Changes In Public Policy Research Articles

Situating inservice teacher training in reform community of developing holistic competence to engage practice

This article investigates the situating of inservice teacher training (TT) in teaching-learning, education, and other sector reform communities for developing holistic competence to engage practice. It vignettes a holistic inservice TT resilience to situate in an often transient reform community of developing capacity to engage practice, including competence-based education (CBE) reform that often spews vague ideas in pieces amid low incentive and commitment to undergo practice. To assist, this article adopts the situated learning lens to investigate the extent to which contextualising inservice TT in authentic teaching-learning reform community resources develops competence to engage practice. In this holistic regard, the article mixes text, interview, and questionnaire methods involving 420 Cameroon inservice TT-CBE reform community subjects as part of the global education-for-all-practice reform flow. From findings, few teachers undergo narrow inservice training and lead few partners in reform oration, resenting few means and evading complex teaching-learning reform community practices. Inservice TT’s bare oration of public education policy and reform community changes prepares teachers to facilitate teacher-centred acquisition of less competence than what learners need to engage practice. The article opines ongoing inservice TT preplanning-research, onsite activity, and outcome sustainability themes to further situate in authentic reform community resources to develop holistic competence to engage complex practice.

Voice, Protest, and Democracy

In the last 10-15 years, there has been a surge of protests around the world, spanning from Budapest to Beirut and from Seoul to Sao Paulo. Through protest, ordinary people challenge the status quo and the powerful structures maintaining it. They advocate for positive social change on issues such as increasing access to nutritious food and clean water, improving healthcare, fostering civic peace, and advancing environmental protections. They demand justice, often in opposition to elected representatives. Although protests frequently advocate for specific changes in public understanding or policy, these mobilizations also play a broader role in the democratic process by allowing people to be heard: protest is the realization of political agency. For marginalized groups, mobilizing through protest can often be more meaningful than other forms of civic participation, such as casting a ballot in elections or participating in formal partisan organizations.

Evaluating Policy Shifts on Perceived Greenspace Quality: Applying Regression Discontinuity During the COVID-19 Reopening Period

Abstract: Urban greenspaces have been essential in supporting residents’ well-being during the COVID-19 pandemic, particularly under strict lockdown measures. However, the impact of changing containment policies on residents’ perceived greenspace quality remains insufficiently explored. This study utilized online survey data collected between 11 October and 29 December 2022, in Shanghai, coinciding with the major policy shift on 5 December 2022. A probability proportionate to size sampling was adopted to survey residents aged 18 and above who had lived in the city for at least six months, yielding a total of 577 valid responses. We assessed residents’ perceived greenspace quality using 20 park- and community-level variables, focusing on both overall quality and specific features of greenspaces. A regression discontinuity design (RDD) was applied to evaluate how the lifting of the COVID-19 policies influenced residents’ perceptions of parks and community greenspaces. Our RDD estimation indicates no statistically significant change in residents’ overall perceived quality of parks after the policy shift, except for increased satisfaction with specific features such as plant diversity, maintenance, seating areas, trails, and large open spaces. In contrast, residents who responded after the policy shift reported a significantly higher perceived quality of community greenspaces compared to those who completed the survey before the shift (0.609 score difference, p < 0.01), with notable increases in satisfaction regarding plant diversity, maintenance, and seating areas. Perception of plant quantity remained unchanged in both types of greenspaces. Residents expressed greater satisfaction with sports facilities in parks, while community greenspaces were preferred for their water features and esthetic qualities. By adopting an RDD with a unique dataset, this study contributes empirical evidence to the current ongoing debate on the role of urban greenspace during the later stages of COVID-19. Specifically, it examines how changes in public health policy and the resulting increase in mobility might affect residents’ perceived greenspace quality. The findings can assist decision-makers and urban planners in developing more adaptive strategies to address the diverse needs of residents for greenspaces during the transitional period of a public health crisis.

Consumer Support for Climate Policies Driven by Political Ideologies

Consumer support for climate policies is essential for new sustainable consumption patterns, which may face challenges considering the left-right political spectrum. This study aims to understand how different types of climate policies receive different levels of support from Liberals (Left), Moderates (Center), and Conservatives (Right). We analyzed data from an online panel with 1000 Brazilians through linear (ANOVA, MANOVA, and Correspondence Analysis) and non-linear predictive (Artificial Neural Networks) methods. Although Liberals are more concerned about overall global warming and climate change than Conservatives, both groups are more prone to support than to oppose climate change public policies. Moreover, while Moderates and Conservatives are getting more concerned about climate change, Liberals are becoming more pessimistic about mitigation strategies. Policies based on opportunity-facilitating or constraining using regulatory or economic instruments are associated differently with Liberals, Moderates, and Conservatives, indicating specific preferences for each political ideology.

The "Green Doctor" Initiative: Ethical Healthcare in the Age of Medical Commercialization

The "Green Doctor" initiative represents a groundbreaking shift in global healthcare systems, aiming to prioritize ethical, compassionate, and patient-centered care in an era of increasing commercialization. Proposed by Professor Reza Ghalamghash, the "Green Doctor" concept focuses on the moral obligations of healthcare professionals to provide care that transcends financial considerations and commercial pressures. This innovative model emphasizes the humanistic aspects of medicine, where physicians are encouraged to focus on patients' holistic well-being, mental and emotional health, and equitable access to care. In the face of rising healthcare costs, systemic inequities, and ethical dilemmas posed by profit-driven models, the "Green Doctor" approach is particularly timely. This article explores the philosophical foundation of the "Green Doctor" concept, its implications for healthcare systems around the globe, and its potential to drive meaningful change in public health policy and medical practices. Through a detailed exploration of real-world case studies, the article delves into how this model is being adopted in different healthcare settings, examining its efficacy in enhancing patient outcomes, promoting healthcare equity, and reshaping the relationship between doctors and their patients. Additionally, the article discusses the structural challenges faced by healthcare providers in implementing this approach, including financial constraints, regulatory hurdles, and the need for institutional support. It also highlights the role of technology in facilitating the "Green Doctor" model, particularly through the use of telemedicine, digital health platforms, and AI-driven diagnostics, which allow doctors to extend care to underserved populations while maintaining a patient-centered focus. Finally, the article assesses the future of the "Green Doctor" initiative in the context of evolving global healthcare challenges, offering insights into how it could serve as a sustainable model for ethical healthcare in the 21st century.

Toward an assessment of the relevance of proposed public policy in contemporary African society: A retrospective review of Kenya's now‐defunct building bridges initiative, with special reference to post‐election violence

AbstractWhereas competing interests characterize the African public policy sphere today, the lens of mass‐elite differences has hardly been employed to study electoral violence. Accordingly, this article juxtaposes the lived experiences of ordinary Kenyan citizens, obtained through focus groups, with the content of the now‐defunct Building Bridges Initiative (BBI), a comprehensive set of public policy changes proposed by Kenya's political protagonists Uhuru Kenyatta and Raila Odinga in 2017. It poses the following broad question: did the BBI proposals truly intersect with the opinions and lived experiences of the masses? I find that various factors, including the lack of electoral and judicial integrity, and a winner‐takes‐all democratic system, are responsible for post‐election violence according to citizens. A comparative analysis of citizen perspectives and the BBI Report reveals considerable congruence in the understanding of the causes of post‐election violence. The study partly concludes that African leaders should continue to engage in policy entrepreneurship.Related ArticlesHodzi, Obert. 2020. “African Political Elites and the Making(s) of the China Model in Africa.” Politics & Policy 48(5): 887–987. https://doi.org/10.1111/polp.12380.Kouladoum, Jean‐Claude. 2023. “The Role of Freedom of Communication in Modulating the Effect of Political Participation on Electoral Outcome in Africa.” Politics & Policy 51(4): 588–613. https://doi.org/10.1111/polp.12539.Onyango, Gedion. 2024. “DHR‐PA—Democracy and Human Rights in Public Administration in Africa.” Politics & Policy 52(2): 426–49. https://doi.org/10.1111/polp.12584.

Analysis of Indirect Costs of Absence Associated with Mental Disorders on the Basis of Social Security Data (2012-2023).

Mental and behavioral disorders significantly impair psychophysical functioning, leading to challenges in daily activities. The increasing recognition of the importance of mental health in global development goals has resulted in its inclusion in the United Nations' Sustainable Development Goals. The burden of mental disorders has grown worldwide due to demographic changes, with substantial economic and social impacts. This study aimed to examine the indirect costs of mental disorders in Poland by analyzing the expenditures by the Social Insurance Institution (ZUS) on work incapacity benefits and disability pensions from 2012 to 2023. The goal was to identify trends, dependencies, and the economic impact of policy changes. Data were collected from ZUS reports on annual expenditures for work incapacity benefits and disability pensions. Advanced statistical methods, including linear regression and Pearson correlation, were employed to analyze trends and relationships. Student's t-tests assessed the statistical significance of the observed trends. The expenditures on benefits for work incapacity due to mental disorders increased significantly over the past decade, particularly from 2020 to 2023, partly due to the COVID-19 pandemic. Short-term absenteeism due to mental disorders accounted for 10.5% of the total sick leave days. A strong positive correlation was found between years and benefit expenditures. Conversely, the disability pension expenditures exhibited a downward trend, potentially reflecting improvements in public health or policy changes. The significant increase in expenditures on benefits related to mental disorders may reflect greater awareness, improved diagnostics, and the impact of the COVID-19 pandemic. In contrast, the decline in disability pension expenditures could suggest improved mental health or effective policy measures. However, it is important to emphasize that the presented data are not the only factor influencing this situation. Multiple variables, including societal, economic, and healthcare system changes, contribute to these trends. Therefore, further research is necessary to fully understand the underlying causes and to guide effective policy development. Regular monitoring and continued investment in mental health are essential to managing indirect costs such as absenteeism and presenteeism efficiently.

Multilevel determinants of antiretroviral therapy initiation and retention in the test-and-treat era of Nepal: a qualitative study

BackgroundThe transition to the “test-and-treat” policy in Nepal in 2017, coupled with the rapid initiation of antiretroviral therapy (ART) in 2020, necessitates an in-depth understanding of factors influencing ART initiation and retention. This study investigates these factors from the perspectives of healthcare providers, families/communities, and people living with HIV (PLHIV).MethodsEmploying a qualitative design, in-depth interviews were conducted with 24 ART clients and 26 healthcare providers across different provinces of Nepal. A comprehensive interview guide facilitated the exploration of experiences and perceptions. Interviews were transcribed verbatim, and thematic analysis was applied to distill key insights. Guided by a socio-ecological model, interviews were analyzed to identify the barriers and facilitators to ART initiation and continuation at the individual, family/community, and health system levels.ResultsFacilitators and barriers were identified at three levels. Individual-level facilitators included fear of death, perceived health benefits, knowledge about HIV/ART, confidentiality, and financial support. Barriers encompassed concerns about lifelong medication, side effects, denial of HIV status, fear of disclosure, and financial constraints. At the family/community level, support from family and community health workers facilitated ART adherence, while social stigma and discrimination posed barriers. The health system’s role was dual; the provision of free treatment, a client tracking system and a robust drug supply chain were facilitators, whereas logistical challenges and service accessibility during the COVID-19 pandemic were notable barriers.ConclusionsThis study highlights the various factors that influence ART initiation and retention in Nepal during the test-and-treat era. Tailored interventions should focus on increasing awareness about HIV and ART, strengthening healthcare systems, ensuring availability of medications, and providing accessible treatment during service disruptions. Furthermore, these interventions should encourage supportive environments at the individual, community, and healthcare system levels. Taking this holistic approach is essential for effectively implementing ART and achieving long-term health outcomes in light of changing public health policies.

Neighborhood-Level Social Determinants of Health and Presenting Characteristics for Rhegmatogenous Retinal Detachments

Functional outcomes after repair of rhegmatogenous retinal detachments (RRDs) are highly dependent on baseline visual acuity and foveal status. Adverse social determinants of health (SDOH) can present barriers to timely presentation for repair and limit vision outcomes. To evaluate the association between neighborhood-level SDOH with baseline severity (visual acuity and fovea status) of RRD. This was a retrospective cohort study that included adult patients 18 years and older who underwent primary repair of uncomplicated RRD at the Wilmer Eye Institute from January 2008 to December 2018. Study data were analyzed from December 2023 to April 2024. The census block group of patient home addresses were matched to multiple neighborhood-level SDOH including the Area Deprivation Index (ADI), per capita income, percentage of renters, percentage of rent burden, percentage of people using a food assistance program, percentage of uninsured individuals, mode of transportation to work, distance to the nearest transit stop, total road density, National Walkability Index, Index of Medical Underservice score, and aggregate cost of medical care. Odds of presenting with vision worse than 20/40 or fovea-involving RRD using multivariable logistic regression adjusting for age, sex, race and ethnicity, and insurance. A total of 700 patients (mean [SD] age, 57.9 [12.4] years; 432 male [61.7%]) were included. Every decile increase in ADI, indicating more socioeconomic disadvantage, was associated with an increased odds of presenting with worse visual acuity and fovea-involving RRD (odds ratio [OR], 1.14; 95% CI, 1.04-1.24; P = .004 and OR, 1.13; 95% CI, 1.04-1.22; P = .005, respectively). Each $1000 increase in per capita income was associated with lower odds of presenting with worse vision (OR, 0.99; 95% CI, 0.98-0.99; P = .001). Every 1% increase in percentage of workers who drove to work was associated with an increased odds of presenting with worse vision and fovea-involving RRD (OR, 1.02; 95% CI, 1.01-1.03; P = .005 and OR, 1.01; 95% CI, 1.00-1.03; P = .04, respectively). Results of this cohort study suggest that patients with a residence in neighborhoods with more socioeconomic deprivation or a higher percentage of workers who drove to work were more likely to present with more severe RRD even after accounting for multiple individual-level characteristics. These findings support consideration of public policy changes to address the barriers faced by patients residing in certain neighborhoods who seek prompt surgical intervention for RRD to reduce health disparities in RRD outcomes.

What's hot and what's not in the aquatic sciences—Understanding and improving news coverage

AbstractThe frequency of news reporting about scientific topics is positively related to public interest as well as to public support for science funding and public policy change. This correlation can also have positive impacts on individual scientific careers depending on the chosen subject area of research. Analysis of a public news database shows the frequency and trends in news reporting of several popular research areas in the aquatic sciences. The frequency of appearance of topics in the news varies over more than three orders of magnitude. Temporal trends in reporting vary from steeply increasing (+25% per year) to declining (−4% per year). Suggestions are offered concerning the framing of research topics and overall better communication of research findings to journalists and the general public. This understanding may increase news prominence, public interest, science funding, and policy change in aquatic research areas.

Local Democratic School: Community Social Training for Improving the Quality of Democracy

The lack of awareness and knowledge among the Banjar community regarding government participation and transparency led to the implementation of the community service activity at the Local Democratic School. The purpose of this community service is to provide education to the community about democracy and governance. The community service method, using the participatory action research approach, began with an initial survey, focus group discussions, and training targeting KPU partners, attended by 25 participants serving as the Election Committee in each village or neighborhood across Banjar City. Through a series of concrete and collaborative steps, it is expected to establish a stronger foundation for inclusive and sustainable democracy at the local level, enhancing community involvement and contribution to positive changes in social structures and public policies. The duration of this PkM activity is seven months, from March to September 2023. The outcomes of the activity received positive feedback from the community, with a 91% response rate from participants indicating an understanding of various topics covered, including local content, governance, civil society, gender and democracy, welfare state, Pancasila democracy, sociopreneurship, law and human rights, and citizen participation in government. The implication is that this program can enhance community understanding and involvement in creating positive changes in social structures and public policies at the local level.

Digest: Individual- and population-level effects of SARS-CoV-2 evolution and changing preventative measures.

Although COVID-19 is no longer classified as a pandemic, variants of SARS-CoV-2 continue to arise. It is critical to understand how changes in viral characteristics, public policy, and behavior affect disease load and mortality. An analysis by Otto et al. (2024) shows that changes in transmission rate and immunological properties have differing effects on disease load, even among variants with similar selective advantages. The impact of various strategies aimed at countering disease spread is also analyzed.

Implementasi Pelibatan Masyarakat dalam Meningkatkan Kualitas Pendidikan Berdasarkan Instrumen Akreditasi Satuan Pendidikan (IASP) Tahun 2020 di MIN 1 Bandung

Indonesia's education policy is closely linked to other public policies and can change if public policies change. Education requires community participation to produce an effective learning community. This research uses a qualitative approach with descriptive method located in MIN 1 Bandung. With the committee, some programs run smoothly, and socialization with students can be coordinated easily. The participation of the committee and other elements such as Polsek, Puskesmas, and local RT/RW received positive responses, especially with programs that involve interaction with the surrounding environment and habituation programs that create new habits in the school environment. Community participation or individual participation in the development of self, life, and the environment, which involves two-way interaction between the government and the community.

‘Black dealers kill people and come from the projects; Whites dealers kill people and come from nice families’: contextualized racialized perceptions of related criminal behaviors within an attribution theory framework

ABSTRACT Some believe certain racial groups are associated with specific behaviors, like homicide, drug dealing, and drug use. It is unclear if these perceptions are connected or if culpability as offender or victim for these behaviors is also racialized. The present study examines perceptions of people’s involvement in these related criminal behaviors. Using semi-structured interviews, data were gathered from men and women (n=32) living in 15 contiguous neighborhoods in a mid-sized city in the northeastern US. All study area neighborhoods experienced the effects of the opioid epidemic and repercussions of subsidized public housing policy changes, and some had high levels of violent and drug crimes. Interview data were analyzed using thematic content analysis applying iterative, open coding techniques to identify themes and recurrent concepts across participants. Findings show that respondents viewed Black persons engaged in homicides and drug dealers as offenders and white persons engaged in drug use as victims. Crimes attributed to Black people were also contextualized as a problem among gang members and people receiving subsidized public housing. Applying the racial threat hypothesis, study findings and implications for research on racialized perceptions of related criminal behaviors and culpability as offenders or victims are discussed within an attribution theory framework.

Public health policy impact evaluation: A potential use case for longitudinal monitoring of viruses in wastewater at small geographic scales

Public health policy impact evaluation is challenging to study because randomized controlled experiments are infeasible to conduct, and policy changes often coincide with non-policy events. Quasi-experiments do not use randomization and can provide useful knowledge for causal inference. Here we demonstrate how longitudinal wastewater monitoring of viruses at a small geographic scale may be used in a quasi-experimental design to evaluate the impact of COVID-19 public health policies on the spread of COVID-19 among a university population. We first evaluated the correlation between incident, reported COVID-19 cases and wastewater SARS-CoV-2 RNA concentrations and observed changes to the correlation over time, likely due to changes in testing requirements and testing options. Using a difference-in-differences approach, we then evaluated the association between university COVID-19 public health policy changes and levels of SARS-CoV-2 RNA concentrations in wastewater. We did not observe changes in SARS-CoV-2 RNA concentrations associated with most policy changes. Policy changes associated with a significant change in campus wastewater SARS-CoV-2 RNA concentrations included changes to face covering recommendations, indoor gathering bans, and routine surveillance testing requirements and availability.

Risk factors for the development of cervical cancer: analysis of the evidence

IntroductionCervical cancer (CC) is the fourth most prevalent female cancer globally. Understanding its epidemiology is crucial for devising practical strategies suited to geographic and social contexts to attain the global eradication of CC. Hence, this study examined the latest evidence of risk factors contributing to CC development.MethodsAn independent literature search was conducted on PubMed using MESH terms. The primary sources were meta-analyses published from 2010 to 2023, which detail updated evidence on risk factors associated with CC. Additionally, the quality of the evidence was evaluated using the GRADE system and recommendations were made accordingly.ResultsThe main risk factors related to the cause of CC include co-infections with other sexually transmitted infections, genetic markers, cervicovaginal microbiota, nutritional factors, comorbidities that affect the immune response, smoking, and the use of hormonal contraceptives with a quality evidence based on the GRADE scale moderate.ConclusionsSince the necessary cause for CC is persistent cervicovaginal HPV, all the risk factors implicated in the causality of CC act as non-independent cofactors that increase the risk of CC. Thus, changes in public policies aimed at addressing these risk factors are highly recommended and can substantially decrease the risk of CC.

Contemporary Insights into Hepatitis C Virus: A Comprehensive Review.

Hepatitis C virus (HCV) remains a significant global health challenge. Approximately 50 million people were living with chronic hepatitis C based on the World Health Organization as of 2024, contributing extensively to global morbidity and mortality. The advent and approval of several direct-acting antiviral (DAA) regimens significantly improved HCV treatment, offering potentially high rates of cure for chronic hepatitis C. However, the promising aim of eventual HCV eradication remains challenging. Key challenges include the variability in DAA access across different regions, slightly variable response rates to DAAs across diverse patient populations and HCV genotypes/subtypes, and the emergence of resistance-associated substitutions (RASs), potentially conferring resistance to DAAs. Therefore, periodic reassessment of current HCV knowledge is needed. An up-to-date review on HCV is also necessitated based on the observed shifts in HCV epidemiological trends, continuous development and approval of therapeutic strategies, and changes in public health policies. Thus, the current comprehensive review aimed to integrate the latest knowledge on the epidemiology, pathophysiology, diagnostic approaches, treatment options and preventive strategies for HCV, with a particular focus on the current challenges associated with RASs and ongoing efforts in vaccine development. This review sought to provide healthcare professionals, researchers, and policymakers with the necessary insights to address the HCV burden more effectively. We aimed to highlight the progress made in managing and preventing HCV infection and to highlight the persistent barriers challenging the prevention of HCV infection. The overarching goal was to align with global health objectives towards reducing the burden of chronic hepatitis, aiming for its eventual elimination as a public health threat by 2030.

Challenges for a Brazilian Amazonian bioeconomy based on forest foods

The creation of a forest bioeconomy based on the extraction of non-timber forest products (NTFP) is being recommended to create wealth from standing forests and halt deforestation in Amazonia. Current proposals do not recognize the limits of this system, nor the impacts of capitalism that drive NTFPs with elastic demand into monoculture plantations. We use a narrative review to revisit the history of these ideas and examine public policies. Among 2,253 Amazonian NTFPs, 1,037 produce edible fruits and 131 of these are extremely abundant (hyperdominant) across the biome and common in the extractive economy. Low productivity per hectare in the forest, low return on labor to harvest the production, and scarcity of labor are three critical limits to expanding supply, with the last being the most critical in forest areas. Overcoming these limitations requires changes in public policies and public investment for health care, communication, logistics, and especially for quality education designed for rural areas and a forest bioeconomy. A mix of public policies to alleviate market failures and increase supply, efficiency, and demand via R&D, minimum prices, payment for environmental services, distinct types of certifications may be able to make food NTFP harvesting, processing, and commercialization lucrative enough to halt rural exodus and keep forest specialists in standing forests. An Amazonian forest bioeconomy depends upon both social and biodiversity, and the full participation and collaboration of Indigenous People and local communities in developing these value chains that can contribute to food security.

TINJAUAN PERUBAHAN KEBIJAKAN PELAYANAN PUBLIK BERBASIS HAK ASASI MANUSIA DI INDONESIA

There have been changes in human rights-based public service policy as efforts to advance human rights and improve service quality in Indonesia. Therefore, this study aims to identify existing changes, factors driving policy changes, policy implementation in the field, and challenges arising in policy implementation. The research method used is descriptive qualitative, with data collected from observations, interviews, and documentation. The results show changes in human rights-based public service policy, including the addition of definitions, human rights principles, scope, stages of forming P2HAM, P2HAM criteria, involvement of academics and civil society in assessments, and no longer focusing on the term 'appreciation' but using the term 'P2HAM Work Unit'. Factors driving public policy changes include the government's responsibility in enforcing human rights, evaluation of existing regulations, and the need for terminological changes. Moreover, the implementation of human rights-based public services in the field is not optimal due to challenges such as inadequate resource availability, absence of sanction regulations, lack of work programs and budget plans, and deviant practices in public service provision. Based on the research results, practical or managerial implications emphasize the importance of adaptation and innovation in policy and operational management to enhance the quality and effectiveness of human rights-based public services.

School-based health centers as an approach to address health disparities among rural youth: A study protocol for a multilevel research framework.

School-Based Health Centers (SBHCs) are important healthcare providers for children in medically underserved communities. While most existing research on SBHCs has focused on urban environments, this study protocol proposes a mixed-methods, multi-level research framework to evaluate the role of SBHCs in addressing health disparities among underserved children and adolescents in rural communities. The study area includes four high-poverty rural counties in New York State served by Bassett Healthcare Network that permits a comparison of school districts with SBHCs to those without SBHCs, all served by providers within the Bassett Healthcare Network. We employ a human ecological framework that integrates the micro layer of individuals and families, the meso layer of school districts and community institutions, and the macro layer of local and state policies. Our research framework first identifies the socioecological health risk factors, and then proposes innovative strategies to investigate how SBHCs impact them. We propose evaluating the impact of SBHCs on the individual (micro) level of child healthcare utilization using patient records data. At the meso level, we propose to investigate how School-SBHCs partnership may facilitate greater cross-agency collaboration and broader structural and social determinist of health to address health disparities. At the macro level, we propose to assess the impact of SBHCs and cross-agency collaboration on outcomes associated with a culture of community health. This study protocol will enable researchers to assess how SBHCs reduce rural health disparities, and provide evidence for organizational and public policy change.