example, a public has no trade on a the licence holder is entitled to the premises’ (p. The end result of the Guidance, if it into will be a the new local licensing authorities will be with and but will be almost to the licensing power to the or of operation of the alcohol in their for local to have power to alcohol licensing is also not For instance, the in that there was local input when the licensing system was In such the for in some local control alcohol has been through their planning and In for instance, have good of which essentially impose controls on hours and conditions of through the planning system & The UK Guidance that the local planning process is also in local control of alcohol In it the argument that local authorities should provide control and licensing will be to and (p. it is hard to how is to However, the of the has arguments that the limited local planning powers in England cannot work as a for licensing powers 2003). A for the Prime Minister's Office of the of a measure by the government in to local gives support to this that ‘the local authorities the of about uses planning ‘The by of the is about the for and drinking in ‘the of public that has taken in This a market that has been by the central constraints on local ‘It is by planning authorities to have the of and to have given to because of the number of people in one area and by in the (UK Ministry of Culture, Media & Sport 2001, As the report on the there is a problem in British and with alcohol and the & et al. 2003). The planning powers of local governments have been they cannot provide a The Guidance on the new Licensing to ensure that licensing cannot provide a and there is in the Strategy which is likely to have much in reducing these The consistent which is of a central government which is to be with respect to alcohol and which effort to any by local government to adopt effective alcohol This is a which England has to at the end of of efforts on the Strategy and on the Licensing The one feature of the is that the because this gives some to the that there has been the government the is I itself is a very and is to alcohol industry In recent some have taken of the The supply of to was to have between and A member of noted ‘a rather change in the The most of the while the of drinking are . . . I have there are now more people than before who in the in a 2002). Media have also to drinking among a on Home Office proposals to by it just the and suggested that the Home Secretary was by the of the Home 2002). Alcohol industry interests are in and in the government. The is the at with of and industry interests to have as an on this government as they on the governments which In March for instance, the government that it was on its dating from to reduce the blood–alcohol limit for from 0.08% to the general level of the European Union, to this the with the which is by the drinks industry and reducing the The Department of on research by the A of noted that ‘the with that of the alcohol industry but is by local the the British Medical the the for the of the and the for (UK of 2002). The of the of a noted that by the of the drinks 2002). The also general of the Blair government. has a to problems in individual to the in pubs and outside on the street to be seen as a matter of and the are individual and from or a law for the police to on the for and antisocial This from the Prime with police but up again in the Strategy as a of to be by the and (p. in the is thus solely in terms of steering away from the and commercial in which the trouble as more to than any government . . . It that it has been to to the more than any of its It would be hard to of a more of than the of the Blair government on alcohol the end of the Strategy, under the ‘ensuring the is there is an attempt to the are to the industry to its to by best that in the should be voluntary . . . the next if industry actions are not to an in reducing will the case for including legislation. However, in the light of the it is hard to much to this There was a not long when was of on alcohol It is to the new Strategy with the report on Alcohol in in the final of the government, by the The report was but never published in in beyond the of the Act the Strategy, the review noted the of alcohol issues UK government departments, by the for the for for However, the of the do not much further than The review on the literature a of alcohol consumption to of in the and not the It proposed that ‘the should a positive on the in consumption and on the reduction of alcohol-related (p. It the of alcohol taxes as an of alcohol with the at a minimum being level with changes in the price licensing should not be further it should be and in respect to under drinking its ‘the on drinking and should be and legislation (p. A the review still a than the document for a British strategy on alcohol.

Indigenous people's perceptions of benefits and costs of China's second phase of the grain for green program and the influencing factors

This study examined the relationship of age and gender with risk of arrest among adolescents and young adults who were intensive adolescent users of public mental health services. Data were obtained from the Massachusetts Department of Mental Health (DMH) and juvenile and criminal courts. Participants were youths receiving DMH adolescent case management services sometime in 1994-1996 who were born between 1976 and 1979 (781 males and 738 females). They were cross-matched to document arrests between age seven and 25. The study examined age at first arrest, age-specific risk, and the relationship between arrest history and arrest risk by gender and age. Most males (69%) and almost half the females (46%) were arrested by age 25. First arrest was most common before age 18. As in the general population, males' arrest patterns were more concerning than those of females, although patterns were of concern in both groups. Most female arrestees had multiple arrests, many as adults. No gender differences were observed for several factors, including risk of first arrest over age 18. Risk was far greater for those arrested in the previous year than for those never arrested. Findings justify concerns of public mental health systems regarding justice system involvement of adolescent clients. Risk of first arrest was significant from early adolescence through age 24, indicating a need for arrest prevention into young adulthood. The heightened arrest risk at all ages among those who were recently arrested demarcates a population in need of immediate intervention.

In October 2013, the South Australian government introduced the Late Night Trading Code of Practice ('the Code') as a means of reducing incidences of alcohol-related violence and antisocial behaviour in and around late night licensed venues in South Australia. Adelaide's notorious West End club district was especially targeted following a spate of brutal attacks including cowardly 'king hits'. In support of the move, then Minister for Business Services and Consumers, John Rau, issued a media release citing statistics which indicated there were 12 500 hospital admissions and 600 deaths attributable to alcohol in the state annually. Mr Rau also noted South Australia Police data demonstrating that the demand for police and health resources responding to alcoholrelated issues was at its greatest in the early hours of Saturday and Sunday mornings. Alcohol, and the trading hours of the late night venues which served it, were said to be the problem.

Over the last decade growing public health evidence suggests that, in addition to health-related benefits, there are also social and economic benefits of vaccination. Research to understand how caregivers in low-and-middle-income countries perceive these social and economic benefits, or if these benefits factor into their vaccination decisions for their children, has been limited. Leveraging qualitative strategies to gain more nuanced insights into caregiver perceptions of vaccination benefits has also been significantly underexplored. We conducted in-depth interviews with 13 caregivers of children, at which point we reached saturation, in Mewat District, Haryana, an area in India with low vaccination coverage. Interview results suggest that caregivers of children associate positive health outcomes with vaccination programs, and some additional social and economic benefits beyond improved health outcomes. Caregivers also shared how local advocacy and gaps in vaccination programs can affect their perceptions of vaccination benefits. Qualitatively exploring the perceived benefits provides a unique understanding of the value that caregivers assign to vaccination and complements existing knowledge on factors that dissuade caregivers from vaccination. These insights will allow researchers to better identify and design context-specific advocacy strategies to strengthen vaccination programs in communities with low vaccine uptake and acceptance.

The influence of commercial actors, practices and processes on the health and wellbeing of women is still not well understood. The alcohol industry has developed a range of products to appeal to new ‘health conscious’ markets, such as ‘low-calorie’ and ‘low-sugar’ products. While these products may have specific appeal for women, there has been little in-depth research that has sought to understand how women conceptualize these products and the range of symbolic meanings that women associate with these products. An online qualitatively led survey was conducted with n = 497 Australian women who had consumed alcohol in the last year. Questions related to the reasons for and influences on alcohol use, the purchasing of ‘low-calorie’ or ‘low-sugar’ products and the influence that these products might have on women’s alcohol use. Data were interpreted using reflexive thematic analysis. Women consumed alcohol to relax, cope with everyday stressors and because of the alignment with social practices and social connection. Women perceived that these products provided a healthier alternative to traditional alcohol products and that they aligned with women’s values relating to weight and the thin ideal. Some women were concerned that these products could increase alcohol consumption by reducing the perceptions of risk associated with alcohol. Policy consideration is needed to address how product claims and attributes may influence population groups’ interpretations of the risks and benefits of these alcohol products, including the illusion that these products have protective potential and are better for overall health and wellbeing.

Hospital in the Home models are rapidly expanding in response to increasing bed pressures. This study examined patient and multidisciplinary health professional perceptions of a new geriatric evaluation and management and rehabilitation hospital in the home service in Australia. The service was unique, as adults of all ages with a variety of rehabilitation or geriatric evaluation and management needs were within scope. A qualitative descriptive approach was used with a consumer co-researcher and a consumer advisor being integral to decision-making. Patient feedback was collected via a paper-based patient satisfaction survey between August 2020 and February 2022. Additionally, interviews with current and past staff were conducted from July to November 2021. Reflexive thematic analysis was conducted for qualitative data and descriptive statistics used for quantitative data. Patient surveys were analysed (n = 199, 42.2% response rate) with 60.8% of participants aged 75years or over and 26.6% speaking a language other than English. High satisfaction was expressed. Feelings of comfort, familiarity, convenience, and reassurance were voiced. A person-centred approach enhanced involvement in care. Challenges included carer burden and clear communication. Sixteen staff (33% response rate) were interviewed. In general, staff said the service was inclusive and responsive, and the home environment beneficial, particularly for patients from culturally diverse backgrounds. A strong hospital partnership and comprehensive multidisciplinary approach were vital. Challenges included fragmentation due to part-time roles and combining with a pre-existing acute hospital in the home service. This qualitative exploration of staff and patients' perceptions of a geriatrician-led, multidisciplinary geriatric evaluation and management and rehabilitation hospital in the home service demonstrated that it was person-centred and optimised patients' control and ownership of care. The inclusive service parameters ensured responsiveness to diverse needs whilst allowing earlier return home from hospital, both of which are vital for quality patient care.

Urban green spaces (UGS) provide many social benefits and improves residents’ wellbeing. Studying residents’ perceptions of UGS’s social benefits and driving factors could promote public health and environmental justice. A questionnaire survey of 432 Beijing residents and statistical tests assessed the impacts of residents’ living environments and self-rated health status on UGS perceptions. The results showed: (1) perceptions of UGS’ physical health benefits were subdued, with an inclination towards other social benefits. Respondents more highly perceived accelerating patient recovery and reducing morbidity and mortality rates. Perceptions of bearing larger-head babies with higher weight were relatively low. For other social benefits, perceptions of improving the environment and life quality were higher, but reducing anger outbursts and resolving conflicts were lower. (2) Childhood living environments did not affect perceptions of social benefits, but current living environments did. Suburb residents understood reducing pain-relief medication demands and bearing larger-head babies better than city residents. City residents understood UGS’ investments considerable and sustained returns better than village residents. City residents agreed with accelerating patient recovery higher than village ones. (3) Respondents with “poor” self-rated health status had better perceptions of other social benefits. Those with “excellent” ratings did not fully understand UGS’ physical health benefits. “Poor” ratings understood improving a city’s image and making cities livable and sustainable better than “good” or “fair” ratings. “Excellent” ratings had less understanding of larger-head babies than “good” or “fair” ratings. The study could enhance appreciation of UGS’ social benefits to facilitate planning and management to meet residents’ expectations.

The sharing economy is a business model that has revolutionized the way individuals travel, work, and engage with each other (Akhmedova et al., 2021). The rise of digital technologies has led to changes in how sharing is performed, making it simpler and more efficient (Teodorović and Orco, 2008). The present study focuses on ridesharing facilitated by Facebook rather than specialized commercial peer-to-peer (P2P) platforms. This form of ridesharing is a type of community-based sharing economy with a high level of contribution to a more sustainable economy but still has not received the deserved scientific attention (de Rivera et al., 2017; Wai Lai and Ying Ho, 2022). Facebook groups have emerged as viable platforms for peer-to-peer ridesharing (Santa and Ciunova-Shuleska, 2019), where drivers and passengers are using informal Facebook groups to pre-arrange and self-organize the riding while sharing the costs with no intention for financial gain (Eskelinen and Venäläinen, 2021). However, it is not only the economic exchange transaction that matters in this form of sharing but also the social benefit, which has its role in the subjective cost-benefit analysis and comparison of alternatives that individuals do when making decisions (Kim et al., 2015). The Social Exchange Theory can be used to comprehend how the interactions between people lead to the development of relationships, which people may choose to maintain or end depending on the advantages (costs and rewards) associated with the relationship (Boateng et al., 2019). This theory resonates with the specifics of the sharing economy concept which is also embedded in interpersonal exchanges (Kim et al., 2015; Yan et al., 2016). Through the Social Exchange Theory (SET) lens, the present study focuses on identifying the main benefits of using Facebook ridesharing and the main costs (risk/uncertainties) of its use. Based on this theory, we expect that users’ actual ride-sharing participation is driven by economic and social benefits (Hamari et al., 2016; Boateng et al., 2019). On the other hand, the cost of participating in ridesharing is the perceived risk and uncertainties in the arrangement and performing processes (Kim et al., 2015). By researching users’ behavior and underlying motivations, a deeper understanding of the sharing economy concept will be provided, and the strategies to encourage users’ interest. Furthermore, this study seeks to fill the research gap on the drivers of users' sharing behavior that has arisen in addition to the rising research focus on the sharing economy (Davlembayeva et al., 2020). Although previous research studies have focused on ridesharing via dedicated ridesharing platforms (Kooti et al., 2017; Wallsten, 2015), our study focuses on ridesharing via social media i.e., Facebook. Moreover, although previous research studies focused on analyzing users’ motivations to use ridesharing platforms (Amirkiaee and Evangelopoulos, 2018; Furuhata et al., 2017; Zhu, So, and Hudson, 2017) along with perceived risks (Wang, Wang, and Wang, 2019; Chean et al., 2022), it is still unclear what benefits, value and risks users perceive in sharing time and space with strangers using social media self-organizing ridesharing groups such as Facebook. This is even more important given that Facebook ridesharing groups do not have an online rating system that allows customers to rate drivers after the ride and to rely on drivers’ ratings before making the decision to share a ride (Aw, Basha, Ng, and Sambasivan, 2019; Anderson, 2016). So, this study will be the first study to analyze the motivations and risks of using ridesharing via social media self-organized ridesharing groups providing valuable insights into the perceptions and behavior of the participants in ridesharing groups on Facebook. The present research is based on a qualitative study applying focus groups as a data collection method. Focus groups are deemed suitable for this research as they provide exploration and generation of in-depth insights, opinions, and experiences of participants on the researched topic (Nyumba et al., 2018). The interactive nature of focus groups also facilitates group dynamics and the sharing of diverse perspectives. A convenience sample of 21 users of Facebook ridesharing groups was used, divided into three focus group sessions. The focus group sessions were conducted online and each lasted approximately 100 minutes, ranging from 88 to 112 minutes. The identified Facebook groups are dedicated to inter-city ridesharing in North Macedonia where more than ten public Facebook groups successfully assist in the organization of ridesharing in North Macedonia (Santa and Ciunova-Shuleska, 2019). The discussions were led by experienced moderators following a semi-structured list of questions/discussion topics, guiding the conversation and eliciting participants' thoughts, opinions, and experiences related to the research topic. The video recordings from each session were transcribed verbatim to maintain accuracy. Transcripts, along with any field notes taken during the sessions, were then subjected to a systematic coding process. The obtained qualitative data will be analyzed by applying a reflexive thematic analysis approach to provide deeper insights into the researched topics through interpretation (Braun and Clarke, 2021). The six-step process for reflexive thematic analyses is applied: 1) familiarity with the data, 2) generating initial codes, 3) constructing themes, 4) revising themes, 5) defining themes, and 6) reporting (Braun and Clarke, 2019). Based on the initial exploration of the data, we strive to identify the crucial functional and economic benefits of using community-based P2P ridesharing (e.g., convenience, lower price, etc.) as well as some social benefits (e.g., enjoyment, social belonging, social interactions). On the other side of the cost-benefit matrix, we expect users to report some concerns and potential costs, such as uncertainty regarding the arranged price, safety, reliability, emotional labor, etc. By identifying the economic and social aspects of the ridesharing exchange, this study will provide insights into the underlying reasons for users’ contribution to this form of sharing economy, thus obtaining a deeper understanding of the usage patterns.

Perceived benefits from reclaimed rural landscapes: Evidence from the lowlands of the Po River Delta, Italy

BackgroundPersonalisation is a growing international policy paradigm that aims to create both improved outcomes for individuals, and reduce fiscal pressures on government, by giving greater choice and control to citizens accessing social services. In personalisation schemes, individuals purchase services from a ‘service market’ using individual budgets or vouchers given to them by governments. Personalisation schemes have grown in areas such as disability and aged care across Europe, the UK and Australia.There is a wealth of evidence in public health and health care that demonstrates that practically all forms of social services, programs and interventions produce unequal benefit depending on socio-economic position. Research has found that skills required to successfully negotiate service systems leads to disproportionate benefit to the ‘middle class. With an unprecedented emphasis on individual skills, personalisation has even greater potential to widen and entrench social inequalities. Despite the increase in numbers of people now accessing services through such schemes, there has been no examination of how different social groups benefit from these schemes, how this widens and entrenches social inequities, and – in turn – what can be done to mitigate this.MethodsThis article presents a meta-review of the evidence on personalisation and inequality. A qualitative meta-analysis was undertaking of existing research into personalisation schemes in social services to identify whether and how such schemes are impacting different socio-economic groups.ResultsNo research was identified which seeks to understand the impact of personalisation schemes on inequality. However, a number of ‘proxies’ for social class were identified, such as education, income, and employment, which had a bearing on outcome. We provide a theoretical framework for understanding why this is occurring, using concepts drawn from Bourdieu.ConclusionPersonalisation schemes are likely to be entrenching, and potentially expanding, social inequalities. More attention needs to be given to this aspect of personal budgets by policymakers and researchers.

Background and Aims The gap between guidelines and practice regarding care for myocardial infarction is greater amongst individuals with chronic kidney disease than those without. Identifying why variation exists enables determination of its clinical significance and facilitates the development of effective interventions to reduce disparities in care, where appropriate. The aim of this study was to understand the process of treatment decision-making for myocardial infarction amongst patients with kidney disease and their clinicians. Method Semi-structured qualitative interviews were conducted with patients and clinicians from four National Health Service hospital centers in the United Kingdom from February 2022 to July 2024. All centers offered cardiology and acute medical services; some offered nephrology in addition. Participants were purposively sampled, aiming for diversity in gender, ethnicity, specialty (clinicians only) and/or use of kidney replacement therapy (patient participants). Clinicians were senior doctors-in-training or consultants in cardiology, nephrology, acute or emergency care or cardiac surgery. Patient participants had chronic kidney disease, defined as an estimated glomerular filtration rate of less than 60 ml/min/1.73 m2, or receipt of kidney replacement therapy, in addition to a recent hospital admission for myocardial infarction. Braun and Clarke's reflexive thematic analysis was used to analyze interview data and generate themes associated with myocardial infarction treatment decision-making for, and by, patients with chronic kidney disease. Results Participants included 32 clinicians (12 cardiologists, 9 nephrologists, 8 acute and emergency clinicians and 3 cardiac surgeons) and 14 patients with chronic kidney disease. Seven main themes were identified:(1) Limited patient involvement in treatment decisions, (2) Inter-clinician communication supports high-risk decision-making, (3) Variation in use of written guides to decision-making, (4) The safety net of associated health services support intervention, (5) The value assigned to experience over evidence, (6) Individual perception of risk and benefit, (7) Harm from action perceived as worse than inaction. Despite holding strong health preferences, patients had minimal involvement in inpatient treatment decisions regarding myocardial infarction. Clinicians’ decision-making was driven by the fear of causing harm by active intervention. Fear and self-blame for negative outcomes were some of the most influential factors biasing clinicians towards making conservative treatment decisions for patients with chronic kidney disease (Figs 1 and 2a). This was despite evidence and guidelines recommending more aggressive treatment. Collaborative decision-making between trusted colleagues and the existence of a clinical safety-net for managing treatment complications were however reported by clinicians to counter this bias and enable them to make what they perceived to be appropriately aggressive treatment decisions (Fig. 2b). Conclusion Interventions to foster teamworking between specialists and ensure adequately resourced clinical service safety-nets may improve access to perceived “higher-risk” treatments for myocardial infarction amongst people with chronic kidney disease. Intervention development and evaluation should follow to determine if quality of care and outcomes for people with chronic kidney disease and myocardial infarction can be improved by these means.

BackgroundLocal public health service delivery and policy-setting in England was overhauled in 2013, with local government now responsible for the complex tasks involved in protecting and improving population health and addressing health inequalities. Since 2013, public health funding per person has declined, adding to the challenge of public health decision-making. In a climate of austerity, research evidence could help to guide the more effective use of resources, although there are concerns that the reorganisation of public health decision-making structures has disrupted traditional evidence use patterns. This study aimed to explore local public health evidence use and needs in this new decision-making climate.MethodsSemi-structured interviews with Public Health Practitioners across three Local Authorities were conducted, with sites purposefully selected to represent urban, suburban and county Local Authorities, and to reflect a range of public health issues that might be encountered. A topic guide was developed that allowed participants to reflect on their experience and involvement in providing evidence for, or making a decision around, commissioning a public health service. Data were transcribed and template analysis was employed to understand the findings, which involved developing a coding template based on an initial transcript and applying this to subsequent transcripts.ResultsIncreased political involvement in local public health decision-making, while welcomed by some participants as a form of democratising public health, has influenced evidence preferences in a number of ways. Political and individual ideologies of locally elected officials meant that certain forms of evidence could be overlooked in favour of evidence that corresponded to decision-makers’ preferences. Political involvement at the local level has increased the appetite for local knowledge and evidence. Research evidence needs to demonstrate its local salience if it is to contribute to decision-making alongside competing sources, particularly anecdotal information.ConclusionTo better meet decision-making needs of politicians and practitioners, a shift in the scope of public health evidence is required. At a systematic review level, this could involve moving away from producing evidence that reflects broad global generalisations about narrow and simple questions, and instead towards producing forms of evidence that have local applicability and can support complex policy-focussed decisions.