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Implementation Science : IS Nov 2017It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve... (Review)
Review
BACKGROUND
It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The secondary aim of the review was to describe factors perceived to be associated with effective strategies and the inter-relationship between these factors.
METHODS
An electronic search was developed to identify studies published between January 01, 2000, and February 02, 2016. This was supplemented by checking the reference list of included articles, systematic reviews, and hand-searching publication lists from prominent authors. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data.
RESULTS
After duplicate removal, the search strategy identified 3830 titles. Following title and abstract screening, 96 full-text articles were reviewed, of which 19 studies (21 articles) met all inclusion criteria. Three studies were included in the narrative synthesis, finding policy briefs including expert opinion might affect intended actions, and intentions persisting to actions for public health policy in developing nations. Workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making in US public health departments. Tailored, targeted messages were more effective in increasing public health policies and programs in Canadian public health departments compared to messages and a knowledge broker. Sixteen studies (18 articles) were included in the thematic synthesis, leading to a conceptualisation of inter-relating factors perceived to be associated with effective research implementation strategies. A unidirectional, hierarchal flow was described from (1) establishing an imperative for practice change, (2) building trust between implementation stakeholders and (3) developing a shared vision, to (4) actioning change mechanisms. This was underpinned by the (5) employment of effective communication strategies and (6) provision of resources to support change.
CONCLUSIONS
Evidence is developing to support the use of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The design of future implementation strategies should be based on the inter-relating factors perceived to be associated with effective strategies.
TRIAL REGISTRATION
This systematic review was registered with Prospero (record number: 42016032947).
Topics: Canada; Communication; Decision Making; Evidence-Based Practice; Health Policy; Humans; Leadership; Organizational Innovation; Policy Making; Public Health Administration; Trust; United States
PubMed: 29137659
DOI: 10.1186/s13012-017-0662-0 -
Epidemiologic Reviews Jan 2017The American Society of Clinical Oncology (ASCO) recently convened an Ad Hoc Palliative Care Expert Panel to update a 2012 provisional clinical opinion by conducting a... (Review)
Review
Implementing Evidence-Based Palliative Care Programs and Policy for Cancer Patients: Epidemiologic and Policy Implications of the 2016 American Society of Clinical Oncology Clinical Practice Guideline Update.
The American Society of Clinical Oncology (ASCO) recently convened an Ad Hoc Palliative Care Expert Panel to update a 2012 provisional clinical opinion by conducting a systematic review of clinical trials in palliative care in oncology. The key takeaways from the updated ASCO clinical practice guidelines (CPGs) are that more people should be referred to interdisciplinary palliative care teams and that more palliative care specialists and palliative care-trained oncologists are needed to meet this demand. The following summary statement is based on multiple randomized clinical trials: "Inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment. Referral of patients to interdisciplinary palliative care teams is optimal, and services may complement existing programs" (J Clin Oncol. 2017;35(1):96). This paper addresses potential epidemiologic and policy interpretations and implications of the ASCO CPGs. Our review of the CPGs demonstrates that to have clinicians implement these guidelines, there is a need for support from stakeholders across the health-care continuum, health system and institutional change, and changes in health-care financing. Because of rising costs and the need to improve value, the need for coordinated care, and change in end-of-life care patterns, many of these changes are already underway.
Topics: Evidence-Based Medicine; Health Policy; Humans; Medical Oncology; Neoplasms; Palliative Care; Practice Guidelines as Topic; Referral and Consultation; Societies, Medical; Terminal Care; United States
PubMed: 28472313
DOI: 10.1093/epirev/mxw002 -
Nutrition Reviews Jul 2022Policy-specific actions to improve food environments will support healthy population diets.
CONTEXT
Policy-specific actions to improve food environments will support healthy population diets.
OBJECTIVE
To identify cited barriers and facilitators to food environment policy (FEP) processes reported in the literature, exploring these according to the nature of the policy (voluntary or mandatory) and country development status.
DATA SOURCES
A systematic search was conducted of 10 academic and 7 grey-literature databases, national websites, and manual searches of publication references.
DATA EXTRACTION
Data on government-led FEPs, barriers, and facilitators from key informants were collected.
DATA SYNTHESIS
The constant-comparison approach generated core themes for barriers and facilitators. The appraisal tool developed by Hawker et al. was adopted to determine the quality of qualitative and quantitative studies.
RESULTS
A total of 142 eligible studies were identified. Industry resistance or disincentive was the most cited barrier in policy development. Technical challenges were most frequently a barrier for policy implementation. Frequently cited facilitators included resource availability or maximization, strategies in policy process, and stakeholder partnership or support.
CONCLUSIONS
The findings from this study will strategically inform health-reform stakeholders about key elements of public health policy processes. More evidence is required from countries with human development indices ranging from low to high and on voluntary policies.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration no. CRD42018115034.
Topics: Diet, Healthy; Government; Humans; Motivation; Nutrition Policy
PubMed: 35388428
DOI: 10.1093/nutrit/nuac016 -
BMC Public Health Dec 2015This umbrella review aimed at identifying evidence-based conditions important for successful implementation of interventions and policies promoting a healthy diet,... (Review)
Review
BACKGROUND
This umbrella review aimed at identifying evidence-based conditions important for successful implementation of interventions and policies promoting a healthy diet, physical activity (PA), and a reduction in sedentary behaviors (SB). In particular, we examined if the implementation conditions identified were intervention-specific or policy-specific. This study was undertaken as part of the DEterminants of DIet and Physical Activity (DEDIPAC) Knowledge Hub, a joint action as part of the European Joint Programming Initiative a Healthy Diet for a Healthy Life.
METHODS
A systematic review of reviews and stakeholder documents was conducted. Data from nine scientific literature databases were analyzed (95 documents met the inclusion criteria). Additionally, published documentation of eight major stakeholders (e.g., World Health Organization) were systematically searched (17 documents met the inclusion criteria). The RE-AIM framework was used to categorize elicited conditions. Across the implementation conditions 25 % were identified in at least four documents and were subsequently classified as having obtained sufficient support.
RESULTS
We identified 312 potential conditions relevant for successful implementation; 83 of these received sufficient support. Using the RE-AIM framework eight implementation conditions that obtained support referred to the reach in the target population; five addressed efficacy of implementation processes; 24 concerned adoption by the target staff, setting, or institutions; 43 referred to consistency, costs, and adaptations made in the implementation process; three addressed maintenance of effects over time. The vast majority of implementation conditions (87.9 %; 73 of 83) were supported by documents referring to both interventions and policies. There were seven policy-specific implementation conditions, which focused on increasing complexities of coexisting policies/legal instruments and their consequences for implementation, as well as politicians' collaboration in implementation.
CONCLUSIONS
The use of the proposed list of 83 conditions for successful implementation may enhance the implementation of interventions and policies which pursue identification of the most successful actions aimed at improving diet, PA and reducing SB.
Topics: Cooperative Behavior; Diet; Exercise; Health Policy; Health Promotion; Humans; Sedentary Behavior; World Health Organization
PubMed: 26678996
DOI: 10.1186/s12889-015-2585-5 -
Eastern Mediterranean Health Journal =... Sep 2020Reaching married and unmarried young people in Jordan with family planning information and services is a priority, especially considering Jordan's large refugee... (Review)
Review
BACKGROUND
Reaching married and unmarried young people in Jordan with family planning information and services is a priority, especially considering Jordan's large refugee populations. To date, dissemination of family planning research and programmatic experience targeting young people in Jordan has been limited.
AIMS
This study aimed to provide in-depth information on family planning intervention programmes, research and policies in Jordan that focus on young people aged 10-24 years.
METHODS
Data were gathered through a systematic review of peer-reviewed and grey literature related to reproductive health of young people, and focus groups discussions with stakeholders from 18 relevant governmental and nongovernmental organizations.
RESULTS
The literature review included 37 documents produced since 2008, which provide information at the individual, family/community, service delivery and policy levels. Young people in Jordan have limited knowledge of family planning methods and where to obtain family planning services. Little information is available on the availability of family planning services for young people. Several policy documents discuss family planning and reproductive health of young people in Jordan. Focus group discussions identified opportunities to integrate services and strengthen the development of future policies.
CONCLUSIONS
The results of this study highlight key lessons learnt, opportunities for interventions and research gaps related to family planning among young people in Jordan. More attention should be paid to understanding and meeting the needs of Jordan's most vulnerable populations of young people, including urban refugees and married adolescents, especially as these populations continue to grow. Future programmes should build from past evidence and explore new areas and interventions.
Topics: Adolescent; Family Planning Services; Focus Groups; Humans; Jordan; Marriage; Policy
PubMed: 33047803
DOI: 10.26719/emhj.20.018 -
The Cochrane Database of Systematic... Oct 2014School tobacco policies (STPs) might prove to be a promising strategy to prevent smoking initiation among adolescents, as there is evidence that the school environment... (Review)
Review
BACKGROUND
School tobacco policies (STPs) might prove to be a promising strategy to prevent smoking initiation among adolescents, as there is evidence that the school environment can influence young people to smoke. STPs are cheap, relatively easy to implement and have a wide reach, but it is not clear whether this approach is effective in preventing smoking uptake.
OBJECTIVES
To assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools.
SEARCH METHODS
We searched seven electronic bibliographic databases, including the Cochrane Tobacco Addiction Group specialized register, MEDLINE, EMBASE, PsycINFO and ERIC. We also searched the grey literature and ongoing trials resources. The most recent search was performed in May 2014.
SELECTION CRITERIA
We included cluster-randomised controlled trials (c-RCTs) in which primary and secondary schools were randomised to receive different levels of smoking policy or no intervention. Non-randomised controlled trials, interrupted time series and controlled before-after studies would also have been eligible. Cross-sectional studies were not formally included but we describe their findings and use them to generate hypotheses to inform future research.
DATA COLLECTION AND ANALYSIS
We independently assessed studies for inclusion in the review, and present a narrative synthesis, as the studies are too limited in quality to undertake a formal meta-analysis.
MAIN RESULTS
We found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow-up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face-to-face interviews with school staff members, and the outcome evaluation was performed using self-administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal STPs when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies.
AUTHORS' CONCLUSIONS
Despite a comprehensive literature search, and rigorous evaluation of studies, we found no evidence to support STPs. The absence of reliable evidence for the effectiveness of STPs is a concern in public health. We need well-designed randomised controlled trials or quasi-experimental studies to evaluate the effectiveness of school tobacco policies.
Topics: Adolescent; China; Health Policy; Humans; Observational Studies as Topic; Randomized Controlled Trials as Topic; School Health Services; Schools; Smoking Prevention
PubMed: 25342250
DOI: 10.1002/14651858.CD009990.pub2 -
International Journal of Public Health 2022Effective public policy to prevent falls among independent community-dwelling older adults is needed to address this global public health issue. This paper aimed to... (Review)
Review
Improving Policy for the Prevention of Falls Among Community-Dwelling Older People-A Scoping Review and Quality Assessment of International National and State Level Public Policies.
Effective public policy to prevent falls among independent community-dwelling older adults is needed to address this global public health issue. This paper aimed to identify gaps and opportunities for improvement of future policies to increase their likelihood of success. A systematic scoping review was conducted to identify policies published between 2005-2020. Policy quality was assessed using a novel framework and content criteria adapted from the World Health Organization's guideline for Developing policies to prevent injuries and violence and the New Zealand Government's Policy Quality Framework. A total of 107 articles were identified from 14 countries. Content evaluation of 25 policies revealed that only 54% of policies met the WHO criteria, and only 59% of policies met the NZ criteria. Areas for improvement included quantified objectives, prioritised interventions, budget, ministerial approval, and monitoring and evaluation. The findings suggest deficiencies in a substantial number of policies may contribute to a disconnect between policy intent and implementation. A clear and evidence-based model falls prevention policy is warranted to enhance future government efforts to reduce the global burden of falls.
Topics: Aged; Humans; Independent Living; New Zealand; Public Policy; Violence
PubMed: 35832390
DOI: 10.3389/ijph.2022.1604604 -
The Lancet. Global Health Jun 2023Smokeless tobacco, used by more than 300 million people globally, results in substantial morbidity and mortality. For smokeless tobacco control, many countries have...
BACKGROUND
Smokeless tobacco, used by more than 300 million people globally, results in substantial morbidity and mortality. For smokeless tobacco control, many countries have adopted policies beyond the WHO Framework Convention on Tobacco Control, which has been instrumental in reducing smoking prevalence. The impact of these policies (within and outside the Framework Convention on Tobacco Control) on smokeless tobacco use remains unclear. We aimed to systematically review policies that are relevant to smokeless tobacco and its context and investigate their impact on smokeless tobacco use.
METHODS
In this systematic review, we searched 11 electronic databases and grey literature between Jan 1, 2005, and Sept 20, 2021, in English and key south Asian languages, to summarise smokeless tobacco policies and their impact. Inclusion criteria were all types of studies on smokeless tobacco users that mentioned any smokeless tobacco relevant policies since 2005, except systematic reviews. Policies issued by organisations or private institutions were excluded as well as studies on e-cigarettes and Electronic Nicotine Delivery System except where harm reduction or switching were evaluated as a tobacco cessation strategy. Two reviewers independently screened articles, and data were extracted after standardisation. Quality of studies was appraised using the Effective Public Health Practice Project's Quality Assessment Tool. Outcomes for impact assessment included smokeless tobacco prevalence, uptake, cessation, and health effects. Due to substantial heterogeneity in the descriptions of policies and outcomes, data were descriptively and narratively synthesised. This systematic review was registered in PROSPERO (CRD42020191946).
FINDINGS
14 317 records were identified, of which 252 eligible studies were included as describing smokeless tobacco policies. 57 countries had policies targeting smokeless tobacco, of which 17 had policies outside the Framework Convention on Tobacco Control for smokeless tobacco (eg, spitting bans). 18 studies evaluated the impact, which were of variable quality (six strong, seven moderate, and five weak) and reported mainly on prevalence of smokeless tobacco use. The body of work evaluating policy initiatives based on the Framework Convention on Tobacco Control found that these initiatives were associated with reductions in smokeless tobacco prevalence of between 4·4% and 30·3% for taxation and 22·2% and 70·9% for multifaceted policies. Two studies evaluating the non-Framework policy of sales bans reported significant reductions in smokeless tobacco sale (6·4%) and use (combined sex 17·6%); one study, however, reported an increased trend in smokeless tobacco use in the youth after a total sales ban, likely due to cross-border smuggling. The one study reporting on cessation found a 13·3% increase in quit attempts in individuals exposed (47·5%) to Framework Convention on Tobacco Control policy: education, communication, training, and public awareness, compared with non-exposed (34·2%).
INTERPRETATION
Many countries have implemented smokeless tobacco control policies, including those that extend beyond the Framework Convention on Tobacco Control. The available evidence suggests that taxation and multifaceted policy initiatives are associated with meaningful reductions in smokeless tobacco use.
FUNDING
UK National Institute for Health Research.
Topics: Adolescent; Humans; Tobacco, Smokeless; Tobacco Control; Electronic Nicotine Delivery Systems; Smoking; Policy
PubMed: 37202029
DOI: 10.1016/S2214-109X(23)00205-X -
Ambio May 2022Agricultural land use is transforming rapidly in Southeast Asia, often supported by development policies aiming primarily at economic growth. However, the socioeconomic... (Review)
Review
Agricultural land use is transforming rapidly in Southeast Asia, often supported by development policies aiming primarily at economic growth. However, the socioeconomic outcomes of these changes for smallholder farmers remain unclear. Here, we systematically review cases of agricultural land use change in Southeast Asia to assess their socioeconomic outcomes and potential trade-off and synergies in these outcomes. Of the 126 reviewed cases, we find mostly positive outcomes for income (SDG 1, 100 cases) and employment (SDG 8, 11 cases), while outcomes on health (SDG 3, 9 cases) were mixed, and outcomes for food security (SDG 2, 44 cases), gender equality (SDG 5, 13 cases), and economic equality (SDG 10, 14 cases) were mostly negative. Studies describing multiple outcomes show indications of synergies between income and food security, and between income and employment, but also potential trade-offs between income and economic equality. In addition, we find that economic land concessions result in multiple negative outcomes more often than other types of land governance regimes. The results provide evidence that economic gains from agricultural land use change often come at a cost of other dimensions of sustainable development.
Topics: Agriculture; Asia, Southeastern; Economic Development; Income; Sustainable Development
PubMed: 35181854
DOI: 10.1007/s13280-022-01712-4 -
Value in Health Regional Issues May 2018To review drug policies, health technology assessment (HTA), and HTA's use in drug policies in China, to further improve the quality and efficiency of drugs. (Review)
Review
OBJECTIVE
To review drug policies, health technology assessment (HTA), and HTA's use in drug policies in China, to further improve the quality and efficiency of drugs.
METHODS
This study draws on multiple methods. A systematic review of the literature, review of Chinese government documents and statistical handbooks, and authors' experiences in drug policies and HTA in China were combined to achieve the objective.
RESULTS
Of 571 studies identified in the initial search, 14 eligible articles (6 English, 8 Chinese) were finally included. On the Web site of the National Health and Family Planning Commission, the National Development and Reform Commission, and the Ministry of Human Resources and Social Security, we found that HTA or pharmacoeconomics evaluation is mentioned in recent years and its frequency has been increasing; however, there was not one hit about HTA or PE on the Web site of China Food and Drug Administration.
CONCLUSIONS
The decision makers have realized the importance and value of HTA and have tried to integrate HTA into drug policies and regulations. However, the application of HTA findings to drug policymaking is not yet widespread and there are a number of challenges in using HTA in China. Therefore, it is necessary to establish a national HTA commission and develop pharmacoeconomics guidelines to support the use of HTA in decision making. Moreover, the most important steps are to encourage technology innovation, groom more HTA experts, and build reliable databases in China.
Topics: China; Drug and Narcotic Control; Health Impact Assessment; Health Policy; Humans; Policy Making; Technology Assessment, Biomedical
PubMed: 29729645
DOI: 10.1016/j.vhri.2018.01.010