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1.  Patterns of research activity related to government policy: a UK web based survey 
Archives of Disease in Childhood  2005;90(11):1107-1111.
Aims: To describe the patterns of child and family health and wellbeing research activity in the fiscal year (FY) 2002/2003 in relation to UK government policies.
Methods: Projects investigating the health and wellbeing of children and families were located through a web based survey of major research funders, including UK government departments and non-departmental public bodies, research councils, and medical charities. A budget was estimated for each project for the FY 2002/2003, and each project coded according to a framework which reflected government priorities and research methodologies.
Results: There was a substantial amount of project information posted on the websites of the funding organisations, but the level of detail varied. For the FY 2002/2003, 31 organisations were identified that commissioned 567 projects investigating the health and wellbeing of children and families. Based on information from organisations' websites, this represented approximately 3% of their research budgets. Within this funding area, low proportions of research activity related to health inequalities (9% of total expenditure on child and family health research), health economic analysis (8%), primary and secondary prevention (12%), and children and adolescents at high risk of ill health (14%).
Conclusions: A limited amount of research activity on children and families health funded in the FY 2002/2003 is addressing UK government policy priorities. This suggests the need to commission further research to fill gaps in the evidence.
doi:10.1136/adc.2004.069781
PMCID: PMC1720150  PMID: 16243861
2.  Situational analysis of teaching and learning of medicine and nursing students at Makerere University College of Health Sciences 
Background
Makerere University College of Health Sciences (MakCHS) in Uganda is undergoing a major reform to become a more influential force in society. It is important that its medicine and nursing graduates are equipped to best address the priority health needs of the Ugandan population, as outlined in the government’s Health Sector Strategic Plan (HSSP). The assessment identifies critical gaps in the core competencies of the MakCHS medicine and nursing and ways to overcome them in order to achieve HSSP goals.
Methods
Documents from the Uganda Ministry of Health were reviewed, and medicine and nursing curricula were analyzed. Nineteen key informant interviews (KII) and seven focus group discussions (FGD) with stakeholders were conducted. The data were manually analyzed for emerging themes and sub-themes. The study team subsequently used the checklists to create matrices summarizing the findings from the KIIs, FGDs, and curricula analysis. Validation of findings was done by triangulating information from the different data collection methods.
Results
The core competencies that medicine and nursing students are expected to achieve by the end of their education were outlined for both programs. The curricula are in the process of reform towards competency-based education, and on the surface, are well aligned with the strategic needs of the country. But implementation is inadequate, and can be changed:
• Learning objectives need to be more applicable to achieving competencies.
• Learning experiences need to be more relevant for competencies and setting in which students will work after graduation (i.e. not just clinical care in a tertiary care facility).
• Student evaluation needs to be better designed for assessing these competencies.
Conclusion
MakCHS has made a significant attempt to produce relevant, competent nursing and medicine graduates to meet the community needs. Ways to make them more effective though deliberate efforts to apply a competency-based education are possible.
doi:10.1186/1472-698X-11-S1-S3
PMCID: PMC3059475  PMID: 21411003
3.  A cross-sectional pilot study of the Scottish early development instrument: a tool for addressing inequality 
BMC Public Health  2013;13:1187.
Background
Early childhood is recognised as a key developmental phase with implications for social, academic, health and wellbeing outcomes in later childhood and indeed throughout the adult lifespan. Community level data on inequalities in early child development are therefore required to establish the impact of government early years’ policies and programmes on children’s strengths and vulnerabilities at local and national level. This would allow local leaders to target tailored interventions according to community needs to improve children’s readiness for the transition to school. The challenge is collecting valid data on sufficient samples of children entering school to derive robust inferences about each local birth cohort’s developmental status. This information needs to be presented in a way that allows community stakeholders to understand the results, expediting the improvement of preschool programming to improve future cohorts’ development in the early years. The aim of the study was to carry out a pilot to test the feasibility and ease of use in Scotland of the 104-item teacher-administered Early Development Instrument, an internationally validated measure of children’s global development at school entry developed in Canada.
Methods
Phase 1 was piloted in an education district with 14 Primary 1 teachers assessing a cohort of 154 children, following which the instrument was adapted for the Scottish context (Scottish Early Development Instrument: SEDI). Phase 2 was then carried out using the SEDI. Data were analysed from a larger sample of 1090 participants, comprising all Primary 1 children within this school district, evaluated by 68 teachers.
Results
The SEDI displayed adequate psychometric and discriminatory properties and is appropriate for use across Scotland without any further modifications. Children in the lowest socioeconomic status quintiles were 2–3 times more likely than children in the most affluent quintile to score low in at least one developmental domain. Even in the most affluent quintile though, 17% of children were ‘developmentally vulnerable’, suggesting that those in need cannot be identified by socioeconomic status alone.
Conclusions
The SEDI offers a feasible means of providing communities with a holistic overview of school readiness for targeting early years’ interventions.
doi:10.1186/1471-2458-13-1187
PMCID: PMC3890505  PMID: 24341526
Early development instrument; Child development; Scotland; Socioeconomic factors; Health inequalities/disparities
4.  Reversing the trend of weak policy implementation in the Kenyan health sector? – a study of budget allocation and spending of health resources versus set priorities 
Background
Policy implementation in the context of health systems is generally difficult and the Kenyan health sector situation is not an exception. In 2005, a new health sector strategic plan that outlines the vision and the policy direction of the health sector was launched and during the same year the health sector was allocated a substantial budget increment. On basis of these indications of a willingness to improve the health care system among policy makers, the objective of this study was to assess whether there was a change in policy implementation during 2005 in Kenya.
Methodology
Budget allocations and actual expenditures compared to set policy objectives in the Kenyan health sector was studied. Three data sources were used: budget estimates, interviews with key stakeholders in the health sector and government and donor documentation.
Results
Budget allocations and actual expenditures in part go against policy objectives. Failures to use a significant proportion of available funds, reallocation of funds between line items and weak procurements systems at the local level and delays in disbursement of funds at the central level create gaps between policy objectives and policy implementation. Some of the discrepancy seems to be due to a mismatch between responsibilities and capabilities at different levels of the system.
Conclusion
We found no evidence that the trend of weak policy implementation in the Kenyan health sector was reversed during 2005 but ongoing efforts towards hastening release of funds to the districts might help solving the issue of low absorption capacity at the district level. It is important, however, to work with clear definitions of roles and responsibilities and well-functioning communications between different levels of the system.
doi:10.1186/1478-4505-5-3
PMCID: PMC1851957  PMID: 17394640
5.  A survey of local health promotion initiatives for older people in Wales 
BMC Public Health  2008;8:217.
Background
As the demographic profile of the UK changes, policy makers and practitioners have to respond to health challenges presented by a progressively ageing population. The health promotion plan for older people, aged over 50 years, in Wales included eight key areas: physical activity, healthy eating, home safety and warmth, emotional health, health protection, smoking, alcohol and sexual health. The aim of this study was to describe the extent, content and regional variation of existing health promotion initiatives for older people in Wales, provided by statutory, voluntary and private sector agencies.
Method
A questionnaire was sent to senior health promotion specialists employed in the 22 local authority areas in Wales to ascertain details of all projects promoting health and wellbeing in the eight key areas where the priority population was aged over 50, or the majority of users were older people. Additional information was sought from project leads and websites.
Results
Eighteen questionnaires were returned; not all were fully completed. Four areas did not return a questionnaire. Additional information was obtained from internet searches but this mainly concerned national initiatives rather than local projects. In all, 120 projects were included, 11 were throughout Wales. Best provision was for physical activity, with 3 national and 42 local initiatives, but local provision was patchy. Healthy eating, and home safety and warmth had far fewer initiatives, as did health protection, which comprised two national immunisation campaigns. Smoking and alcohol misuse were poorly provided for, and there was no provision for older people's sexual health. Evaluation arrangements were poorly described. Half of those who responded identified unmet training needs.
Conclusion
The reasons for patchy provision of services were not clear. Increased efforts to improve the coverage of interventions known to be effective should be made. Rigorous evaluation of projects is needed to ascertain the most effective and appropriate interventions, especially for alcohol misuse and sexual health. These conclusions are relevant to the other countries of the United Kingdom (UK), and more widely across Europe.
doi:10.1186/1471-2458-8-217
PMCID: PMC2492859  PMID: 18565238
6.  Health, policy and geography: Insights from a multi-level modelling approach☆ 
Social Science & Medicine (1982)  2013;92(100):61-73.
Improving the health and wellbeing of citizens ranks highly on the agenda of most governments. Policy action to enhance health and wellbeing can be targeted at a range of geographical levels and in England the focus has tended to shift away from the national level to smaller areas, such as communities and neighbourhoods. Our focus is to identify the potential for targeting policy interventions at the most appropriate geographical levels in order to enhance health and wellbeing. The rationale is that where variations in health and wellbeing indicators are larger, there may be greater potential for policy intervention targeted at that geographical level to have an impact on the outcomes of interest, compared with a strategy of targeting policy at those levels where relative variations are smaller. We use a multi-level regression approach to identify the degree of variation that exists in a set of health indicators at each level, taking account of the geographical hierarchical organisation of public sector organisations. We find that for each indicator, the proportion of total residual variance is greatest at smaller geographical areas. We also explore the variations in health indicators within a hierarchical level, but across the geographical areas for which public sector organisations are responsible. We show that it is feasible to identify a sub-set of organisations for which unexplained variation in health indicators is significantly greater relative to their counterparts. We demonstrate that adopting a geographical perspective to analyse the variation in indicators of health at different levels offers a potentially powerful analytical tool to signal where public sector organisations, faced increasingly with many competing demands, should target their policy efforts. This is relevant not only to the English context but also to other countries where responsibilities for health and wellbeing are being devolved to localities and communities.
Highlights
•Policies to enhance wellbeing may be targeted at different hierarchical levels such as individual, neighbourhood or region.•Organisations responsible for implementing such policies also operate in geographically defined administrative boundaries.•We explore the variation in a range of health-related indicators at a number of geographical hierarchical levels.•We find evidence of variation between organisations within the same hierarchy and also between hierarchical levels.•The results direct policymakers in public sector organisations to target their policy efforts where impact may be greatest.
doi:10.1016/j.socscimed.2013.05.021
PMCID: PMC3726938  PMID: 23849280
England; Multilevel models; Small area analysis; Health indicators; Public sector organisations; Policy intervention
7.  Stakeholders’ participation in planning and priority setting in the context of a decentralised health care system: the case of prevention of mother to child transmission of HIV programme in Tanzania 
Background
In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has remained a challenge. The study assessed the priority setting processes in the planning of the prevention of mother to child transmission of HIV (PMTCT) programme at the district level in Tanzania.
Methods
This qualitative study was conducted in Mbarali district, south-western Tanzania. The study applied in-depth interviews and focus group discussions in the data collection. Informants included members of the Council Health Management Team, regional PMTCT managers and health facility providers.
Results
Two plans were reported where PMTCT activities could be accommodated; the Comprehensive Council Health Plan and the Regional PMTCT Plan that was donor funded. As donors had their own globally defined priorities, it proved difficult for district and regional managers to accommodate locally defined PMTCT priorities in these plans. As a result few of these were funded. Guidelines and main priority areas of the Ministry of Health and Social Welfare (MoHSW) also impacted on the ability of the districts and regions to act, undermining the effectiveness of the decentralisation policy in the health sector.
Conclusion
The challenges in the priority setting processes revealed within the PMTCT initiative indicate substantial weaknesses in implementing the Tanzania decentralisation policy. There is an urgent need to revive the strategies and aims of the decentralisation policy at all levels of the health care system with a view to improving health service delivery.
doi:10.1186/1472-6963-13-273
PMCID: PMC3720200  PMID: 23849730
Planning; Priority setting; PMTCT; Decentralisation; Donor influence; Tanzania
8.  What should be done about policy on alcohol pricing and promotions? Australian experts’ views of policy priorities: a qualitative interview study 
BMC Public Health  2013;13:610.
Background
Alcohol policy priorities in Australia have been set by the National Preventative Health Task Force, yet significant reform has not occurred. News media coverage of these priorities has not reported public health experts as in agreement and Government has not acted upon the legislative recommendations made. We investigate policy experts’ views on alcohol policy priorities with a view to establishing levels of accord and providing suggestions for future advocates.
Methods
We conducted semi-structured in depth interviews with alcohol policy experts and advocates around Australia. Open-ended questions examined participants’ thoughts on existing policy recommendations, obvious policy priorities and specifically, the future of national reforms to price and promotions policies. All transcripts were analysed for major themes and points of agreement or disagreement.
Results
Twenty one alcohol policy experts agreed that pricing policies are a top national priority and most agreed that “something should be done” about alcohol advertising. Volumetric taxation and minimum pricing were regarded as the most important price policies, yet differences emerged in defining the exact form of a proposed volumetric tax. Important differences in perspective emerged regarding alcohol promotions, with lack of agreement about the preferred form regulations should take, where to start and who the policy should be directed at. Very few discussed online advertising and social networks.
Conclusions
Despite existing policy collaborations, a clear ‘cut through’ message is yet to be endorsed by all alcohol control advocates. There is a need to articulate and promote in greater detail the specifics of policy reforms to minimum pricing, volumetric taxation and restrictions on alcohol advertising, particularly regarding sporting sponsorships and new media.
doi:10.1186/1471-2458-13-610
PMCID: PMC3717017  PMID: 23800324
Alcohol advertising; Alcohol pricing; Policy; Public health; Advocacy
9.  A network approach for researching partnerships in health 
Background
The last decade has witnessed a significant move towards new modes of governing that are based on coordination and collaboration. In particular, local level partnerships have been widely introduced around the world. There are few comprehensive approaches for researching the effects of these partnerships. The aim of this paper is to outline a network approach that combines structure and agency based explanations to research partnerships in health. Network research based on two Primary Care Partnerships (PCPs) in Victoria is used to demonstrate the utility of this approach. The paper examines multiple types of ties between people (structure), and the use and value of relationships to partners (agency), using interviews with the people involved in two PCPs – one in metropolitan Melbourne and one in a rural area.
Results
Network maps of ties based on work, strategic information and policy advice, show that there are many strong connections in both PCPs. Not surprisingly, PCP staff are central and highly connected. Of more interest are the ties that are dependent on these dedicated partnership staff, as they reveal which actors become weakly linked or disconnected without them. Network measures indicate that work ties are the most dispersed and strategic information ties are the most concentrated around fewer people. Divisions of general practice are weakly linked, while local government officials and Department of Human Services (DHS) regional staff appear to play important bridging roles. Finally, the relationships between partners have changed and improved, and most of those interviewed value their new or improved links with partners.
Conclusion
Improving service coordination and health promotion planning requires engaging people and building strong relationships. Mapping ties is a useful means for assessing the strengths and weaknesses of partnerships, and network analysis indicates concentration and dispersion, the importance of particular individuals, and the points at which they will fragment. A narrative approach adds an assessment of whether the partnerships are being used and valued. The approach outlined here, which examines structure and agency as separate but related explanations, has much to offer in examining partnerships.
doi:10.1186/1743-8462-2-22
PMCID: PMC1276782  PMID: 16209718
10.  UK Breastfeeding Helpline support: An investigation of influences upon satisfaction 
Background
Helpline services have become an increasingly popular mode of providing community access to information and expert information and advice in the health and welfare sector. This paper reports on data collected from 908 callers to UK-based breastfeeding helplines.
Methods
A mixed methods design was adopted utilising a structured interview schedule to elicit callers experiences of the help and support received. In this paper we report on a series of multiple regression models undertaken to elicit the variables associated with callers’ ‘overall satisfaction’ with the helpline service. Three models were constructed; 1) caller demographic/call characteristics; 2) attitudes and effectiveness of service characteristics and 3) impact of support on caller wellbeing.
Results
Overall, 74.6% of callers were very satisfied, and 19.8% were satisfied with the help and support received by the helpline service. The caller demographic/call characteristics found to have a significant relationship with overall satisfaction related to the ease of getting through to the helpline and whether the woman had previously breastfed. Service characteristics associated with overall satisfaction related to whether the information received was helpful and whether the support helped to resolve their issues. The extent to which the volunteer was perceived to have enough time, whether the support had encouraged them to continue breastfeeding, met the caller’s expectations and/or provided the support the caller needed were also significantly associated. Caller outcomes contributing significantly to overall satisfaction concerned callers feeling less stressed, more confident, reassured and determined to continue breastfeeding following the call. Consideration of the effect sizes indicated that key factors associated with overall satisfaction related to: volunteers having sufficient time to deal with the callers’ issues; the information being perceived as helpful; the volunteers providing the support the callers needed; and for callers to feel reassured following the call.
Conclusion
Overall, these results highlight the value of the breastfeeding helpline(s) in terms of providing rapid, targeted, realistic, practical, and responsive support that provides affirmation and encouragement. The benefits include confidence building and callers feeling reassured and motivated to continue breastfeeding. Care needs to be taken to ensure that helpline support is easily accessible to ensure that callers and their families can access support when needed. This may require consideration of extension to a 24 hour service.
doi:10.1186/1471-2393-12-150
PMCID: PMC3534517  PMID: 23234293
Breastfeeding; Helpline; Survey; Descriptive; Evaluation; Peer support
11.  Promoting community participation in priority setting in district health systems: experiences from Mbarali district, Tanzania 
Global Health Action  2013;6:10.3402/gha.v6i0.22669.
Background
Community participation in priority setting in health systems has gained importance all over the world, particularly in resource-poor settings where governments have often failed to provide adequate public-sector services for their citizens. Incorporation of public views into priority setting is perceived as a means to restore trust, improve accountability, and secure cost-effective priorities within healthcare. However, few studies have reported empirical experiences of involving communities in priority setting in developing countries. The aim of this article is to provide the experience of implementing community participation and the challenges of promoting it in the context of resource-poor settings, weak organizations, and fragile democratic institutions.
Design
Key informant interviews were conducted with the Council Health Management Team (CHMT), community representatives, namely women, youth, elderly, disabled, and people living with HIV/AIDS, and other stakeholders who participated in the preparation of the district annual budget and health plans. Additionally, minutes from the Action Research Team and planning and priority-setting meeting reports were analyzed.
Results
A number of benefits were reported: better identification of community needs and priorities, increased knowledge of the community representatives about priority setting, increased transparency and accountability, promoted trust among health systems and communities, and perceived improved quality and accessibility of health services. However, lack of funds to support the work of the selected community representatives, limited time for deliberations, short notice for the meetings, and lack of feedback on the approved priorities constrained the performance of the community representatives. Furthermore, the findings show the importance of external facilitation and support in enabling health professionals and community representatives to arrive at effective working arrangement.
Conclusion
Community participation in priority setting in developing countries, characterized by weak democratic institutions and low public awareness, requires effective mobilization of both communities and health systems. In addition, this study confirms that community participation is an important element in strengthening health systems.
doi:10.3402/gha.v6i0.22669
PMCID: PMC3841300  PMID: 24280341
community participation; priority setting; district health systems; Tanzania
12.  Insights into the Government’s Role in Food System Policy Making: Improving Access to Healthy, Local Food Alongside Other Priorities 
Government actors have an important role to play in creating healthy public policies and supportive environments to facilitate access to safe, affordable, nutritious food. The purpose of this research was to examine Waterloo Region (Ontario, Canada) as a case study for “what works” with respect to facilitating access to healthy, local food through regional food system policy making. Policy and planning approaches were explored through multi-sectoral perspectives of: (a) the development and adoption of food policies as part of the comprehensive planning process; (b) barriers to food system planning; and (c) the role and motivation of the Region’s public health and planning departments in food system policy making. Forty-seven in-depth interviews with decision makers, experts in public health and planning, and local food system stakeholders provided rich insight into strategic government actions, as well as the local and historical context within which food system policies were developed. Grounded theory methods were used to identify key overarching themes including: “strategic positioning”, “partnerships” and “knowledge transfer” and related sub-themes (“aligned agendas”, “issue framing”, “visioning” and “legitimacy”). A conceptual framework to illustrate the process and features of food system policy making is presented and can be used as a starting point to engage multi-sectoral stakeholders in plans and actions to facilitate access to healthy food.
doi:10.3390/ijerph9114103
PMCID: PMC3524615  PMID: 23202834
food policy; community food security; public health; government; land use planning; food access
13.  Wellbeing, alcohol use and sexual activity in young teenagers: findings from a cross-sectional survey in school children in North West England 
Background
Adolescent health is a growing concern. High rates of binge drinking and teenage pregnancies, documented in the UK, are two measures defining poor wellbeing. Improving wellbeing through schools is a priority but information on the impact of wellbeing on alcohol use, and on sexual activity among schoolchildren is limited.
Methods
A cross-sectional survey using self-completed questionnaires was conducted among 3,641 schoolchildren aged 11-14 years due to participate in a sex and relationships education pilot programme in 15 high schools in North West England. Bivariate and multivariate analyses were conducted to examine the relationship between wellbeing and alcohol use, and wellbeing and sexual activity.
Results
A third of 11 year olds, rising to two-thirds of 14 year olds, had drunk alcohol. Children with positive school wellbeing had lower odds of ever drinking alcohol, drinking often, engaging in any sexual activity, and of having sex. General wellbeing had a smaller effect. The strength of the association between alcohol use and the prevalence of sexual activity in 13-14 year olds, increased incrementally with the higher frequency of alcohol use. Children drinking once a week or more had 12-fold higher odds of any sexual activity, and 10-fold higher odds of having sex. Rare and occasional drinkers had a significantly higher odds compared with non-drinkers.
Conclusions
The relationship between wellbeing and alcohol use, and wellbeing and sexual activity reinforces the importance of initiatives that enhance positive wellbeing in schoolchildren. The association between alcohol use and sexual activity highlights the need for integrated public health programmes. Policies restricting alcohol use may help reduce sexual exposure among young teenagers.
doi:10.1186/1747-597X-5-27
PMCID: PMC2993686  PMID: 21067562
14.  The interactions of ethical notions and moral values of immediate stakeholders of immunisation services in two Indian states: a qualitative study 
BMJ Open  2013;3(3):e001905.
Objectives
This study examines the existing norms regarding immunisation within the communities and the ethical notions that govern the actions of different health professionals and their collective synergistic or conflicting effects on the governance of the programme.
Design
We used descriptive and analytical qualitative methods as it suited the research question.
Setting
The data were collected from areas under 16 primary health centres in Kerala and Tamil Nadu identified through a three-step sampling process.
Participants
This involved in-depth interviews with stakeholders including providers, beneficiaries and other stakeholders, focus group discussions with mothers of under-five children and participant and non-participant observations of vaccination-related activities.
Results
Unlike most other ethical analyses that look at the ethics of vaccination policies, the interactions of normative principles and notions are analysed in this article. Moral obligation of parents towards their children, beneficence of healthcare providers and the utilitarian aspirations of the state are the key normative principles involved. Our analysis points to the interplay of both synergy and conflict in ethical notions and moral values in the context of immunisation services. Paternalistic interventions like special immunisation campaigns against polio and Japanese encephalitis are a case in point: they generate conflict at the normative level and create mistrust.
Conclusions
Analysis of vaccination policies and programmes needs to go beyond factors that assess monetary benefits or herd immunity. Understanding the interactions of normative notions that shape the social organisation of the providers and the users of vaccination is important in creating a sustainable environment for the programme.
doi:10.1136/bmjopen-2012-001905
PMCID: PMC3612786  PMID: 23457322
Ethics (see Medical Ethics); Primary Care; Social Medicine
15.  Admission to day stay early parenting program is associated with improvements in mental health and infant behaviour: A prospective cohort study 
Background
Australia’s Early Parenting Services support families and intervene early in mental health problems in parents. The Victorian Early Parenting Strategy, a platform for government policy recommended a stronger evidence base for early parenting services. Tweddle Child and Family Health Service (TCFHS) is a not-for-profit public sector early parenting centre, which provides residential, day stay, home visiting and outreach programs. This study aimed i) to examine the health, social circumstances and presenting needs of clients attending the Tweddle Day Stay Program (DSP) with infants under 12 months old and ii) to assess the parent mental health and infant behaviour outcomes and the factors associated with program success.
Methods
A cohort of clients was recruited prior to admission and followed-up 8 weeks after discharge. Data were collected using standardised measures in a study specific questionnaire at baseline, participant’s Tweddle records and a follow-up telephone interview. Health, social circumstances and presenting needs of clients were described. Changes in parents’ symptoms of depression and infants’ sleep and settling between admission and follow-up were calculated. Multiple regression analyses were conducted to examine factors associated with changes in primary outcomes.
Results
Of the total 162 clients who were eligible and invited to participate, 115 (72%) were recruited. Parents admitted to the DSP had worse general self-reported physical and mental health than community samples. Infants of DSP participants were no more likely to be premature or have low birth weight, but significantly more unsettled than other community samples. Participants’ mental health and their infants’ behaviours were significantly improved after DSP admission. In multivariate analysis, higher depression score at baseline and greater educational attainment were significantly associated with improvements in parents’ mental health. Worse unsettled infant behaviours and longer time between discharge and follow up were significantly associated with improvements in infant sleep and settling.
Conclusions
Tweddle DSPs appear to respond effectively to the needs of families presenting with substantial physical and emotional health morbidity and a range of vulnerabilities by treating parental mental health and infant behaviour problems together. DSPs offer important potential benefits for prevention of more serious family problems and consequent health care cost savings.
doi:10.1186/1752-4458-6-11
PMCID: PMC3464700  PMID: 22889314
Parenting; Infants; Mental health; Health services
16.  How do government health departments in Australia access health economics advice to inform decisions for health? A survey 
Background
Government anticipates that health economic analysis will contribute to evidence-based policy development. Early examples in Australia where this expectation has been met include the economic evaluations of breast and cervical screening. However, the level of integration of health economics within health services that require this advice appears uneven. We sought to describe how government health departments in Australia use specialist health economic advice to inform policy and planning and the mechanisms through which they access this advice.
Methods
Information describing the arrangements for gaining health economics input into health decision-making was sought through interviews with a purposeful sample of economists and non-economists employed by all departments of health in Australia (state, territories and national). The survey was undertaken in August 2004. To aid interpretation of the results eight health economic functions were identified. As a comparison, four other government departments in NSW provided information about their access to economic advice.
Results
All health departments except one reported being current users of health economics expertise. A variety of arrangements were described to source this, from building organisational capacity with self-sufficient in-house units to forging links with external sources. However, specialist positions for economists or health economists employed within health were few. A framework mapping these arrangements for sourcing advice with the eight common health economic functions to be met is presented. All other non-health government departments approached accessed economic advice, with three having in-house units.
Discussion
A small health economics capacity in Australia has been established over the past 30 years through a variety of structural and strategic mechanisms. Health departments value health economic advice and use a variety of arrangements to obtain this. These arrangements have strengths and weaknesses depending upon the task to be undertaken. The lack of uniformity of approach suggests that health departments are still seeking the best ways to incorporate this form of specialist advice into mainstream decision-making.
Implications
Summarises ways that governments source specialist services. Demonstrates how to describe an organisation's need for specialist services as a set of functions. This approach could be applied to assessing need for other specialist areas of advice.
doi:10.1186/1743-8462-6-6
PMCID: PMC2674050  PMID: 19358711
17.  Government Monitoring of the Mental Health of Children in Canada: Five Surveys (Part II) 
Objective
Canadian governments produced 64 reports containing data about the mental health of children but no reports could adequately be called monitoring reports. Surveys sought to clarify definitions, challenges and processes that could help lead to regular reports.
Method
(Details in Part I). The 2006 survey clarified government current data use and future need, challenges to producing reports and the role of NGOs. The 2008 survey clarified the definition of reports, governments’ most desired indicators, and national factors.
Results
Governments wanted the data for policy making, program construction, priority setting and resource allocation. The most challenging difficulties were governments themselves: coordinating among departments, lack of funding, lack of an agency and lowered priority. Governments most wanted indicators of child functioning, population health and early identification. Reports needed to meet specific criteria for contents, indicator qualities, population characteristics and regularity.
Conclusions
Governments wanted a national strategy, national framework and agreement on a measuring agency. Good general agreement existed about reporting criteria. A partnership model may lead to quicker results given the difficulties within governments. NGOs and others need to continue collaborative advocacy. Monitoring is one of two steps that could help turn collections of services into self-regulating systems.
PMCID: PMC3269247  PMID: 22299013
government; population surveillance; mental health; children; gouvernement; suivi de la population; santé mentale; enfants
18.  Information Technology for Children's Health and Health Care 
In September 2000, the Agency for Healthcare Quality and Research and the American Academy of Pediatrics Center for Child Health Research sponsored a meeting of experts and knowledgeable stakeholders to identify 1) the special information needs of pediatric care and 2) health service research questions related to the use of information technology in children's health care. Technologies that support the care of children must address issues related to growth and development, children's changing physiology, and the unique diseases of children and interventions of pediatric care. Connectivity and data integration are particular concerns for child health care workers. Consumer health information needs for this population extend beyond the needs of one individual to the needs of the family. Recommendations of the attendees include rapid implementation of features in electronic health information systems that support pediatric care and involvement of child health experts in policy making, standards setting, education, and advocacy. A proposed research agenda should address both effectiveness and costs of information technology, with special consideration for the needs of children, the development and evaluation of clinical decision support in pediatric settings, understanding of the epidemiology of iatrogenic injury in childhood, supplementation of vocabulary standards with pediatrics-specific terminology, and improvement in health care access for children, using telemedicine.
PMCID: PMC130065  PMID: 11687562
19.  Addressing the Social Determinants of Subjective Wellbeing: The Latest Challenge for Social Policy 
Journal of Social Policy  2013;42(3):541-565.
The idea that the happiness and wellbeing of individuals should shape government policy has been around since the enlightenment; today such thinking has growing practical policy relevance as governments around the world survey their populations in an effort to design social policies that promote wellbeing. In this article, we consider the social determinants of subjective wellbeing in the UK and draw lessons for social policy. Survey data are taken from the ‘Measuring National Wellbeing Programme’ launched by the UK's Office for National Statistics in 2010. For the empirical strategy, we develop bivariate and multivariate logistic regression models, as well as testing for interaction effects in the data. The findings show that wellbeing is not evenly distributed within the UK. Socio-demographic characteristics such as age, gender, ethnicity, employment, household composition and tenure all matter, as does health status. Influencing population wellbeing is inherently complex, though, that said, there is a clear need to place greater emphasis on the social, given the direction of current policy.
doi:10.1017/S0047279413000202
PMCID: PMC3663082  PMID: 23710101
20.  Development of guidelines for recently arrived immigrants and refugees to Canada: Delphi consensus on selecting preventable and treatable conditions 
Background:
Setting priorities is critical to ensure guidelines are relevant and acceptable to users, and that time, resources and expertise are used cost-effectively in their development. Stakeholder engagement and the use of an explicit procedure for developing recommendations are critical components in this process.
Methods:
We used a modified Delphi consensus process to select 20 high-priority conditions for guideline development. Canadian primary care practitioners who care for immigrants and refugees used criteria that emphasize inequities in health to identify clinical care gaps.
Results:
Nine infectious diseases were selected, as well as four mental health conditions, three maternal and child health issues, caries and periodontal disease, iron-deficiency anemia, diabetes and vision screening.
Interpretation:
Immigrant and refugee medicine covers the full spectrum of primary care, and although infectious disease continues to be an important area of concern, we are now seeing mental health and chronic diseases as key considerations for recently arriving immigrants and refugees.
doi:10.1503/cmaj.090290
PMCID: PMC3168668  PMID: 20547714
21.  Mapping and exploring health systems’ response to intimate partner violence in Spain 
BMC Public Health  2013;13:1162.
Background
For a comprehensive health sector response to intimate partner violence (IPV), interventions should target individual and health facility levels, along with the broader health systems level which includes issues of governance, financing, planning, service delivery, monitoring and evaluation, and demand generation. This study aims to map and explore the integration of IPV response in the Spanish national health system.
Methods
Information was collected on five key areas based on WHO recommendations: policy environment, protocols, training, monitoring and prevention. A systematic review of public documents was conducted to assess 39 indicators in each of Spain’s 17 regional health systems. In addition, we performed qualitative content analysis of 26 individual interviews with key informants responsible for coordinating the health sector response to IPV in Spain.
Results
In 88% of the 17 autonomous regions, the laws concerning IPV included the health sector response, but the integration of IPV in regional health plans was just 41%. Despite the existence of a supportive national structure, responding to IPV still relies strongly on the will of health professionals. All seventeen regions had published comprehensive protocols to guide the health sector response to IPV, but participants recognized that responding to IPV was more complex than merely following the steps of a protocol. Published training plans existed in 43% of the regional health systems, but none had institutionalized IPV training in medical and nursing schools. Only 12% of regional health systems collected information on the quality of the IPV response, and there are many limitations to collecting information on IPV within health services, for example underreporting, fears about confidentiality, and underuse of data for monitoring purposes. Finally, preventive activities that were considered essential were not institutionalized anywhere.
Conclusions
Within the Spanish health system, differences exist in terms of achievements both between regions and between the areas assessed. Progress towards integration of IPV has been notable at the level of policy, less outstanding regarding health service delivery, and very limited in terms of preventive actions.
doi:10.1186/1471-2458-13-1162
PMCID: PMC3890595  PMID: 24325328
Health system; Health policy; Intimate partner violence; Spain; Mixed methods; Content analysis
22.  Barriers to the participation of people with psychosocial disability in mental health policy development in South Africa: a qualitative study of perspectives of policy makers, professionals, religious leaders and academics 
Background
This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa.
Method
Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people’s organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions.
Results
Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports.
Conclusion
A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development.
doi:10.1186/1472-698X-13-17
PMCID: PMC3600028  PMID: 23497079
Psychosocial disability; Rights; Participation barriers; Policy development; South Africa
23.  Privatisation & marketisation of post-birth care: the hidden costs for new mothers 
Retrenchment of government services has occurred across a wide range of sectors and regions. Care services, in particular, have been clawed away in the wake of fiscal policies of cost containment and neoliberal policies centred on individual responsibility and market autonomy. Such policies have included the deinstitutionalisation of care from hospitals and clinics, and early discharge from hospital, both of which are predicated on the notion that care can be provided informally within families and communities. In this paper we examine the post-birth "care crisis" that new mothers face in one region of Canada.
Method
The data are drawn from a larger study of social determinants of pregnant and new mothers' health in Victoria, Canada. Mixed methods interviews were conducted among a purposive sample of women at three points in time. This paper reports data on sample characteristics, length of stay in hospital and health service gaps. This data is contextualised via a more in-depth analysis of qualitative responses from Wave 2 (4-6 weeks postpartum).
Results
Out results show a significant portion of participants desired services that were not publically available to them during the post-birth period. Among those who reported a gap in care, the two most common barriers were: cost and unavailability of home care supports. Participants' open-ended responses revealed many positive features of the public health care system but also gaps in services, and economic barriers to receiving the care they wanted. The implications of these findings are discussed in relation to recent neoliberal reforms.
Discussion & conclusions
While Canada may be praised for its public provision of maternity care, mothers' reports of gaps in care during the early postpartum period and increasing use of private doulas is a worrying trend. To the extent that individual mothers or families rely on the market for care provision, issues of equity and quality of care are pivotal. This paper concludes with suggestions for further research on the impact of recent changes in post-birth care on new fathers and on inequities in pre and post-birth care in less-resourced regions of the world.
doi:10.1186/1475-9276-11-61
PMCID: PMC3492130  PMID: 23061517
Welfare states; Neoliberalisation; Marketisation; Familialisation; Commodification; Post-birth care; Canada
24.  A qualitative examination of the health workforce needs during climate change disaster response in Pacific Island Countries 
Background
There is a growing body of evidence that the impacts of climate change are affecting population health negatively. The Pacific region is particularly vulnerable to climate change; a strong health-care system is required to respond during times of disaster. This paper examines the capacity of the health sector in Pacific Island Countries to adapt to changing disaster response needs, in terms of: (i) health workforce governance, management, policy and involvement; (ii) health-care capacity and skills; and (iii) human resources for health training and workforce development.
Methods
Key stakeholder interviews informed the assessment of the capacity of the health sector and disaster response organizations in Pacific Island Countries to adapt to disaster response needs under a changing climate. The research specifically drew upon and examined the adaptive capacity of individual organizations and the broader system of disaster response in four case study countries (Fiji, Cook Islands, Vanuatu and Samoa).
Results
‘Capacity’ including health-care capacity was one of the objective determinants identified as most significant in influencing the adaptive capacity of disaster response systems in the Pacific. The research identified several elements that could support the adaptive capacity of the health sector such as: inclusive involvement in disaster coordination; policies in place for health workforce coordination; belief in their abilities; and strong donor support. Factors constraining adaptive capacity included: weak coordination of international health personnel; lack of policies to address health worker welfare; limited human resources and material resources; shortages of personnel to deal with psychosocial needs; inadequate skills in field triage and counselling; and limited capacity for training.
Conclusion
Findings from this study can be used to inform the development of human resources for health policies and strategic plans, and to support the development of a coordinated and collaborative approach to disaster response training across the Pacific and other developing contexts. This study also provides an overview of health-care capacity and some of the challenges and strengths that can inform future development work by humanitarian organizations, regional and international donors involved in climate change adaptation, and disaster risk reduction in the Pacific region.
doi:10.1186/1478-4491-12-9
PMCID: PMC3937042  PMID: 24521057
Climate change; Health workforce governance; Health-care management; Health-care capacity; Competencies; Human resources for health; Workforce development; Emergency; Disaster response; Pacific Islands
25.  Regional differences in multidimensional aspects of health: findings from the MRC cognitive function and ageing study 
BMC Public Health  2006;6:90.
Background
Differences in mortality and health experience across regions are well recognised and UK government policy aims to address this inequality. Methods combining life expectancy and health have concentrated on specific areas, such as self-perceived health and dementia. Few have looked within country or across different areas of health. Self-perceived health, self-perceived functional impairment and cognitive impairment are linked closely to survival, as well as quality of life.
This paper aims to describe regional differences in healthy life expectancy using a variety of states of health and wellbeing within the MRC Cognitive Function and Ageing Study (MRC CFAS).
Methods
MRC CFAS is a population based study of health in 13,009 individuals aged 65 years and above in five centres using identical study methodology. The interviews included self-perceived health and measures of functional and cognitive impairment. Sullivan's method was used to combine prevalence rates for cognitive and functional impairment and life expectancy to produce expectation of life in various health states.
Results
The prevalence of both cognitive and functional impairment increases with age and was higher in women than men, with marked centre variation in functional impairment (Newcastle and Gwynedd highest impairment). Newcastle had the shortest life expectancy of all the sites, Cambridgeshire and Oxford the longest. Centre differences in self-perceived health tended to mimic differences in life expectancy but this did not hold for cognitive or functional impairment.
Conclusion
Self-perceived health does not show marked variation with age or sex, but does across centre even after adjustment for impairment burden. There is considerable centre variation in self-reported functional impairment but not cognitive impairment. Only variation in self-perceived health relates to the ranking of life expectancy. These data confirm that quite considerable differences in life experience exist across regions of the UK beyond basic life expectancy.
doi:10.1186/1471-2458-6-90
PMCID: PMC1475575  PMID: 16600044

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