Health Policy Agencies Research Articles

Would offering vegetables to children for breakfast increase their total daily vegetable intake?

The consumption of vegetables is vitally important for children's health and development. However, in many Westernised countries, most children do not eat sufficient quantities of vegetables and consume many energy-dense and high-sugar foods; a health behaviour associated with the onset of non-communicable diseases. To address this important public health concern, it is necessary to think 'outside the box' and consider innovative and pragmatic ways to increase children's daily vegetable intake. In many countries, caregivers implementing best-practice child feeding methods typically offer children vegetables at lunch, dinner and for snacks. It is unusual for children to be routinely offered vegetables for breakfast, yet there is no nutritional, physiological or medical reason why vegetables should not be eaten at breakfast. Indeed, in some countries, children frequently consume vegetables for breakfast. Increasing children's exposure to vegetables at breakfast from an early age would allow for the development of a positive association between eating vegetables and breakfast, thus providing another opportunity in the day where vegetables might be regularly consumed by children. In this paper, we propose a rationale for why vegetables should be routinely offered to young children at breakfast time in countries where this may not be the norm. Future research assessing the feasibility and acceptability of such a public health intervention would provide health policy agencies with evidence about a potentially effective and easily implementable approach for increasing children's vegetable intake, thus improving their overall nutritional status, as well as their heath and development.

The how and why of producing policy relevant research: perspectives of Australian childhood obesity prevention researchers and policy makers

BackgroundUnderstanding why research is conducted may help address the under-utilisation of research. This study examined the reasons for childhood obesity prevention knowledge production in New South Wales (NSW), Australia, and the factors influencing research choices from the perspective of the researchers and health policy agencies contributing to the research.MethodsA literature search of SCOPUS and ISI Web of Knowledge (affiliation and key word searches) was conducted to compile a database of NSW childhood obesity research outputs, published between 2000 and 2015 (n = 543). Descriptive statistics were used to quantify outputs by research type, differentiating measurement, descriptive, and intervention research, systematic reviews and other publications. Interviews were conducted with a sample of researchers drawn from the database (n = 13) and decision makers from health policy agencies who funded and contributed to childhood obesity research in NSW (n = 15). Researcher interviews examined views about societal impacts, why and under what circumstances the research was conducted. Decision-maker interviews examined policy agency research investment and how research was used in decision making. Content analysis and a thematic approach was used to analyse the interview transcripts.ResultsThe research in this case was conducted for mix of reasons including those traditionally associated with academic inquiry, as well as intentions to influence policy and practice. Differences in funding mechanisms, administrative and employment arrangements, and ‘who’ initiated the research, created differing incentives and perspectives for knowledge production. Factors associated with the characteristics and experience of the individuals involved also influenced goals, as did the type of research conducted. Policy agencies played a role in directing research to address policy needs.ConclusionsThe findings of this study confirm that researchers are strongly influenced by their working environment. Funding schemes and other incentives to support policy relevant knowledge production are important. Contextual factors such as policy priorities, policy-driven research funding and the embedded nature or strong connections between some researchers and the policy agencies involved, are likely to have influenced the extent to which policy goals were reported in this study.

Increasing the capacity of policy agencies to use research findings: a stepped-wedge trial

BackgroundThis paper describes the trial of a novel intervention, Supporting Policy In health with evidence from Research: an Intervention Trial (SPIRIT). It examines (1) the feasibility of delivering this kind of programme in practice; (2) its acceptability to participants; (3) the impact of the programme on the capacity of policy agencies to engage with research; and (4) the engagement with and use of research by policy agencies.MethodsSPIRIT was a multifaceted, highly tailored, stepped-wedge, cluster-randomised, trial involving six health policy agencies in Sydney, Australia. Agencies were randomly allocated to one of three start dates to receive the 1-year intervention programme. SPIRIT included audit, feedback and goal setting; a leadership programme; staff training; the opportunity to test systems to facilitate research use in policies; and exchange with researchers. Outcome measures were collected at each agency every 6 months for 30 months.ResultsParticipation in SPIRIT was associated with significant increases in research use capacity at staff and agency levels. Staff reported increased confidence in research use skills, and agency leaders reported more extensive systems and structures in place to support research use. Self-report data suggested there was also an increase in tactical research use among agency staff. Given the relatively small numbers of participating agencies and the complexity of their contexts, findings suggest it is possible to effect change in the way policy agencies approach the use of research. This is supported by the responses on the other trial measures; while these were not statistically significant, on 18 of the 20 different measures used, the changes observed were consistent with the hypothesised intervention effect (that is, positive impacts).ConclusionsAs an early test of an innovative approach, SPIRIT has demonstrated that it is possible to increase research engagement and use in policy agencies. While more work is needed to establish the replicability and generalisability of these findings, this trial suggests that building staff skills and organisational structures may be effective in increasing evidence use.

Organisational capacity and its relationship to research use in six Australian health policy agencies.

There are calls for policymakers to make greater use of research when formulating policies. Therefore, it is important that policy organisations have a range of tools and systems to support their staff in using research in their work. The aim of the present study was to measure the extent to which a range of tools and systems to support research use were available within six Australian agencies with a role in health policy, and examine whether this was related to the extent of engagement with, and use of research in policymaking by their staff. The presence of relevant systems and tools was assessed via a structured interview called ORACLe which is conducted with a senior executive from the agency. To measure research use, four policymakers from each agency undertook a structured interview called SAGE, which assesses and scores the extent to which policymakers engaged with (i.e., searched for, appraised, and generated) research, and used research in the development of a specific policy document. The results showed that all agencies had at least a moderate range of tools and systems in place, in particular policy development processes; resources to access and use research (such as journals, databases, libraries, and access to research experts); processes to generate new research; and mechanisms to establish relationships with researchers. Agencies were less likely, however, to provide research training for staff and leaders, or to have evidence-based processes for evaluating existing policies. For the majority of agencies, the availability of tools and systems was related to the extent to which policymakers engaged with, and used research when developing policy documents. However, some agencies did not display this relationship, suggesting that other factors, namely the organisation’s culture towards research use, must also be considered.

Do policy-makers find commissioned rapid reviews useful?

BackgroundRapid reviews are increasingly used by policy agencies to access relevant research in short timeframes. Despite the growing number of programmes, little is known about how rapid reviews are used by health policy agencies. This study examined whether and how rapid reviews commissioned using a knowledge brokering programme were used by Australian policy-makers.MethodsThis study used interview data to examine the use of 139 rapid reviews by health policy agencies that were commissioned between 2006 and 2015. Transcripts were coded to identify how rapid reviews were used, the type of policy processes in which they were used, what evidence of use was provided and what reasons were given when rapid reviews were not used. Fisher’s exact test was used to assess variation between types of agencies.ResultsOverall, 89% of commissioned rapid reviews were used by the commissioning agencies and 338 separate instances of use were identified, namely, on average, three uses per review. Policy-makers used reviews primarily to determine the details of a policy or programme, identify priorities for future action or investment, negotiate interjurisdictional decisions, evaluate alternative solutions for a policy problem, and communicate information to stakeholders. Some variation in use was observed across agencies. Reasons for non-use were related to changes in organisational structures, resources or key personnel in the commissioning agencies, or changes in the broader political environment.ConclusionsThis study found that almost all rapid reviews had been used by the agencies who commissioned them, primarily in policy and programme development, agenda-setting, and to communicate information to stakeholders. Reviews were used mostly in instrumental and conceptual ways and there was little evidence of symbolic use. Variations in use were identified across agencies. The findings suggest that commissioned rapid reviews are an effective means of providing timely relevant research for use in policy processes and that review findings may be applied in a variety of ways.

The pivotal position of ‘liaison people’: facilitating a research utilisation intervention in policy agencies

This paper explores the enormous variation in views, championing behaviours and impacts of liaison people: staff nominated to facilitate, tailor and promote SPIRIT (a research utilisation intervention trial in six Australian health policy agencies). Liaison people made cost/benefit analyses: they weighed the value of participation against its risks and demands in the context of organisational goals, knowledge utilisation norms, epistemology and leadership support. There was a degree of self-fulfilment (organisations got what they put in), but SPIRIT could not always be tailored to address local knowledge needs. We present nine propositions for identifying and supporting liaison people in similar interventions.

Rapid reviews in health policy: a study of intended use in the New South Wales’ Evidence Check programme

Rapid reviews of research are a key way in which policy makers use research. This paper examines 74 rapid reviews commissioned by health policy agencies through the Sax Institute's Evidence Check programme. We examine what prompted policy makers to commission rapid reviews, their purpose, how and when they intended to use them, and how this varied by agency. Policy makers commissioned rapid reviews primarily as part of planned policy processes and to identify alternative solutions to problems. Government departments responsible for multiple policy domains were more likely to commission rapid reviews for agenda setting and to test new ideas.

Figuring out fidelity: a worked example of the methods used to identify, critique and revise the essential elements of a contextualised intervention in health policy agencies.

BackgroundIn this paper, we identify and respond to the fidelity assessment challenges posed by novel contextualised interventions (i.e. interventions that are informed by composite social and psychological theories and which incorporate standardised and flexible components in order to maximise effectiveness in complex settings).We (a) describe the difficulties of, and propose a method for, identifying the essential elements of a contextualised intervention; (b) provide a worked example of an approach for critiquing the validity of putative essential elements; and (c) demonstrate how essential elements can be refined during a trial without compromising the fidelity assessment.We used an exploratory test-and-refine process, drawing on empirical evidence from the process evaluation of Supporting Policy In health with Research: an Intervention Trial (SPIRIT). Mixed methods data was triangulated to identify, critique and revise how the intervention’s essential elements should be articulated and scored.ResultsOver 50 provisional elements were refined to a final list of 20 and the scoring rationalised. Six (often overlapping) challenges to the validity of the essential elements were identified. They were (1) redundant—the element was not essential; (2) poorly articulated—unclear, too specific or not specific enough; (3) infeasible—it was not possible to implement the essential element as intended; (4) ineffective—the element did not effectively deliver the change principles; (5) paradoxical—counteracting vital goals or change principles; or (6) absent or suboptimal—additional or more effective ways of operationalising the theory were identified. We also identified potentially valuable ‘prohibited’ elements that could be used to help reduce threats to validity.ConclusionsWe devised a method for critiquing the construct validity of our intervention’s essential elements and modifying how they were articulated and measured, while simultaneously using them as fidelity indicators. This process could be used or adapted for other contextualised interventions, taking evaluators closer to making theoretically and contextually sensitive decisions upon which to base fidelity assessments.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0378-6) contains supplementary material, which is available to authorized users.

Predicting research use in a public health policy environment: results of a logistic regression analysis.

BackgroundUse of research evidence in public health policy decision-making is affected by a range of contextual factors operating at the individual, organisational and external levels. Context-specific research is needed to target and tailor research translation intervention design and implementation to ensure that factors affecting research in a specific context are addressed. Whilst such research is increasing, there remain relatively few studies that have quantitatively assessed the factors that predict research use in specific public health policy environments.MethodA quantitative survey was designed and implemented within two public health policy agencies in the Australian state of Victoria. Binary logistic regression analyses were conducted on survey data provided by 372 participants. Univariate logistic regression analyses of 49 factors revealed 26 factors that significantly predicted research use independently. The 26 factors were then tested in a single model and five factors emerged as significant predictors of research over and above all other factors.ResultsThe five key factors that significantly predicted research use were the following: relevance of research to day-to-day decision-making, skills for research use, internal prompts for use of research, intention to use research within the next 12 months and the agency for which the individual worked.ConclusionsThese findings suggest that individual- and organisational-level factors are the critical factors to target in the design of interventions aiming to increase research use in this context. In particular, relevance of research and skills for research use would be necessary to target. The likelihood for research use increased 11- and 4-fold for those who rated highly on these factors. This study builds on previous research and contributes to the currently limited number of quantitative studies that examine use of research evidence in a large sample of public health policy and program decision-makers within a specific context. The survey used in this study is likely to be relevant for use in other public health policy contexts.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0142-8) contains supplementary material, which is available to authorized users.

Supporting Policy In health with Research: an Intervention Trial (SPIRIT)—protocol for a stepped wedge trial

IntroductionGovernments in different countries have committed to better use of evidence from research in policy. Although many programmes are directed at assisting agencies to better use research, there have been...

Developing definitions for a knowledge exchange intervention in health policy and program agencies: reflections on process and value

The development of definitions is an integral part of the research process but is often poorly described. This paper details the iterative development of five definitions: Policy, Health policy-maker, Health policy agency, Policy documents, and Research findings. We describe the challenges of developing definitions in a large multidisciplinary team and the important methodological repercussions. We identify four factors that were most helpful in this process: (1) An emphasis on fit-for-purpose functionality, (2) Consultation with in-context experts, (3) Our willingness to amend terms as well as definitions, and to revisit some methods and goals as a consequence, and (4) Agreement that we would satisfice: accept ‘good enough’ solutions rather than struggle for optimality and consensus.

Values, institutions and shifting policy paradigms: Expansion of the Israeli National Health Insurance Basket of Services

To examine the roles of policy paradigms, in particular new public management and regulated competition in different areas of health policy. Quantitative and qualitative methods are used to assess the degree of success of regulated competition in the Israeli context in terms of public understanding, trust, and the basic viability of the system and in somatic as opposed to mental health policy. As Israel's explicit priority setting processes in the area of somatic health services have proceeded, the public indicates increased relative preference for treatments adding quality of life, shifting from prioritizing extending life. The public and physicians gave high scores to preventative screening. Between 1998 and 2001 levels of awareness of the decision-making process rose and then retreated, perhaps due to varying levels of decision-making activity. High levels of trust are evinced in health policy agencies and in the priority setting process. The Israeli case demonstrates that New Public Management (NPM) paradigms, such as regulated competition, can successfully be deployed in attempting to manage health care policy. However, as health policy moves beyond somatic health care into areas requiring more inter-sector orientation, such as mental health, the appropriateness of NPM models is called into question. However, the very success of models such as regulated competition causes policy makers to resort to them instead of developing new paradigms.

Hearing-Loss Prevention Practices Should Be Taught in Schools

Children are often exposed to excessive levels of sound, such as loud music, firearms, power tools, and noisy toys. Such exposure puts children at risk for developing noise-induced hearing loss (NIHL) and tinnitus. For more than 30 years, health policy agencies and numerous experts in hearing science have recommended teaching hearing-loss prevention practices to children in schools as a way to reduce the prevalence of NIHL. Despite these recommendations, basic hearing-loss prevention information that could prevent countless cases of NIHL remains conspicuously absent from most school curricula. At least 10 organizations produce or use a variety of materials in a comprehensive hearing-loss prevention curriculum for school-age children. At least 18 additional organizations produce or disseminate materials (Web-based, video, or printed matter) that could be used to teach hearing-loss prevention in classrooms. Therefore, adequate materials and curricula are available for presenting this information to school-age children. It is time to implement the repeated recommendations of experts by providing hearing-loss prevention instruction in all of our nation's schools on a regular basis. These educational efforts should eventually help to reduce the prevalence of NIHL, which is a fully preventable condition.

Conselhos Municipais de Saúde: atuação e representação das comunidades populares

This article was based on the results of research concerning health policy in municipalities that achieved the most extensive development of decentralization and innovation in the State of Rio de Janeiro, Brazil. The study applied a questionnaire for health system users' representatives in Municipal Health Councils. The central issues were: the Councils' political role; social control by the Councils, viewed as surveillance by organized society over government actions; the nature of social representation exercised by the Council members; and the type of mandate they serve. Community representatives in the Councils reinforce aspects pertaining to the exercise of representation in unequal societies. There is a predominance of a differentiated elite consisting of older males with more schooling and higher income than the community average. The notion of "social control" as the basis for the Councils is difficult for the members to grasp. Exercise of representation is diffuse, occurring by way of designation by community associations, election in assemblies, or designation by institutional health policy agencies.