Health Policy Development Research Articles

Analisis Penerapan Sistem Manajemen Keselamatan dan Kesehatan Kerja Di PT. PLN (Persero) Sektor Tambora Kabupaten Sumbawa Barat

Occupational Safety and Health Management System (SMK3) is part of a management system that includes the company's organizational structure, planning, responsibility, implementation, achievement, assessment and development of occupational safety and health policies. PLN Tambora West Sumbawa is a business unit of PT PLN (Persero) which manages the electricity system in West Nusa Tenggara Province PT PLN (PERSERO) Tambora sector. In the Tambora sector, it was found that the implementation of SMK3 is still not effective, which can cause occupational accidents and occupational diseases such as the use of coal as a flammable material, slipping, falling from a height, disturbance, electric shock, and coal ash residue (FABA) which, if inhaled continuously, will cause respiratory problems. Continuous inhalation will cause respiratory distress. Therefore, an analysis was carried out on the implementation of the occupational safety and health system (SMK3) at PT PLN (PERSERO) by using data in the form of a questionnaire related to the implementation of the company's K3 management towards ISO 45001: 2018 and processing the data using the Gap Analysis method, then providing recommendations for improvement. The results showed that the implementation of ISO 45001: 2018 amounted to 88%. There is a gap of 12% because there are 4 clauses that have not been implemented optimally, namely clause 4.2 concerning understanding the needs and expectations of workers and other interested parties, clause 5.3 concerning roles, responsibilities and organizational management, clause 5.4 concerning worker consultation and participation and clause 7.2 concerning competence, so improvements are proposed for each clause.

One Health surveillance of colistin-resistant Enterobacterales in Belgium and the Netherlands between 2017 and 2019.

Colistin serves as the last line of defense against multidrug resistant Gram-negative bacterial infections in both human and veterinary medicine. This study aimed to investigate the occurrence and spread of colistin-resistant Enterobacterales (ColR-E) using a One Health approach in Belgium and in the Netherlands. In a transnational research project, a total of 998 hospitalized patients, 1430 long-term care facility (LTCF) residents, 947 children attending day care centres, 1597 pigs and 1691 broilers were sampled for the presence of ColR-E in 2017 and 2018, followed by a second round twelve months later for hospitalized patients and animals. Colistin treatment incidence in livestock farms was used to determine the association between colistin use and resistance. Selective cultures and colistin minimum inhibitory concentrations (MIC) were employed to identify ColR-E. A combination of short-read and long-read sequencing was utilized to investigate the molecular characteristics of 562 colistin-resistant isolates. Core genome multi-locus sequence typing (cgMLST) was applied to examine potential transmission events. The presence of ColR-E was observed in all One Health sectors. In Dutch hospitalized patients, ColR-E proportions (11.3 and 11.8% in both measurements) were higher than in Belgian patients (4.4 and 7.9% in both measurements), while the occurrence of ColR-E in Belgian LTCF residents (10.2%) and children in day care centres (17.6%) was higher than in their Dutch counterparts (5.6% and 12.8%, respectively). Colistin use in pig farms was associated with the occurrence of colistin resistance. The percentage of pigs carrying ColR-E was 21.8 and 23.3% in Belgium and 14.6% and 8.9% in the Netherlands during both measurements. The proportion of broilers carrying ColR-E in the Netherlands (5.3 and 1.5%) was higher compared to Belgium (1.5 and 0.7%) in both measurements. mcr-harboring E. coli were detected in 17.4% (31/178) of the screened pigs from 7 Belgian pig farms. Concurrently, four human-related Enterobacter spp. isolates harbored mcr-9.1 and mcr-10 genes. The majority of colistin-resistant isolates (419/473, 88.6% E. coli; 126/166, 75.9% Klebsiella spp.; 50/75, 66.7% Enterobacter spp.) were susceptible to the critically important antibiotics (extended-spectrum cephalosporins, fluoroquinolones, carbapenems and aminoglycosides). Chromosomal colistin resistance mutations have been identified in globally prevalent high-risk clonal lineages, including E. coli ST131 (n = 17) and ST1193 (n = 4). Clonally related isolates were detected in different patients, healthy individuals and livestock animals of the same site suggesting local transmission. Clonal clustering of E. coli ST10 and K. pneumoniae ST45 was identified in different sites from both countries suggesting that these clones have the potential to spread colistin resistance through the human population or were acquired by exposure to a common (food) source. In pig farms, the continuous circulation of related isolates was observed over time. Inter-host transmission between humans and livestock animals was not detected. The findings of this study contribute to a broader understanding of ColR-E prevalence and the possible pathways of transmission, offering insights valuable to both academic research and public health policy development.

DORMITORY ENVIRONMENT, LEARNING ENGAGEMENT, AND COLLEGE STUDENTS’ MENTAL HEALTH: AN EMPIRICAL STUDY OF SURVEY DATA FROM 45 UNIVERSITIES IN CHINA

ABSTRACT In the context of the COVID-19 pandemic, this research aimed to explore the relationship between dormitory environment, learning engagement, and mental health among college students, with a special focus on college students of different gender groups. We conducted a cross-sectional survey of students from 45 universities in China. For mental health, we tested students for depression using the 5-Item WHO Well-Being Index (WHO-5). The dormitory environment is exemplified by a typical four-person dormitory layout in China, which is assessed in four main areas: site location, functional layout, maintenance management, and view from the window. Meanwhile, we examined the relationship between mental health and the dormitory environment using learning engagement as a mediating variable. We found that the dormitory environment positively influences college students’ mental health through the mediating role of learning engagement. We found gender differences in mental health among Chinese college students. The mental health of male students was better than that of female students. More importantly, we found differences in the influence of dormitory environment on the mental health of college students in different gender groups. In the dormitory environment-learning engagement pathway, the influence was more pronounced for male students. In the learning engagement—mental health pathway, the total and indirect effects were more substantial for women than for men. As our study took place during the epidemic, the examination of the relationship between dormitory environment and college students’ mental health in this study will also inspire college administrators to pay more attention to the dormitory environment and support the development of public health policies to promote college students’ mental health. We encourage further research on the relationship between dormitory environment and college students’ mental health, which will promote the greening of college dormitories and improve college students’ mental health.

“I think they should give primary health care a little more priority”. The primary health care in Caribbean SIDS: what can be said about adaptation to the changing climate? The case of Dominica— a qualitative study

BackgroundAdaptation to climate change (CC) is a priority for Small Island Developing States (SIDS) in the Caribbean, as these countries and territories are particularly vulnerable to climate-related events. Primary health care (PHC) is an important contributor to CC adaptation. However, knowledge on how PHC is prepared for CC in Caribbean SIDS is very limited. The aim of this paper is to discuss health system adaptation to climate change, with a focus on PHC.MethodsWe explored the perspectives of PHC professionals in Dominica on PHC adaptation to climate change. Focus group discussions (FGDs) were conducted in each of the seven health districts in Dominica, a Caribbean SIDS, between November 2021 and January 2022. The semi-structured interview guide was based on the Essential Public Health Functions: assessment, access to health care services, policy development and resource allocation. Data coding was organized accordingly.ResultsFindings suggest that health care providers perceive climate change as contributing to an increase in NCDs and mental health problems. Climate-related events create barriers to care and exacerbate the chronic deficiencies within the health system, especially in the absence of high-level policy support. Healthcare providers need to take a holistic view of health and act accordingly in terms of disease prevention and health promotion, epidemiological surveillance, and ensuring the widest possible access to healthcare, with a particular focus on the environmental and social determinants of vulnerability.ConclusionThe primary health care system is a key stakeholder in the design and operationalization of adaptation and transformative resilience. The Essential Public Health Functions should integrate social and climate and other environmental determinants of health to guide primary care activities to protect the health of communities. This study highlights the need for improved research on the linkages between climate events and health outcomes, surveillance, and development of plans informed by contextual knowledge in the SIDS.

Strategies for engaging older adults and informal caregivers in health policy development: A scoping review.

Care for older adults is high on the global policy agenda. Active involvement of older adults and their informal caregivers in policy-making can lead to cost-effective health and long-term care interventions. Yet, approaches for their involvement in health policy development have yet to be extensively explored. This review maps the literature on strategies for older adults (65+years) and informal caregivers' involvement in health policy development. As part of the European Union TRANS-SENIOR program, a scoping review was conducted using the Joanna Briggs Institute's methodology. Published and grey literature was searched, and eligible studies were screened. Data were extracted from included studies and analysed using the Multidimensional Framework for Patient and Family Engagement in Health and Healthcare. A total of 13 engagement strategies were identified from 11 publications meeting the inclusion criteria. They were categorized as "traditional", "deliberative" and "others", adopting the World Bank's categorization of engagement methods. Older adults and informal caregivers are often consulted to elicit opinions and identify priorities. However, their involvement in policy formulation, implementation and evaluation is unclear from the available literature. Findings indicate that older adults and their informal caregivers do not often have equal influence and shared leadership in policy-making. Although approaches for involving older adults and their informal caregivers' involvement were synthesized from literature, we found next to no information about their involvement in policy formulation, implementation and evaluation. Findings will guide future research in addressing identified gaps and guide policy-makers in identifying and incorporating engagement strategies to support evidence-informed policy-making processes that can improve health outcomes for older adults/informal caregivers.

The Sociology of South Asian Women’s Health

In this lucidly written book, The Sociology of South Asian Women’s Health, Sara Rizvi Jafree, emphasises how health policies have left out the cultural knowledge about the unique circumstances and experiences of South Asian women. The author deftly explored the importance of re-conceptualising health policy development with a culturally and socially appropriate background for women in South Asia. In the introductory chapter of the book, Jafree starts by giving a concise structural description of how South Asian women’s health behaviour and health outcomes are affected by social systems of family, gender, faith, culture, government, schooling, and the media. Sara Rizvi Jafree aims to connect health policy efforts with knowledge of socio-environment and structural factors to propose better health policies for women. The book consists of nine chapters that are co-authored by different scholars with Jafree.

How do South African policies address provision of contraception among adolescents?

The South African government has pioneered several policy documents that emphasise the importance of sexual and reproductive health (SRH). We examined how national policies address access and provision of contraception to adolescents in South Africa. South African national policies. We systematically searched various academic databases such as EbscoHost, Science Direct, Google Scholar, PubMed and Scopus, and other relevant sources to obtain 854 policy documents. Using a set of explicit inclusion criteria, we screened and selected 11 South African policies for analysis. Next, we analysed three international policies and frameworks to extract the key elements from them. Thereafter, we used these key elements to develop an analytical framework for conducting the analysis of the South African national policies. We found that South Africa's SRH policies largely address the provision of contraception by following international guidelines. These policies recognise the value of providing contraception to adolescent girls. However, we also found gaps in some policies, which could impede how they are translated into practice. These include recognising that adolescent boys can play a role in contraception; adolescents have varying SRH needs and are a key stakeholder not only for policy development but also for monitoring and accountability. With a specific focus on South Africa's contraception services in the public sector, these findings are relevant to policymakers, providers and users of contraceptives.Contribution:This review proposes recommendations that will assist with strengthening health policy development and thus improve primary health care services related to contraception for adolescents.

Assessment of potential transthyretin amyloid cardiomyopathy cases in the Brazilian public health system using a machine learning model.

To identify and describe the profile of potential transthyretin cardiac amyloidosis (ATTR-CM) cases in the Brazilian public health system (SUS), using a predictive machine learning (ML) model. This was a retrospective descriptive database study that aimed to estimate the frequency of potential ATTR-CM cases in the Brazilian public health system using a supervised ML model, from January 2015 to December 2021. To build the model, a list of ICD-10 codes and procedures potentially related with ATTR-CM was created based on literature review and validated by experts. From 2015 to 2021, the ML model classified 262 hereditary ATTR-CM (hATTR-CM) and 1,581 wild-type ATTR-CM (wtATTR-CM) potential cases. Overall, the median age of hATTR-CM and wtATTR-CM patients was 66.8 and 59.9 years, respectively. The ICD-10 codes most presented as hATTR-CM and wtATTR-CM were related to heart failure and arrythmias. Regarding the therapeutic itinerary, 13% and 5% of hATTR-CM and wtATTR-CM received treatment with tafamidis meglumine, respectively, while 0% and 29% of hATTR-CM and wtATTR-CM were referred to heart transplant. Our findings may be useful to support the development of health guidelines and policies to improve diagnosis, treatment, and to cover unmet medical needs of patients with ATTR-CM in Brazil.

Early developments of psychiatric epidemiology in Chile: a local history with global implications

Abstract This viewpoint discusses a conference paper titled: “Epidemiological research on mental morbidity in Chile”, which summarizes a handful of studies from 1950s in Chile covering conditions such as alcoholism, psychosis, epilepsy, and neurosis. These were the first psychiatric epidemiological population studies conducted in the Southern hemisphere, but they are largely unknown globally. We argue that the Chilean studies have important implications for modern psychiatric epidemiology, as well as for related fields such as global mental health and mental health services research. This piece starts by describing the general sociopolitical context and presenting the main methodological features of the studies. It focuses then on three specific implications for the field: 1) promoting decoloniality in psychiatric epidemiology; 2) ensuring methodological rigor and feasibility; and 3) informing the development of mental health policy and services.

Social inequalities in health within the City of Milan (Lombardy Region, Northern Italy): An ecological assessment.

to document existing geographical inequalities in health in the city of Milan (Lombardy Region, Northern Italy), examining the association between area socioeconomic disadvantage and health outcomes, with the aim to suggest policy action to tackle them. the analysis used an ecological framework; multiple health indicators were considered in the analysis; socioeconomic disadvantage was measured through indicators such as low education, unemployment, immigration status, and housing crowding. For each municipal statistical area, Bayesian Relative Risks of the outcomes (using the Besag-Yorkand-Mollié model) were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated. residents in the City of Milan aged between 30 and 75 years who were residing in Milan as of 01.01.2019, grouped in 88 statistical areas. all-cause mortality, type-2 diabetes mellitus, hypertension, neoplasms, respiratory diseases, metabolic syndrome, antidepressants use, polypharmacy, and multimorbidity. the results consistently demonstrated a significant association between socioeconomic disadvantage and various health outcomes, with low education exhibiting the strongest correlations. Neoplasms displayed an inverse social gradient, while the relationship with antidepressant use varied. these findings provide valuable insights into the distribution of health inequalities in Milan and contribute to the existing literature on the social determinants of health. The study highlights the need for targeted interventions to address disparities and promote equitable health outcomes. The results can serve to inform the development of effective public health strategies and policies aimed at reducing health inequalities in the city.

Health Improvement by Design Through Partnership and Empathy.

The application of technology in precision medicine (i.e., using data to tailor care for specific groups) and machine learning (modeling data to develop new ways to meet particular needs) plays a vital role in population health. And yet, technology alone cannot resolve the challenges presented by the underlying social determinants of health (SDOH) and the structure of healthcare institutions. Progress requires a partnership of stakeholders to build holistic solutions. Typically, a rigid institutional reliance on a sequential process of hypothesis, study, experimentation, and evaluation drives the development of health programs and policies. While this process works in many cases, the results are not always long-lasting. The roots of many health problems persist in their communities, despite expanded funding and advanced resources. In light of this reality, should healthcare leaders do more of what has been done in the past, or should they explore another way-a new way of thinking-to design collaborative, people-driven programs and policies that can improve and sustain the health of their communities? The response presented here and detailed in our book, Public Health and Health Systems Management: A Population Health Perspective (scheduled for publication in 2025 by Health Administration Press), considers healthcare's complex structure and SDOH and promotes the value of design thinking to address those factors.

The barriers and enablers to accessing sexual health and sexual well-being services for midlife women (aged 40-65 years) in high-income countries: A mixed-methods systematic review.

Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40-65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups.

Hospital quality of life for children: development of a new measurement tool for hospitalised children.

Hospitalisation affects children's quality of life (QoL) regardless of illness, treatment and care. The objective of this study was to create an instrument for evaluating QoL of hospitalised children aged 7 to 18 years. Initially, 46 items for the preliminary Hospital Quality of Life for Children Scale (HQL-children) were developed through a combination of literature reviews and individual interviews. The study was conducted with 230 participants from a general paediatric ward of a hospital. Exploratory and confirmatory factor analyses were conducted to examine the construct, convergent and discriminant validities of the measure. Criterion validity was assessed by confirming split-half reliability, whereas reliability was established using Cronbach's alpha coefficient. The HQL-child scale consists of 17 items and the total variance is 51.14%. The scale is categorised into five sub-dimensions: illness, fear, activity, hospital and perception. The scale demonstrated construct, convergent and divergent validity, discriminant and split-half reliability, with Cronbach's alpha coefficient 0.75. The scale is a promising instrument to determine children's perception by capturing their experiences on hospitalisation. Assessing the QoL in hospitalised children is crucial for enhancing patient satisfaction and facilitating the development of health policies based on patient self-reporting in Turkey.

SWOT-TOWS ANALYSIS OF THE PANDEMIC STRATEGIES APPLIED IN ROMANIA BETWEEN 2020-2021

This paper outlines pandemic management strategies, focusing on effective health policy improvements in Romania. Utilizing SWOT and TOWS analysis, it develops attack, defense, adaptation, and survival strategies to mitigate threats, leverage strengths, address weaknesses, and maximize national benefits. Emphasizing early disease detection and non-pharmaceutical interventions as crucial in pandemic control, the study highlights the importance of high vaccination rates. It advocates for health crisis management through the innovation of existing policies and the introduction of new methods, demonstrating the efficacy of the SWOT-TOWS approach in global health policy development

Estimation of the number needed to treat, the number needed to be exposed, and the exposure impact number with instrumental variables

Abstract Objectives The Number Needed to Treat (NNT) is an efficacy index defined as the average number of patients needed to treat to attain one additional treatment benefit. In observational studies, specifically in epidemiology, the adequacy of the populationwise NNT is questionable since the exposed group characteristics may substantially differ from the unexposed. To address this issue, groupwise efficacy indices were defined: the Exposure Impact Number (EIN) for the exposed group and the Number Needed to be Exposed (NNE) for the unexposed. Each defined index answers a unique research question since it targets a unique sub-population. In observational studies, the group allocation is typically affected by confounders that might be unmeasured. The available estimation methods that rely either on randomization or the sufficiency of the measured covariates for confounding control result in statistically inconsistent estimators of the true EIN, NNE, and NNT. This study presents a theoretical framework for statistically consistent point and interval estimation of the NNE, EIN and NNE in observational studies with unmeasured confounders. Methods Using Rubin’s potential outcomes framework, this study explicitly defines the NNT and its derived indices, EIN and NNE, as causal measures. Then, we use instrumental variables to introduce a novel method to estimate the three aforementioned indices in observational studies where the omission of unmeasured confounders cannot be ruled out. To illustrate the novel methods, we present two analytical examples – double logit and double probit models. Next, a corresponding simulation study and a real-world data example are presented. Results This study provides an explicit causal formulation of the EIN, NNE, and NNT indices and a comprehensive theoretical framework for their point and interval estimation using the G-estimators in observational studies with unmeasured confounders. The analytical proofs and the corresponding simulation study illustrate the improved performance of the new estimation method compared to the available methods in terms of consistency and the confidence intervals empirical coverage rates. Conclusions In observational studies, traditional estimation methods to estimate the EIN, NNE, or NNT result in statistically inconsistent estimators. We introduce a novel estimation method that overcomes this pitfall. The novel method produces consistent estimators and reliable CIs for the true EIN, NNE, and NNT. Such a method may facilitate more accurate clinical decision-making and the development of efficient public health policies.

An integrated knowledge translation (iKT) approach to advancing community-based depression care in Vietnam: lessons from an ongoing research-policy collaboration

BackgroundEvidence-based mental health policies are key to supporting the expansion of community-based mental health care and are increasingly being developed in low and middle-income countries (LMICs). Despite this, research on the process of mental health policy development in LMICs is limited. Engagement between researchers and policy makers via an integrated Knowledge Translation (iKT) approach can help to facilitate the process of evidence-based policy making. This paper provides a descriptive case study of a decade-long policy and research collaboration between partners in Vietnam, Canada and Australia to advance mental health policy for community-based depression care in Vietnam.MethodsThis descriptive case study draws on qualitative data including team meeting minutes, a focus group discussion with research team leaders, and key informant interviews with two Vietnamese policy makers. Our analysis draws on Murphy et al.’s (2021) findings and recommendations related to stakeholder engagement in global mental health research.ResultsConsistent with Murphy et al.’s findings, facilitating factors across three thematic categories were identified. Related to ‘the importance of understanding context’, engagement between researchers and policy partners from the formative research stage provided a foundation for engagement that aligned with local priorities. The COVID-19 pandemic acted as a catalyst to further advance the prioritization of mental heath by the Government of Vietnam. ‘The nature of engagement’ is also important, with findings demonstrating that long-term policy engagement was facilitated by continuous funding mechanisms that have enabled trust-building and allowed the research team to respond to local priorities over time. ‘Communication and dissemination’ are also crucial, with the research team supporting mental health awareness-raising among policy makers and the community, including via capacity building initiatives.ConclusionsThis case study identifies factors influencing policy engagement for mental health system strengthening in an LMIC setting. Sustained engagement with policy leaders helps to ensure alignment with local priorities, thus facilitating uptake and scale-up. Funding agencies can play a crucial role in supporting mental health system development through longer term funding mechanisms. Increased research related to the policy engagement process in global mental health will further support policy development and improvement in mental health care in LMICs.

Digital food behaviours, motivations, and delivery application usage among saudis during COVID-19: A mixed-methods study

Food delivery apps (FDAs) and smartphones in Saudi Arabia have become ubiquitous and increasingly popular methods for food ordering and consumption. Such app use during the COVID-19 pandemic has become a convenient and popular response to pandemic restrictions. However, the motivations and preferences behind FDA use are complex, as are the perceptions of FDA users regarding nutrition and healthy foods. To explore FDA usage, motivations, perceptions, and food behaviours in the unique cultural context of Saudi Arabia at the intersection of two epidemics, COVID-19 and obesity, a convergent parallel mixed-methods study design was used with 566 Saudis in the quantitative phase and 17 continuing to the qualitative phase. Of the respondents, 71.9 % reported using FDA typically once a week. Frequent FDA usage was reported by 33.3 % of the participants aged 30–40 years (P = .049). Nearly two-thirds of the sample (62 %) reported that time and convenience were the driving factors in using FDAs. Qualitatively, six main themes were identified: ‘Perceived benefits and drawbacks’, ‘Effects of Promotions and Food Preferences’, ‘Nutritional information and dietary guidelines’, ‘Concepts of healthy food’, ‘Obstacles to healthy food consumption’, and ‘Maintaining Customs and Traditions’. Although convenience and taste were the primary drivers of FDA usage, the roles of tradition and culture in Saudi Arabia were also important FDA usage factors. Overall, understanding the determinants of how Saudis engage with FDAs, in concert with a deeper understanding of food preferences, perceptions, and nutritional knowledge, should help guide future efforts in nutrition education, app development, and public health policy.

Engaging Families in Supporting the Whole Child: Chicago West Side Parents’ Perceptions of Child Health

Schools and districts nationwide have heavily emphasized supporting students’ health and wellbeing by engaging families and caregivers to truly support the “whole child,” as outlined in the Whole School, Whole Community, Whole Child (WSCC) model. The COVID-19 pandemic only heightened the important role of school and family partnerships in supporting children’s health. The Chicago Public Schools (CPS) Healthy CPS initiative is designed to support schools in their compliance with existing health and wellness policies to support child health. This study aimed to explore parents’ primary health concerns for their children, characterize these views, explore any alignment with WSCC, and identify recommendations for family engagement in school health promotion. Eleven semi-structured focus groups (seven English, four Spanish) were conducted with CPS parents/caregivers. Groups were conducted in spring 2021 on Chicago’s West Side, one of the more historically disinvested communities in the city. Focus groups were recorded, transcribed, and analyzed using constant comparison, incorporating both inductive and deductive approaches. Key themes emerged related to parents’ perceptions of schools’ role in promoting health including: (1) parents see child health as a shared responsibility between families and schools; and (2) parents identify significant structural barriers and inequities that impede child health, such as racism, community violence, and a lack of community resources in their neighborhoods, and believe schools can do more to address them. Parents’ viewed child health and wellbeing as multidimensional and stated that these dimensions must be considered holistically. Their views aligned with WSCC family engagement-related components. Parents recommended that schools employ a variety of strategies to engage families. Findings from this paper have implications for engaging families in school health policy and program development as well as implementation, particularly those in lower income, urban communities that have faced a history of structural inequities.

The Role of Pensioner Councils in Regional Healthcare Policy: A Holistic Perspective

AbstractTo ensure older individuals actively engage in healthcare service development and policymaking, it is crucial to counteract declining social and civic participation with age. It is also necessary to clarify the potential and impact of participatory activities. This study examines citizen participation among older adults in Swedish health policy development. Using Thurston et al.‘s (2005) holistic framework, the study analyzes pensioner councils (PCs) in politically governed healthcare regions. Through 13 interviews and six years of PC meeting minutes, findings from a deductive content analysis suggest that PCs build trust and foster deeper dialogues between older adults and politicians, due to their long-term nature. A trusting relationship between citizens and decision-makers may benefit society at large by enhancing the legitimacy of policy decisions. Although achieving direct policy impact is challenging, these councils serve vital participatory and deliberative democratic functions, contributing to a stronger policy community and increased transparency in the democratic process. This study highlights the complexities of assessing PCs solely based on policy influence and immediately evident outcomes, emphasizing their role in promoting democratic values, while also drawing attention to the tension between participatory and representative democracy.

Digital Transformation in Public Hospital Management: Improving the Patient Experience

Purpose: This article aims to investigate the impact of digital transformation on public hospital management in Peru, with a specific focus on enhancing the patient experience through the adoption of digital technologies. Objective: The primary objective is to assess the effectiveness of digital transformation strategies in improving the efficiency and accessibility of health services in public hospitals, ultimately aiming to enhance the overall patient experience. Theoretical Reference: The study is grounded in a mixed-method approach, incorporating elements of qualitative and quantitative research. It includes a comparative analysis of digital transformation strategies implemented in a representative sample of public hospitals at international, regional, and national levels. Method: The research design involves in-depth interviews with healthcare professionals and patients, as well as the analysis of secondary data from national and international health databases. The study encompasses a diverse sample of public hospitals, considering varying technological capabilities and levels of digital development. Results and Conclusion: The findings indicate that the progressive implementation of digital technologies in public hospitals in Peru has shown promise in improving the efficiency and accessibility of health services. However, challenges related to infrastructure, systems integration, and data security remain. The study underscores the need for a comprehensive and coordinated strategy for digital transformation in public hospital management. Implications of Research: The study highlights the importance of greater investment and development of digital health policies at the national level to bridge the gap in the adoption and implementation of digital technologies in hospital management. It emphasizes the significance of a collaborative approach between government, healthcare providers, and technology developers to drive digital transformation in the healthcare sector in Peru. Originality/Value: This research contributes to the understanding of the potential of digital transformation in public hospital management, particularly in developing countries like Peru. It provides insights into the challenges, opportunities, and implications of implementing digital technologies to enhance the patient experience and improve healthcare delivery in public hospitals.