-
International Journal of Health Policy... 2023Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems...
BACKGROUND
Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy.
METHODS
Systematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS.
RESULTS
4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use.
CONCLUSION
This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.
Topics: Humans; Health Policy; Noncommunicable Diseases; Policy Making; Obesity; Systems Analysis
PubMed: 37579437
DOI: 10.34172/ijhpm.2023.6772 -
Canadian Journal of Psychiatry. Revue... Jul 2021Concerns surrounding the mental health and well-being of Canadian postsecondary students have increased in recent years, with data suggesting increases in the prevalence... (Review)
Review
Postsecondary Mental Health Policy in Canada: A Scoping Review of the Grey Literature: Politique de santé mentale post-secondaire au Canada: un examen de la portée de la littérature grise.
OBJECTIVE
Concerns surrounding the mental health and well-being of Canadian postsecondary students have increased in recent years, with data suggesting increases in the prevalence of self-reported stress and psychological distress. Strategies to address postsecondary mental health have emerged at the national, provincial, and institutional levels. While reviews of the academic literature on the subject have been conducted, a detailed review of the grey literature has not. The objective of this study was to map the current state of grey literature related to current or recommended action supporting postsecondary mental health and well-being in Canada, with a focus on policy documents and guiding frameworks.
METHODS
We conducted a review following Arksey and O'Malley's 5-step framework for scoping reviews, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Our search was restricted to documents with a primary focus on postsecondary mental health, a national or provincial scope, and publication date between 2000 and 2019.
RESULTS
While a national policy or guiding framework applicable to all postsecondary institutions across Canada does not yet exist, recommendations for policy at both the national and provincial levels were well aligned, emphasizing the need for a comprehensive approach to addressing mental health services through the use of a whole-campus approach that encompasses both upstream and downstream services.
CONCLUSION
Postsecondary sector stakeholders should consider how existing policy documents and guiding frameworks can be used to inform evidence-based, institutionally specific action on postsecondary mental health. More work is required to align the fragmented action occurring across Canada and incentivize postsecondary institutions to create a sustainable, effective strategy to address the increasingly complex and unique mental health needs of their students, staff, and faculty.
Topics: Canada; Health Policy; Humans; Mental Health Services
PubMed: 33016127
DOI: 10.1177/0706743720961733 -
BMJ Open Sep 2016The UK Department of Health recommends annual influenza vaccination for healthcare workers, but uptake remains low. For staff, there is uncertainty about the rationale... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The UK Department of Health recommends annual influenza vaccination for healthcare workers, but uptake remains low. For staff, there is uncertainty about the rationale for vaccination and evidence underpinning the recommendation.
OBJECTIVES
To clarify the rationale, and evidence base, for influenza vaccination of healthcare workers from the occupational health, employer and patient safety perspectives.
DESIGN
Systematic appraisal of published systematic reviews.
RESULTS
The quality of the 11 included reviews was variable; some included exactly the same trials but made conflicting recommendations. 3 reviews assessed vaccine effects in healthcare workers and found 1 trial reporting a vaccine efficacy (VE) of 88%. 6 reviews assessed vaccine effects in healthy adults, and VE was consistent with a median of 62% (95% CI 56 to 67). 2 reviews assessed effects on working days lost in healthcare workers (3 trials), and 3 reported effects in healthy adults (4 trials). The meta-analyses presented by the most recent reviews do not reach standard levels of statistical significance, but may be misleading as individual trials suggest benefit with wide variation in size of effect. The 2013 Cochrane review reported absolute effects close to 0 for laboratory-confirmed influenza, and hospitalisation for patients, but excluded data on clinically suspected influenza and all-cause mortality, which had shown potentially important effects in previous editions. A more recent systematic review reports these effects as a 42% reduction in clinically suspected influenza (95% CI 27 to 54) and a 29% reduction in all-cause mortality (95% CI 15 to 41).
CONCLUSIONS
The evidence for employer and patient safety benefits of influenza vaccination is not straightforward and has been interpreted differently by different systematic review authors. Future uptake of influenza vaccination among healthcare workers may benefit from a fully transparent guideline process by a panel representing all relevant stakeholders, which clearly communicates the underlying rationale, evidence base and judgements made.
Topics: Health Personnel; Health Policy; Humans; Influenza Vaccines; Influenza, Human; Mortality; Occupational Health; Patient Safety; Uncertainty; United Kingdom; Vaccination
PubMed: 27625062
DOI: 10.1136/bmjopen-2016-012149 -
European Journal of Public Health Nov 2022Successful implementation of health policies require acceptance from the public and policy-makers. This review aimed to identify tools used to assess the acceptability...
BACKGROUND
Successful implementation of health policies require acceptance from the public and policy-makers. This review aimed to identify tools used to assess the acceptability of policies targeting physical activity and dietary behaviour, and examine if acceptability differs depending on characteristics of the policy and of the respondents.
METHODS
A systematic review (PROSPERO: CRD42021232326) was conducted using three databases (Science Direct, PubMed and Web of Science).
RESULTS
Of the initial 7780 hits, we included 48 eligible studies (n = 32 on dietary behaviour, n = 11 on physical activity and n = 5 on both), using qualitative and quantitative designs (n = 25 cross-sectional, quantitative; n = 15 qualitative; n = 5 randomized controlled trials; n = 3 mixed-methods design). Acceptability was analysed through online surveys (n = 24), interviews (n = 10), focus groups (n = 10), retrospective textual analysis (n = 3) and a taste-test experiment (n = 1). Notably, only 3 (out of 48) studies applied a theoretical foundation for their assessment. Less intrusive policies such as food labels and policies in a later stage of the implementation process received higher levels of acceptability. Women, older participants and respondents who rated policies as appropriate and effective showed the highest levels of acceptability.
CONCLUSION
Highly intrusive policies such as taxations or restrictions are the least accepted when first implemented, but respondents' confidence in the relevance and effectiveness of the policy may boost acceptability over the course of implementation. Studies using validated tools and a theoretical foundation are needed to further examine opportunities to increase acceptability.
Topics: Humans; Female; Cross-Sectional Studies; Retrospective Studies; Diet; Exercise; Health Policy
PubMed: 36444105
DOI: 10.1093/eurpub/ckac053 -
Human Vaccines & Immunotherapeutics Dec 2016Vaccine-preventable deaths among adults remain a major public health concern, despite continued efforts to increase vaccination rates in this population. Alternative... (Review)
Review
Vaccine-preventable deaths among adults remain a major public health concern, despite continued efforts to increase vaccination rates in this population. Alternative approaches to immunization delivery may help address under-vaccination among adults. This systematic review assesses the feasibility, acceptability, and effectiveness of community pharmacies as sites for adult vaccination. We searched 5 electronic databases (PubMed, EMBASE, Scopus, Cochrane, LILACS) for studies published prior to June 2016 and identified 47 relevant articles. We found that pharmacy-based immunization services (PBIS) have been facilitated by state regulatory changes and training programs that allow pharmacists to directly provide vaccinations. These services are widely accepted by both patients and pharmacy staff, and are capable of improving access and increasing vaccination rates. However, political and organizational barriers limit the feasibility and effectiveness of vaccine delivery in pharmacies. These studies provide evidence to inform policy and organizational efforts that promote the efficacy and sustainability of PBIS.
Topics: Adult; Health Policy; Health Services Accessibility; Humans; Patient Acceptance of Health Care; Pharmacies; Vaccination
PubMed: 27715409
DOI: 10.1080/21645515.2016.1215393 -
International Journal of Environmental... Jan 2022Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events... (Review)
Review
A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice.
INTRODUCTION
Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters.
OBJECTIVE
There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition.
METHODS
A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported.
RESULTS
The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort.
CONCLUSION
This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.
Topics: Firefighters; Humans; Military Personnel; Prevalence; Public Policy; Stress Disorders, Post-Traumatic
PubMed: 35162587
DOI: 10.3390/ijerph19031565 -
Obesity Reviews : An Official Journal... May 2015Policies and changes to the built environment are promising targets for obesity prevention efforts and can be evaluated as 'natural'- or 'quasi'-experiments. This... (Review)
Review
Policies and changes to the built environment are promising targets for obesity prevention efforts and can be evaluated as 'natural'- or 'quasi'-experiments. This systematic review examined the use of natural- or quasi-experiments to evaluate the efficacy of policy and built environment changes on obesity-related outcomes (body mass index, diet or physical activity). PubMed (Medline) was searched for studies published 2005-2013; 1,175 abstracts and 115 papers were reviewed. Of the 37 studies included, 18 studies evaluated impacts on nutrition/diet, 17 on physical activity and 3 on body mass index. Nutrition-related studies found greater effects because of bans/restrictions on unhealthy foods, mandates offering healthier foods, and altering purchase/payment rules on foods purchased using low-income food vouchers compared with other interventions (menu labelling, new supermarkets). Physical activity-related studies generally found stronger impacts when the intervention involved improvements to active transportation infrastructure, longer follow-up time or measured process outcomes (e.g., cycling rather than total physical activity), compared with other studies. Only three studies directly assessed body mass index or weight, and only one (installing light-rail system) observed a significant effect. Studies varied widely in the strength of their design and studies with weaker designs were more likely to report associations in the positive direction.
Topics: Body Mass Index; Cardiovascular Diseases; Diet; Environment Design; Exercise; Food; Health Promotion; Humans; Nutritional Physiological Phenomena; Obesity; Policy Making; Public Policy
PubMed: 25753170
DOI: 10.1111/obr.12269 -
BMC Health Services Research Oct 2016Little is known about the interventions required to build the capacity of mental health policy-makers and planners in low- and middle-income countries (LMICs). We... (Review)
Review
BACKGROUND
Little is known about the interventions required to build the capacity of mental health policy-makers and planners in low- and middle-income countries (LMICs). We conducted a systematic review with the primary aim of identifying and synthesizing the evidence base for building the capacity of policy-makers and planners to strengthen mental health systems in LMICs.
METHODS
We searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, ScieELO, Google Scholar and Cochrane databases for studies reporting evidence, experience or evaluation of capacity-building of policy-makers, service planners or managers in mental health system strengthening in LMICs. Reports in English, Spanish, Portuguese, French or German were included. Additional papers were identified by hand-searching references and contacting experts and key informants. Database searches yielded 2922 abstracts and 28 additional papers were identified. Following screening, 409 full papers were reviewed, of which 14 fulfilled inclusion criteria for the review. Data were extracted from all included papers and synthesized into a narrative review.
RESULTS
Only a small number of mental health system-related capacity-building interventions for policy-makers and planners in LMICs were described. Most models of capacity-building combined brief training with longer term mentorship, dialogue and/or the establishment of networks of support. However, rigorous research and evaluation methods were largely absent, with studies being of low quality, limiting the potential to separate mental health system strengthening outcomes from the effects of associated contextual factors.
CONCLUSIONS
This review demonstrates the need for partnership approaches to building the capacity of mental health policy-makers and planners in LMICs, assessed rigorously against pre-specified conceptual frameworks and hypotheses, utilising longitudinal evaluation and mixed quantitative and qualitative approaches.
Topics: Administrative Personnel; Capacity Building; Developing Countries; Government Programs; Health Policy; Health Services Research; Humans; Interprofessional Relations; Medical Assistance; Mental Health Services; Poverty; Quality of Health Care
PubMed: 27769270
DOI: 10.1186/s12913-016-1853-0 -
Journal of Medical Internet Research Jan 2016Growing evidence attests to the efficacy of e-mental health services. There is less evidence on how to facilitate the safe, effective, and sustainable implementation of... (Review)
Review
BACKGROUND
Growing evidence attests to the efficacy of e-mental health services. There is less evidence on how to facilitate the safe, effective, and sustainable implementation of these services.
OBJECTIVE
We conducted a systematic review on e-mental health service use for depressive and anxiety disorders to inform policy development and identify policy-relevant gaps in the evidence base.
METHODS
Following the PRISMA protocol, we identified research (1) conducted in Australia, (2) on e-mental health services, (3) for depressive or anxiety disorders, and (4) on e-mental health usage, such as barriers and facilitators to use. Databases searched included Cochrane, PubMed, PsycINFO, CINAHL, Embase, ProQuest Social Science, and Google Scholar. Sources were assessed according to area and level of policy relevance.
RESULTS
The search yielded 1081 studies; 30 studies were included for analysis. Most reported on self-selected samples and samples of online help-seekers. Studies indicate that e-mental health services are predominantly used by females, and those who are more educated and socioeconomically advantaged. Ethnicity was infrequently reported on. Studies examining consumer preferences found a preference for face-to-face therapy over e-therapies, but not an aversion to e-therapy. Content relevant to governance was predominantly related to the organizational dimensions of e-mental health services, followed by implications for community education. Financing and payment for e-services and governance of the information communication technology were least commonly discussed.
CONCLUSIONS
Little research focuses explicitly on policy development and implementation planning; most research provides an e-services perspective. Research is needed to provide community and policy-maker perspectives. General population studies of prospective treatment seekers that include ethnicity and socioeconomic status and quantify relative preferences for all treatment modalities are necessary.
Topics: Australia; Female; Health Policy; Health Services Research; Humans; Internet; Male; Mental Disorders; Mental Health; Mental Health Services; Sex Factors; Telemedicine
PubMed: 26764181
DOI: 10.2196/jmir.4827 -
BMJ Open Mar 2015Drug counterfeiting has serious public health and safety implications. The objective of this study was to systematically review the evidence on the effectiveness of... (Review)
Review
OBJECTIVE
Drug counterfeiting has serious public health and safety implications. The objective of this study was to systematically review the evidence on the effectiveness of interventions to combat or prevent drug counterfeiting.
DATA SOURCES
We searched multiple electronic databases and the grey literature up to March 2014. Two reviewers completed, in duplicate and independently, the study selection, data abstraction and risk of bias assessment.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS
We included randomised trials, non-randomised studies, and case studies examining any intervention at the health system-level to combat or prevent drug counterfeiting. Outcomes of interest included changes in failure rates of tested drugs and changes in prevalence of counterfeit medicines. We excluded studies that focused exclusively on substandard, degraded or expired drugs, or that focused on medication errors.
APPRAISAL AND SYNTHESIS
We assessed the risk of bias in each included study. We reported the results narratively and, where applicable, we conducted meta-analyses.
RESULTS
We included 21 studies representing 25 units of analysis. Overall, we found low quality evidence suggesting positive effects of drug registration (OR=0.23; 95% CI 0.08 to 0.67), and WHO-prequalification of drugs (OR=0.06; 95% CI 0.01 to 0.35) in reducing the prevalence of counterfeit and substandard drugs. Low quality evidence suggests that licensing of drug outlets is probably ineffective (OR=0.66; 95% CI 0.41 to 1.05). For multifaceted interventions (including a mix of regulations, training of inspectors, public-private collaborations and legal actions), low quality evidence suggest they may be effective. The single RCT provided moderate quality evidence of no effect of 'two extra inspections' in improving drug quality.
CONCLUSIONS
Policymakers and stakeholders would benefit from registration and WHO-prequalification of drugs and may also consider multifaceted interventions. Future effectiveness studies should address the methodological limitations of the available evidence.
TRIAL REGISTRATION NUMBER
PROSPERO CRD42014009269.
Topics: Counterfeit Drugs; Fraud; Health Policy; Humans; International Cooperation; Pharmaceutical Services, Online; Public Health
PubMed: 25787989
DOI: 10.1136/bmjopen-2014-006290