Support Policy Changes Research Articles

Examining Emotional and Physical Burden in Informal Saudi Caregivers: Links to Quality of Life and Social Support.

Caregiver burden is an important issue for individuals who tend to be chronically ill, disabled or elderly family members. This burden affects caregivers around the world and can have a negative impact on their physical and mental health, ultimately reducing their quality of life. This study of informal adult caregivers in Saudi Arabia used a cross-sectional analytic design to explore the connections between caregiver burden, social support and quality of life. Data were collected using nonprobability convenience sampling through electronic questionnaires in Arabic. The Zarit Caregiver Burden Interview (ZBI-12), the Oslo Social Support Scale (OSSS-3) and the SF-12 Health Survey (short form of 12 questions) were used to assess caregiver burden, social support and quality of life, respectively. The relationships between these variables were analysed, and the statistical significance of the findings was reported. The study revealed a connection between caregiver burden and both social support and quality of life. Caregivers with moderate to high burdens often had poor social support (60.52%) and a lower quality of life (72.47%). A statistically significant negative correlation between caregiver burden and quality of life (p < 0.05) indicated that caregivers with a higher burden had a lower quality of life. Similarly, a statistically significant negative correlation was found between social support and caregiver burden (p < 0.05), suggesting that caregivers with more social support experienced a lower burden. A higher caregiver burden is linked to a lower quality of life, especially when social support is inadequate. These findings highlight the need for targeted interventions to reduce caregiver burden by enhancing social support systems for caregivers and improving their quality of life. Recommendations include the development of community-based support programmes and policy changes to support informal caregivers.

Identifying strategies and related principles supporting a co-design approach in an assistive device service delivery and research platform.

Possibilities Project Plus (PPPlus) is a free assistive device (AD) marketplace and research platform for persons with disabilities. The overall aim of PPPlus is to increase access to ADs through an integration of service, research and education. To maximize positive outcomes and reflect community needs a co-design approach informed by guiding principles of Integrated Knowledge Translation (IKT) was adopted, with examination of methods related to Experience Based Co-design. The integrated nature of PPPlus benefits from the use of specific engagement strategies that align with IKT principles to meet project objectives. The extent to which partnership and engagement strategies are specified in the rehabilitation research literature vary greatly and studies that provide information on specific strategies used to operationalize principles are limited. The objective of this manuscript is to provide a description of the co-design approach and the specific strategies that strive to achieve meaningful user engagement. By reflecting on these processes we also report on limitations and strategies for improvement. The co-design approach is highlighted through specific project activities including a representative governance structure, ongoing environmental scan and iterative Health Equity Impact Assessments (HEIA). The inherent engagement strategies that align with IKT and co-design principles are described. The most impactful engagement strategies included early engagement of partners throughout all phases, ensuring project relevance across partners through alignment of objectives with complementary aims, using HEIAs to promote equitable outcomes from diverse stakeholders, the representative governance structure beyond individuals with disabilities and caregivers, and the use of experiences and stories to inform development. This examination of specific strategies related to co-design focused on partnership engagement and informed targets for enhancement of the PPPlus initiative. These include being more intentional in developing a more rigorous process for evaluation that includes an assessment of strategies and their impact-especially as related to partner engagement. In addition, ongoing and enhanced efforts will focus on developing knowledge products that bring to life the most salient experience-based user stories emerging from the environmental scan with these being used to drive distinct co-creation events as well as serve other knowledge mobilization purposes (i.e., supporting policy change).

A Multimethod Exploration of Moral Distress and Moral Injury Among Health Care Assistants Working in Psychiatric Settings

Moral distress and moral injury among health workers yield adverse physical, psychological, and labor force outcomes. Research is limited on how psychiatric healthcare assistants experience these issues. In this multi-method study, we conducted a quantitative survey and qualitative interviews to examine moral distress and injury among psychiatric healthcare assistants. Almost half screened positive for moral injury. Three qualitative themes emerged: 1) hierarchies prevent contributions to care; 2) trust as a factor in de-escalating patient violence; and 3) navigating psychosocial challenges. Further research is recommended to investigate how to best support and inform practice and policy changes for psychiatric healthcare assistants.

From Division to Coordination: A Study on the Power of Urban Rural Integration of the Minimum Living Security System from the Perspective of Multi Source Flow

For a long time, China's minimum subsistence guarantee system has suffered from the problem of large differences between provinces and cities, and between cities and rural areas within provinces and cities, and in this context, some regions have gradually implemented the urban-rural integration policy and have gained some experience. Based on the theory of multiple streams, it can be found that the convergence of problem or policy streams can open a window of opportunity for policy change, and in China, the political environment and the party's philosophy of governance can also provide reliance on and support for policy change, and the coupling of the three streams provides the conditions for the promotion of the process of urban-rural integration. On this basis, countermeasures are proposed to promote the urban-rural integration of the minimum subsistence guarantee system in three aspects: paying attention to the emergence of problems, exploring policy options and adhering to the political philosophy.

Exploration of how youth justice staff perceive the speech-language pathology role and service provision in an Australian youth justice setting

Purpose The aims of this project were to explore how youth justice staff perceive the speech-language pathology role and provision in an Australian youth justice setting, including the speech-language pathologist’s role in supporting young people to participate in the activities of the youth justice service studied. Method A narrative inquiry approach was employed to guide semi-structured interviews with youth justice staff. Perceptions and experiences were analysed via reflexive thematic analysis, with member checking and inter-rater coding utilised for rigour. Result Seven semi-structured interviews were conducted. Interviewees worked in either the custodial setting (n = 3) or the community setting (n = 4) for the youth justice service studied, though most had worked in both settings. Six themes and six subthemes were identified from the interview data and related to factors that supported improved participation in the activities of the youth justice service studied. These factors were the speech-language pathology skillset and approach, and that there were systemic barriers within the service. All participants perceived speech-language pathology input as valuable for the young people in the service studied. There was also acknowledgement by the participants of how speech, language, and communication needs of the young people impacted their participation in the activities of the service studied. These findings were despite the perceived need for organisation-wide education on the speech-language pathologist role and offering. Conclusion Increased understanding of how youth justice staff perceive the role and benefits of speech-language pathology in supporting young people in contact with the youth justice system will assist with service planning, inform education strategies, and may support policy change.

Forgone healthcare for medically vulnerable groups during the pandemic era: experiences of family caregivers of young adults with substance use disorders in Zambia.

Scholars worldwide have defined the COVID-19 pandemic as a mass-disabling event of our time. The situation is grave for families experiencing financial hurdles while caring for young adults in recovery from addiction problems. Using semi-structured interviews with 30 purposively selected family caregivers (FCGs) of young adults with substance use disorders (SUDs) in Lusaka, Zambia, this study reveals several factors influencing forgone healthcare for this medically vulnerable group. Financial challenges and huge out-of-pocket bills; caregivers' perceived far-fetched recovery of the young adult; the cost of medication and transportation; the young adult's little perceived need for healthcare service use, their runaway and treatment elusive tendencies; caregiver concerns about contracting the virus, and the stigma associated with it; and a fragmented child and adolescent mental health system influenced forgone healthcare. The young adults were often unavailable for days and months, posing challenges to the continuity of care. Despite caregivers' acknowledgment of the availability of healthcare professionals, young adults with problematic substance use had limited access to SUD recovery services, resulting in adverse health outcomes. Results also show that most family caregivers encountered challenges in accessing and purchasing psychotropic medications, which were difficult to find during the lockdowns. Some family caregivers lost their sources of income by being laid off from work due to the pandemic and skipping work to attend to caregiving responsibilities. Most of those in self-employment had to close their business and stay home to look after their youth. Several caregivers kept their youth at home because they failed to access private residential SUD recovery services. Family caregivers mostly relied on outpatient public health services, alternative medicine from traditional healers, and faith-based healing, all of which some young adults rarely accessed because of their problematic behaviors of escaping healthcare. These identifiable risk factors, and their detrimental consequences highlight the need for interventions to improve healthcare access for this vulnerable population. Supporting FCGs of addicted young adults is crucial in ensuring the well-being of both the caregivers and care recipients. Further research is warranted to explore potential solutions, such as peer support programs, policy changes, and education initiatives for carers and recipients in the (post) pandemic era.

Ascertainment of the most suitable water harvesting sites in a data-scarce region via an integrated PROMETHEE-II–AHP method in GIS environment

Abstract People residing in arid and semi-arid regions face significant challenges because of water scarcity and floods. These challenges become more severe in downstream areas of hill torrents that experience highly unpredictable periods of droughts and floods due to highly variable rainfall. Constructing small dams in hill torrents to capture rainwater from watersheds, mitigate flash floods, and recharge artificial groundwater is one of the solutions to address these issues in South Punjab. However, the success of rainwater harvesting (RWH) systems depends on their technical design and suitable site selection. To identify appropriate sites for small dams for rainwater harvesting, a combination of Geographical Information Systems (GIS), Remote Sensing (RS), and Multi-Criteria Decision Analysis (MCDA) has been utilized in the catchment of the Vidore Hill Torrent, Punjab, Pakistan. The primary goal of this study was to evaluate the use of RS and MCDA in developing a suitability map, in a data-scarce region that can be useful for hydrologists, decision-makers, and planners in quickly identifying areas with the highest potential for RWH. The model incorporated several factors, including slope, runoff depth, land use, soil texture, drainage density, and lineament density. Implementing this method could also support policy changes toward widespread adoption of RWH.

Food Insecurity and Health Inequities in Food Allergy.

The intersection of food insecurity among those with food allergy is a growing public health concern. Both food allergy and food insecurity have profound implications on health, social, and economic outcomes. The interaction of social determinants of health, poverty, racism, housing insecurity, and access to care has direct impact on individuals with food allergy. There is increasing evidence that universal screening for food insecurity is vital in the routine care of patients with food allergy. Individuals with food allergy who are also burdened by food insecurity face unique challenges related to the need to maintain dietary modifications often with expensive specialized diets, which are difficult to access. This may lead to limited dietary options, malnutrition, increased financial burden, and social isolation. While there are available resources and support systems that can assist individuals with food allergies in managing food insecurity, there is an increasing need for advocacy and inclusivity in policy frameworks involving multiple stakeholders. Multi-sector efforts involving healthcare providers and advocacy and government agencies are necessary to support policy changes that protect the rights and well-being of individuals affected by food allergy and food insecurity. By increasing awareness, improving access to safe, affordable, allergen-free food, and advocating for policy change, we can work toward ensuring universal access to safe, nutritious food for all individuals, regardless of their food allergy status or socioeconomic background.

Inhibitors and Supporters of Policy Change in the Regulation of Unhealthy Food Marketing in Australia.

Evidence on the impact of policies that regulate unhealthy food marketing demonstrates a need for a shift from pure industry self-regulation toward statutory regulation. Institutional rules, decision-making procedures, actor practices, and institutional norms influence the regulatory choices made by policy-makers. This study examined institutional processes that sustain, support, or inhibit change in the food marketing regulation in Australia using the three pillars of institutions framework - regulatory, normative, and cultural cognitive pillars. This was a qualitative study. Twenty-four in-depth semi-structured interviews were conducted with industry, government, civil society, and academic actors who are involved in nutrition policy in Australia. The regulatory pillar was perceived to inhibit policy change through the co-regulation and self-regulation frameworks that assign rulemaking, monitoring and enforcement to industry bodies with minimal oversight by regulatory agencies and no involvement of health actors. The normative pillar was perceived to provide pathways for comprehensive statutory regulation through institutional goals and norms for collaboration that centre on a whole-of-government approach. The framing of food marketing policies to highlight the vulnerability of children is a cultural cognitive element that was perceived to be essential for getting support for policy change; however, there was a lack of shared understanding of food marketing as a policy issue. In addition, government ideologies that are perceived to be reluctant to regulate commercial actors and values that prioritize economic interest over public health make it difficult for health advocates to argue for statutory regulation of food marketing. Elements of all three pillars (regulatory, normative, and cultural-cognitive) were identified as either inhibitors or pathways that support policy change. This study contributes to the understanding of factors that inhibit policy change and potential pathways for implementing comprehensive statutory regulation of unhealthy food marketing.

Passing a Bill “Nobody Especially Cared About": The Creation of the Department of Education

This article is a case study of the creation of the Department of Education. President Jimmy Carter promised to create a separate Department of Education during his 1976 campaign. The National Education Association (NEA) provided the impetus for the legislation but it was the White House Domestic Policy staff and OMB Director that guided the bill through by working to narrow the scope of the conflict over the proposed legislation to ensure passage. Using both primary and secondary sources I explore the methods the Carter administration used to advance passage of the bill. Carter domestic policy advisor Elizabeth Abramowitz noted that, “if we get the Department, it will be a good example of the President’s ability to get something through Congress nobody especially cared about” (Abramowitz 1979). As a result, a new cabinet agency was created with little broad-based political support and substantive policy change, creating a Department that continues to be vulnerable to calls for abolishment partially due to a lack of broad public support.

Translating data into narratives

Today more than ever, it is evident the role that data can play when designing policies. Not only can understandable data orient better strategies, but they can also enable reflexive practices within Public Administrations, giving directions for knowledge management and smarter governance. However, multiple gaps concur to affect data understanding and interpretation, hindering their subsequent translation into policy-valuable information. To tackle challenges related to data interpretation and usage, the article (i) illustrates a narrative approach for building profiles of cities as narrative feedback from sets of data and (ii) investigates their potential as a (self-)evaluation and a decision-making support device. The feedback structure relies on the conceptual model built for the DIGISER Project, which investigated multidimensional digital transition processes across European cities. Dynamic feedback retrieves data from the project dataset, translating them into discursive form. The effectiveness of the approach and its device is validated through a qualitative enquiry on a textual excerpt provided to three different departments of one of the cities that participated in the survey. The study corroborates that designing narrative feedback as semantic interpretations can trigger understanding, (self-)reflection and support policy change, informing policy formulation and facilitating cross-silo interactions across administrative units engaged in digital transformation processes.

Impressions of ChatGPT: Using Survey Results to Inform AI Policy in Education

ChatGPT is a powerful artificial intelligence chatbot developed by OpenAI. Because of the public availability and unprecedented writing capabilities of ChatGPT, it presents a unique policy obstacle for schools. On the one hand, ChatGPT and similar chatbots have the potential to be revolutionary learning tools, helping students to learn, study, and understand material. On the other hand, ChatGPT provides students with the means to cheat with unprecedented ease and competence, producing quality work in seconds with minimal understanding of the material required. In this paper, I examine the results of a survey I sent out to students, parents, and teachers in order to gauge policy opinions with regards to ChatGPT. The hope is that public opinion in this space can be used to inform policy making. I find that students are currently using ChatGPT at high rates, and that there is broad support for policy changes that can prevent AI cheating. Ultimately, I suggest that schools should minimize the use of take home assignments as a middle ground response to the growing risks of AI cheating.

APF Gold Medal Award for Impact in Psychology: Jillian C. Shipherd.

The APF Gold Medal for Impact in Psychology recognizes Jillian C. Shipherd for her extensive work to improve the lives of lesbian, gay, bisexual, transgender, queer (LGBTQ+) veterans. Jillian Shipherd has pioneered national training programs for the Department of Veterans Affairs (VA) on all facets of transgender health care to support policy changes and improvements, positioning clinicians to evaluate and treat this previously ignored and stigmatized group of veterans. Her research has received wide attention in the media and in senior management within the VA. Dr. Shipherd has taken her research findings and applied them to make groundbreaking change throughout the VA spanning education and policy. Her trailblazing work has had a transformational impact on the lives of LGBTQ+ veterans and will continue to affect access to care for generations to come. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Are intellectual property policies for gene‐edited crops fit for purpose? The perspectives of German scientists

Societal Impact StatementA growing body of research indicates that intellectual property policies for agricultural biotechnologies are hindering research and limiting the use of the technologies. Research also indicates that public resistance to agricultural biotechnologies, including transgenic and gene‐edited crops, is at least in part motivated by concerns about intellectual property restrictions. Therefore, changing the policies governing agricultural biotechnologies promises to reduce public resistance and to enhance the diffusion of research outputs. Because so many patents related to gene editing are held by universities and because so much cutting‐edge research is conducted by public scientists, exploring the scientists' perspectives on these policies offers insights into possibilities for policy changes.Summary After the European Court of Justice's ruling that gene‐edited crops would be regulated the way transgenic crops are regulated, the European Commission consulted with stakeholders and concluded that policies governing gene‐edited crops are not fit for purpose. This research explores whether public scientists in Germany also consider intellectual property policies not fit for purpose. The data come from intensive interviews with 10 scientists working at German universities and research institutes. The interviewed scientists describe how intellectual property policies limited the use of transgenic breeding techniques and how they now limit applications of gene‐editing techniques. They overwhelmingly support policy changes that facilitate the use of their scientific breakthroughs to solve problems in the world, and they do not want to see large companies use the technologies to consolidate economic power or to profit at the expense of solving problems. Because intellectual property policies are often cited as a key reason for the resistance to agricultural biotechnologies and because research indicates that current policies are not enhancing crop innovations or social welfare, a change in intellectual property policies is likely to reduce resistance to the new crop breeding technologies and yield more social benefits.

Aiding empirical research on the commercial determinants of health: a scoping review of datasets and methods about lobbying

BackgroundTo support public health researchers and advocates seeking to challenge the influence of powerful commercial actors on health, it is necessary to develop a deeper understanding of corporate political activities. This project explores political science scholarship analysing lobbying to identify new datasets and research methods that can be applied to public health and stimulate further research and advocacy.MethodsWe undertook a systematic scoping review of peer-reviewed and grey literature reports analysing the practice of lobbying. Titles and abstracts of 4533 peer-reviewed and 285 grey literature reports were screened, with 233 peer-reviewed and 280 grey literature reports assessed for eligibility. We used a two-stage process for data extraction. In stage 1, we collected two pieces of information from all included studies: data sources and indicators used to measure lobbying. For the second stage, data extraction was limited to 15 studies that focused on meetings.ResultsThe most common indicators used to measure lobbying activity were: registrations of active lobbyists; expenditure on lobbying; meetings; written comments and submissions made to government consultations; bills; and committee participation. A range of different data sources were used to analyse lobbying, including from governments, not-for-profits and commercial sources. All 15 studies analysing lobbyist meetings were from high-income contexts. The studies analysed three key variables: the types of government actors targeted by lobbying; the policies of interest; and the lobbyists and/or their clients. The studies used a range of taxonomies to classify policy issues and the types of actors engaged in lobbying. All studies discussed challenges with accessing and analysing lobbying data.ConclusionsThere is enormous potential for public health research and advocacy concerned with commercial lobbying to learn from political science scholarship. This includes both conceptual frameworks and sources of empirical data. Moreover, the absence of good quality transparency internationally emphasises the importance of advocacy to support policy change to improve the quality of political transparency to make it easier to monitor commercial lobbying.

A time for moral actions: Moral identity, morality-as-cooperation and moral circles predict support of collective action to fight the COVID-19 pandemic in an international sample

Understanding what factors are linked to public health behavior in a global pandemic is critical to mobilizing an effective public health response. Although public policy and health messages are often framed through the lens of individual benefit, many of the behavioral strategies needed to combat a pandemic require individual sacrifices to benefit the collective welfare. Therefore, we examined the relationship between individuals’ morality and their support for public health measures. In a large-scale study with samples from 68 countries worldwide (Study 1; N = 46,576), we found robust evidence that moral identity, morality-as-cooperation, and moral circles are each positively related to people’s willingness to engage in public health behaviors and policy support. Together, these moral dispositions accounted for 9.8%, 10.2%, and 6.2% of support for limiting contact, improving hygiene, and supporting policy change, respectively. These morality variables (Study 2) and Schwartz’s values dimensions (Study 3) were also associated with behavioral responses across 42 countries in the form of reduced physical mobility during the pandemic. These results suggest that morality may help mobilize citizens to support public health policy.

Foreign pressure and public opinion in target states

To influence states’ treatment of their citizens, various foreign actors deploy a broad array of tools, including moral suasion and material assistance. The efficacy of international pressure is often contingent on how publics in target states respond. Employing survey experiments, we examine how two common tools of external influence employed by other countries —verbal condemnation and the threat of aid withdrawal—affect public opinion in three Asian states that have been criticized for their human rights practices: Myanmar, Nepal, and Indonesia. Overall, we find that, in the face of such pressure, preference for the status quo policy becomes stronger among the supporters of incumbent governments in target states. In contrast, those who are not government partisans are more likely to support policy change for better human rights conditions. The latter, however, is the constituency less likely to exert influence on the government to revise its policy. Together, these findings point to the possibility that criticism and aid sanction threats employed by foreign countries will be ineffective or even counterproductive at least in the short run.

OnabotulinumtoxinA for Pediatric Migraine

BackgroundMigraine is a painful, prevalent, and problematic condition among children. Children need access to safe and effective treatment options to alleviate the impact of this chronic condition on their wellbeing. Clinical ImplicationsNurses have a crucial role in supporting patient access to BTX-A. Given the results of this and other studies demonstrating the safety and efficacy of BTX-A in children, nurses can support policy change for health plans to fund this intervention for pediatric migraineurs. Allowing children to receive the safe and effective BTX-A injections will lessen the already significant impact of chronic migraine on their physical, emotional and mental health. Nurses can also play a key role in providing education to patients regarding safe administration of BTX-A for migraine. AimThe objective of this study was to define the experiences, effects, and clinical response of children to onabotulinumtoxinA (BTX-A) for migraine prevention. MethodsClinical documentation for patients aged 13-17 years presenting for BTX-A treatment for chronic migraine between 2016-2022 in a community-based specialty clinic within a large, urban, pediatric academic medical center were included. A series of one-way repeated measures (analysis of variance [ANOVA]) were conducted to compare headache frequency, severity, and duration at baseline, and following first and second injections of BTX-A. ResultsOf 32 eligible participants, administration of BTX-A demonstrated a decrease in headache frequency and severity. Participants reported nearly seven fewer headache days per month. Participants reported neck stiffness, fever or flu-like symptoms, fatigue, and worsening pain following BTX-A administration. ConclusionsPediatric migraineurs need therapies that are safe, effective, and accessible. BTX-A was a safe and effective treatment for migraine among the children included in this study.

Comparing the effectiveness of different consensus messages in communicating global environmental issues: The role of referent groups, emotions, and message evaluation

Considering effective messaging strategies as one important way of mobilizing the general public to join the fight in addressing some of the world's most critical environmental problems, this study compared the effectiveness of different consensus messages that varied in referent groups and content in communicating two global environmental issues. It proposed and tested a theoretical framework that includes two mediational pathways leading to changes in policy support. U.S. adults (N = 2296) were randomly assigned to 1 of 16 experimental conditions as part of a 4 (consensus message: control vs. seriousness vs. anger vs. hope) × 2 (referent group: scientists vs. public) × 2 (issue: plastic pollution vs. biodiversity loss) between-subjects factorial design. Overall, the proposed framework received solid support in both contexts. Scientific (vs. public) consensus was found to be more credible, which positively influenced policy support. Anger consensus (vs. control) worked through perceived anger consensus and then anger to increase policy support. In contrast, hope consensus and the feeling of hope were largely ineffective in improving policy support. These findings contribute to a deeper understanding of the potentials and limitations of consensus messaging in communicating global environmental issues.

"What do I think about implementing lung cancer screening? It all depends on how." Acceptability and feasibility of lung cancer screening in Australia: The view of key stakeholders about health system factors.

Lung cancer is the number one cause of cancer death worldwide. Although international trials demonstrate that targeted screening using low dose computed tomography (LDCT) significantly reduces lung cancer mortality, implementation of screening in the high-risk population presents complex health system challenges that need to be thoroughly understood to support policy change. To elicit health care providers' and policymakers' views about the acceptability and feasibility of lung cancer screening (LCS) and barriers and enablers to implementation in the Australian setting. We conducted 24 focus groups and three interviews (22 focus groups and all interviews online) in 2021 with 84 health professionals, researchers, and current cancer screening program managers and policy makers across all Australian states and territories. Focus groups included a structured presentation about lung cancer and screening and lasted approximately one hour each. A qualitative approach to analysis was used to map topics to the Consolidated Framework for Implementation Research. Nearly all participants considered LCS to be acceptable and feasible but identified a wide range of implementation challenges. Topics (five specific to health systems and five cross-cutting with participant factors) identified were mapped to CFIR constructs, of which 'readiness for implementation', 'planning' and 'executing' were most salient. Health system factor topics included delivery of the LCS program, cost, workforce considerations, quality assurance and complexity of health systems. Participants strongly advocated for streamlined referral processes. Practical strategies to address equity and access, such as using mobile screening vans, were emphasised. Key stakeholders readily identified the complex challenges associated with the acceptability and feasibility of LCS in Australia. The barriers and facilitators across health system and cross-cutting topics were clearly elicited. These findings are highly relevant to the scoping of a national LCS program by the Australian Government and a subsequent recommendation for implementation.