Context Of Health Policy Research Articles

Trends and inequalities in health system satisfaction: results from the latest nationally representative surveys in Qatar

BackgroundHealth system satisfaction is an important but understudied indicator of health system performance. It has far-reaching implications for sustainability but has been widely understudied particularly for non-European settings. Qatar represents a growing international experience of rapid development requiring steadfast system funding and reorganisation. After decades of unprecedented immigration and nearly free health care, Qatar sought to expand the system by 2016, reorganise it by 2022, and accelerate private funding and health system outcomes by 2030.AimThe aim of this study is to conduct a comprehensive assessment of health system satisfaction in Qatar, in anticipation of the 2024–2030 health reforms, with a particular emphasis on detailed policy attribution and the formulation of recommendations. The overarching aim of this study is to contribute to the limited body of international literature on health system satisfaction, particularly in non-European contexts, with a focus on specific populations such as migrants, labourers, and labour camp residents.MethodsWe analysed the levels of, and individual inequalities in, health system satisfaction in Qatar between 2012 and 2014. Descriptive statistics were employed to assess satisfaction levels, while inequalities were examined using logit analysis. The satisfaction variables encompass the key aspects of health system provision and management, whereas the individual variables are focused on their attributability to Qatar’s specific health policy context, including regionally distinct socio-economic groups.FindingsHealth system satisfaction levels in Qatar were relatively high in both 2012 and 2014, particularly regarding service provision, though they did not reach exceptionally high levels. Both satisfaction dimensions—provision and management—improved in 2014, with management showing more rapid progress. However, males, Qatari citizens, individuals with chronic disease, labourers, and residents of the largest labour camps were less likely to express satisfaction with the system.ConclusionQatar’s satisfaction trends and inequalities between 2012 and 2014 emphasise the significance of both dedicated efforts and effective organisational structures in maintaining high levels of health system satisfaction during periods of rapid development. To ensure continued satisfaction, performance, and sustainability throughout the 2024–2030 reforms, it is essential to address unresolved organisational constraints before eroding dedicated efforts through increased private health funding.

State discretization for continuous-state MDPs in infectious disease control

Repeated decision-making problems may arise in the health policy context, such as infectious disease control for COVID-19 and other epidemics. These problems may sometimes be effectively solved using Markov decision processes (MDPs). However, the continuous or large state space of such problems for capturing infectious disease prevalence renders it difficult to implement tractable MDPs to identify the optimal disease control policy over time. We therefore develop an algorithm for discretizing continuous states for approximate MDP solutions in this context. We benchmark performance against a uniform discretization using both a synthetic example and an example of COVID-19 in Los Angeles County.

Annual Survey of State and Territorial Chronic Disease Prevention and Health Promotion Capacity and Organizational Development Needs—United States, 2023

Objective: The National Association of Chronic Disease Directors (NACDD) is a nonprofit organization that supports state and territorial chronic disease prevention and health promotion efforts through capacity building and technical assistance. Each year, NACDD surveys health department leaders who oversee chronic disease prevention and health promotion (hereafter, Chronic Disease Directors). We have previously used the annual survey results to inform strategic planning and resource allocation but have not historically published key findings in the peer-reviewed literature. In this paper, we report on NACDD’s 2023 survey outcomes and place those findings into the broader public health policy context. Design: State Chronic Disease Directors completed a survey about their organizational capacity and development needs. Responses were summarized in aggregate and by jurisdiction size. Results: State chronic disease units have varied staffing and responsibilities, but most address diabetes, cardiovascular diseases, and cancer screening and prevention. Chronic Disease Directors generally reported strong or improving capacity in most practice areas but ranked workforce development lower. Staffing increased slightly during 2023 compared with the 2020 baseline (median of 1.3 and 1.1 employees per 100 000 jurisdiction population, respectively). However, Chronic Disease Directors expressed ongoing concerns about turnover, hiring, and training of inexperienced staff, as well as about funding limitations and uncertainty. Looking forward to 2024, many Chronic Disease Directors expressed intentions to focus on supporting their workforce with training and development opportunities and addressing health equity. Conclusions: During this period of pandemic recovery, turnover, hiring, and training—particularly of the many new public health staff—remain key areas of concern for many chronic disease units. Continued stabilization of public health funding and increased prioritization of organizational capacity development—particularly workforce development, chronic disease data systems, and tools for addressing health equity—could help ensure chronic disease units can better address current and emerging challenges in chronic disease prevention and health promotion.

The financial benefits of health engagement programs to life insurers

Life insurance companies, as equity stakeholders in policyholders’ lives, have incentives to mitigate their health risks. I introduce a framework that enables life insurers to evaluate the financial viability of developing and implementing health engagement programs. By leveraging a proprietary big database of health and mortality information from a large U.S. life insurer, I use machine learning techniques to quantify the benefits and use a rational addiction model to calculate the costs associated with these programs. The estimated net benefit available to the life insurer from the smoking cessation program is USD 87 million and the aggregate benefit from including other chronic conditions is USD 872 million. I explore the broader application of this framework in a general health policy context.

Diálogo Inicial

This study investigates the application of the Collective Benefit, Authority to Control, Responsibility, and Ethics (CARE) principles to the indigenous health data collected by the Secretariat of Indigenous Health (SESAI) in Brazil. Initially, the context of indigenous health policies in the country is discussed, highlighting the importance of integrating the Unified Health System (SUS) with indigenous policy to promote access to health for all. The research focuses on the need to align SESAI's data with the CARE principles, aiming to promote transparency and data availability for scientific research. Using a quantitative approach with exploratory aspects, the methodology included a bibliographic and documentary analysis to understand the CARE principles and propose strategies for aligning SESAI's data. The results indicate a growing interest in the topic, although there are gaps in data availability and in recognizing the rights of indigenous peoples over their data. The study initiated data processing, prioritizing the CARE principles, with the data made available in a geolocated tool. It concludes that the CARE Principles should guide future data collection and processing, supporting transparency and access to indigenous health data within the context of open government.

Vaccination campaign implementation in Madagascar: a Dynamic Sustainability Framework approach

Abstract Background The COVID-19 pandemic has highlighted the need for equitable and timely access to vaccination. Limited evidence is available on how to implement vaccination campaigns (VCs) that are sustainable and responsive to changes in real-world health policy and practice contexts. We present lessons learned from the implementation of a COVID-19 VC in the Boeny region of Madagascar. Methods Informed by the Dynamic Sustainability Framework, VC implementation was continuously reviewed during multisectoral stakeholder feedback rounds, key informant interviews, and problem-solving meetings to identify and put key adaptations throughout the campaign process into practice. Outcome indicators include pre- and post-VC vaccine hesitancy and trends in vaccine doses deployed were analyzed using generalized linear models. Results Key adaptations of the implementation strategy included community-led awareness-raising and outreach activities also in remote areas, strengthening VC through the training of 340 staff, and addressing gaps identified in the cold chain, waste management, vaccine transportation, and IT equipment. Overall, 24888 COVID-19 vaccines were administered in six months. Changes in campaign strategy increased the number of doses administered by 8% (RR = 1.08; CI 95%: 1.01; 1.15) per week. No changes in vaccine hesitancy post-VC were observed in an unvaccinated population(Δ = 0.02, CI 95%: -0.04; 0.08). Conclusions Collaborative and dynamic multi-sectoral VC strategies that combine healthcare-based approaches with pro-active outreach and community-led awareness-raising activities are essential in increasing vaccine uptake in limited-resource settings. Our findings show that despite boosting vaccination coverage, such initiatives may not have an impact on COVID-19 vaccine hesitancy at the community level Key messages • Multisectoral stakeholder collaboration and engagement are key to successful vaccination campaign implementation. • A Dynamic Sustainability Framework approach can be effective in ensuring a continuous fit between campaign and its setting.

Learning About Mental Health Lived Experience in Social Work Education

ABSTRACT Lived experience education occupies an increasingly important space in mental health education for social workers. Despite being plagued by practices that continue to be discriminating and exclusionary, the mental health policy and practice context demand robust attention to the meaningful inclusion of service users and their families to achieve genuine partnership, reciprocity, and equality in mental health service provision. For social work educators, lived experience education is now an indispensable component of a critically informed mental health curriculum and pedagogy. Framed within an appeal for epistemic justice, this article reports on qualitative survey data from social work students who experienced teaching from people with lived experience. Findings show that students greatly valued lived experience education, as it created opportunities for authentic and more diverse understandings of mental health that fostered critical reflection. A curriculum that supports epistemic equality and a social justice agenda would help scaffold lived experience expertise for student learning. IMPLICATIONS Mental health lived experience education positively impacts social work students’ values and attitudes towards mental health service users. Lived experience education supports social work students to expand their understandings of mental health and recovery beyond dominant biomedical perspectives. Genuine valuing of lived experience knowledge and expertise in social work education helps address epistemic injustice.

Quality indicators for occupational therapy: a scoping review

BackgroundOccupational therapists are increasingly asked to demonstrate the effectiveness, appropriateness, and efficiency of their interventions to funding bodies. However, the extent to which this is practiced and the health policy context within which such a practice is situated differs internationally. The aim of this scoping review was to establish which quality indicators are used internationally for this purpose.MethodsWe conducted a scoping review, limiting our search to Europe and the English-speaking world. To search for suitable literature, we used specialized databases from medicine, health sciences, and related fields, including CINAHL Complete and MEDLINE, as well as free internet search via Google. Furthermore, we contacted national occupational therapy associations from several countries asking for access to documents found within this search that were only accessible to association members.ResultsThe screening process identified 32 studies and documents from six national contexts. We identified and described process-level indicators, functional outcome indicators, one outcome indicator based on individual goal attainment (the Goal Attainment Scale, or GAS), and PRO-Ergo, a patient-reported experience measure (PREM). There was little information on the use of quality indicators to demonstrate the effectiveness, appropriateness, and efficiency of occupational therapy services to funding bodies in Europe and the English-speaking world that was openly available. The identified process indicators were in most cases not specific to occupational therapy interventions. Functional outcome indicators were highly specific to certain client groups or health conditions and partially appropriate for use in occupational therapy. The GAS was found to be a highly customizable measure which allowed an evaluation on body structure and function levels as well as activity and participation levels. PRO-Ergo was focused on the clients’ subjective view and their experience with occupational therapy interventions.ConclusionsAll identified quality indicators have advantages and disadvantages. Process-level indicators specific to occupational therapy could be a chance to foster the use of best practice methods. GAS and PRO-Ergo seem to be the most versatile assessment, allowing an evaluation on the level of activity and participation. Functional outcome indicators that cover a broad area of client problems may be useful additional quality indicators for some areas of practice.

Retaining doctors in emergency medicine: an ethnographic study of emergency departments in England

ObjectivesTo gain a deep understanding of factors driving retention in emergency medicine. To understand in detail the day-to-day lived experience of emergency medicine doctors, to identify and explore factors influencing...

Negative health classifications: understanding avoidance and social exclusion during a pandemic

During a pandemic, there is a fine line between distancing and avoiding other people, with stigmatizing classifications sometimes transforming social distance into social exclusion. Drawing on Bourdieu's under-utilised theory of classification struggles, this paper conceptualises schemes of pandemic Othering in terms of Negative Health Classifications. Complementing the interactionist approach in pandemic stigma research, classification struggles are a social practice that denote a conceptual link between the individual and social structures of inequality. When social structures are unstable, as was the case during the pandemic, an established common sense can become questionable. Based on the analysis of survey data from 2606 respondents collected during one of the peaks of COVID-19 in Austria and Germany, the paper explores two struggles over health classifications, (1) social cleavages created and exacerbated by individuals who strive to tackle medical crises by avoiding the 'disease carriers', and (2) conflict over illegitimate pandemic practices resulting in the loss of social capital and a polarization of social groups. The findings offer evidence of widespread negative health classifications emerging during the COVID-19 pandemic that future research should explore in their implications for inequalities in other health policy contexts.

Sample Size Considerations for Fine-Tuning Large Language Models for Named Entity Recognition Tasks: Methodological Study.

Large language models (LLMs) have the potential to support promising new applications in health informatics. However, practical data on sample size considerations for fine-tuning LLMs to perform specific tasks in biomedical and health policy contexts are lacking. This study aims to evaluate sample size and sample selection techniques for fine-tuning LLMs to support improved named entity recognition (NER) for a custom data set of conflicts of interest disclosure statements. A random sample of 200 disclosure statements was prepared for annotation. All "PERSON" and "ORG" entities were identified by each of the 2 raters, and once appropriate agreement was established, the annotators independently annotated an additional 290 disclosure statements. From the 490 annotated documents, 2500 stratified random samples in different size ranges were drawn. The 2500 training set subsamples were used to fine-tune a selection of language models across 2 model architectures (Bidirectional Encoder Representations from Transformers [BERT] and Generative Pre-trained Transformer [GPT]) for improved NER, and multiple regression was used to assess the relationship between sample size (sentences), entity density (entities per sentence [EPS]), and trained model performance (F1-score). Additionally, single-predictor threshold regression models were used to evaluate the possibility of diminishing marginal returns from increased sample size or entity density. Fine-tuned models ranged in topline NER performance from F1-score=0.79 to F1-score=0.96 across architectures. Two-predictor multiple linear regression models were statistically significant with multiple R2 ranging from 0.6057 to 0.7896 (all P<.001). EPS and the number of sentences were significant predictors of F1-scores in all cases ( P<.001), except for the GPT-2_large model, where EPS was not a significant predictor (P=.184). Model thresholds indicate points of diminishing marginal return from increased training data set sample size measured by the number of sentences, with point estimates ranging from 439 sentences for RoBERTa_large to 527 sentences for GPT-2_large. Likewise, the threshold regression models indicate a diminishing marginal return for EPS with point estimates between 1.36 and 1.38. Relatively modest sample sizes can be used to fine-tune LLMs for NER tasks applied to biomedical text, and training data entity density should representatively approximate entity density in production data. Training data quality and a model architecture's intended use (text generation vs text processing or classification) may be as, or more, important as training data volume and model parameter size.

Talking About Strengths-Based Nursing and Healthcare Leadership: What Canadian Nurse Leaders Have to Say.

Nursing leadership is essential to improving nurse retention, their well-being, the quality of nursing care and patient safety. As healthcare leaders become increasingly aware of Strengths-Based Nursing and Healthcare Leadership (SBNH-L), we dialogued with Canadian nurse leaders to understand their views on this leadership approach. Five senior nursing leaders representing practice, academic and health policy contexts were interviewed. Five themes emerged: connections, opportunities for growth, humanism, optimism and hope for the future. Leaders shared that SBNH-L is a valuable, timely leadership approach that will promote system-wide health and healing post-pandemic. A call to action is offered to advance adoption of this essential leadership approach.

A modified action framework to develop and evaluate academic-policy engagement interventions

BackgroundThere has been a proliferation of frameworks with a common goal of bridging the gap between evidence, policy, and practice, but few aim to specifically guide evaluations of academic-policy engagement. We present the modification of an action framework for the purpose of selecting, developing and evaluating interventions for academic-policy engagement.MethodsWe build on the conceptual work of an existing framework known as SPIRIT (Supporting Policy In Health with Research: an Intervention Trial), developed for the evaluation of strategies intended to increase the use of research in health policy. Our aim was to modify SPIRIT, (i) to be applicable beyond health policy contexts, for example encompassing social, environmental, and economic policy impacts and (ii) to address broader dynamics of academic-policy engagement. We used an iterative approach through literature reviews and consultation with multiple stakeholders from Higher Education Institutions (HEIs) and policy professionals working at different levels of government and across geographical contexts in England, alongside our evaluation activities in the Capabilities in Academic Policy Engagement (CAPE) programme.ResultsOur modifications expand upon Redman et al.’s original framework, for example adding a domain of ‘Impacts and Sustainability’ to capture continued activities required in the achievement of desirable outcomes. The modified framework fulfils the criteria for a useful action framework, having a clear purpose, being informed by existing understandings, being capable of guiding targeted interventions, and providing a structure to build further knowledge.ConclusionThe modified SPIRIT framework is designed to be meaningful and accessible for people working across varied contexts in the evidence-policy ecosystem. It has potential applications in how academic-policy engagement interventions might be developed, evaluated, facilitated and improved, to ultimately support the use of evidence in decision-making.

Integrating Public Health Ethics into Public Health Policymaking: Being in the Room Where It Happens.

This commentary takes up a challenge posed by Franklin Miller in a 2022 essay in Bioethics Forum. Dr. Miller queried whether bioethicists could be useful in public health policy contexts and while he refrained from issuing an ultimate opinion, did identify several challenges to such utility. The current piece responds to the challenges Dr. Miller identifies and argues that with appropriate training, public health ethicists can be of service in virtually any context in which public health policies are deliberated and decided.

Cardiovascular disease incidence rates: a study using routinely collected health data

BackgroundThere is substantial evidence that systemic anticancer therapies and radiotherapy can increase the long-term risk of cardiovascular disease (CVD). Optimal management decisions for cancer patients therefore need to take into account the likely risks from a proposed treatment option, as well as its likely benefits. For CVD, the magnitude of the risk depends on the incidence of the disease in the general population to which the patient belongs, including variation with age and sex, as well as on the treatment option under consideration. The aim of this paper is to provide estimates of CVD incidence rates in the general population of England for use in cardio-oncology and in other relevant clinical, research and health policy contexts.MethodsWe studied a population-based representative cohort, consisting of 2,633,472 individuals, derived by electronic linkage of records from primary care with those of admitted-patient care in England during April 1, 2010, to April 1, 2015. From 38 individual CVDs available via the linked dataset we identified five relevant categories of CVD whose risk may be increased by cancer treatments: four of heart disease and one of stroke.ResultsWe calculated incidence rates by age-group and sex for all relevant CVD categories combined, for the four relevant categories of heart disease combined, and for the five relevant CVD categories separately. We present separate incidence rates for all 38 individual CVDs available via the linked dataset. We also illustrate how our data can be used to estimate absolute CVD risks in a range of people with Hodgkin lymphoma treated with chemotherapy and radiotherapy.ConclusionsOur results provide population-based CVD incidence rates for a variety of uses, including the estimation of absolute risks of CVD from cancer treatments, thus helping patients and clinicians to make appropriate individualized cancer treatment decisions.Graphical Graphical : Cardiovascular incidence rates for use in cardio-oncology and elsewhere: A presentation of age- and sex-specific cardiovascular disease (CVD) incidence rates for use in calculation of absolute cardiovascular risks of cancer treatments, and in other clinical, research and health policy contexts. Abbreviations– CVD: cardiovascular disease; y: years

INTEGRATION OF PUBLIC HEALTH POLICY AND LABORATORY SCIENCE IN NIGERIA: A REVIEW OF RESPONSES TO COVID-19

The COVID-19 pandemic has spotlighted the criticality of an integrated approach between public health policy and laboratory science, especially in countries like Nigeria, with unique healthcare challenges. This study aimed to comprehensively analyze the synergy between these two domains, focusing on their collaborative potential and implications for pandemic response in Nigeria. Adopting a mixed-methods approach, the research combined qualitative and quantitative data to provide a holistic perspective. The study delved into Nigeria's pre-COVID-19 public health landscape, the historical context of health policy and laboratory collaboration, and this synergy's economic, social, regulatory, and ethical facets. Key findings revealed that Nigeria's public health policies during the pandemic were adaptive, with laboratory science showcasing innovations in diagnostic tools, techniques, and infrastructure enhancements. Mutual feedback mechanisms and international engagements marked the collaboration between policymakers and laboratories. The study concludes that fostering a robust synergy between health policy and laboratory science is paramount for future pandemic preparedness. Recommendations include the need for continuous training, infrastructure development, and international collaborations to bolster Nigeria's healthcare system. This research offers valuable insights for policymakers, healthcare professionals, and researchers, emphasizing the importance of a collaborative approach in health crises.&#x0D; Keywords: Public Health Policy, Laboratory Science, COVID-19, Nigeria, Pandemic Response.

Small numbers, big impact: making a utilitarian case for the contribution of inclusion health to population health in England

Inclusion health groups make up a small proportion of the general population, so despite the extreme social exclusion and poor health outcomes that these groups experience, they are often overlooked...

Situating commercial determinants of health in their historical context: a qualitative study of sugar-sweetened beverages in Jamaica

BackgroundNon-communicable diseases (NCDs) are the leading cause of mortality across the Caribbean and similar regions. Structural determinants include a marked increase in the dependency on food imports, and the proliferation of processed foods, including sugar-sweetened beverages (SSBs). We focused on Jamaica as a case study and the health challenge of SSBs, and situated contemporary actions, experiences and policies within their historical context to investigate underlying drivers of commercial determinants of health and attempts to counter them. We asked: how can a historical perspective of the drivers of high level SSB consumption in Jamaica contribute to an enhanced understanding of the context of public health policies aimed at reducing their intake?MethodsAn ethnographic approach with remote data collection included online semi-structured interviews and workshops with 22 local experts and practitioners of health, agriculture and nutrition in Jamaica and attending relevant regional public webinars on SSBs and NCD action in the Caribbean. Our analysis was situated within a review of historical studies of Caribbean food economies with focus on the twentieth century. Jamaican and UK-based researchers collected and ethnographically analysed the data, and discussed findings with the wider transdisciplinary team.ResultsWe emphasise three key areas in which historical events have shaped contextual factors of SSB consumption. Trade privileged sugar as a cash crop over food production during Jamaica’s long colonial history, and trade deregulation since the 1980s through structural adjustment opened markets to transnational companies. These changes increased Jamaican receptiveness to the mass advertisement and marketing of these companies, whilst long-standing power imbalances hampered taxation and regulation in contemporary public health actions. Civil society efforts were important for promoting structural changes to curb overconsumption of SSBs and decentring such entrenched power relations.ConclusionThe contemporary challenge of SSBs in Jamaica is a poignant case study of commercial determinants of health and the important context of global market-driven economies and the involvement of private sector interests in public health policies and governance. Historically contextualising these determinants is paramount to making sense of the sugar ecology in Jamaica today and can help elucidate entrenched power dynamics and their key actors.

Use of preferred contraceptive method among young adults in Texas and California: A comparison by state and insurance coverage.

Young people's ability to use their preferred contraceptive method is an indicator of reproductive autonomy and healthcare access. State policies can hinder or facilitate access to a preferred contraceptive method. This study compared use of preferred contraceptive method in Texas and California, states with contrasting health policy contexts that impact health insurance coverage and access to subsidized family planning services. We used baseline survey data from an ongoing cluster randomized controlled trial of sexually active students, assigned female at birth, ages 18-25, at 29 community colleges in Texas and California (N = 1,974). We described contraceptive preferences and use, as well as reasons for nonuse of a preferred method. We conducted multivariable-adjusted mixed-effects logistic regression analyses for clustered data, and then calculated the predicted probability of using a preferred contraceptive method in Texas and California by insurance status. More Texas participants were uninsured than Californians (30% vs. 8%, p<0.001). Thirty-six percent of Texas participants were using their preferred contraceptive method compared to 51% of Californians. After multivariable adjustments, Texas participants had lower odds of using their preferred method (adjusted odds ratio = 0.62, 95% confidence interval = 0.48-0.81) compared to those in California. Texas participants in all insurance categories had a lower predicted probability of preferred method use compared to California participants. In Texas, we found a 12.1 percentage-point difference in the predicted probability of preferred method use between the uninsured (27.5%) and insured (39.6%) (p<0.001). Texans reported financial barriers to using their preferred method more often than Californians (36.7% vs. 19.2%, p<0.001) as did the uninsured compared to the insured (50.9% vs. 18.7%, p<0.001). These findings present new evidence that state of residence plays an important role in young people's ability to realize their contraceptive preference. Young people in Texas, with lower insurance coverage and more limited access to safety net programs for contraceptive care than in California, have lower use of preferred contraception. It has become urgent in states with abortion bans to support young people's access to their preferred methods.

Pathways to Suicide among Police in Rajasthan: Perceptions and Experiences of Police Personnel.

Background: Evidence regarding the experience and perceptions of police personnel with suicide in South Asia is limited. This study explored the lived experiences and perceptions of suicide among police personnel in an Indian state. The focus was on explanations of and reasons for suicide. Methods: We conducted 20 qualitative interviews in 2021 with police of different ranks, guided by a topic guide. The reflexive thematic analysis approach was supported by the use of NVivo 12, a qualitative software package. Results: We explore three intersecting key themes around suicide in the police force, including: (1) the stressful police environment; (2) expectations of mental strength; and (3) police image and help-seeking. We discuss the tensions between these themes and how to address the challenges of supporting police personnel. Conclusions: To support and improve police personnel's mental well-being training and support are needed but also broader changes at the organisational level. These need to take social and historical factors into account. An increased level of suicide and mental health literacy will not only benefit the police force but also the general public, and it would be very timely with recent changes in the Indian mental health and suicide policy context.