Public Participation Research Articles

How to build a powerline: Fast policies for decarbonization, the slow work of public participation, and the profitability of energy capital

Community opposition to new low-carbon energy infrastructure – and resulting project delays and cancellations – is increasingly taken by some climate activists, policymakers, and scholars as evidence of the incompatibility between urgent decarbonization and expanded public participation. This paper argues that too narrow a focus on this duality risks overlooking an additional mandate: the profitability of energy capital. This paper intervenes in the ‘rapid vs. just transitions’ debate by arguing that building low-carbon energy infrastructure requires a balancing of trade-offs between speed, local support, and profit for private developers. Using a case study of a controversial transmission project in the northeastern United States, I argue that project delays are attributable not (just) to uncooperative publics, but to energy capital's drive for profit, which discourages compromises with host communities that would increase project costs but cultivate local support. By treating the social legitimacy of low-carbon energy infrastructure as contingent on its ability to meet criteria for public acceptability, this paper argues that the slow work of public participation can in fact be the route to ‘fast policies’ for decarbonization when it fosters developer norms in line with community expectations for projects.

Challenges and opportunities of sustained public involvement in maternal health research: a practice case study with reflections from researchers and public contributors

It is widely agreed that collaboration with people with lived experience of specific health conditions or health services is both a moral imperative and a utility to improve research quality, validity and impact. However, there is little agreement about how to practise public involvement. In this article, we describe the formation and work of the Nottingham Maternity Research Network, an ongoing research reference panel that supports public involvement in maternal health research. Drawing on nine years’ experience, researchers and public contributors reflect together on the key issues to consider when co-producing research with maternity service users: first, pragmatic considerations, and second, creating a safe space for drawing on intimate and sometimes traumatic experiences. We argue that a sustained model of public involvement and engagement – that is, a standing group rather than a series of project-based, time-limited opportunities for involvement – brings opportunities to build trust and to develop a community that is supportive and inclusive. However, the sustained model of public involvement also brings practical challenges.

Designing infographics in health research with patients and the public: A scoping review

Abstract Patient and public involvement (PPI) in health research is increasing, in recognition for its potential to enhance the quality and relevance of research. To date, there has been no comprehensive review of the literature on the design of infographics with patients and the public in health research. This scoping review aims to explore the extent and nature of PPI in the design of infographics, a commonly used tool for communicating complex health information to diverse audiences. The review used Arksey and O’Malley’s methodological framework by Levac et al. Comprehensive searches were carried out in the following databases: Scopus, PubMed Central, Web of Science, EMBASE, CINAHL Complete, PsychINFO, and Cochrane Library. Identified citations were exported to Endnote and imported into Rayyan software for title and abstract screening. Preliminary results report a total of 738 citations imported, out of which 364 duplicates were removed and 374 citations underwent title and abstract screening. Of these, 80 citations were relevant for full-text review. Two independent reviewers evaluated full texts, resolving discrepancies through discussion or by a third reviewer. 62 studies were included in the review. Relevant data was extracted, and numeric and narrative analyses were performed to synthesize findings across included studies. The review found growing interest in PPI for health infographic design, using diverse approaches to engage patients and the public at various design stages. A wide variety of health topics were represented including disease specific topics, pain and weight gain. Common themes identified included the importance of accessibility, clarity, and cultural sensitivity in infographic development, as well as challenges related to generalisability, social desirability bias and ensuring meaningful involvement. This review offers insights and suggests further research and practice in leveraging PPI to optimize the design and impact of health infographics. Key messages • Growing Interest and Importance of Patient and Public Involvement (PPI) in Health Research Design. • Challenges and Opportunities in Infographic Design for Health Communication.

7.Y.2. Solidarity and public health teaching and practice in the age of new normal

Abstract This workshop will address the concept and topic of solidarity as it pertains to public health (PH). The objectives of the workshop are: • To explore what is understood by solidarity in the context of PH; • To consider the PH scenarios in which solidarity may be an important construct; • To consider how solidarity is understood by PH experts and practitioners, and • To profile investigate how solidarity is represented in educational and training programme in PH. Solidarity is a social determinant of health. It is proven as a crucial factor in achieving PH objectives such as: compliance with vaccination campaigns; donations of bodily samples to biobanks; or refraining from polluting. It can be defined as a cost taken upon oneself for the sake of a group with which one identifies (Prainsack and Buyx 2017). As PH is about achieving health objectives through public participation, solidarity can be seen as the kernel of PH practice. In an era with emerging PH threats, from pandemics to climate crises, the importance of understanding the many meanings and uses of solidarity is essential to PH practitioners. There is much more in solidarity than meets the eye. Solidarity is largely a mystification of a collective identity, a boundary-making mechanism that draw the line between ‘us’ and ‘them’, and most importantly, it is the generator of what is understood as ‘public’. Facing increasing challenges in PH, solidarity is a concept to be thoroughly apprehended. Is there one solidarity, or rather multiple solidarities? What are the referent publics of different solidarities and how do they interact? Can be a global solidarity? Is solidarity a normative or descriptive concept? Is solidarity the outcome or the generator of pro-social behaviour. These are questions that will be discussed in this round table workshop session. Curious to learn about PH views on solidarity, we conducted structured interviews with PH experts to ascertain views on solidarity as a key concept in PH; whether the concept should be incorporated into PH education programme, and if so, how best to do that. Preliminary findings suggest that all interviewees agreed that solidarity is a key concept in PH but when asked to define solidarity, provided diverse answers. They acknowledged that solidarity should be taught in different stages of PH education, but admitted that it rarely appears in current curricula. Many interviewees stated that solidarity may be culturally and politically determined and should be discussed through case studies and guest lectures as well as theory. The added value of this workshop is to raise awareness about the importance of the concept of solidarity and its importance in PH education and training programmes. The workshop will run as a Round table discussion, in which each panellist will make a short presentation on a specific subject, which will then be discussed between panel members and audience. Key messages • Solidarity is considered a key concept for the practice of public health, yet has been constantly contested as too vague and even too political. • Presenting key challenges facing the teaching of solidarity as competence in public health; its conceptual ambiguities and cultural differences and the different uses of solidarity as a value and tool. Speakers/Panelists Farhang Tahzib Faculty of Public Health, Haywards heath, UK Mary Codd University College Dublin, Dublin, Ireland Alison Mc Callum University of Edinburgh, Edinburgh, UK Hagai Boas Van Leer Jerusalem Institute, Jerusalem, Israel

Engaging nursing home residents in clinical research: insights from a patient advisory board, a patient advocate, and a study team

BackgroundPatient and Public Involvement (PPI) is increasingly recognized as an essential aspect of clinical research, particularly for ensuring relevancy and impact of research to those most affected. This study addresses the gap in involving older patients, particularly nursing home residents, in the research process by exploring motivations, expectations, and experiences of nursing home residents in Bremen, Germany, involved in PPI for developing a clinical trial on polypharmacy.MethodsTwo Patient Advisory Boards (PABs) were established in nursing homes as part of the INVOLVE-Clin project. A Patient Advocate (PA) facilitated communication between nursing home residents and researchers. A qualitative case study approach was employed, involving semi-structured interviews and group discussions with nursing home residents and researchers. Data was analyzed using structured qualitative content analysis.ResultsThe study found varied motivations and expectations between nursing home residents and researchers. Nursing home residents valued the social interaction and the opportunity to voice their health concerns, while researchers aimed to incorporate patients’ perspectives into study design. The PA was considered crucial in facilitating communication between nursing home residents and researchers. Challenges included the complexity of the study topic and the need for methodological adjustments to suit nursing home residents´ cognitive abilities. Generally, PAB participation was experienced to provide mental stimulation and increased confidence among nursing home residents in discussing their medication management. The PAB’s influence led to the decision not to conduct a polypharmacy study.DiscussionThe findings underscore the importance of flexible approaches to PPI, particularly when involving older nursing home residents. Methodological adjustments, such as tailoring content and structure of PABs, and the inclusion of additional boards for diverse perspectives, are vital for effective involvement. The study also highlights the need for ongoing innovation in PPI methods to ensure meaningful engagement of older patients in clinical research.ConclusionThis study contributes essential insights into the practical implementation of PPI with nursing home residents, highlighting the need for patient-centric approaches that recognize their unique challenges and contributions. These findings are critical for shaping scientifically robust but also socially relevant and impactful research, especially in an aging society.

A systematic review on the effect of identity-related interventions on physical activity and smoking

Abstract Background Identity (self-perceptions of ‘who I am’) is important for health behavior change. Hence, identity-related interventions, aiming to influence how people view themselves, show promise for health promotion. This systematic review describes the effect of identity-related interventions on physical activity (PA), a health-promoting behavior, and smoking, a health-compromising behavior, and PA- and smoking-related identities in adults. Methods A comprehensive search, updated in May 2023, identified 5801 publications across eleven databases. After screening, 19 quantitative and mixed-methods publications were selected, describing 20 different studies. Relevant data were systematically extracted and a quality assessment was conducted using the Mixed Methods Appraisal Tool. Results Identity-related interventions were more common for enhancing PA (n = 13) than for smoking cessation (n = 6). Only one study targeted PA- and smoking-related identities to change both behaviors simultaneously. Various identity-related interventions were used, e.g. possible (future) selves manipulations and avatar games. The target population was rarely involved in intervention development. The results are mixed; some studies showed (significant) positive effects of identity-related interventions on identities or behavior, and no significant negative effects were shown. Similar results were found for PA and smoking. The one study targeting both behaviors showed positive results. Conclusions Identity-related interventions hold promise in promoting PA and smoking cessation. Future research could investigate identity-related interventions targeting multiple health behaviors, e.g., PA-promotion and smoking cessation, leveraging the synergy between those identities and behaviors. Collaboratively developing these interventions with the target population (i.e., patient and public involvement) could optimize them for different populations, improving public health and reducing health disparities. Key messages • Identity-related interventions could improve public health. • Collaboratively developing identity-related interventions with the target population could optimize them for different populations.

CARD-SARC: mixed-method study to develop a disease-specific health-related quality of life tool for cardiac sarcoidosis

Abstract Introduction Sarcoidosis is a rare inflammatory condition caused by the formation of lumps (granulomas) of abnormal tissue in any organ, and can affect physical, functional, mental, social and economic aspects of life. People living with cardiac sarcoidosis (CS) are likely to have worse clinical outcomes and greater impairment on health-related quality of life (HRQoL) than other sarcoidosis manifestations. HRQoL is the main concern for people living with sarcoidosis. However, measuring HRQoL in people with CS is difficult as existing tools focus on other forms of sarcoidosis (for example, lung, eye or skin involvement) or for specific cardiac symptoms (for example, atrial fibrillation, angina or heart failure), but not specifically for CS. Purpose To develop a disease-specific patient-reported outcome measure (CARD-SARC) to assess the impact of CS on HRQoL. Methods A sequential exploratory mixed-method, multicentre observational cohort study using a clinimetric approach was conducted. The McMaster Framework for evaluative instruments involved three steps (item selection, item scaling and item reduction) which were complemented with recommendations from the consensus-based standards for the selection of health measurement instruments (COSMIN). The item-generation process connected data from quantitative (theory, research findings and systematic review) and qualitative components (qualitative semistructured interviews, clinical observations and experts’ opinion). A simultaneous triangulation (QUAN+qual) method was followed to ensure a comprehensive list of preliminary items. The formatting of items was guided by patient and public involvement (PPI) with a 2-weeks recall period. The item reduction strategy was led by PPI and an international multidisciplinary clinical CS-experts. Results 740 potential items were generated by converging all the different sources and techniques. After removal of duplicates and simultaneous triangulation, a preliminary list with 111 items was reviewed by the CS-expert panel with 26 members (including 11 pulmonologists, 7 cardiologists, 5 CS-patients and 3 specialist-nurses). After a consensus meeting, the CARD-SARC included 61 relevant items in six sections for pilot-testing: "functioning", "social, leisure and occupation", "emotional", psychological", "physical" and "healthcare/self-care". Conclusions This study combined a robust methodology with active PPI engagement to develop the first disease-specific HRQoL tool for CS. Each data source was planned independently, however the input from PPI members was critical during the simultaneous triangulation for item-generation. The contributions of CS-experts (members of the PPI group and clinical multidisciplinary experts) enhanced the content validity of the CARD-SARC. The CARD-SARC has the potential to influence clinical management and treatment options, future research and health-economic stakeholders’ decisions for CS.

Innovation in border regions: from inequality to equity! Starting with acknowledgment in policy

Abstract Living in a border area can create health inequalities due to limited access to healthcare compared to people in central regions. In centrally located areas, citizens can choose healthcare providers 360 degrees around them, benefiting from full prevention and health promotion coverage. In contrast, border residents have only 180 degrees of access, leading to partial inclusion in health services. National systems typically prioritize health equality but not necessarily equity, especially for those living in border regions. To address this gap, innovative policies that account for cross-border interactions are needed, benefiting over 35% of the EU population living in border areas. A key question is how to ensure health equity in border regions. To explore this, cross-border case studies, like air pollution, food purchases, antibiotic availability and q fever were looked at to identify the situation, the public health challenges it entails and existing solutions. The Essential Public Health Functions (EPHF) framework, developed by the World Health Organization and the International Association of National Public Health Institutes, was used to evaluate public health functions with a focus on achieving greater equity and inclusiveness. Currently in cross-border health key EPHF functions such as health promotion and disease prevention are emphasized, while others like public health governance and community participation need improvement. To better implement health equity in border regions, for use of the EPHF framework an additional and short guideline was developed on how border regions should be considered in national, regional, and local public health policies. This approach offers a pathway to addressing health inequalities in these unique environments: a crucial step towards creating health equity. Key messages • The EPHF framework as an innovative tool to strengthen public health in border regions. • Take the geographical living space of citizens in a border region into account to achieve health equity.

An Irish public health policy research team: impact and lessons learned, one year on

Abstract Issue In 2023, in Ireland, a public health policy research team was established in the Health Information and Quality Authority to conduct evidence syntheses and provide evidence-based advice to inform national decision-making, at the request of the Department of Health. One year on, we reflect on the impact of this team and outline lessons learned. These findings may support other countries in creating and developing public health policy research teams. Description of the problem We aim to answer the following questions: What impact can a public health policy research team have and what are the lessons learned, one year on? Projects completed by the team in 2023 were reviewed for stakeholder engagement (such as expert and public and patient involvement) and impact (feedback from policymakers, resulting public health actions or policies and online report downloads). Results Seven public health projects were completed in 2023, in areas including: Long COVID, public health reform, rapid multiplex testing, and medical countermeasure stockpiling. National and international stakeholders were engaged with via expert advisory group membership, document review and project presentations. Patient representatives were included from Long COVID Advocacy Ireland and Rare Diseases Ireland. Project reports were downloaded a total of 281 times. Positive feedback was received from all stakeholders. Project findings were presented to policymakers to inform national public health and rare disease strategy development, and the Long COVID model of care in Ireland. Lessons Early and ongoing stakeholder engagement is key when translating research to practice, via policy. Innovative methods of engagement, including public and patient involvement, can ensure meaningful collaboration. Adapting methodologies to meet stakeholder needs, such as rapid evidence synthesis, enhances impact. Lastly, research impact on policy takes time, and an understanding of national policy development is required. Key messages • A public health policy research team provides impactful evidence synthesis to advise national policymakers. • Stakeholder engagement is key to developing impactful policy advice.

Using PPI and UDL principles to design a gastrointestinal endoscopy patient information video series

Abstract Introduction Patients undergoing GI endoscopy often experience anxiety and due to limited health literacy. Traditional paper-based information leaflets are often not sufficient to accommodate for the diverse way in which people consume information. Public and patient involvement (PPI) and universal design for learning are two well-described pedagogical principles. We wanted to use these principles to design more effective patient education materials. Objectives Given the heterogeneity of resources available to patients, the authors wanted to develop a high-quality and trustable video resources for patients that would be available on our hospital website. These videos would be co-designed by patients and ancillary staff, through the formation of a key stakeholder panel. Results Using PPI principles, we were able to improve the relevance and quality of our content, through the use of storyboards and the expertise of the stakeholder panel. Through the three key UDL principles of multiple means of representation, engagement and action and expression, we were able to ensure that our videos were accessible and appropriate for all of our patients. Initial feedback from stakeholders and patients provided valuable insights, prompting necessary adjustments for accuracy and patient understanding. This comprehensive approach underscores the commitment to enhancing healthcare delivery. Our project is the first guide in combining both pedagogical principles in the development of patient information and education materials. Conclusions The meticulous steps taken, from stakeholder engagement to video production, reflect a commitment to inclusivity and patient-centred care. Ongoing evaluation and feedback mechanisms ensure continuous improvement, contributing to the overall success and sustainability of the digital service. Key messages • This is the first research/patient education piece designed using both PPI and UDL principles. • The importance of patient-centred educational design is key to improving health literacy and education in our patients.

Passing the hot potato: a multinational study on public trust in the health policy process

Abstract Background Health data-sharing initiatives are central to European and national e-health strategies, aiming to improve healthcare quality, inform policymaking, and drive research. Public trust is crucial for their success, influencing public participation and policymakers’ legitimacy. This study investigates the role of public trust in the health policy process at both the European level and in Italy, France, and Switzerland to determine 1) if a common conceptual understanding of public trust across different countries and policy stages exists, and 2) if policymakers explicitly discuss and implement trust-building measures in their legislative work Methods A total of 60 interviews were conducted with 16 European, 15 Italian, 14 French, and 15 Swiss policymakers from the World Health Organization, the Council, Parliament, and Commission at the European level, along with representatives from the Ministry of Health, Parliament, regional councils, local health authorities, frontline staff, and relevant agencies at the national levels Results Preliminary results reveal that a common definition of public trust in health data sharing is missing. Associations to public trust are observed at the European level with citizens’ reassurance about their sensitive data being shared, and in Switzerland with data security. In France, public trust is connected to public engagement, while no distinct patterns were identified in Italy. Findings also reveal a consensus among interviewees on the central role public trust plays in health data-sharing initiatives; yet public trust is perceived as a vague concept, often addressed implicitly without a clear strategy Conclusions The study reveals widespread ambiguity among policymakers regarding the definition of public trust and its translation into policy. Practical guidance is crucial to effectively integrate elements of public trust into policymaking, thereby actively reinforcing trust in health data sharing through legislative efforts Key messages • While policymakers recognize the importance of public trust for data-driven health initiatives, they lack a common conceptual understanding on what trust is and how to build it. • Guidance is needed to help policymakers actively contributing building trust in health data sharing through their legislative work.

Bridging the gap: mapping co-creation methods for public health impact and innovation

Abstract Background Co-creation offers a promising approach to public health innovation, particularly for tackling complex issues. However, the lack of a standardized methodology limits its reliability and reproducibility, especially across diverse contexts. This study explores co-creation methods used by researchers and practitioners, aiming to shed light on their implications for public health. Understanding this methodological landscape can enhance the effective implementation of co-creation processes to address complex challenges. Methods Utilizing the Systematic Methods Overview approach, we examined co-creation methods. Data were gathered from the Health CASCADE Co-Creation Database and grey literature using an artificial intelligence-assisted recursive search strategy and a two-step screening process. We conducted textual, comparative, and bibliometric analyses to evaluate methodological underpinnings and relationships between methods. Results Analysis of 2,627 academic articles and grey literature sources identified over 900 co-creation methods. While surveys, focus groups, and group discussions were prevalent, participatory methods were underutilized. Notably, 91.3% of methods co-occurred, with a predominant combination of qualitative approaches. Furthermore, a significant discrepancy between research and practice was evident, with only 10.2% convergence. Conclusions This study revealed a critical gap between co-creation in research and practice, emphasizing the need to bridge this methodological divide for advancing co-creation as a reliable approach in public health. The over-reliance on qualitative methods raises concerns about tokenistic engagement and undermines meaningful public participation in co-creation. Addressing this trend is vital to preserve the essence of true co-creation and maximize its potential for addressing complex public health challenges. Key messages • Mapping the diverse methods of co-creation in public health reveals both richness and disparities in approach, from surveys to participatory methods. • Addressing the discrepancy between co-creation in research and practice is vital for establishing a reliable and effective approach to tackling public health challenges.

Developing a trustworthy national health data space: public needs and policy implications

Abstract Background The ongoing development of a national health data space in Switzerland presents an opportunity to transform health delivery and care by enabling large-scale secondary health research. Central to this development is the Health2030 strategy, which calls for the establishment of public trust in the reliability and security of data collection, storage, and exchange. Methods We conducted four focus groups across the German, French and Italian-speaking regions of Switzerland to inform the development of the Swiss health data space that fosters public trust. To inform Swiss policy, we held a panel discussion with patient experts and healthcare professionals to translate the focus group findings into governance and public communication requirements. We synthesized our findings using a thematic analysis approach and proposed a guiding health policy strategy. Results Citizens perceive the health data space as trustworthy conditional on the delivery of its promised higher levels of transparency, security, and lower risk compared to other data sharing initiatives. To ensure its trustworthiness, citizens call for the provision of value-based consent to control data access based on the actors involved and research purposes, alongside implementing accountability measures for data misuse. Governance framework requirements entail establishing an advisory group for the health data space with sufficient representation of the Swiss population, including members of the public, patient advisory groups, and researchers. Public communication requirements call for ongoing monitoring of public opinion on health data space, alongside establishing public engagement initiatives, such as public fora, to inform ongoing progress. Conclusions Policy efforts should prioritize the meaningful involvement of relevant stakeholders throughout all stages of the health data space development to foster trust. Central to these efforts is balancing public expectations with their practical implementation. Key messages • For the health data space to be trustworthy, citizens require transparency on their data use and the security measures taken, value-based consent for data access, and accountability measures. • Diverse representation in governance and continuous public involvement are key policy measures to build public trust in the development of national health data spaces.

Patient engagement in pulmonary embolism research: Insights form the Attend-PE study

Abstract Background There is growing recognition of the significance of a close collaboration between patients, clinicians, and researchers to ensure that research and health service delivery effectively meets the needs of end users [1-3]. However, there is limited understanding of best practices for patient engagement in research among patients with venous thromboembolism, and there is sparse knowledge about challenges to and facilitators of this process [4, 5]. Purpose To describe and explore the process and evaluate the impact of patient engagement in the development of a structured nurse-led post pulmonary embolism care model (the Attend-PE model). Method This prospective embedded case study of patient engagement was conducted within the research project - A structured Integrated post Pulmonary Embolism care model (Attend-PE). The study was based on documents from patient journey mapping (PJM), documents and field notes from workshops, and semi-structured interviews with two patients with pulmonary embolism, two clinicians working with pulmonary embolism patients and the Attend-PE researchers. Data were analyzed based on research questions guided by the United Kingdom six Standards for Public Involvement; Inclusive opportunities, Working together, Support & learning, Governance, Communications and Impact [6]. Result Patients played a crucial role throughout the entire Attend-PE study, contributing to research questions, design, execution, and dissemination, as illustrated in Figure 1. The patients were involved at a higher engagement level in the co-creation of the Attend-PE model and co-creation of patient education and information material. Comparatively the engagement level was lower in decisions regarding outcomes, feasibility testing and implementation of the Attend-PE model, as shown in Figure 2. Notably, despite lower engagement level, the continuous involvement in the research process was invaluable to the patients. This ensured that they maintained insight in the research process, even though their contributions varied in the different phases. Important facilitators of patient engagement within the Attend-PE were related to "Inclusive opportunities" and "Support and learning". Patients highlighted the importance of being a part of the process, working together as a team, and being prepared for the work. Important challenges to patient involvement related to "Communication" and "Governance", including lack of expectation alignment and communication regarding clinical elements where clinicians often dominated the discussions. Conclusion Patient involvement has been invaluable in the development of a structured nurse-led post pulmonary embolism care model. Further, patients will be involved in evaluation of the national implementation process and dissemination of study results.Figure 1Figure 2

Participation in Energy Transitions: A Comparison of Policy Styles

Stakeholder and public participation in policymaking for energy transitions is one of the most promising approaches to fulfilling the promises of a democratic sustainability transition. Over the years, many studies have been published about concepts, methodologies, and empirical results of participatory approaches and implementations. In this paper, we focus on the compatibility of participatory processes with different policy styles of democratic governance. We conducted a systematic literature search comparing different concepts of democratic governance and applying them to public participation, in particular that associated with energy transitions. Our main objective in this paper is to link the requirements for a sustainable energy transition to governance processes and structures; we further aim to delineate suitable formats for stakeholder and public participation. Our analysis provides a basis for a wide-ranging and multi-perspective research agenda that promises to provide a deeper understanding and explanation of complex governance arrangements for energy transitions. The five democratic policy styles that we selected for this review are: autocratic, adversarial, collaborative, reflexive, and inclusive governance. We conclude that none are adequate on their own, and so we put forth a novel hybrid we call the “mediative approach.” From this approach, we derive a new research framework for addressing the current challenges of democratic decision-making in energy transitions. Three pressing questions emerge, one relating to the interplay of top-down and bottom-up modes of governance; a second to the conditions for actor collaboration; and a third to the perception of democratic legitimacy by affected parties.

Establishing the Effect of Democratic Governance on the Performance of Public Hospitals in Selected Counties in Kenya

Background The study critically evaluates the effect of democratic governance on the performance of public hospitals in Kenyan counties, following the 2010 Constitution that introduced devolved governance. This shift aimed to enhance local decision-making, accountability, and service delivery, specifically in the health sector, by empowering county governments. Democratic governance principles, such as transparency, accountability, and citizen participation are critical for addressing long-standing challenges like inequitable resource distribution, underfunding, and inefficiencies in public health services. This study explored the effect of democratic governance on the performance of public health hospitals in Kenya.  Methodology A mixed-methods approach was employed combining quantitative data from surveys with qualitative insights from interviews with county officials. Factor analysis was used to assess the relationship between democratic governance indicators - transparency, accountability, citizen participation, and public health service performance. Qualitative data, were gathered through interviews and content analysis of responses from county officials complemented the quantitative findings.  Results The study revealed that while democratic governance positively influences the performance of public hospitals in delivering health services in Kenyan counties, there are discrepancies in implementation across counties. Most respondents agreed that public participation and transparency in decision-making are strong, but the accessibility of financial records and county documents remains limited. Factor analysis confirmed that democratic governance significantly impacts health service outcomes, but qualitative findings indicated moderate transparency in financial matters, with only 8.3% of respondents rating transparency as high.  Recommendations To improve the performance of public hospitals in the delivery of health services, county governments should enhance the accessibility of public records, strengthen financial reporting and transparency, and foster deeper citizen engagement in governance. Improved oversight mechanisms and better governance practices are essential for leveraging the benefits of devolved governance.

An anthropological critique of psychiatric rating scales

SUMMARY This article discusses sceptical arguments about measurement scales. Measurement scales are part of a promising agenda of openness, transparency and patient and public involvement (PPI) in medical research, but have received critical, sometimes hostile attention from anthropologists. This is because scales repackage localised cultural assumptions about distress as something universal and pan-human and have the capacity to reshape people's interior lives in unhelpful, possibly harmful ways. We take as an example the Patient Health Questionnaire-9 (PHQ-9). Use of the PHQ-9 is currently mandated by major funders. But its history suggests flawed PPI and a lack of openness. The article suggests a constructive role for anthropology in mental health research, using ethnographic evidence and theory to show how, although they have their uses, mental health scales should not be regarded as inert or harmless.

Analysis of the Potential Carbon Emission Reduction Through Interaction Between New Energy Vehicles and Smart Grids

Abstract: This paper analyzes the potential for carbon emission reduction through the interaction between new energy vehicles and smart grids, discussing how the optimization of energy efficiency and balancing of grid loads can be achieved through Vehicle-to-Grid (V2G) technology. The interaction between new energy vehicles and smart grids can enhance energy utilization efficiency, optimize grid management, and reduce reliance on fossil fuels by leveraging renewable energy sources, thereby achieving the goal of carbon emission reduction. However, this process faces multiple challenges including technological integration, cost-effectiveness, policy support, and societal acceptance. The paper proposes a series of strategic recommendations, including promoting technological standardization, enhancing policy and economic incentives, and increasing public awareness and participation, to support the effective interaction between new energy vehicles and smart grids, and to achieve long-term carbon emission reduction goals.

ENVIRONMENTAL POLICY IN THE PUBLIC ADMINISTRATION SYSTEM: CHALLENGES OF SUSTAINABLE DEVELOPMENT

Sustainable development is a key topic on today's global agenda due to the threats posed by climate change, environmental pollution, and other ecological issues. Governments and international institutions aim to achieve a balance between economic growth, social welfare, and environmental protection. In this context, new technologies and support for green innovations, which have the potential to enhance environmental safety, play a particularly important role. Effective public administration must adapt to these challenges by actively implementing environmental policies and promoting sustainable development. International cooperation is also critical for integrating global commitments into national strategies. The purpose of this article is to demonstrate how environmental policy can support sustainable development through the improvement of the public administration system. The study provides a detailed analysis of international legal frameworks that regulate environmental policy and sustainability in public administration. Based on a systems approach, the complex interrelationships between government, society, business, and environmental factors are explored, allowing for a deeper understanding of how these elements interact. Using Switzerland as an example, one of the leading countries in environmental governance, the article identifies key elements for integrating environmental principles into public administration. This example demonstrates specific approaches and tools that other countries can adopt. Additionally, the statistics highlight not only global trends in plastic production and consumption but also the number of countries that have implemented environmental policy instruments between 2010 and 2023. This helps assess the scale of environmental initiatives at the global level. A SWOT analysis was conducted to assess the strengths and weaknesses of existing environmental policies, as well as to identify opportunities and threats for future development. This analysis helped outline the key directions for improving environmental policy to further support sustainable development. As a result, it was found that environmental policy within public administration has significant potential for growth, but its success depends on the establishment of an effective monitoring system, the intensification of international cooperation, the adoption of advanced technologies, and active public participation.

CURRENT CHALLENGES AND PROSPECTS OF LEGAL REGULATION OF PUBLIC ADMINISTRATION OF THE SOCIAL SPHERE IN THE TERRITORIAL COMMUNITIES OF UKRAINE

The article defines that public administration is a system of activities of state authorities aimed at optimizing the use of resources to achieve the priority goals of social policy. It is emphasized that the social sphere covers a wide range of services that ensure the well-being of citizens, including health care, education, social protection and other critically important elements. The study of the problems of public management of the social sphere in territorial communities reveals a number of challenges, such as insufficient financial support, the absence of a clear legal framework, and a low level of public involvement in decision-making processes. Analysis of modern approaches to legal regulation in this area showed that effective management of social policy requires the integration of innovative methods, in particular digitalization of processes, which will contribute to the transparency and accountability of local self-government bodies. As a result of the research, it was found that the public management of the social sphere in the territorial communities of Ukraine is a complex, multifaceted process that requires a comprehensive analysis and a comprehensive approach to its improvement. The development of recommendations for improving management mechanisms should become a priority for researchers and practitioners in this important field. Effective management of the social sphere requires systematic control over the implementation of state policy. This involves not only an internal audit of the activities of local self-government bodies, but also mechanisms of public control that would allow residents to actively participate in the processes of evaluating the effectiveness of social programs. The study showed that the key factors in the effectiveness of public management of the social sphere in territorial communities are: adaptability of management mechanisms; integration of modern technologies; formation of partnership relations; personnel training and development; community involvement in decision-making processes, etc. Legal regulation of public management of the social sphere in territorial communities of Ukraine is conditioned by the need to create effective management mechanisms that meet modern challenges. Among the prospects for the development of legal regulation of public management of the social sphere in the territorial communities of Ukraine, the need for: improvement of the legal framework was emphasized; strengthening of financial autonomy; development of professional training; integration of modern technologies; community involvement in decision-making processes; focus on inclusiveness; monitoring and evaluation of efficiency; cooperation with international organizations; adaptation to changes in the socio-economic environment; increasing the level of trust in the authorities, etc. It is emphasized that the successful implementation of public policy in the social sphere depends on the effective interaction of all interested parties, which in turn will ensure sustainable development and increase the quality of life of the population.