Influence Health Policy Research Articles

Nature and scope of certified nurse-midwifery practice: A workforce study.

To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers. Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice. Mixed methods research utilising prospective descriptive survey and interview. An online survey was administered to nurse-midwives practicing in the state of Texas (N=449) with a subset (n=10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed. The survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master's degree. A majority worked full-time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5years. An ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice. Robust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long-term service in underserved areas, and development of skills crucial for impacting health policy change.

In the Shadow of Politics: The Pathways of Research Evidence to Health Policy Making

Research-based evidence has the potential to influence health policy making, but its impact is contingent on a number of factors. Past analyses have underscored the role of politics in shaping policy choices, reflecting the nature of the social learning process and access of political forces at every stage of the policy continuum from agenda formation to policy enactment and implication. This article focuses on the mechanisms of the research evidence enterprise itself, delving directly into what influences the pathways of research evidence into policy making, taking into consideration both the production and consumption functions of such evidence. It presents a process model of the role of research evidence in policy making, examining in conceptual detail variations in the production of evidence in the research community; the communication of policy-relevant results through translation, framing, and other means; the methods of acquisition of the evidence by policy makers and their advisers; and the multiple ways in which evidence is put to use in policy decision making. I use examples from health care reform to illustrate features of the process model.

Conceptualizing “Race” and Racism in Health Disparities Discourse: A Critical Discourse Analysis

Critically analyzing how language and discourse influence health policy agendas to eliminate racial and ethnic health disparities (REHD) supports social work’s commitment to address oppression and marginalization. Various institutions construct health policy agendas regarding REHD without explicitly conceptualizing terms such as “race,” “racism,” “African American/Black,” “Latino/a,” “Asian,” and “White”, and their relationship to racialized health outcomes. However, there is limited research examining the inherent ideologies and meaning related to racial concepts, which rely heavily on conveying historical influences through discourse over time. The purpose of the current qualitative study is to explore how policy initiatives to address REHD conceptualized “race” and racism. By employing grounded theory (GT) and critical discourse analysis (CDA), the study examined the discourse underpinning city, state, and national policy agendas to eliminate REHD. The study’s findings highlighted how terminology, assigned meanings, and ideology are replicated over time to reproduce a non-critical analysis of “race” and racism. The resulting implications suggest that conceptualizing “race” void of understanding differential racial health outcomes as racism omits the structural, historical, and ethical characteristics of racial concepts. Within health disparities discourse, the meanings assigned to “race” and racism ultimately influence which interventions are identified to address REHD.

The Impact of the Role of Doctor of Nursing PracticeNurses on Healthcare and Leadership

ced nursing roles that include clinical practice and leadership. These individuals are well positioned to meet the Institute of Medicine’s mandate for nurses to add their unique perspective to the interprofessional efforts to improve health care. This article demonstrates how DNP graduates design, evaluate and create innovative patient care models, evaluate the cost effectiveness of patient care strategies and influence health policy at multiple levels. The DNP project is the culmination of the educational process where core competencies and the clinical scholarship of the graduate become evident. A discussion of projects is included. Nurses who have completed the DNP are making significant impact on quality, efficiencies, and effectiveness of health care systems through their contributions in clinical practice, advocacy in health policy, implementation and evaluation of evidence-based practice, and contribution to nursing education.

Assessing the influence of knowledge translation platforms on health system policy processes to achieve the health millennium development goals in Cameroon and Uganda: a comparative case study.

There is a scarcity of empirical data on the influence of initiatives supporting evidence-informed health system policy-making (EIHSP), such as the knowledge translation platforms (KTPs) operating in Africa. To assess whether and how two KTPs housed in government-affiliated institutions in Cameroon and Uganda have influenced: (1) health system policy-making processes and decisions aiming at supporting achievement of the health millennium development goals (MDGs); and (2) the general climate for EIHSP. We conducted an embedded comparative case study of four policy processes in which Evidence Informed Policy Network (EVIPNet) Cameroon and Regional East African Community Health Policy Initiative (REACH-PI) Uganda were involved between 2009 and 2011. We combined a documentary review and semi structured interviews of 54 stakeholders. A framework-guided thematic analysis, inspired by scholarship in health policy analysis and knowledge utilization was used. EVIPNet Cameroon and REACH-PI Uganda have had direct influence on health system policy decisions. The coproduction of evidence briefs combined with tacit knowledge gathered during inclusive evidence-informed stakeholder dialogues helped to reframe health system problems, unveil sources of conflicts, open grounds for consensus and align viable and affordable options for achieving the health MDGs thus leading to decisions. New policy issue networks have emerged. The KTPs indirectly influenced health policy processes by changing how interests interact with one another and by introducing safe-harbour deliberations and intersected with contextual ideational factors by improving access to policy-relevant evidence. KTPs were perceived as change agents with positive impact on the understanding, acceptance and adoption of EIHSP because of their complementary work in relation to capacity building, rapid evidence syntheses and clearinghouse of policy-relevant evidence. This embedded case study illustrates how two KTPs influenced policy decisions through pathways involving policy issue networks, interest groups interaction and evidence-supported ideas and how they influenced the general climate for EIHSP.

Does the Structured Operational Research and Training Initiative (SORT IT) continue to influence health policy and/or practice?

ABSTRACTBackground: The Structured Operational Research and Training Initiative (SORT IT) is a successful model of integrated operational research and capacity building with about 90% of participants completing the training and publishing in scientific journals.Objective: The study aims at assessing the influence of research papers from six SORT IT courses conducted between April 2014 and January 2015 on policy and/or practice.Methods: This was a cross-sectional mixed-method study involving e-mail based, self-administered questionnaires sent to course participants coupled with telephone/Skype/in-person responses from participants, senior facilitators and local co-authors of course papers. A descriptive content analysis was performed to generate themes.Results: Of 71 participants, 67 (94%) completed the course. A total of 67 papers (original research) were submitted for publication, of which 61 (91%) were published or were in press at the censor date (31 December 2016). Among the 67 eligible participants, 65 (97%) responded to the questionnaire. Of the latter, 43 (66%) research papers were self-reported to have contributed to a change in policy and/or practice by the course participants: 38 to a change in government policy or practice (26 at the national level, six at the subnational level and six at the local/hospital level); four to a change in organisational policy or practice; and one study fostered global policy development.Conclusion: Nearly two-thirds of SORT IT course papers contributed to a change in policy and/or practice as reported by the participants. Identifying the actual linkage of research to policy/practice change requires more robust methodology, in-depth assessment and independent validation of the reported change with all concerned stakeholders.

Economic impact of medication non-adherence by disease groups: a systematic review

ObjectiveTo determine the economic impact of medication non-adherence across multiple disease groups.DesignSystematic review.Evidence reviewA comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost...

Demographic factors and attitudes that influence the support of the general public for the introduction of universal healthcare in Ireland: A national survey

Ireland is still struggling to end the inequitable two-tiered health system and introduce universal healthcare (UHC). Public opinion can influence health policy choice and implementation. However, the public are rarely asked for their views. This study describes the demographic and attitudinal factors that influence the support of the public for the introduction of UHC. It provides data on a nationally representative survey sample of n=972. There are high levels of support for the introduction of UHC (n=846 87.0%). Logistic regression analyses indicated that demographic factors, such as, the location of respondent, whether the respondent was in receipt of Government supported healthcare, a purchaser of private health insurance or neither; plus attitudinal factors, such as, opinions on the Government prioritising healthcare, healthcare being free at the point of access, taxes being increased to provide care free at the point of access and how well informed participants felt about UHC were associated with agreeing with the introduction of UHC in Ireland. This paper is timely for policy leaders both in Ireland and internationally as countries with UHC, such as the United Kingdom, are facing difficulties maintaining health services in the public realm.

Immunity and Impunity: Corruption in the State-Pharma Nexus

Critical criminology repeatedly has drawn attention to the state-corporate nexus as a site of corruption and other forms of criminality, a scenario exacerbated by the intensification of neoliberalism in areas such as health. The state-pharmaceutical relationship, which increasingly influences health policy, is no exception. That is especially so when pharmaceutical products such as vaccines, a burgeoning sector of the industry, are mandated in direct violation of the principle of informed consent. Such policies have provoked suspicion and dissent as critics question the integrity of the state-pharma alliance and its impact on vaccine safety. However, rather than encouraging open debate, draconian modes of governance have been implemented to repress and silence any form of criticism, thereby protecting the activities of the state and pharmaceutical industry from independent scrutiny. The article examines this relationship in the context of recent legislation in Australia to intensify its mandatory regime around vaccines. It argues that attempts to undermine freedom of speech, and to systematically excoriate those who criticise or dissent from mandatory vaccine programs, function as a corrupting process and, by extension, serve to provoke the notion that corruption does indeed exist within the state-pharma alliance.

Be the Change: An Interprofessional Team-Based Health Advocacy Summit.

In a complex health care environment, nursing and health care professional graduates should be able to understand and collaboratively advocate for health policy benefitting patients, families, and communities. This study explored the effectiveness of interprofessional team-based learning to improve political astuteness in undergraduate health profession students. This engaging method may prove to enhance health care professionals' likelihood of understanding, involvement, and influencing health policy in the future.

Looking at hospitalized persons throughout the prism of the handicap

ObjectiveTo describe the disability status of non-selected hospitalized persons. Methods and findingsWe conducted a cross-sectional survey to assess activity limitations of every person older than 18 years hospitalized in a regional university hospital covering all medical fields. Evaluators rated, on a scale from 0 to 4, 22 selected items of the International Classification of Functioning (ICF), covering the 6 following domains: learning and applying knowledge, general tasks and demands, communication, mobility, self-care, and interpersonal interactions and relationships. Univariate and multivariate analyses were performed to analyze the prevalence, severity and profile of the handicap in terms of sociodemographic characteristics and care pathways. ResultsAmong 1572 eligible persons, 1267 (81%) were surveyed (mean age 62.7±20.4years; 655 males [51.7%]). Overall, 82% showed at least one activity limitation. For 52%, disability was severe or total for at least one ICF item. Prevalence of disabilities was higher for mobility (75%) and self-care domains (63%). Disability was strongly related to age: age older than 80years versus 18 to 44years (OR=12.8 95% CI 6.4–27.9]; P<0.01). Disability was associated with hospitalization in rehabilitation units (96%; OR=4.3 [95% CI 2.2–5.3]; P<0.01). Severe disability was associated with hospitalization in critical care units (OR=6.7 [CI 3.2–15.1]; P<0.001) and psychiatry units (OR=5.3 [CI 2.7–11.4]; P<0.001). ConclusionHandicap was common in hospitalized persons, involving all 6 tested ICF activity domains, particularly mobility and self-care. This study alerts care givers, hospital administrators, and in general, people influencing health policies about the need to plan actions to reduce activity limitations of hospitalized persons, whatever the cause of the hospitalization.

Assessing the impact of health research on health policies: a study of the Dodowa Health Research Centre, Ghana

BackgroundThe importance of assessing research impact is increasingly recognised. Ghana has a long tradition of research dating from the 1970s. In the Ghana Health Service there are three health research centres under the Research and Development Division. Dodowa Health Research Centre (DHRC) is the youngest in the country dating from the 1990s. The objective of this study is to analyse the influence of the research conducted in DHRC on national and local health policies.MethodsThe study used the Research Impact Framework. Six projects were selected based on a set of criteria. Thirteen interviews were conducted with researchers and policy makers using a semi-structured interview guide.ResultsDHRC had numerous policy impacts in terms of researchers participating in policy networks, increasing political capital and influencing policy documents. Factors identified to be associated with policy impact included collaboration with policy makers at the design stage, addressing health priorities, and communicating results mainly through the participation in annual review meetings.ConclusionsDHRC was successful in influencing health policies. Recommendations were made that could be included in the DHRC strategic planning to improve the research process and its policy impact.

Oquendo Recounts Past Year’s Victories, Coming Year’s Challenges

Oquendo Recounts Past Year’s Victories, Coming Year’s Challenges

Practicing in the New World: From Perplexed to Proactive

Practicing in the New World: From Perplexed to Proactive

Influencing Health Policy with Pain Management Nursing Research

Influencing Health Policy with Pain Management Nursing Research

Influencing health policy through public deliberation: Lessons learned from two decades of Citizens'/community juries

Citizens’/community juries [CJs] engage members of the public in policy decision-making processes. CJs can be employed to develop policy responses to health problems that require the consideration of both community values and scientific evidence. Based on the principles of deliberative democracy, recent reviews indicate that findings from CJs have successfully been used to influence health policy decision-making. Despite this evidence of success, there appears to be a gap between the goals of health researchers who organize CJs and the needs of policy actors and decision makers. Drawing on our experiences working with CJs and recent research on CJ methods, we describe a synopsis of the current state of the art organized around four key questions, and informed by insights from deliberative theory and critical policy studies. Our intention is to stimulate further discussion as to the types of health policy questions that can be usefully addressed through public deliberation, and provide guidance on the methodological and political dimensions that need to be considered in deciding whether a CJ is an appropriate approach for informing a policy decision-making process.

The influence of globalization on medical regulation: a descriptive analysis of international medical graduates registered through alternative licensure routes in Ontario

The increasing globalization of the medical profession has influenced health policy, health human resource planning, and medical regulation in Canada. Since the early 2000s, numerous policy initiatives have been created to facilitate the entry of international medical graduates (IMGs) into the Canadian workforce. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO) developed alternative licensure routes to increase the ability of qualified IMGs to obtain licenses to practice. The current study provides demographic and descriptive information about the IMGs registered through the CPSO's alternative licensure routes between 2000 and 2012. An analysis of the characteristics and career trajectories of all IMGs practicing in the province sheds light on broader globalization trends and raises questions about the future of health human resource planning in Canada. As the medical profession becomes increasingly globalized, health policy and regulation will continue to be influenced by trends in international migration, concerns about global health equity, and the shifting demographics of the Canadian physician workforce. Implications for future policy development in the complex landscape of medical education and practice are discussed.

Health advocacy

In the medical profession, activities related to ensuring access to care, navigating the system, mobilizing resources, addressing health inequities, influencing health policy and creating system change are known as health advocacy. Foundational concepts in health advocacy include social determinants of health and health inequities. The social determinants of health (i.e. the conditions in which people live and work) account for a significant proportion of an individual’s and a population’s health outcomes. Health inequities are disparities in health between populations, perpetuated by economic, social, and political forces. Although it is clear that efforts to improve the health of an individual or population must consider “upstream” factors, how this is operationalized in medicine and medical education is controversial. There is a lack of clarity around how health advocacy is delineated, how physicians’ scope of responsibility is defined and how teaching and assessment is conceptualized and enacted. Numerous curricular interventions have been described in the literature; however, regardless of the success of isolated interventions, understanding health advocacy instruction, assessment and evaluation will require a broader examination of processes, practices and values throughout medicine and medical education. To support the instruction, assessment and evaluation of health advocacy, a novel framework for health advocacy is introduced. This framework was developed for several purposes: defining and delineating different types and approaches to advocacy, generating a “roadmap” of possible advocacy activities, establishing shared language and meaning to support communication and collaboration across disciplines and providing a tool for the assessment of learners and for the evaluation of teaching and programs. Current approaches to teaching and assessment of health advocacy are outlined, as well as suggestions for future directions and considerations.

Enhancing Nurse Leadership Capacity in Resource-Limited Countries

Background: Nurse leaders are essential contributors to global health and health care delivery systems. Developing and strengthening nurse leader capacity enhances quality care and improves patient outcomes so no one is left behind. Low workforce capacity leads to poor health outcomes for patients. Collaborations between institutions have been shown to strengthen nurse capacity in resource-limited countries and supplement the brain drain phenomenon. This discursive paper aims to share lessons learned from implementing a graduate nursing program to develop leadership capacity in a resourcelimited country and to discuss strategies to enhance partnerships, influence health policies, and improve global health care. Materials and Method: Develop nurse leadership capacity through a graduate nursing program. Results: To date, 51 students have been enrolled and 16 have successfully completed the master’s program with thesis. Most of the graduates now hold top management positions ranging from middle to senior management. These nurse leaders are in charge of operations and management, programming and policy implementation. Contributions of the program is demonstrated in changes in leadership capacity exemplified in marked infrastructural and process changes in the National Association of Gambian Nurses through increased nurse involvement at the Ministry of Health level, and enthusiasm and commitment to quality care for patients. Conclusions: Efforts to strengthen nurse leadership capacity through collaborations between developed and developing countries are essential to improve nurse leadership capacity, increase health policy engagement, and workforce retention. Workforce improvement and quality nursing services through these collaborations will strengthen nurse leadership and propagate positive health outcomes for patients as well as contribute to solving the brain drain in resource-limited countries.

A need for an augmented review when reviewing rehabilitation research

There is a need for additional strategies for performing systematic reviews (SRs) to improve translation of findings into practice and to influence health policy. SRs critically appraise research methodology and determine level of evidence of research findings. The standard type of SR identifies randomized controlled trials (RCTs) as providing the most valid data and highest level of evidence. RCTs are not among the most frequently used research design in disability and health research. RCTs usually measure impairments for the primary research outcome rather than improved function, participation or societal integration. It forces a choice between “validity” and “utility/relevance.” Other approaches have effectively been used to assess the validity of alternative research designs, whose outcomes focus on function and patient-reported outcomes. We propose that utilizing existing evaluation tools that measure knowledge, dissemination and utility of findings, may help improve the translation of findings into practice and health policy.