Implementation Of Policy Changes Research Articles

Emerging Policy Entrepreneurs and Their Potential After the Great East Japan Earthquake

This study highlights new facts regarding the rise of local human resources during the policy decision process by reviewing policy entrepreneurs active in areas affected by the Great East Japan Earthquake. Specifically, the study reviews these stakeholders concerning the definitions and frameworks of prior research as well as the discussed development of policy entrepreneurs. A policy entrepreneur has been defined as “an energetic actor that conducts collaborative efforts within and around the government to promote policy innovation.” This study provides a comparative analysis of how the five strategies, as a requirement for establishing policy entrepreneurs, have been used to implement policy changes. Two cases are selected to confirm the extent to which they have utilized their respective strategies. The results reveal that both individuals have become active at their respective national and local levels by adopting the five strategies, despite there being differences in the extent of adoption. The recognition of the new existence of “policy entrepreneurs” could offer great support and identity to NPOs in disaster-afflicted areas. Promoting policy entrepreneurship could present a powerful message from the disaster-afflicted areas in Tohoku that could be shared with the entire nation of Japan, particularly considering recent times, when innovation has become necessary in Japan’s public domain.

Assessing the performance of health technology assessment (HTA) agencies: developing a multi-country, multi-stakeholder, and multi-dimensional framework to explore mechanisms of impact

BackgroundHealth technology assessment (HTA) agencies have an important role to play in managing the rising demands on health systems. However, creating and running such agencies potentially diverts resources from frontline services. A large number of studies address the question of ‘what is the impact of HTA?’. Several points of heterogeneity in this literature include: purpose of the study, definition of HTA, definition of impact, and scope and rigour of evaluations. Our study seeks to address several limitations in this literature. This study aims to explore the mechanisms of impact of an HTA agency. In doing so, we consider HTA as an institution rather than a knowledge product to build an impact evaluation framework from an international, multi-stakeholder and multi-dimensional perspective.MethodsWe conducted 9 key informant interviews with experts from the international HTA community. We addressed several questions, informed by existing frameworks of impact within the literature, to understand their perspectives on the mechanisms of impact of an HTA agency. We analyse data using logic modelling and impact mapping, as tools to understand and visualise mechanisms of change.FindingsOur impact mapping highlights several distinct, but not necessarily mutually exclusive, mechanisms through which the overall impact of an HTA agency is achieved. These are: the effective conduct of HTA studies; effective use of HTA in agenda-setting and policy formulation processes; effective engagement and external communications; good institutional reputation and fit within the healthcare and policy-making system; effective use of HTA as a tool for the negotiation of health technology prices; and the effective implementation of policy change regarding health technologies. We also identify indicators of these effects.ConclusionsOur findings and resulting evaluation framework complement and add to existing literature by offering a new perspective on the mechanisms by which HTA agencies generate impact. This new perspective considers HTA as an institution rather than a knowledge product, is international, multi-dimensional, and includes multi-stakeholder views. We hope the analysis will be useful to countries interested in managing HTA performance.

POLICY CHANGE IMPLEMENTATION: THE CASE OF THE CEFR IN MALAYSIAN ESL CLASSROOMS

Background and purpose: With rapid global development happening in the world today, the field of education has been awash with various change forces. In an effort to ensure its system is globally competitive, Malaysia has taken a step to align its English language education system to the Common European Framework of Reference (CEFR). However, any change in policy is not without problems and challenges as studies have shown that challenges were inevitable and stakeholders’ buy-in on the new change is necessary. Hence, this study was undertaken to investigate the challenges faced by teachers in implementing the CEFR in Malaysian ESL classrooms, their belief on this new reform and their readiness to implement the CEFR.
 
 Methodology: A mixed-method design was utilized with the use of questionnaire and semi structured interview as means for data collection. 365 English language teachers responded to the questionnaire while 15 English language teachers participated in interview sessions.
 
 Findings: The data revealed five challenges namely teachers’ motivation, materials, time, students’ proficiency level and facilities. Despite facing multiple challenges, all teachers exhibited positive belief towards the adoption of the CEFR. The study also showed that although teachers were emotionally ready to accept the change, their cognitive readiness for change however is dependent upon three important facets namely time, collective effort and adequate materials.
 
 Contributions: The study provides insights into the change in policy involving the CEFR implementation in the Malaysian English language education system which contributes to the scarce literature on the implementation of CEFR.
 
 Keywords: Policy implementation, challenges in policy change, teachers’ belief, Common European Framework of Reference (CEFR), readiness for change.
 
 Cite as: C. Alih, N. A., Abdul Raof, A. H., & Md. Yusof, M. A. (2021). Policy change implementation: The case of the CEFR in Malaysian ESL classrooms. Journal of Nusantara Studies, 6(2), 296-317. http://dx.doi.org/10.24200/jonus.vol6iss2pp296-317

Cannabis Policy Changes and Adolescent Cannabis Use: Evidence from Europe.

Cannabis accounts for the largest share of the illicit drug market, with a high prevalence of use even among adolescents. To tackle this longstanding problem, many kinds of reforms to national cannabis control policies have been implemented in Europe, but their effectiveness is still unclear. This paper analyses the association between selected categories of cannabis policy reforms and changes in perceived cannabis availability and patterns of use among adolescents. Data from 20 European countries across 15 years were drawn from a novel database of the European school Survey Project on Alcohol and other Drugs (ESPAD). Our analysis is based on a Difference-in-Differences design, which application is allowed by the fact that only thirteen out of the twenty countries included implemented policy changes. The results suggest that selected categories of reforms influence the availability and prevalence of cannabis use. In particular, some forms of restrictive intervention reduce the general prevalence of use and more liberal reforms seem linked to an increase in the share of students initiating use of cannabis. We find no evidence of an effect of policy changes on the share of frequent users, which are presumably those more likely to develop use-related health consequences.

Public Health Strengths During the COVID-19 Response.

Public Health Strengths During the COVID-19 Response.

‘Not Going to Plan’: Urban Planning, Flooding, and Sustainability in Port Harcourt City, Nigeria

Flooding is the most widespread environmental disaster in Nigeria and flooding impacts are exacerbated by poor urban planning. Flooding is a direct impediment to Nigeria achieving its sustainable development goals (SDGs). While urban planners are responsible for implementing policy changes to address the issue of flooding, there is very little research that explores their views on the linkages between urban planning, flooding, and public policy. Using the city of Port Harcourt, Nigeria, as a case study, this paper presents data from interviews with practicing urban planning professionals. It argues that Port Harcourt’s urban planners have a sound understanding of principles of sustainability and are fully aware of the connections between poor urban planning and flooding. They do however see widespread public non-compliance with planning laws and improper building approvals, rather than systemic failures of governance, as the main issues that undermine the city’s legal and planning architecture put in place to control floods.

Changing course: supporting a shift to environmental strategies in a state prevention system

BackgroundThis study examines how the North Carolina state prevention system responded to a policy shift from individual-level prevention strategies to environmental strategies from the perspective of the organizations implementing the policy shift.MethodsWe use two data sources. First, we conducted interviews to collect qualitative data from key informants. Second, we used prevention provider agency expenditure data from the year the shift was announced and the following year.ResultsThe interviews allowed us to identify effective features of policy change implementation in complex systems, such as the need for clear communication and guidance about the policy changes. Our interview and expenditure analyses also underscore variation in the level of guidance and oversight provided by implementing agencies to prevention providers.ConclusionsOur analyses suggest that more active monitoring and oversight may have facilitated more consistent implementation of the policy shift toward greater use of environmental prevention strategies.

It's Like We Speak a Different Language: Support Needs and Preferences of Older LGB Women Who Have Lost a Spouse or Partner

Needs during and following end-of-life (EOL) experiences are distinctive for sexual and gender minority (SGM) people and, in particular, older lesbian, gay, and bisexual women (LGB) women; however, access to supportive services is limited. This poster presents findings from a qualitative study of older (60+) LGB women who have lost a spouse or partner. This work draws on queer gerontological theory, addressing issues of individual agency, systemic silence, and marginalization by invisibility of older SGM women in order to illuminate specific areas in which policy may be changed and improved. The study analyzed participants’ (n = 16) reflections on their experiences of losing a loved one, including how they sought out and received essential grief support and the type of support they would have preferred and from whom, particularly immediately following their spouse or partner’s death. Thematic analysis revealed three main findings: 1) having a women-identifying support presence at the time of death for both themselves and their spouse or partner; 2) needing LGB women (or women allies) during EOL for support; and 3) preferring grief groups comprised of other LGB women (or women allies) based on their feelings of difference from gay men and heterosexual/non-SGM women and men. Findings reveal the need for a better understanding among healthcare and social work support professionals regarding LGB women’s grief needs and preferences; grief options (e.g. lesbian and non-monosexual (bi+) grief groups); and how to implement policy changes reflecting these needs and preferences.

Adjusted Net Savings of CEE and Baltic Nations in the Context of Sustainable Economic Growth: A Panel Data Analysis

The article investigates the contribution of adjusted net savings to sustainable economic growth for 10 Central and Eastern European and Baltic nations, which are former Soviet bloc nations known as transition economies, using panel data analysis for the period 2005–2016. Our results indicated that adjusted net savings impacted on the GDP across the 10 countries analyzed. Nevertheless, national authorities are called on to implement policy changes in these countries to achieve sustainable economic growth and make an efficient transition from a brown economy towards a green economy.

An Examination of State and Federal Opioid Analgesic and Continuing Education Policies: 2016-2018.

IntroductionOpioid overdose deaths in the United States have climbed sharply over the past two decades. Simultaneously, increased awareness of inadequately treated chronic pain has resulted in increased opioid analgesic prescribing. The correlation between these two phenomena has led policymakers to posit that they are causally linked, and to implement policy changes supporting safe opioid prescribing.PurposeTo evaluate the impact of its Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) program, the US Food and Drug Administration (FDA) requested the opioid manufacturers responsible for implementing that program provide information regarding opioid policy changes from 2016 to 2018. FDA also requested a survey of state requirements for pain and opioid prescribing continuing education (CE), the number of prescribers affected by those requirements, the extent to which a REMS-compliant CE program would meet each state’s requirements, and the number of relevant CE programs available.ResultsResults indicate that 527 federal and state opioid-related policies (statutes, rules/regulations, and guidelines) were approved during the 2016–2018 study period. While the largest number of these policies focused on prescription drug monitoring programs, 170 specifically imposed limits on opioid prescribing and an additional 35 specifically referred to, or incorporated, the Centers for Disease Control and Prevention opioid prescribing guideline. We also found that 46 states and the District of Columbia mandated some amount of pain or opioid prescribing CE for prescribers renewing their licenses. These mandates potentially affected as many as 1.7 million prescribers. In 69% of cases, a REMS-compliant CE program would fully meet the state mandates for various types of prescribers.ConclusionThe severity and complexity of the problems of pain management and opioid overdose have led to large-scale intervention by policymakers. Assessing the impact of these changes is difficult, at best, but will be necessary if interventions are to be refined to increase their effectiveness.

Teaching Note—Illuminating Policy Practice Close to Home: The Syracuse University Experience

ABSTRACT Appreciation of policy practice and its rudiments can be achieved beyond the walls of a university classroom, an understanding exemplified by Syracuse University School of Social Work’s annual James L. Stone Legislative Policy Day (LPD). This article describes the school’s approach and its creative use of the Onondaga County Legislative Chambers as venue of choice. Students, faculty, government officials, local and national presenters, and community members all come together to explore the development and implementation of policy change through the lens of social and economic justice. Seven key components of LPD are explicated. Dignity and worth of humankind, one of social work’s professional values, remains at the center of LPD’s efforts. In addition, strengths associated with people and causes are interwoven in the presentations associated with the day. This is coupled with showcasing how the legislative process works and highlighting salient social activist tactics that may be used, given the area of focus.

Rural High School Principals and the Challenge of Standards-Based Grading

The purpose of this study was to better understand how principals in rural schools are thinking about assessment and grading practices and if they anticipate implementing policy changes in the near future that may require increased support. Principals of schools in rural areas often face challenges that are significantly different from those of their urban and suburban counterparts. The researchers used a mixed-method survey to better understand if progressive grading policies were a part of the vision for principals of rural high schools, if they possessed conceptual underpinnings of such practices, and if they believed they had the capacity within their districts to lead teachers toward more effective grading policies. A high frequency of high school principals in rural schools said standards-based grading (SBG) was a part of their 5-year vision. These principals also showed relatively high mean scores of standards-based assessment literacy, and moderately high percentages believed they have the resources and capacity to support SBG. The researchers thus conclude that there is a high likelihood that many rural high schools will be implementing some form of SBG within the next 5 years.

Otolaryngology Resident Practices and Perceptions in the Initial Phase of the U.S. COVID-19 Pandemic.

ObjectiveThe coronavirus 2019 (COVID‐19) pandemic has had widespread implications on clinical practice at U.S. hospitals. These changes are particularly relevant to otolaryngology–head and neck surgery (OHNS) residents because reports suggest an increased risk of contracting COVID‐19 for otolaryngologists. The objectives of this study were to evaluate OHNS residency program practice changes and characterize resident perceptions during the initial phase of the pandemic.Study DesignA cross‐sectional survey of U.S. OHNS residents at 81 programs was conducted between March 23, 2020, and March 29, 2020.ResultsEighty‐two residents from 51 institutions (63% of invited programs) responded. At the time of survey, 98% of programs had enacted policy changes to minimize COVID‐19 spread. These included filtered respirator use for aerosol‐generating procedures even in COVID‐19‐negative patients (85%), decreased resident staffing of surgeries (70%), and reduced frequency of tracheotomy care (61%). The majority of residents (66%) perceived that residents were at higher risk of contracting COVID‐19 compared to attendings. Residents were most concerned about protective equipment shortage (93%) and transmitting COVID‐19 to patients (90%). The majority of residents (73%) were satisfied with their department's COVID‐19 response. Resident satisfaction correlated with comfort level in discussing concerns with attendings (r = 0.72, P < .00001) and inversely correlated with perceptions of increased risk compared to attendings (r = −0.52, P < .00001).ConclusionU.S. OHNS residency programs implemented policy changes quickly in response to the COVID‐19 pandemic. Sources of resident anxieties demonstrate the importance of open communication and an integrated team approach to facilitate optimal patient and provider care during this unprecedented crisis.Level of Evidence4. Laryngoscope, 130:2550–2557, 2020

Response and role of palliative care during the COVID-19 pandemic: A national telephone survey of hospices in Italy

Background: Palliative care is an important component of health care in pandemics, contributing to symptom control, psychological support, and supporting triage and complex decision making. Aim: To examine preparedness for, and impact of, the COVID-19 pandemic on hospices in Italy to inform the response in other countries. Design: Cross-sectional telephone survey, in March 2020. Setting: Italian hospices, purposively sampled according to COVID-19 regional prevalence categorised as high (>25), medium (15–25) and low prevalence (<15) COVID-19 cases per 100,000 inhabitants. A brief questionnaire was developed to guide the interviews. Analysis was descriptive. Results: Seven high, five medium and four low prevalence hospices provided data. Two high prevalence hospices had experienced COVID-19 cases among both patients and staff. All hospices had implemented policy changes, and several had rapidly implemented changes in practice including transfer of staff from inpatient to community settings, change in admission criteria and daily telephone support for families. Concerns included scarcity of personal protective equipment, a lack of hospice-specific guidance on COVID-19, anxiety about needing to care for children and other relatives, and poor integration of palliative care in the acute planning response. Conclusion: The hospice sector is capable of responding flexibly and rapidly to the COVID-19 pandemic. Governments must urgently recognise the essential contribution of hospice and palliative care to the COVID-19 pandemic and ensure these services are integrated into the health care system response. Availability of personal protective equipment and setting-specific guidance is essential. Hospices may also need to be proactive in connecting with the acute pandemic response.

Nationally standardized policy and locally interpreted implementation: how Vietnamese school leaders enact education reform

ABSTRACT This study examines how Vietnamese high school leaders interpreted and implemented policy changes of the Vietnamese National High School Examination—a nationally standardized exam that determines whether students may graduate from high school and attend post-secondary education. The research found that at the national level, the policy is highly prescriptive, with expected uniformity and fidelity in implementation; however, at the same time, it is vaguely worded and inconsistent. At the local level, how school leaders interpreted the new policy varied according to their knowledge, experiences, values, and beliefs, making their implementations deviate from the original policy’s intent. Their policy interpretation and implementation were also shaped by systemic inequities in academic rankings and educational resources of schools that they led.

Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases

Air pollution, climate change, and reduced biodiversity are major threats to human health with detrimental effects on a variety of chronic noncommunicable diseases in particular respiratory and cardiovascular diseases. The extent of air pollution both outdoor and indoor air pollution and climate change including global warming is increasing-to alarming proportions particularly in the developing world especially rapidly industrializing countries worldwide. In recent years, Asia has experienced rapid economic growth and a deteriorating environment and increase in allergic diseases to epidemic proportions. Air pollutant levels in many Asian countries especially in China and India are substantially higher than are those in developed countries. Moreover, industrial, traffic-related, and household biomass combustion, indoor pollutants from chemicals and tobacco are major sources of air pollutants, with increasing burden on respiratory allergies. Here we highlight the major components of outdoor and indoor air pollutants and their impacts on respiratory allergies associated with asthma and allergic rhinitis in the Asia-Pacific region. With Asia-Pacific comprising more than half of the world's population there is an urgent need to increase public awareness, highlight targets for interventions, public advocacy and a call to action to policy makers to implement policy changes towards reducing air pollution with interventions at a population-based level.

Heat Health Prevention Measures and Adaptation in Older Populations-A Systematic Review.

The population of older people is increasing at a rapid rate, with those 80 years and older set to triple by 2050. This systematic review aimed to examine older people’s perceptions and behaviours against existing heatwaves prevention measures and systematically categorize and analyse those measures using the Ottawa charter for health promotion framework. Peer-reviewed published literature between 22nd September 2006 and 24th April 2018 was retrieved, according to the PRISMA guidelines, from five different databases. Eighteen articles were finally included. There is a lack of published studies from developing countries. Results were categorized and analysed using the Ottawa charter five action areas. Mitigation strategies from current heat action plans are discussed and gaps are highlighted. A lack of systematic evaluation of heat action plans efficacy was identified. Older people are not demonstrating all recommended preventative measures during heatwaves. Support personnel and health professionals are not being pro-active enough in facilitating prevention of adverse effects from heatwaves. Governments are beginning to implement policy changes, but other recommended support measures outlined in the Ottawa charter are still lacking, and hence require further action. Linkage between specific components of heat action plans and outcomes cannot be ascertained; therefore, more systematic evaluation is needed.

A System Dynamics Model Examining Alternative Wildfire Response Policies

In this paper, we develop a systems dynamics model of a coupled human and natural fire-prone system to evaluate changes in wildfire response policy. A primary motivation is exploring the implications of expanding the pace and scale of using wildfires as a forest restoration tool. We implement a model of a forested system composed of multiple successional classes, each with different structural characteristics and propensities for burning at high severity. We then simulate a range of alternative wildfire response policies, which are defined as the combination of a target burn rate (or inversely, the mean fire return interval) and a predefined transition period to reach the target return interval. We quantify time paths of forest successional stage distributions, burn severity, and ecological departure, and use departure thresholds to calculate how long it would take various policies to restore forest conditions. Furthermore, we explore policy resistance where excessive rates of high burn severity in the policy transition period lead to a reversion to fire exclusion policies. Establishing higher burn rate targets shifted vegetation structural and successional classes towards reference conditions and suggests that it may be possible to expand the application of wildfires as a restoration tool. The results also suggest that managers may be best served by adopting strategies that define aggressive burn rate targets but by implementing policy changes slowly over time.

“It’s a Trade off:” Perspectives of Ryan White Social Service Providers on the Implementation of the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA) was expected to reduce health disparities, including among people living with HIV. The aim of this study was to explore experiences of Ryan White HIV/AIDS Program social service providers in a Medicaid-expansion southwestern state. Thematic analysis of semi-structured focus groups revealed that participants view the ACA implementation as posing impossible bureaucratic demands and increasing role conflict. Participants described the ACA impact on clients as “a trade off,” with greater medical coverage for some clients, along with increased red tape and challenges for at-risk groups and for their therapeutic alliance with clients. These findings highlight the importance of incorporating the perspectives of providers in planning and implementing policy changes and in measuring the quality of HIV services.

Promoting congregant health in faith-based organizations across Los Angeles County, 2013-2016.

The Los Angeles County Department of Public Health (DPH) launched the Nutrition Education and Obesity Prevention (NEOP) Project in fall 2013. As the local arm of the Supplemental Nutrition Assistance Program Education (SNAP-Ed), this project partnered with faith-based organizations (FBOs) in Los Angeles County to implement policy, systems, and environmental change interventions (PSEs) at selected church sites, alongside the usual delivery of health education.A 2-part programmatic assessment was conducted to better understand how the NEOP Faith Based Project at one of the FBOs was implemented during the 2013–2016 SNAP-Ed funding cycle. A qualitative component (key informant interviews) sought to understand and describe the PSE implementation process at each of the participating church sites, whereas the quantitative component (surveys) focused on assessing congregant perceptions about their awareness of the PSEs, their knowledge and beliefs about health, and their self-reported health behaviors after exposure to onsite changes.Among congregants who participated in the survey, 52% expressed desire for more health education classes. However, only 37% reported being aware of them at church sites that hosted them. When asked to compare their behaviors for “today” versus 6 months ago, more than half reported greater interest in eating more fruits and vegetables (66%), choosing water over soda (69%), and becoming more physically active (59%).Results from the NEOP Project have implications for how local health departments could partner with FBOs to outreach and promote health among congregants, particularly for those who are at high-risk of diet-related diseases due to poor nutrition and obesity.