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1.  The Visible Politics of the Privatization Debate in Quebec 
Healthcare Policy  2012;8(1):67-79.
This paper analyzes the debates surrounding the privatization of health services financing in Quebec. The objective is to clarify policy-making processes with regard to this important issue and, more generally, to provide a realistic understanding of health-related policy processes in Canada. The analysis is based on a large and continuous sample of mass media and National Assembly debates on the question during the four-and-a-half years following the Chaoulli ruling of the Supreme Court of Canada. These data are used to test four hypotheses about relationships among the types of political actors involved, their policy preferences, the rhetoric they use and the anticipated policy effects they assert. The results are applied to a discussion of questions about the factors that influence the effectiveness of political communication.
PMCID: PMC3430155  PMID: 23968604
2.  Understanding Public Opinion in Debates over Biomedical Research: Looking beyond Political Partisanship to Focus on Beliefs about Science and Society 
PLoS ONE  2014;9(2):e88473.
As social scientists have investigated the political and social factors influencing public opinion in science-related policy debates, there has been growing interest in the implications of this research for public communication and outreach. Given the level of political polarization in the United States, much of the focus has been on partisan differences in public opinion, the strategies employed by political leaders and advocates that promote those differences, and the counter-strategies for overcoming them. Yet this focus on partisan differences tends to overlook the processes by which core beliefs about science and society impact public opinion and how these schema are often activated by specific frames of reference embedded in media coverage and popular discourse. In this study, analyzing cross-sectional, nationally representative survey data collected between 2002 and 2010, we investigate the relative influence of political partisanship and science-related schema on Americans' support for embryonic stem cell research. In comparison to the influence of partisan identity, our findings suggest that generalized beliefs about science and society were more chronically accessible, less volatile in relation to media attention and focusing events, and an overall stronger influence on public opinion. Classifying respondents into four unique audience groups based on their beliefs about science and society, we additionally find that individuals within each of these groups split relatively evenly by partisanship but differ on other important dimensions. The implications for public engagement and future research on controversies related to biomedical science are discussed.
doi:10.1371/journal.pone.0088473
PMCID: PMC3928253  PMID: 24558393
3.  Chinese newspaper coverage of genetically modified organisms 
BMC Public Health  2012;12:326.
Background
Debates persist around the world over the development and use of genetically modified organisms (GMO). News media has been shown to both reflect and influence public perceptions of health and science related debates, as well as policy development. To better understand the news coverage of GMOs in China, we analyzed the content of articles in two Chinese newspapers that relate to the development and promotion of genetically modified technologies and GMOs.
Methods
Searching in the Chinese National Knowledge Infrastructure Core Newspaper Database (CNKI-CND), we collected 77 articles, including news reports, comments and notes, published between January 2002 and August 2011 in two of the major Chinese newspapers: People’s Daily and Guangming Daily. We examined articles for perspectives that were discussed and/or mentioned regarding GMOs, the risks and benefits of GMOs, and the tone of news articles.
Results
The newspaper articles reported on 29 different kinds of GMOs. Compared with the possible risks, the benefits of GMOs were much more frequently discussed in the articles. 48.1% of articles were largely supportive of the GM technology research and development programs and the adoption of GM cottons, while 51.9% of articles were neutral on the subject of GMOs. Risks associated with GMOs were mentioned in the newspaper articles, but none of the articles expressed negative tones in regards to GMOs.
Conclusion
This study demonstrates that the Chinese print media is largely supportive of GMOs. It also indicates that the print media describes the Chinese government as actively pursuing national GMO research and development programs and the promotion of GM cotton usage. So far, discussion of the risks associated with GMOs is minimal in the news reports. The media, scientists, and the government should work together to ensure that science communication is accurate and balanced.
doi:10.1186/1471-2458-12-326
PMCID: PMC3370988  PMID: 22551150
4.  Does Local Television News Coverage Cultivate Fatalistic Beliefs about Cancer Prevention? 
The Journal of communication  2010;60(2):230-253.
A substantial proportion of American adults hold fatalistic beliefs about cancer prevention despite evidence that a large proportion of cancer deaths are preventable. Several scholars suggest that news media coverage is one source of these beliefs, but scant evidence has been brought to bear on this assertion. We report findings from two studies that assess the plausibility of the claim that local television (TV) news cultivates fatalistic beliefs about cancer prevention. Study 1 features a content analysis of an October 2002 national sample of local TV and newspaper coverage about cancer (n=122 television stations; n=60 newspapers). Study 2 describes an analysis of the 2005 Annenberg National Health Communication Survey (ANHCS, n=1,783 respondents). Study 1 indicates that local TV news stories were more likely than newspaper stories to mention cancer causes and scientific research and less likely to provide follow-up information. Study 2 reveals that local TV news viewing was positively associated with fatalistic beliefs about cancer prevention. Overall, findings are consistent with the claim that local TV news coverage may promote fatalistic beliefs about cancer prevention. We conclude with a discussion of study implications for cultivation theory and the knowledge gap hypothesis and suggest foci for future research.
doi:10.1111/j.1460-2466.2009.01474.x
PMCID: PMC2885705  PMID: 20563221
cultivation; knowledge gap; health communication; news coverage
5.  Advocates, interest groups and Australian news coverage of alcohol advertising restrictions: content and framing analysis 
BMC Public Health  2012;12:727.
Background
Legislating restrictions on alcohol advertising is a cost-effective measure to reduce consumption of alcohol. Yet Australia relies upon industry self-regulation through voluntary codes of practice regarding the content, timing and placement of alcohol advertising. Ending industry self-regulation was recommended by the National Preventative Health Taskforce; a suggestion contested by the drinks industry. Debates about emerging alcohol-control policies regularly play out in the news media, with various groups seeking to influence the discussion. This paper examines news coverage of recommendations to restrict alcohol advertising to see how supporters and opponents frame the debate, with a view to providing some suggestions for policy advocates to advance the discussion.
Methods
We used content and framing analyses to examine 329 Australian newspaper items mentioning alcohol advertising restrictions over 24 months. All items were coded for mentions of specific types of advertising and types of advertising restrictions, the presence of news frames that opposed or endorsed advertising restrictions, statements made within each frame and the news-actors who appeared.
Results
Restrictions were the main focus in only 36% of 329 items. Alcohol advertising was conceived of as television (47%) and sport-related (56%). Restrictions were mentioned in non-specific terms (45%), or specified as restrictions on timing and placement (49%), or content (22%). Public health professionals (47%) appeared more frequently than drinks industry representatives (18%). Five supportive news frames suggested the policy is a sensible public health response, essential to protect children, needed to combat the drinks industry, required to stop pervasive branding, or as only an issue in sport. Four unsupportive frames positioned restrictions as unnecessary for a responsible industry, an attack on legitimate commercial activities, ineffective and ‘nannyist’, or inessential to government policy. Support varied among news-actors, with public health professionals (94%) more supportive than the public (68%), community-based organisations (76%), the government (72%), and the sports (16%), drinks (3%), or advertising (4%) industries.
Conclusion
Restrictions on alcohol advertising currently have low newsworthiness as a standalone issue. Future advocacy might better define the exact nature of required restrictions, anticipate vocal opposition and address forms of advertising beyond televised sport if exposure to advertising, especially among children, is to be reduced.
doi:10.1186/1471-2458-12-727
PMCID: PMC3495017  PMID: 22938674
Alcohol policy; Content analysis; News reportage; Advertising restrictions
6.  Unwanted pregnancy, mental health and abortion: untangling the evidence 
Abortion policy is still contentious in many parts of the world, and periodically it emerges to dominate health policy debates. This paper examines one such debate in Australia centering on research findings by a New Zealand research group, Fergusson, Horwood & Ridder, published in early 2006. The debate highlighted the difficulty for researchers when their work is released in a heightened political context. We argue that the authors made a logical error in constructing their analysis and interpreting their data, and are therefore not justified in making policy claims for their work. The paper received significant public attention, and may have influenced the public policy position of a major professional body. Deeply held views on all sides of the abortion debate are unlikely to be reconciled, but if policy is to be informed by research, findings must be based on sound science.
doi:10.1186/1743-8462-5-2
PMCID: PMC2390567  PMID: 18442413
7.  Opinion editorials: the science and art of combining evidence with opinion 
Evidence-Based Medicine  2013;18(5):161-164.
In the policy environment, the news media play a powerful and influential role, determining not only what issues are on the broad policy agenda, but also how the public and politicians perceive these issues. Ensuring that reporters and editors have access to information, that is, credible and evidence-based is critical for stimulating healthy public discourse and constructive political debates. EvidenceNetwork.ca is a non-partisan web-based project that makes the latest evidence on controversial health-policy issues available to the Canadian news media. This article introduces EvidenceNetwork.ca, the benefits it offers to journalists and researchers, and the important niche it occupies in working with the news media to build a more productive dialogue around healthcare.
doi:10.1136/eb-2012-100996
PMCID: PMC3786663  PMID: 23143923
Medical Journalism
8.  Suicide Coverage in U.S. Newspapers Following the Publication of the Media Guidelines 
In 2001 several U.S. government agencies and health organizations, including the Center for Disease Control and Prevention, the American Foundation for Suicide Prevention, the American Association of Suicidology and the Annenberg Public Policy Center, published consensus recommendations for the media reporting of suicide. This study evaluated whether these guidelines were followed in U.S. newspapers articles on suicide published in 2002 and 2003. We examined articles featuring individual cases of suicidal behavior (N = 157) published in a nationally representative sample of 968 local and national newspapers. Our main finding is that U.S. newspaper suicide coverage did not consistently reflect the influence of the media guidelines in the two years following their publication. On the positive side, a minority (19%) of stories included inappropriate imagery. On the negative side, suicide stories often detailed suicide method (56% of stories) and location (58%) but rarely provided information about warning signs and risk factors (1% of stories), the role of depression (4%), the role of alcohol (2%), and prevention resources (6%). Our findings, together with previous evidence, suggest the need for sustained dialogue and collaboration with the media about the responsible reporting of suicide.
doi:10.1521/suli.2010.40.5.524
PMCID: PMC3015096  PMID: 21034215
9.  Electromagnetic hypersensitivity (EHS) in the media – a qualitative content analysis of Norwegian newspapers 
JRSM Short Reports  2013;4(11):2042533313487332.
Objectives
Electromagnetic hypersensitivity (EHS) is a condition characterized by experiencing symptoms after perceived exposure to weak electromagnetic fields (EMFs). There is substantial debate concerning the aetiology of EHS, but experimental data indicate no association between EHS and actual presence of EMFs. Newspapers play a key role in shaping peoples’ understanding of health-related issues. The aim of this study was to describe the content of newspaper articles concerning aetiology and treatment of EHS.
Design
Qualitative content analysis of newspaper articles.
Setting
Norwegian newspaper articles were identified using a comprehensive electronic media archive.
Participants
Norwegian newspaper articles published between 1 February 2006 and 11 August 2010.
Main outcome measures
Statements coded according to source of information, whether it was pro or con scientific evidence on EHS aetiology, and type of intervention presented as treatment option for EHS.
Results
Of the statements concerning EHS aetiology (n = 196), 35% (n = 69) were categorized as pro evidence, 65% (n = 127) as con evidence. Of the statements about EHS interventions assessed, 78% (n = 99) were categorized as ‘radiance reduction’, 4% (n = 5) as ‘complementary medicine’, and 18% (n = 23) as ‘other’. Cognitive behavioural therapy (CBT) and psychotropic drugs were never presented as possible treatment options for EHS.
Conclusions
The newspaper media discourse of EHS aetiology and recommended treatment interventions is much in conflict with the current evidence in the field. The majority of statements concerning aetiology convey that EHS is related to the presence of weak EMFs, and radiance reduction as the most frequently conveyed measure to reduce EHS-related symptoms.
doi:10.1177/2042533313487332
PMCID: PMC3831852  PMID: 24319582
electromagnetic hypersensitivity; EHS; media; newspapers; qualitative content analysis
10.  The privileged normalization of marijuana use – an analysis of Canadian newspaper reporting, 1997–2007 
Critical Public Health  2013;24(1):47-61.
The objective of this study was to systematically examine predominant themes within mainstream media reporting about marijuana use in Canada. To ascertain the themes present in major Canadian newspaper reports, a sample (N = 1999) of articles published between 1997 and 2007 was analyzed. Drawing from Manning's theory of the symbolic framing of drug use within media, it is argued that a discourse of ‘privileged normalization’ informs portrayals of marijuana use and descriptions of the drug's users. Privileged normalization implies that marijuana use can be acceptable for some people at particular times and places, while its use by those without power and status is routinely vilified and linked to deviant behavior. The privileged normalization of marijuana by the media has important health policy implications in light of continued debate regarding the merits of decriminalization or legalization and the need for public health and harm reduction approaches to illicit drug use.
doi:10.1080/09581596.2013.771812
PMCID: PMC3919199  PMID: 24574580
drugs; public policy; media
11.  Use of the Internet as a Resource for Consumer Health Information: Results of the Second Osteopathic Survey of Health Care in America (OSTEOSURV-II) 
Background
The Internet offers consumers unparalleled opportunities to acquire health information. The emergence of the Internet, rather than more-traditional sources, for obtaining health information is worthy of ongoing surveillance, including identification of the factors associated with using the Internet for this purpose.
Objectives
To measure the prevalence of Internet use as a mechanism for obtaining health information in the United States; to compare such Internet use with newspapers or magazines, radio, and television; and to identify sociodemographic factors associated with using the Internet for acquiring health information.
Methods
Data were acquired from the Second Osteopathic Survey of Health Care in America (OSTEOSURV-II), a national telephone survey using random-digit dialing within the United States during 2000. The target population consisted of adult, noninstitutionalized, household members. As part of the survey, data were collected on: facility with the Internet, sources of health information, and sociodemographic characteristics. Multivariate analysis was used to identify factors associated with acquiring health information on the Internet.
Results
A total of 499 (64% response rate) respondents participated in the survey. With the exception of an overrepresentation of women (66%), respondents were generally similar to national referents. Fifty percent of respondents either strongly agreed or agreed that they felt comfortable using the Internet as a health information resource. The prevalence rates of using the health information sources were: newspapers or magazines, 69%; radio, 30%; television, 56%; and the Internet, 32%. After adjusting for potential confounders, older respondents were more likely than younger respondents to use newspapers or magazines and television to acquire health information, but less likely to use the Internet. Higher education was associated with greater use of newspapers or magazines and the Internet as health information sources. Internet use was lower in rural than urban or suburban areas.
Conclusions
The Internet has already surpassed radio as a source of health information but still lags substantially behind print media and television. Significant barriers to acquiring health information on the Internet remain among persons 60 years of age or older, those with 12 or fewer years of education, and those residing in rural areas. Stronger efforts are needed to ensure access to and facility with the Internet among all segments of the population. This includes user-friendly access for older persons with visual or other functional impairments, providing low-literacy Web sites, and expanding Internet infrastructure to reach all areas of the United States.
doi:10.2196/jmir.3.4.e31
PMCID: PMC1761915  PMID: 11772546
Internet, health care surveys, socioeconomic factors, age factors, family practice
12.  Race, Ethnicity, Language, Social Class, and Health Communication Inequalities: A Nationally-Representative Cross-Sectional Study 
PLoS ONE  2011;6(1):e14550.
Background
While mass media communications can be an important source of health information, there are substantial social disparities in health knowledge that may be related to media use. The purpose of this study is to investigate how the use of cancer-related health communications is patterned by race, ethnicity, language, and social class.
Methodology/Principal Findings
In a nationally-representative cross-sectional telephone survey, 5,187 U.S. adults provided information about demographic characteristics, cancer information seeking, and attention to and trust in health information from television, radio, newspaper, magazines, and the Internet. Cancer information seeking was lowest among Spanish-speaking Hispanics (odds ratio: 0.42; 95% confidence interval: 0.28–0.63) compared to non-Hispanic whites. Spanish-speaking Hispanics were more likely than non-Hispanic whites to pay attention to (odds ratio: 3.10; 95% confidence interval: 2.07–4.66) and trust (odds ratio: 2.61; 95% confidence interval: 1.53–4.47) health messages from the radio. Non-Hispanic blacks were more likely than non-Hispanic whites to pay attention to (odds ratio: 2.39; 95% confidence interval: 1.88–3.04) and trust (odds ratio: 2.16; 95% confidence interval: 1.61–2.90) health messages on television. Those who were college graduates tended to pay more attention to health information from newspapers (odds ratio: 1.98; 95% confidence interval: 1.42–2.75), magazines (odds ratio: 1.86; 95% confidence interval: 1.32–2.60), and the Internet (odds ratio: 4.74; 95% confidence interval: 2.70–8.31) and had less trust in cancer-related health information from television (odds ratio: 0.44; 95% confidence interval: 0.32–0.62) and radio (odds ratio: 0.54; 95% confidence interval: 0.34–0.86) compared to those who were not high school graduates.
Conclusions/Significance
Health media use is patterned by race, ethnicity, language and social class. Providing greater access to and enhancing the quality of health media by taking into account factors associated with social determinants may contribute to addressing social disparities in health.
doi:10.1371/journal.pone.0014550
PMCID: PMC3022647  PMID: 21267450
13.  Labour and Hospitals in Urban Yorkshire: Middlesbrough, Leeds and Sheffield, 1919–1938 
Social History of Medicine  2010;23(2):374-392.
In the debates over the politics of National Health Service foundation, there has been little investigation of the attitudes of the inter-war labour movement to a state-run hospital system. In particular, there has been limited assessment of views outside parliament in provincial Labour parties and trade unions. Drawing on a case study of Middlesbrough, Leeds and Sheffield, this article examines the politics of hospital provision prior to the National Health Service (NHS). It focuses on the involvement of the labour movement in hospital provision within localities and on the extent to which the dominant form of labour politics—labourist or socialist—shaped hospital policy. It suggests that, in the heavy industrial towns of Middlesbrough and Sheffield, close involvement with voluntary hospitals through workers contributory schemes dampened the enthusiasm for a state system. However, such a policy was heavily promoted by socialists in more economically diverse Leeds.
doi:10.1093/shm/hkq007
PMCID: PMC2911269
hospitals; Labour movement; contributory schemes; inter-war
14.  Political and Institutional Influences on the Use of Evidence in Public Health Policy. A Systematic Review 
PLoS ONE  2013;8(10):e77404.
Background
There is increasing recognition that the development of evidence-informed health policy is not only a technical problem of knowledge exchange or translation, but also a political challenge. Yet, while political scientists have long considered the nature of political systems, the role of institutional structures, and the political contestation of policy issues as central to understanding policy decisions, these issues remain largely unexplored by scholars of evidence-informed policy making.
Methods
We conducted a systematic review of empirical studies that examined the influence of key features of political systems and institutional mechanisms on evidence use, and contextual factors that may contribute to the politicisation of health evidence. Eligible studies were identified through searches of seven health and social sciences databases, websites of relevant organisations, the British Library database, and manual searches of academic journals. Relevant findings were extracted using a uniform data extraction tool and synthesised by narrative review.
Findings
56 studies were selected for inclusion. Relevant political and institutional aspects affecting the use of health evidence included the level of state centralisation and democratisation, the influence of external donors and organisations, the organisation and function of bureaucracies, and the framing of evidence in relation to social norms and values. However, our understanding of such influences remains piecemeal given the limited number of empirical analyses on this subject, the paucity of comparative works, and the limited consideration of political and institutional theory in these studies.
Conclusions
This review highlights the need for a more explicit engagement with the political and institutional factors affecting the use of health evidence in decision-making. A more nuanced understanding of evidence use in health policy making requires both additional empirical studies of evidence use, and an engagement with theories and approaches beyond the current remit of public health or knowledge utilisation studies.
doi:10.1371/journal.pone.0077404
PMCID: PMC3813708  PMID: 24204823
15.  Working on reform. How workers' compensation medical care is affected by health care reform. 
Public Health Reports  1996;111(1):12-25.
The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies?
Images
PMCID: PMC1381735  PMID: 8610187
16.  Newspaper Coverage of Intimate Partner Violence: Skewing Representations of Risk 
The Journal of communication  2008;58(1):168-186.
How media portray intimate partner violence (IPV) has implications for public perceptions and social policy. Therefore, to better understand these portrayals, this study content analyzes a nationally representative sample of newspaper coverage of IPV over a two-year-period and compares this coverage to epidemiological data in order to examine the implications of the discrepancies between coverage and social reality. Stratified media outlets across the country were used to obtain a representative sample of daily newspapers based on their designated market areas, resulting in 395 IPV-related articles. Results show that newspaper framing of IPV tends to be heavily skewed toward episodic framing. In addition, there are significant differences between our data and epidemiological estimates, particularly in the coverage of homicide and use of alcohol and illegal drugs, which may skew public perceptions of risk. Implications for public perceptions and social policy are discussed.
doi:10.1111/j.1460-2466.2007.00379.x
PMCID: PMC3032440  PMID: 21297889
17.  Effects of Mass Media Coverage on Timing and Annual Receipt of Influenza Vaccination among Medicare Elderly 
Health services research  2010;45(5P1):1287-1309.
Objective
To measure the association between mass media coverage on flu-related topics and influenza vaccination, regarding timing and annual vaccination rates, among the nationally representative community-dwelling elderly.
Data Source
1999, 2000 and 2001 Medicare Current Beneficiary Survey (MCBS).
Study Design
Cross-sectional survival analyses during each of three influenza vaccination seasons between September 1999 and December 2001. The outcome variable was daily vaccine receipt. We measured daily media coverage by counting the number of television program transcripts and newspaper/wire service articles, including keywords of influenza/flu and vaccine shortage/delay. All models’ covariates included three types of media, vaccine supply, and regional/individual factors.
Principal Findings
Influenza-related reports in all three media sources had a positive association with earlier vaccination timing and annual vaccination rate. Four television–networks’ reports had most consistent positive effects in all models, e.g., shifting the mean vaccination timing earlier by 1.8–4.1 days (p<.001) or increasing the annual vaccination rate by 2.3–7.9% (p<.001). These associations tended to be greater when reported in a headline rather than in text only and if including additional keywords, e.g., vaccine shortage/delay.
Conclusions
Timing and annual receipt of influenza vaccination appear to be influenced by media coverage, particularly by headlines and specific reports on shortage/delay.
doi:10.1111/j.1475-6773.2010.01127.x
PMCID: PMC2939276  PMID: 20579128
Vaccination; influenza; timing; annual vaccination rate; mass media coverage
18.  Effects of Mass Media Coverage on Timing and Annual Receipt of Influenza Vaccination among Medicare Elderly 
Health Services Research  2010;45(5 Pt 1):1287-1309.
Objective
To measure the association between mass media coverage on flu-related topics and influenza vaccination, regarding timing and annual vaccination rates, among the nationally representative community-dwelling elderly.
Data Source
Years 1999, 2000, and 2001 Medicare Current Beneficiary Survey.
Study Design
Cross-sectional survival analyses during each of three influenza vaccination seasons between September 1999 and December 2001. The outcome variable was daily vaccine receipt. We measured daily media coverage by counting the number of television program transcripts and newspaper/wire service articles, including keywords of influenza/flu and vaccine/shot shortage/delay. All models' covariates included three types of media, vaccine supply, and regional/individual factors.
Principal Findings
Influenza-related reports in all three media sources had a positive association with earlier vaccination timing and annual vaccination rate. Four television networks' reports had most consistent positive effects in all models, for example, shifting the mean vaccination timing earlier by 1.8–4.1 days (p<.001) or increasing the annual vaccination rate by 2.3–7.9 percentage points (p<.001). These effects tended to be greater when reported in a headline rather than in text only and if including additional keywords, for example, vaccine shortage/delay.
Conclusions
Timing and annual receipt of influenza vaccination appear to be influenced by media coverage, particularly by headlines and specific reports on shortage/delay.
doi:10.1111/j.1475-6773.2010.01127.x
PMCID: PMC2939276  PMID: 20579128
Vaccination; influenza; vaccination timing; annual vaccination rate; mass media coverage
19.  Local government alcohol policy development: case studies in three New Zealand communities 
Addiction (Abingdon, England)  2012;108(5):885-895.
Aims
Local alcohol policies can be effective in reducing alcohol-related harm. The aim of this study was to examine local government responses to alcohol-related problems and identify factors influencing their development and adoption of alcohol policy.
Designsettings and participants
Case studies were used to examine local government responses to alcohol problems in three New Zealand communities: a rural town, a provincial city and a metropolitan city. Newspaper reports, local government documents and key informant interviews were used to collect data which were analysed using two conceptual frameworks: Kingdon's Streams model and the Stakeholder model of policy development.
Measurements
Key informant narratives were categorized according to the concepts of the Streams and Stakeholder models.
Findings
Kingdon's theoretical concepts associated with increased likelihood of policy change seemed to apply in the rural and metropolitan communities. The political environment in the provincial city, however, was not favourable to the adoption of alcohol restrictions. The Stakeholder model highlighted differences between the communities in terms of power over agenda-setting and conflict between politicians and bureaucrats over policy solutions to alcohol-related harm. These differences were reflected in the ratio of policies considered versus adopted in each location. Decisions on local alcohol policies lie ultimately with local politicians, although the policies that can be adopted by local government are restricted by central government legislation.
Conclusions
The adoption of policies and strategies to reduce alcohol-related harm may be better facilitated by an agenda-setting process where no ‘gate-keepers’ determine what is included into the agenda, and community mobilization efforts to create competitive local government elections around alcohol issues. Policy adoption would also be facilitated by more enabling central government legislation.
doi:10.1111/add.12017
PMCID: PMC3652029  PMID: 23130762
Alcohol; case studies; local government; policy development.
20.  Investigating the health implications of social policy initiatives at the local level: study design and methods 
BMC Public Health  2010;10:759.
Background
In this paper we present the research design and methods of a study that seeks to capture local level responses to an Australian national social policy initiative, aimed at reducing inequalities in the social determinants of health.
Methods/Design
The study takes a policy-to-practice approach and combines policy and stakeholder interviewing with a comparative case study analysis of two not-for-profit organisations involved in the delivery of federal government policy.
Discussion
Before the health impacts of broad-scale policies, such as the one described in this study, can be assessed at the population level, we need to understand the implementation process. This is consistent with current thinking in political science and social policy, which has emphasised the importance of investigating how, and if, policies are translated into operational realities.
doi:10.1186/1471-2458-10-759
PMCID: PMC3016388  PMID: 21143875
21.  An integrated strategy of knowledge application for optimal e-health implementation: A multi-method study protocol 
Background
E-health is increasingly valued for supporting: 1) access to quality health care services for all citizens; 2) information flow and exchange; 3) integrated health care services and 4) interprofessional collaboration. Nevertheless, several questions remain on the factors allowing an optimal integration of e-health in health care policies, organisations and practices. An evidence-based integrated strategy would maximise the efficacy and efficiency of e-health implementation. However, decisions regarding e-health applications are usually not evidence-based, which can lead to a sub-optimal use of these technologies. This study aims at understanding factors influencing the application of scientific knowledge for an optimal implementation of e-health in the health care system.
Methods
A three-year multi-method study is being conducted in the Province of Quebec (Canada). Decision-making at each decisional level (political, organisational and clinical) are analysed based on specific approaches. At the political level, critical incidents analysis is being used. This method will identify how decisions regarding the implementation of e-health could be influenced or not by scientific knowledge. Then, interviews with key-decision-makers will look at how knowledge was actually used to support their decisions, and what factors influenced its use. At the organisational level, e-health projects are being analysed as case studies in order to explore the use of scientific knowledge to support decision-making during the implementation of the technology. Interviews with promoters, managers and clinicians will be carried out in order to identify factors influencing the production and application of scientific knowledge. At the clinical level, questionnaires are being distributed to clinicians involved in e-health projects in order to analyse factors influencing knowledge application in their decision-making. Finally, a triangulation of the results will be done using mixed methodologies to allow a transversal analysis of the results at each of the decisional levels.
Results
This study will identify factors influencing the use of scientific evidence and other types of knowledge by decision-makers involved in planning, financing, implementing and evaluating e-health projects.
Conclusion
These results will be highly relevant to inform decision-makers who wish to optimise the implementation of e-health in the Quebec health care system. This study is extremely relevant given the context of major transformations in the health care system where e-health becomes a must.
doi:10.1186/1472-6947-8-17
PMCID: PMC2390530  PMID: 18435853
22.  Integrating Economic Evaluation Methods Into Clinical and Translational Science Award Consortium Comparative Effectiveness Educational Goals 
With the ongoing debate over health care reform in the United States, public health and policy makers have paid growing attention to the need for comparative effectiveness research (CER). Recent allocation of federal funds for CER represents a significant move toward increased evidence-based practice and better informed allocation of constrained health care resources; however, there is also heated debate on how, or whether, CER may contribute to controlling national health care expenditures. Economic evaluation, in the form of cost-effectiveness or cost-benefit analysis, is often an aspect of CER studies, yet there are no recommendations or guidelines for providing clinical investigators with the necessary skills to collect, analyze, and interpret economic data from clinical trials or observational studies. With an emphasis on multidisciplinary research, the Clinical and Translational Science Award (CTSA) consortium and institutional CTSA sites serve as an important resource for training researchers to engage in CER. In this article, the authors discuss the potential role of CTSA sites in integrating economic evaluation methods into their comparative effectiveness education goals, using the Columbia University Medical Center CTSA as an example. By allowing current and future generations of clinical investigators to become fully engaged not only in CER, but in the economic evaluations that result from such analyses, CTSA sites can help develop the necessary foundation for advancing research to guide clinical decision making and efficient use of limited resources.
doi:10.1097/ACM.0b013e318217cf25
PMCID: PMC3103295  PMID: 21512372
23.  Policy mapping for establishing a national emergency health policy for Nigeria 
Background
The number of potential life years lost due to accidents and injuries though poorly studied has resulted in tremendous economic and social loss to Nigeria. Numerous socio-cultural, economic and political factors including the current epidemic of ethnic and religious conflicts act in concert in predisposing to and enabling the ongoing catastrophe of accident and injuries in Nigeria.
Methods
Using the "policymaker", Microsoft-Windows® based software, the information generated on accidents and injuries and emergency health care in Nigeria from literature review, content analysis of relevant documents, expert interviewing and consensus opinion, a model National Emergency Health Policy was designed and analyzed. A major point of analysis for the policy is the current political feasibility of the policy including its opportunities and obstacles in the country.
Results
A model National Emergency Health Policy with policy goals, objectives, programs and evaluation benchmarks was generated. Critical analyses of potential policy problems, associated multiple players, diverging interests and implementation guidelines were developed.
Conclusions
"Political health modeling" a term proposed here would be invaluable to policy makers and scholars in developing countries in assessing the political feasibility of policy managing. Political modeling applied to the development of a NEHP in Nigeria would empower policy makers and the policy making process and would ensure a sustainable emergency health policy in Nigeria.
doi:10.1186/1472-698X-2-5
PMCID: PMC126243  PMID: 12181080
Nigeria; Injuries; Emergency; Health; Policy
24.  Views on the nature of chronic fatigue syndrome: content analysis 
JRSM Short Reports  2013;4(1):4.
Objectives
Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), has provoked much controversy and led to arguments between the medical profession and patient organizations. A particular focus for debate is the categorization of the condition as physical or psychological in its nature. The aim of this study was to compare how the written media, patient organizations and medical authorities regard the illness.
Design
Content analysis of newspaper articles, ME patient organization websites, and medical websites and textbooks were assessed by two independent assessors.
Setting
Three national UK newspapers, UK ME websites, and UK medical websites and textbooks, were accessed during 2010.
Participants
146 source files were scored from 36 patients' organizations, 72 media articles and 38 medical authorities.
Main outcome measured
The overall opinion of an article or website was rated using a five point Likert scale, from ‘extremely psychological’ (scored as 1), ‘moderately psychological’ (2), ‘both psychological and physical’ (3), ‘moderately physical’ (4) or ‘extremely physical’ (5).
Results
Eighty-nine percent (32 of 36) of ME patient organizations considered the illness to be physical, compared with 58% (42/72) of newspaper articles, and 24% (9/38) of medical authorities. Sixty-three percent (24/38) of medical authorities regarded the illness as both physical and psychological. The inter-group differences of the Likert scores were statistically significant (χ2 = 27.37, 2 df, P < 0.001).
Conclusion
The considerable disagreement, particularly between ME patient organizations and medical authorities, may help to explain the gulf in understanding between doctors and patients and the consequent reluctance of some patients to engage in behavioural treatments.
doi:10.1258/shorts.2012.012051
PMCID: PMC3572659  PMID: 23413406
25.  Political economy and population health: is Australia exceptional? 
Background
It is accepted knowledge that social and economic conditions – like education and income – affect population health. What remains uncertain is whether the degree of inequality in these conditions influences population health and if so, how. Some researchers who argue that inequalities are important, say there is a relationship between political economy, inequality and population health. Their evidence comes from comparative studies showing that countries with neo-liberal political economies generally have poorer population health outcomes than those with social or Christian democratic political economies. According to these researchers, neo-liberal political economies adopt labour market and welfare state policies that lead to greater levels of inequality and poorer population health outcomes for us all.
Discussion
Australia has experienced considerable social and economic reforms over the last 20 years, with both major political parties increasingly adopting neo-liberal policies. Despite these reforms, population health outcomes are amongst the best in the world.
Summary
Australia appears to contest theories suggesting a link between political economy and population health. To progress our understanding, researchers need to concentrate on policy areas outside health – such as welfare, economics and industrial relations. We need to do longitudinal studies on how reforms in these areas affect levels of social and economic inequality, as well population health. We need to draw on social scientific methods, especially concerning case selection, to advance our understanding of casual relationships in policy studies. It is important to find out if, and why, Australia has resisted the affects of neo-liberalism on population health so we ensure our high standards are maintained in the future.
doi:10.1186/1743-8462-3-6
PMCID: PMC1513585  PMID: 16737549

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