Context Of Health Policy Research Articles

Students as policymakers and policy advocates: Role-playing evidence-based health policies

Background Role playing has been increasingly utilized as a teaching strategy in the health discipline. However, the utilization of role playing within the field of health policy and systems research, while imperative, remains limited. Thus, this study documented and described a role playing activity and explored students’ experiences within the context of evidence-based health policy. Method The role playing activity was conducted as part of a course assessment – evidence-based health policy brief at a university in Saudi Arabia. Six graduate level students who were enrolled in the course participated in the activity. Through a mixed method approach, the study collected data from different sources including assessment forms, surveys, written reflections, and observational notes, to explore students experiences with the role playing activity. Data analysis included descriptive statistics for quantitative data and content analysis for qualitative data. Results Students reported an overall positive experience with the role playing activity. The activity provided them with an experience mimicking real scenarios, while playing roles of policy advocates and policymakers. Additionally, the activity contributed to students’ knowledge acquisition and expansion as well as skills development relevant to policymaking. Conclusion The study’s findings contribute to the current literature on the utilization of simulation within the health discipline, with valuable contribution to the field of health policy and systems research. Implications of the study require attention from respective policymakers, practitioners, and academicians.

Education as drug policy: A realist synthesis of continuing professional development for opioid agonist therapy.

Continuing professional development (CPD) for opioid agonist therapy (OAT) has been identified as a key health policy strategy to improve care for people living with opioid use disorder (OUD) and to address rising opioid-related harms. To design and deliver effective CPD programs, there is a need to clarify how they work within complex health system and policy contexts. This review synthesizes the literature on OAT CPD programs and educational theory to clarify which interventions work, for whom, and in what contexts. A systematic review and realist synthesis of evaluations of CPD programs focused on OAT was conducted. This included record identification and screening, theory familiarization, data collection, analysis, expert consultation, and iterative context-intervention-mechanism-outcome (CIMO) configuration development. Twenty-four reports comprising 21 evaluation studies from 5 countries for 3373 providers were reviewed. Through iterative testing of included studies with relevant theory, five CIMO configurations were developed. The programs were categorized by who drove the learning outcomes (i.e., system/policy, instructor, learner) and their spheres of influence (i.e., micro, meso, macro). There was a predominance of instructor-driven programs driving change at the micro level, with few policy-driven macro-influential programs, inconsistent with the promotion of CPD as a clear opioid crisis policy-level intervention. OAT CPD is challenged by mismatches in program justifications, objectives, activities, and outcomes. Depending on how these program factors interact, OAT CPD can operate as a barrier or facilitator to OUD care. With more deliberate planning and consideration of program theory, programs more directly addressing diverse learner and system needs may be developed and delivered. OAT CPD as drug policy does not operate in isolation; programs may feed into each other and intercalate with other policy initiatives to have micro, meso, and macro impacts on educational and population health outcomes.

Market positioning in food industry in response to public health policies

Public health agencies have designed and implemented interventions to control the global obesity epidemic using healthfulness messaging and policy changes such as taxation. These changes in the policy environment and marketplace dynamics have shifted consumer trends and have challenged food producers in the industry. The following questions are considered in the food industry in such a context: (i) Should firms offer similar or very different quality offerings? (ii) How should a firm's positioning strategies change as consumers' perceptions of healthful messaging and taxation change? and (iii) How do these factors impact firm profits and social welfare (SW)? Using an analytical model of duopolistic competition, we highlight that both firm profits as well as SW could increase when the importance of healthfulness messaging to consumers increases. Furthermore, we show that increased taxation could reduce the quality gap between alternatives in the market, forcing firms to lower prices. In contrast, when healthfulness messaging becomes more important to consumers, the quality gap between both firms increases. Our results provide important implications for public policy as well as firm profits as a consequence of the strategic decisions of firms in a health policy context.

Agenda setting and socially contentious policies: Ethiopia’s 2005 reform of its law on abortion

BackgroundIn 2005, Ethiopia took a bold step in reforming its abortion law as part of the overhaul of its Penal Code. Unsafe abortion is one of the three leading causes of maternal mortality in low-income countries; however, few countries have liberalized their laws to permit safer, legal abortion.MethodsThis retrospective case study describes the actors and processes involved in Ethiopia’s reform and assesses the applicability of theories of agenda setting focused on internal versus external explanations. It draws on 54 interviews conducted in 2007 and 2012 with informants from civil society organizations, health professionals, government, international nongovernmental organizations and donors, and others familiar with the reproductive health policy context in Ethiopia as well as on government data, national policies, and media reports. The analytic methodology is within-case analysis through process tracing: using causal process observations (pieces of data that provide information about context, process, or mechanism and can contribute to causal inference) and careful description and sequencing of factors in order to describe a novel political phenomenon and evaluate potential explanatory hypotheses.ResultsThe analysis of key actors and policy processes indicates that the ruling party and its receptiveness to reform, the energy of civil society actors, the “open windows” offered by the vehicle of the Penal Code reform, and the momentum of reforms to improve women’s status, all facilitated liberalization of law on abortion. Results suggest that agenda setting theories focusing on national actors—rather than external causes—better explain the Ethiopian case. In addition, the stronger role for government across areas of policy work (policy specification and politics, mobilization for enactment and for implementation), and the collaborative civil society and government policy relationships working toward implementation are largely internal, unlike those predicted by theories focusing on external forces behind policy adoption.ConclusionsEthiopia’s policymaking process can inform policy reform efforts related to abortion in other sub-Saharan Africa settings.

Biopower under a state of exception: stories of dying and grieving alone during COVID-19 emergency measures

During the COVID-19 pandemic, restrictions for visitors and caregivers in healthcare settings and long-term care (LTC) facilities were enacted in the larger context of public health policies that included physical...

The impact of co-location employment partnerships within the Australian mental health service and policy context: A systematic review.

Adults with a serious persistent mental illness (SPMI) express a strong desire to work. However, they continue to experience higher levels of unemployment, barriers, and occupational exclusion that impact their vocational outcomes and choice of work. The aim of this study was to investigate the impact of co‐location partnerships between adult mental health and disability employment services (DES) on employment outcomes and consumer choice of work for adults with a SPMI. Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methodology, a systematic literature review was conducted by searching four databases. The relationship between mental health, employment, and DES was examined. Inclusion criteria were adults with a SPMI; employment services and outcomes; and job retention and sustainability. Twelve studies met inclusion criteria. All studies were peer‐reviewed, Australian‐based, and published between 01 January 2017 and 30 August 2021. Individual placement and support (IPS); DES practice, funding, policy, and reform within the Australian mental health system; and barriers to participation in DES were the three main themes that emerged. Findings highlight the importance of joint, co‐location partnerships between mental health and employment services, including a collaborative approach to policy reform between both services, to assist adults with a SPMI to gain and sustain competitive employment. Vocational, non‐vocational, systemic, and structural barriers still exist; hence, adults with a SPMI continue to face challenges with gaining and sustaining long‐term employment. Hence, it is important for these partnerships to be systematically set up to support the complexity of the employment journey for adults with a SPMI.

Desarrollo de un instrumento de evaluación formativa del agente comunitario de salud

To validate a formative evaluation instrument of the community health agent. DesignMethodological study with a quantitative approach. LocationCarried out in two municipalities in the South of Brazil. Participants40 nurses for 350 community health agents. ParticipantsThe instrument was developed based on a competency framework of the Ministry of Health. The principal component analysis method was used for factor analysis. Internal validity and reliability were measured by Cronbach's alpha. The intraclass correlation coefficient, the Student's t test for paired samples and the ANOVA analysis of variance were used. ResultsThe factor analysis produced a factor structure with six factors and the 52 competencies of the original instrument were maintained. The final version of the instrument was structured into six domains: “Micro-area monitoring” (12 competencies), “Health promotion” (nine competencies), “Prevention and monitoring of specific groups and morbidities” (10 competencies), “Prevention and monitoring of environmental and social risk” (nine competences), “Planning and evaluation” (seven competences), “Teamwork” (five competences). Cronbach's alpha coefficient was 0.981, the test and the new test was p=0.851 by the Student's t-test, and the ICC was 1.0. ConclusionsThe validated instrument constitutes an important reference in the discussion of the work of the Community Health Agent in the current context of public health policies. In addition to supporting the role of nurses in the supervision/in-service training of these professionals.

“Not a free version of a broken system:” Medical humanitarianism and immigrant health justice in the United States

Medical humanitarian organizations are increasingly the primary healthcare providers for unauthorized migrants in high-income countries. Existing studies of medical humanitarianism in the Global North reveal tensions between principles of traditionally apolitical humanitarianism and human rights. In practice, these tensions translate into organizational debates about prioritizing direct service provision to meet immediate needs or advocacy to effect long-term systemic change. Informed by these debates, this paper asserts the importance of immigration and health policy contexts as central to shaping the relationship between healthcare provision and political advocacy within medical humanitarian NGOs. Drawing from twelve months of fieldwork with medical humanitarian NGOs in Arizona, I analyze data from ethnographic participant observation and interviews with volunteer healthcare providers at a medical humanitarian organization I call Community Clinic of Phoenix (CCP), a free clinic for uninsured, undocumented immigrants. I find that, in the context of Arizona's anti-immigrant rhetoric and policies, CCP employs medical humanitarianism as both a discourse and a model of care to challenge immigrants' exclusion from health coverage and criminalization through immigration enforcement. The clinic's emphasis on immigrant health justice shapes their critiques of the structural failures of U.S. immigration and health systems, their approach to providing equitable access to quality healthcare for uninsured immigrants, and their work to create broad social change for immigrant rights and health justice. Driven by their mission of “not replicating a free version of a broken system,” the clinic's healthcare provision amid a climate inhospitable to immigrants demonstrates the importance of both conceptualizing and practicing medical humanitarianism as healthcare advocacy.

The Weight of Words: Co-Analysis of Thick Ethnographic Description and "Friction" as Methodological Strategies in a Health Policy Research Partnership.

Co-production partnerships between policymakers, practitioners, and researchers are designed to facilitate production of relevant and readily usable research in health policy and practice contexts. We describe methodological strategies for in-depth collaborative analysis based on a co-produced ethnography of health promotion practice, involving ethnographic researchers and government-based research partners. We draw on a co-production dialogue to reflect critically on the role and value of co-analyzing research findings using thick ethnographic descriptions. The ambiguity of ethnographic imagery allowed flexibility in interpretation of findings and also generated friction. Specific ethnographic images became focal points for productive friction that crystallized ethical and analytical imperatives underpinning the diverse expertise in the team. To make the most of co-analysis of thick ethnographic descriptions, we assert that friction points must be reflexively considered as key learning opportunities for (a) higher order analysis informed by diverse analytical perspectives and (b) more cohesive and useful interpretations of research findings.

Negotiating social norms, the legacy of vertical health initiatives and contradicting health policies: a qualitative study of health professionals’ perceptions and attitudes of providing adolescent sexual and reproductive health care in Arusha and Kilimanjaro region, Tanzania

ABSTRACT Background Adolescents in Tanzania are at risk of many health problems attributed to limited access to quality sexual and reproductive health services. Health professionals are a crucial part of service delivery, and their perspective on providing care is important in understanding the barriers that hamper access to sexual and reproductive health services for adolescents. Better understanding these barriers will support the development of more effective interventions. This paper explores these perspectives in view of the health-policy context that surrounds them. Objective This study has aimed to explore and understand health professionals’ perceptions and attitudes regarding the provision of adolescent sexual and reproductive health care in a selected national sexual and reproductive health programme in the Arusha region and Kilimanjaro region, Tanzania. Methods A qualitative cross-sectional interview design was applied. Sixteen in-depth interviews were conducted with health professionals and community health workers. Data was analysed following inductive thematic analysis. Results Four main themes are identified in the data: concern about the stigma directed towards adolescents; over-medicalisation of services; difficulty involving adolescent males; and ambiguous policies and contradictory messages. The findings suggest that health professionals providing care in the current adolescent sexual and reproductive health programme must navigate the legacy of vertical health programmes as well as contradicting views and messages that are influenced by social norms, by uncertainties about current laws and by statements from political leaders. Conclusions The findings suggest that future research, policies and health programmes should consider the perspectives of health professionals and their challenges in delivering care for adolescents to help improve the understanding of how to effectively and sensitively implement sexual and reproductive health programmes for adolescents.

Alzheimer's Patient Organizations' Role in Enabling Citizenship Projects: A Comparison of the USA, Germany, and the UK.

This paper examines how Alzheimer's disease (AD) patient support organizations (POs) located in diverse healthcare regimes enable patients to claim and construct their rights as citizens. Since citizenship rights of people with AD are debated widely, it is important to recognize the role of POs in enabling people to construct citizenship identities. This paper thus examines the factors that shape the citizenship projects of the AD POs. Since collective health-related behavior changes in line with national differences, we compare the biggest AD POs in three starkly distinct healthcare regimes: the Alzheimer's Association in the US (ALZ), the Deutsche Alzheimer Gesellschaft (German Alzheimer's Association) in Germany (DAG), and Alzheimer's Society in the UK (AS), to examine how distinct health policy contexts shape their citizenship projects. Based on our website analysis of the three POs and other related secondary documents, we argue that the way each POs work toward enabling its members to claim rights and assume responsibilities depend upon the nature of healthcare funding and resource allocation for AD care. Since AD involves long-term care, the ways in which the three POs enable the people with AD to secure their care expenses set apart the nature of citizenships enactments.

Health Policy as a Barrier to First Nations Peoples' Access to Cancer Screening.

Background:First Nations peoples in Ontario are facing increasing rates of cancer and have been found to have poorer survival. Cancer screening is an important strategy to improve cancer outcomes; yet, Indigenous people in Canada are less likely to participate in screening. Ontario has established organized breast, cervical and colorectal cancer screening programs; this paper examines the health policy context that informs these programs for First Nations peoples in the province.Method:This paper follows an embedded multiple-case study design, drawing upon a document review to outline the existing policy context and on key informant interviews to explore the aforementioned context from the perspective of stakeholders.Results:Policies created by agencies operating across federal, regional and provincial levels impact First Nations peoples' access to screening. Interviews identified issues of jurisdictional ambiguity, appropriateness of program design for First Nations persons and lack of cultural competency as barriers to participation in screening.Conclusion:Federal, provincial and regional policy makers must work in collaboration with First Nations peoples to overcome barriers to cancer screening created and sustained by existing policies.

Implementing 'universal' access to antiretroviral treatment in South Africa: a scoping review on research priorities.

‘Universal’ access to antiretroviral treatment (ART) has become the global standard for treating people living with HIV and achieving epidemic control; yet, findings from numerous ‘test and treat’ trials and implementation studies in sub-Saharan Africa suggest that bringing ‘universal' access to ART to scale is more complex than anticipated. Using South Africa as a case example, we describe the research priorities and foci in the literature on expanded ART access. To do so, we adapted Arksey and O’Malley’s six-stage scoping review framework to describe the peer-reviewed literature and opinion pieces on expanding access to ART in South Africa between 2000 and 2017. Data collection included systematic searches of two databases and hand-searching of a sub-sample of reference lists. We used an adapted socio-ecological thematic framework to categorize data according to where it located the challenges and opportunities of expanded ART eligibility: individual/client, health worker–client relationship, clinic/community context, health systems infrastructure and/or policy context. We included 194 research articles and 23 opinion pieces, of 1512 identified, addressing expanded ART access in South Africa. The peer-reviewed literature focused on the individual and health systems infrastructure; opinion pieces focused on changing roles of individuals, communities and health services implementers. We contextualized our findings through a consultative process with a group of researchers, HIV clinicians and programme managers to consider critical knowledge gaps. Unlike the published literature, the consultative process offered particular insights into the importance of researching and intervening in the relational aspects of HIV service delivery as South Africa’s HIV programme expands. An overwhelming focus on individual and health systems infrastructure factors in the published literature on expanded ART access in South Africa may skew understanding of HIV programme shortfalls away from the relational aspects of HIV services delivery and delay progress with finding ways to leverage non-medical modalities for achieving HIV epidemic control.

Comportamento sedentário em universitários: uma revisão sistemática

Studies on sedentary behavior (SB) among university students have been published, and the knowledge about the methods adopted in surveys is important for science, and the characterization of prevalence and associated factors are essential in the context of health policies for this population group. Thus, the aim of the present study was to describe prevalence, associated factors, and the methodological characteristics used in SB research among university students. A search in the National Library of Medicine (PUBMED), Scientific Electronic Library Online (SciELO), Virtual Health Library (VHL) and SCOPUS databases was performed. This study adopted the items and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA), and the articles selected were analyzed according to their methodological characteristics, as well as prevalence and factors associated with SB. Of the 1,740 articles found in databases, 23 were included in this review. The prevalence for sitting time was from 34.0% to 90.2%. The use of operational definitions and cutoff points diversified, as well as the use of various instruments to estimate SB. The lack of standardization between cutoff points for SB determination and operational definitions, such as the use of non-validated instruments, was observed. Among factors associated with higher prevalence, the most prominent were overweight and depressive symptoms. It was concluded that the prevalence of SB was high in domains not related with the time devoted to studies and biological and psychological characteristics represented attributes more associated with SB.

Scaling up mental health interventions in conflict zones

Scaling up mental health interventions in conflict zones

The sexual health needs of sexual minority women in Western Kenya: An exploratory community assessment and public policy analysis

ABSTRACT Sexual health and rights are a core feature of human development. Yet, most work on sexual health and wellbeing in the Global South and elsewhere has historically focused on heterosexual, cisgender people, as well as sexual minority cisgender men and transgender women. This exploratory study includes an analysis of comments made during a facilitated community forum and an examination of the sociopolitical and legal environment relevant to sexual minority women’s health in Kenya. Through analysis of the group discussion hosted by a sexual minority women’s group, we identified multiple sexual health-related issues, including concerns related to healthcare access, healthy sexual relationships, economic instability, and freedom from violence. Based on issues identified by the forum, we conducted an analysis of law and policy in the areas of community need. The legal and policy analysis indicated that the public policy and health policy context is complicated by the presence of hostile laws regarding same-sex sexuality, an absence of economic policies to protect women, and yet some existing health policy inclusive of sexual and gender minorities that nonetheless render sexual minority women invisible. The findings indicate a need for focus on public opinion, health services, legislation, and health policy as sites of intervention.

International Transferability of Nurse Practitioner Credentials in Five Countries

Globally, better utilization of nurse practitioners is recognized as an important strategy to address country needs for improved population health and increased access to high-quality care. This article examines the mobility of internationally educated nurse practitioners by comparing the regulatory requirements in 5 countries. Differences in health care system and policy contexts regionally and nationally have resulted in variations in education, credentialing, and scope of practice. As a result, mobility of the nurse practitioner workforce within and across countries is restricted. Further policy work is needed at international and national levels to address this issue.

The courts as political players

Courts are political animals; as a result, they strive not only to carry out their assigned role in national governance but also to balance that role within the political and social system in which they operate. Sperling and Cohen offer an elegant, in-depth analysis of how these institutional interests have helped shape decision-making by the Israeli Supreme Court in a health policy context. In doing so, the authors tell a universal story, one with enormous resonance in the U.S.

\u2018Virus Carriers\u2019 and HIV testing: navigating Ukraine\u2019s HIV policies and programming for female sex workers

BackgroundThere are an estimated 80,100 female sex workers (FSWs) in Ukraine, of whom 7% are living with HIV. Early HIV diagnosis continues to be a public health priority in Ukraine as only approximately 54% of people living with HIV are diagnosed nationwide. This study aims to analyse the content, context and discourse of HIV testing policies among female sex workers in Ukraine and how these policies are understood and implemented in practice.MethodsTo analyse past and current national policies, we searched the database of the Ukrainian Parliament and the Ministry of Health for relevant policy documents (e.g. legislation and orders). To analyse the day-to-day practice of those involved in the implementation of these HIV programmes, we conducted face-to-face semi-structured interviews with key stakeholders. All data were coded using deductive thematic analysis initially guided by the Policy Triangle, a framework which addresses policy content, the process of policy-making, the health policy context, actors involved in policy formulation and implementation.ResultsHIV testing policies are formed and implemented in the post-Soviet context through a vertical system of AIDS clinics, resulting in the separation of key affected populations from the rest of the health system. Successive testing policies have been strongly influenced by international donors and non-governmental organisations. Furthermore, a lack of government funding for HIV prevention created a gap that international donors and local non-governmental organisations covered to ensure the implementation of testing policies. Their role, however, had limited influence on the Ukrainian government to increase funding for prevention, including testing of FSWs. Since the early 1990s, when stigmatising and discriminatory forced/mandatory HIV testing was applied, these approaches were slowly replaced with voluntary testing, self-testing and assisted HIV testing, yet stigma was found to be a barrier among FSWs to access testing.ConclusionPoor governance and the fragmentation of the health system, ongoing health sector reforms, shrinking international funding, and persisting stigma towards people living with HIV and sex workers might impede the continuity and sustainability of HIV testing programmes. Local civil society may now have the opportunity to contribute to the development and further implementation of HIV testing policies in Ukraine.

The health equity measurement framework: a comprehensive model to measure social inequities in health

BackgroundDespite the wealth of frameworks on social determinants of health (SDOH), two current limitations include the relative superficial description of factors affecting health and a lack of focus on measuring health equity. The Health Equity Measurement Framework (HEMF) addresses these gaps by providing a more encompassing view of the multitude of SDOH and drivers of health service utilisation and by guiding quantitative analysis for public health surveillance and policy development. The objective of this paper is to present the HEMF, which was specifically designed to measure the direct and indirect effects of SDOH to support improved statistical modelling and measurement of health equity.MethodsBased on a framework synthesis, the HEMF development involved initially integrating theoretical components from existing SDOH and health system utilisation frameworks. To further develop the framework, relevant publications on SDOH and health equity were identified through a literature review in major electronic databases. White and grey literatures were critically reviewed to identify strengths and gaps in the existing frameworks in order to inform the development of a unique health equity measurement framework. Finally, over a two-year period of consultation, scholars, health practitioners, and local policy influencers from municipal and provincial governments provided critical feedback on the framework regarding its components and causal relationships.ResultsThis unified framework includes the socioeconomic, cultural, and political context, health policy context, social stratification, social location, material and social circumstances, environment, biological factors, health-related behaviours and beliefs, stress, quality of care, and healthcare utilisation. Alongside the HEMF’s self-exploratory diagram showing the causal pathways in-depth, a number of examples are provided to illustrate the framework’s usefulness in measuring and monitoring health equity as well as informing policy-making.ConclusionsThe HEMF highlights intervention areas to be influenced by strategic public policy for any organisation whose purview has an effect on health, including helping non-health sectors (such as education and labour) to better understand how their policies influence population health and perceive their role in health equity promotion. The HEMF recognises the complexity surrounding the SDOH and provides a clear, overarching direction for empirical work on health equity.