Powerful policies or paper tigers? An analysis of policy implementation in the child protection space in the Nanumba North Municipality of Northern Ghana.

This narrative and conceptual review examines the interface between implementation science and health policy research. Drawing on literature from both disciplines, we analyze key areas of convergence and divergence, explore how these distinctions contribute to the persistent ‘know-do gap,’ and discuss opportunities for integrated approaches connecting micro-level implementation processes with macro-level policy dynamics, with particular attention to LMICs. Implementation science and health policy research have evolved largely in parallel, despite sharing a common objective: improving population health by translating knowledge into action. Implementation science focuses on integrating evidence-based interventions into real-world settings, while policy research examines how policies are formulated, adopted, and sustained within complex political systems. This disciplinary separation has contributed to a persistent “know–do gap,” particularly in low-and middle-income countries (LMICs), where fragmented health systems, political economy constraints, and donor influence shape both policy trajectories and implementation realities. The disconnect between researchers and policymakers often stems from differing timing, priorities, and even language. Researchers may not address the immediate concerns of policymakers, and scientific evidence alone seldom drives policy changes. In LMICs, this divide is exacerbated by political cycles, vested interests, and the significant influence of international donors. In this review, we argue that bridging implementation science and policy research is not merely desirable but necessary. We examine how differences in scope, actors, settings, and theoretical frameworks have reinforced this divide, and we propose the development of integrated, hybrid approaches that connect micro-level implementation processes with macro-level policy dynamics. Bridging the gap between implementation research and policy change necessitates a context-sensitive approach that acknowledges the complexities of political, economic, and social systems, particularly in LMICs. By leveraging multi-level frameworks, engaging stakeholders, and fostering continuous learning, it is possible to enhance the translation of research into effective, sustainable health policies.

Sugar-Sweetened Beverage Warning Labels and Taxes: Simulated Impacts When Considering Implementation.

Association between national antimicrobial stewardship policies and antibiotic selection for uncomplicated cystitis in Japan: A 10-year database study.

With the implementation of plastic restriction policies and increasing environmental awareness, there is an urgent demand for starch-based straws as alternatives to traditional plastic straws. In this study, three cationic polysaccharides, namely chitosan (CTS), chitosan oligosaccharide (COS), and cationic guar gum (CGG), were selected to prepare starch straws via thermoplastic extrusion. The results indicated that cationic polysaccharides enhanced the mechanical properties, hydrophobicity, compatibility, and short-range order of the starch straws. Mechanistic analyses revealed the presence of hydrogen bonding and electrostatic interactions between starch and polysaccharides. Gaussian fitting indicated that the hydrogen bonding was dominated by OH⋯O. Among the samples, S-COS exhibited the highest interaction energy (-58.94 kcal mol-1), complex index (598.3 g kg-1), and inter-strand hydrogen bond energy (9.805 kcal mol-1). Consequently, S-COS displayed the highest flexural strength, optimal flexural strain at break, and lower water absorption rate and swelling degree. S-CGG demonstrated better flexibility and lowest water absorption. Additionally, after 150 days of storage, the surface of the starch-polysaccharide straws remained uniform without cracks. Our results demonstrated that starch-polysaccharide straws possessed excellent mechanical properties and water resistance, providing a theoretical basis for the development and industrial application of high-performance starch-based materials. © 2026 Society of Chemical Industry.

Marine plastic pollution has emerged as one of the most pressing global environmental challenges, with increasing volumes of plastic waste entering the oceans due largely to complex socio-economic dynamics rather than purely ecological processes. Globally, an estimated 11 million metric tons of plastic waste enter the ocean annually aggravating the 150 million metric tons already circulating in the marine environment. While existing studies often emphasise the ecological consequences of plastic debris on marine biodiversity, comparatively limited attention has been given to the underlying social, economic, and cultural drivers that accelerate plastic leakage into marine environments, as well as the effectiveness of policy responses aimed at mitigating the problem. Using the conventional data collection of qualitative and quantitative approach, and extensive secondary materials, this paper examines the extent to which socio-economic factors are contributing to the escalation of marine plastic pollution and evaluates the effectiveness of existing policies and alternative strategies designed to address the challenge in the Global South. The findings reveal that rapid urbanization, population growth, inadequate waste management infrastructure, and unsustainable consumption patterns are primary and underlying drivers of marine plastic pollution. Additional findings reveal that there are critical governance gaps including weak enforcement, fragmented regulatory mechanisms and limited global cooperation are undermining effective implementation of policies and legislation of marine plastic pollution. The paper recommends an integrated strategy combining strong policies, legislation, and regulations such as bans on single-use plastics, extended producer responsibility (EPR) schemes, improved waste management infrastructure, strict enforcement mechanisms, regional cooperation, and incentives for circular economy innovations. Furthermore, the paper advocates for an integrated socio-economic and governance-based approaches to complement existing marine management policies that reduce marine plastic pollution and support more sustainable ocean management.

Evaluating carbon reduction policy implementation in the Yangtze River Delta in China: A Smith model approach

The nonlinear impact of road safety policy implementation on the severity of road traffic crashes: A fusion of deep learning and Bayesian random parameter methods.

National Landscape and Outcomes of Triple Organ Transplantation in the United States After the 2018 Heart Allocation Policy Implementation

Identifying health care provider, system, and resource-related factors associated with CLABSIs in ICUs of LMICs: A Scoping Review.

The transformation of Posyandu duties and functions into six Minimum Service Standard sectors requires local government readiness, cross-sector coordination, cadre capacity, budget support, and adequate facilities. This study aims to analyze the implementation of Minister of Home Affairs Regulation Number 13 of 2024 Article 2 concerning the transition of Posyandu duties and new functions into six Minimum Service Standard sectors in Payakumbuh City. A descriptive qualitative approach with a case study design was employed. Informants were selected through purposive sampling and included local government officials, urban village officials, and Posyandu cadres. Data were collected through in-depth interviews, observation, and documentation and were analyzed through data reduction, data display, and conclusion drawing based on the Van Meter and Van Horn policy implementation model. The findings indicate that the regulation has begun to be implemented but remains in a transitional stage. Several implementation constraints were identified, including the absence of detailed technical guidelines, limited competent human resources, unclear budget utilization, weak interorganizational coordination, varied community participation, and inadequate supporting facilities. This study concludes that the effective transition of Posyandu functions requires clearer operational standards, stronger institutional coordination, and improved resource readiness at the local level. The findings contribute to public policy implementation literature and provide practical implications for local governments in strengthening technical guidance, cadre training, budget planning, infrastructure provision, and cross-sector coordination.

Dementia is one of the most serious health issues in an aging society, placing a significant burden on patients and their families, while also posing considerable socioeconomic challenges at the national level. In response, the Korean government introduced the National Responsibility for Dementia Care policy in 2017 to improve healthcare accessibility for patients with dementia and reduce their financial burden. This study utilized the cohort data of patients with dementia collected from Ajou University Hospital between 2012 and 2022. To quantitatively assess the changes in healthcare utilization, we applied panel multivariate negative binomial regression and panel multivariate gamma regression analyses. The analysis identified key factors influencing healthcare utilization, including place of residence, presence of comorbidities, age, and duration of dementia. After the policy was implemented, there was a general decline in outpatient visits and medical expenditure, suggesting a positive effect of the policy on alleviating the economic burden on patients with dementia. Significant changes in healthcare utilization were observed among patients in the early stages of dementia, highlighting the importance of early diagnosis and home-based care services. The findings indicate a need for personalized treatment and the expansion of community-based healthcare services for patients with dementia.

Objective Municipal public health nurses (PHNs) provide diverse community health services, including the planning, implementation, and evaluation of local health policies. A well-planned and continuous recruitment system is essential for performing these duties effectively and efficiently; however, many municipalities face difficulties in securing adequate full-time PHNs amid increasing workloads, and establishing sustainable recruitment measures remains a challenge. In this context, supervisory PHNs are expected to possess the ability to establish systems for recruiting and training local government PHNs and are considered to play a crucial role in these processes. However, a quantitative evaluation of the relationship between assignment of supervisory PHNs and number of PHN recruits has not been conducted. This study aimed to clarify this association.Methods This cross-sectional study was conducted by analyzing the data of 1,733 municipalities in the fiscal year 2020. Data on the presence of supervisory PHNs, number of full-time PHNs, annual PHN recruits, and the total population of each municipality were obtained from the Ministry of Health, Labour and Welfare's Survey on Public Health Nurse Activities by Area of Work and the Ministry of Internal Affairs and Communications' Population Census, and other official statistics. The outcome was the annual number of PHN recruits, and the main explanatory variable was the presence of a supervisory PHN. Multivariable negative binomial regression analysis was used to calculate incidence rate ratios and 95% confidence intervals (CIs), with adjustments for variables related to regional characteristics.Results Of the 1,733 municipalities analyzed, 865 (49.9%) had a supervisory PHN. After adjusting for municipality size, retirements, and other covariates, municipalities with a supervisory PHN had 1.167 times more PHN recruits than those without a supervisory PHN (95% CI: 1.040-1.310).Conclusions Municipalities with supervisory PHNs tended to have more PHN recruits than those without supervisory PHNs. This suggests that supervisory PHNs play a crucial role in securing PHN personnel through their involvement in recruitment planning, enhancing workplace attractiveness, and promoting strategic recruitment activities. This result may have important implications for the development of stable and continuous recruitment strategies for municipal PHNs.

Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis, as described in the ASCO Guidelines Methodology Manual. ASCO Living Guidelines follow the ASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines. Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating clinician and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix I and Appendix II). Updates are published regularly and can be found on the ASCO Publications website.

This review examined 28 studies to understand how political economy analysis (PEA) is conceptualized and applied in health. Definitions of political economy varied, with only 11 studies offering explicit definitions. Most commonly, political economy was framed as the study of power, interests, institutions, and ideas shaping health policy processes and outcomes. Applications ranged from analysing structural determinants of health to understanding stakeholder influence in health reforms. Across studies, 31 distinct frameworks and theories were used. Frequently employed models included Campos and Reich's Political Economy of Health Financing Reform Framework, Harris's Applied PEA, and the DFID and World Bank 'How-to' notes. Theoretical underpinnings were drawn from economics, political science, and sociology-such as historical institutionalism, stakeholder theory, and discursive institutionalism-highlighting the interdisciplinary nature of PEA. Health issues analysed through a political economy lens primarily included health financing, governance, human resources for health, and service delivery. PEA was used to explore challenges such as policy reform feasibility, institutional capacity, health workforce equity, and donor dependency. The rationale for applying PEA included uncovering the influence of actors, navigating complex political contexts, and enhancing policy implementation. Overall, PEA in health is marked by conceptual diversity and methodological pluralism. Its growing application reflects the need to understand the interplay of politics, institutions, and economics in addressing systemic health challenges.

Halal tourism development in Indonesia has strong economic potential; however, its implementation remains uneven across regions due to fragmented governance and limited stakeholder integration. This study aims to analyze halal tourism development in Semarang City by examining institutional roles, supporting and inhibiting factors, and implementation mechanisms. A qualitative descriptive approach was applied using purposive sampling, with data collected through in-depth interviews, field observations, and document analysis. The findings, derived from interviews with government officials, tourism stakeholders, and field observations of tourism services, show that halal tourism development in Semarang is supported by inter-agency collaboration, cross-sectoral coordination, and digital promotion strategies. Field evidence indicates that coordination between tourism and food-related agencies plays a key role in accelerating SME halal certification support, while tourism sites have gradually integrated Muslim-friendly services such as prayer facilities and halal food information systems. However, challenges remain, particularly related to differing perceptions of halal tourism among industry actors, uneven institutional coordination, and limited human resource capacity. These findings highlight that implementation gaps are not only structural but also shaped by stakeholder understanding and operational readiness at the local level. In addition, SME halal certification support and the strengthening of halal value chains remain important determinants of tourism performance in the city. The study contributes to halal tourism governance literature by emphasizing the role of micro-level coordination and stakeholder perception in shaping policy implementation outcomes, while practically suggesting stronger inter-agency coordination, clearer communication of halal tourism concepts, and targeted capacity-building programs for tourism actors.

A policy analysis of the three-month waiting period for new and returning residents to access provincial health insurance in Ontario, Canada.

The Centers for Medicare & Medicaid Services (CMS) have mandated the collection of patient-reported outcome measures (PROMs) for inpatient TKA with a submission deadline of September 2025. Not achieving a 20-point improvement in substantial clinical benefit (SCB) on the Knee Injury and Osteoarthritis Outcome Score (KOOS) for joint replacement (JR) will negatively impact hospital reimbursement. However, SCB thresholds for KOOS subscales and factors associated with not achieving SCB remain poorly defined. We retrospectively analyzed a large TKA database at a multisite tertiary healthcare system and asked: (1) What are the SCB thresholds for the KOOS pain, physical function short form (PS), and JR subscales at 1 year after primary TKA? (2) What patient factors are associated with failure to achieve the SCB on these KOOS subscales? This was a retrospective analysis of a longitudinally maintained institutional registry, which evaluated the results of 15,638 patients who underwent primary TKA from 2016 to 2022. Of these, 89% (13,850) of patients completed baseline PROMs, and 79% (10,988 of 13,850) of patients completed 1-year follow-up; data from those patients were used in this analysis. Demographics, comorbidities, as well as baseline and 1-year KOOS scores were recorded. The median (IQR) age of these patients was 67 years (61 to 73), 60% (6615 of 10,988) of patients were women, and the median (IQR) BMI was 31.0 kg/m 2 (27.2 to 35.5). The SCB thresholds were calculated using anchor-based methodology, utilizing item 8 from the Veterans RAND 12-Item Health Survey at 1 year postoperatively as an anchor question: "Compared to one year ago, how would you rate your physical health in general now?" The optimal threshold, defined as the value that maximized the Youden index, was used as the SCB threshold to distinguish patients who had substantially improved in terms of end point versus those who had not. Multivariable logistic regression identified factors that were associated with not achieving the SCB. It should be noted that race was identified by self-report and grouped as White and non-White per our database. The SCB thresholds were 33 of 100 for KOOS pain (sensitivity 0.80, specificity 0.53, area under the receiver operating characteristic curve [AUC] 0.72), 16 of 100 for KOOS PS (sensitivity 0.82, specificity 0.47, AUC 0.69), and 23 of 100 for KOOS JR (sensitivity 0.82, specificity 0.51, AUC 0.72), achieved by 59% (6483) of patients for each subscale. For KOOS pain, factors associated with not achieving the SCB included older age (OR 0.84 [95% confidence interval (CI) 0.78 to 0.9]; p < 0.001), non-White race compared with White race (OR 1.7 [95% CI 1.59 to 1.93]; p < 0.001), a higher Charlson comorbidity index (CCI) (OR 1.11 [95% CI 1.05 to 1.17]; p < 0.001), and commercial insurance (OR 0.80 [95% CI 0.72 to 0.89]; p < 0.001). For KOOS PS, factors associated with not achieving the SCB included older age (OR 0.82 [95% CI 0.76 to 0.89]; p < 0.001), non-White race (OR 1.82 [95% CI 1.59 to 2.1]; p < 0.001), a higher CCI (OR 1.08 [95% CI 1.02 to 1.15]; p < 0.01), commercial insurance (OR 0.77 [95% CI 0.68 to 0.87]; p < 0.001), and lower education level (OR 0.89 [95% CI 0.83 to 0.96]; p < 0.01). For KOOS JR, factors associated with not achieving the SCB included older age (OR 0.84 [95% CI 0.78 to 0.90]; p < 0.001), non-White race (OR 1.77 [95% CI 1.56 to 2.01]; p < 0.001), a higher CCI (OR 1.07 [95% CI 1.01 to 1.12]; p = 0.01), commercial insurance (OR 0.8 [95% CI 0.72 to 0.90]; p < 0.001), and lower education level (OR 0.92 [95% CI 0.86 to 0.98]; p < 0.01). As TKA outcomes are increasingly judged by achievement of the 20-point SCB threshold on the KOOS JR under new CMS policies, determining SCB thresholds is of utmost importance. This study found SCB thresholds of 33 for KOOS pain, 16 for KOOS PS, and 23 for KOOS JR, with only 59% (6483) of patients achieving these thresholds 1 year after TKA. More at-risk populations, including older, non-White, less educated, and patients with medically complex conditions, were at higher risk of not achieving the SCB. These results suggest that SCB nonattainment after TKA is likely found in a meaningful subset of patients-especially those with greater baseline symptom burden and medical complexity. These findings can guide perioperative support to increase the likelihood that all patients achieve the reduction in pain and improvement in function that they seek from arthroplasty, as healthcare systems prepare for the implementation of the new PROM policy for TKA from the CMS. Level III, Therapeutic study.

Following the implementation of the three-child policy in China, an increasing number of pregnant people prefer vaginal delivery over cesarean delivery. However, concerns about unplanned cesarean delivery during labor have increased the demand for a quantitative risk assessment tool. Therefore, developing a prediction model tailored for pregnant Chinese people is essential for assisting clinical decision-making. This study aimed to identify risk factors associated with unplanned cesarean delivery during a trial of labor and to develop a predictive model for determining this risk at admission. This single-center retrospective cohort study analyzed 1,532 pregnant people with a term, singleton, cephalic pregnancy without a history of uterine surgery who were admitted for a trial of labor (April-December 2021). Of these, 138 underwent unplanned cesarean delivery and 1,394 achieved vaginal delivery. Predictors were selected via LASSO regression from an initial set of 13 candidate variables and used to build a multivariate logistic nomogram. The model was assessed by its AUC, sensitivity, specificity, accuracy, positive predictive value, negative predictive value and calibration (Hosmer-Lemeshow test). Clinical utility was evaluated via decision curve analysis, and internal validation was conducted via 1,000 bootstrap repetitions. Eight variables were identified as significant predictors of delivery mode: maternal height, maternal BMI, history of vaginal delivery, Bishop score at admission, premature rupture of membranes, gestational age, complications, and estimated fetal weight. The predictive model achieved an AUC of 0.811 (95% CI: 0.774-0.848). The Hosmer-Lemeshow test indicated P = 0.513. Internal validation yielded a mean AUC of 0.804 and a Brier score of 0.071, demonstrating good discrimination and calibration. A nomogram-based predictive model was developed to assess the risk of unplanned cesarean delivery during trial of labor. This model provides a quantitative tool to guide clinicians in risk assessment and optimize labor management, potentially reducing complications associated with unplanned cesarean deliveries.

Rising levels of household food insecurity in England, and associated health and well-being impacts for children, have led to calls to expand access to free school meals (FSM). Policymakers have been hesitant to extend provision of FSM due to concerns surrounding acceptability, affordability and implementation challenges. The most effective strategies for expanding FSM are not yet fully understood. This work aims to fill this gap by examining school meal policy from the perspective of multiple stakeholders, to provide actionable recommendations for policies that could expand school meal provision. A qualitative interview study design was used. The data were analysed using the Framework Method, underpinned by the Context and Implementation of Complex Interventions (CICI) framework. Themes were categorised into context-related and implementation-related factors. Detailed recommendations were discussed at the macro, meso and micro levels of the school food system. The study was conducted in England, UK. Seventeen stakeholders represented the views of local, regional and national government, policy, academia and schools. Stakeholders indicated that policies should prioritise stigma reduction and integrate expansion of school meals with existing school policies where possible, including the monitoring of school food standards and ensuring maintenance of school food quality. Stakeholders also suggested improvement to the administrative process and communication with families and recommended a joined-up approach linking interventions with common goals across the whole food system. Crucially, sufficient financial support is essential for successful implementation.