-
BMJ Open Jan 2022Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation...
INTRODUCTION
Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment.
METHODS
We included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes. After searching PubMed for peer-reviewed articles published on 26 November 2020 or earlier and screening, all studies were reviewed by three reviewers first independently and then to consensus. The review tool was based on previously developed and released review guidance for COVID-19 policy impact evaluation.
RESULTS
After 102 articles were identified as potentially meeting inclusion criteria, we identified 36 published articles that evaluated the quantitative impact of COVID-19 policies on direct COVID-19 outcomes. Nine studies were set aside because the study design was considered inappropriate for COVID-19 policy impact evaluation (n=8 pre/post; n=1 cross-sectional), and 27 articles were given a full consensus assessment. 20/27 met criteria for graphical display of data, 5/27 for functional form, 19/27 for timing between policy implementation and impact, and only 3/27 for concurrent changes to the outcomes. Only 4/27 were rated as overall appropriate. Including the 9 studies set aside, reviewers found that only four of the 36 identified published and peer-reviewed health policy impact evaluation studies passed a set of key design checks for identifying the causal impact of policies on COVID-19 outcomes.
DISCUSSION
The reviewed literature directly evaluating the impact of COVID-19 policies largely failed to meet key design criteria for inference of sufficient rigour to be actionable by policy-makers. More reliable evidence review is needed to both identify and produce policy-actionable evidence, alongside the recognition that actionable evidence is often unlikely to be feasible.
Topics: COVID-19; Cross-Sectional Studies; Health Policy; Humans; Research Design; SARS-CoV-2
PubMed: 35017250
DOI: 10.1136/bmjopen-2021-053820 -
Frontiers in Public Health 2021Black women in the United States experience maternal mortality three to four times more often than white women (1, 2). States vary in degree of disparity, partially due...
Black women in the United States experience maternal mortality three to four times more often than white women (1, 2). States vary in degree of disparity, partially due to programs and policies available to pregnant people. In Massachusetts, Black women were approximately twice as likely as white women to experience pregnancy-associated mortality, with a large percentage of these deaths reported to be preventable (3). Using Massachusetts as a state-level comparison to national policies, we searched the US Congress and Massachusetts legislative databases for maternal health policies from 2010 to 2020. We screened 1,421 national and 360 Massachusetts bills, following set inclusion/exclusion criteria. Data analysis included (1) assessment of bill characteristics, (2) thematic analysis, and a (3) quality appraisal following an adapted model of the analytical framework for evaluating public health policy proposed by the National Collaborating Centre for Healthy Public Policy. Additionally, our data analysis identified the level of racism (internalized, interpersonal or institutional) that each policy addressed. From 2010 to 2020, 31 national and 16 state-level policies were proposed that address maternal health and racial disparities. The majority of policies addressed racism at the institutional level alone (National: = 19, 61.3%, Massachusetts: = 14, 87.5%). Two national and two Massachusetts-level policies became law, while two national policies passed only the House of Representatives. Our critical appraisal revealed that the majority of unintended effects would be neutral or positive, however, some potential negative unintended effects were identified. The appraisal also identified 54.8% ( = 17) of national policies and 68.8% ( = 11) of Massachusetts with positive impact on health equity. There has been an increase in policies proposed addressing racial disparities and health equity in maternal health over the last 10 years. Although half of national policies proposed showed positive impact on health equity, shedding light on the work the U.S. is doing on a federal level to confront the Black maternal health crisis, only two policies made it to law, only one of which addressed racial disparities directly and had a positive impact on health equity.
Topics: Black or African American; Female; Health Policy; Humans; Massachusetts; Maternal Health; Maternal Mortality; Pregnancy; United States
PubMed: 34746071
DOI: 10.3389/fpubh.2021.664659 -
International Journal of Environmental... Jul 2018. Smoke-free environment policies limit or eliminate the use of smoke-producing tobacco in designated areas thereby reducing second hand smoke. Enforcement is perceived...
. Smoke-free environment policies limit or eliminate the use of smoke-producing tobacco in designated areas thereby reducing second hand smoke. Enforcement is perceived as critical to the successful adoption of a smoke-free policy. However, there is limited guidance available regarding effective enforcement strategies. A systematic review was conducted to examine the effectiveness of enforcement strategies at increasing compliance with and enforcement of smoke-free policies; and to determine circumstances other than enforcement strategies that are associated with compliance with smoke-free policies. . Medline, Medline in Process, The Cochrane Library, Embase, PsycInfo and CINAHL databases were searched using MeSH and keywords for relevant studies published between January 1980 and August 2017. A narrative synthesis and methodological quality assessment of included studies was undertaken. . Policy promotion and awareness-raising activities, signage, enforcement officers, and penalties for violations were the enforcement strategies most frequently cited as being associated with successful policy enforcement. Additionally, awareness of the laws, non-smoking management and lower staff smoking rates, and membership of a network guiding the policy enforcement contributed to higher compliance with smoke-free policies. . There is weak evidence of the effectiveness of strategies associated with compliance with smoke-free policies. Given the evidence base is weak, well-designed trials utilizing appropriate evaluation designs are needed. Overall enforcement strategies associated with total smoke-free bans resulted in higher levels of compliance than strategies for policies that had only partial smoke-free bans.
Topics: Awareness; Humans; Law Enforcement; Perception; Smoke-Free Policy; Tobacco Smoke Pollution
PubMed: 30004425
DOI: 10.3390/ijerph15071386 -
AIDS and Behavior Mar 2017In their response to HIV, many countries have adopted and enacted policies to reduce transmission and increase HIV-related service use. Theoretically, policy-level... (Review)
Review
In their response to HIV, many countries have adopted and enacted policies to reduce transmission and increase HIV-related service use. Theoretically, policy-level interventions for HIV prevention have the potential to improve health behavior outcomes. These policy interventions vary in their scale, from relatively minor changes in clinical policy to major national legal initiatives. Assessing the effectiveness of HIV policy interventions is a challenging undertaking. While many policies exist and guide HIV programmes, relatively few have specifically been evaluated for their effects on reducing HIV risk taking or increasing HIV health-seeking behaviors. Thus, questions on the effectiveness of policy interventions to prevent HIV and change HIV-related risk behaviors remain largely unanswered. To address this current gap in the literature, we systematically reviewed the existing evidence on the effect of HIV policy interventions on changing HIV-related behaviors in low-and middle-income countries.
Topics: Developing Countries; Female; HIV Infections; Health Policy; Health Promotion; Humans; Income; Risk-Taking; Sexual Behavior
PubMed: 27864626
DOI: 10.1007/s10461-016-1615-3 -
Journal of the International AIDS... Jul 2022There is strong global commitment to eliminate HIV-related stigma, and work in this area continues to evolve. Wide variation exists in frameworks and measures used. (Review)
Review
INTRODUCTION
There is strong global commitment to eliminate HIV-related stigma, and work in this area continues to evolve. Wide variation exists in frameworks and measures used.
METHODS
Building on the existing knowledge syntheses, we carried out a systematic review to identify frameworks and measures aiming to understand or assess internalized stigma, stigma and discrimination in healthcare, and in law and policy. The review addressed two questions: Which conceptual frameworks have been proposed to assess internalized stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? Which measures of these different types of stigma and discrimination have been proposed and what are their descriptive properties? Searches, completed on 6 May 2021, cover publications from 2008 onwards. The review is registered in PROSPERO (CRD42021249348), the protocol incorporated stakeholder input, and the data are available in the Systematic Review Data Repository.
RESULTS AND DISCUSSION
Sixty-nine frameworks and 50 measures met the inclusion criteria. Critical appraisal figures and detailed evidence tables summarize these resources. We established a compendium of frameworks and a catalogue of measures of HIV-related stigma and discrimination. Seventeen frameworks and 10 measures addressed at least two of our focus domains, with least attention to stigma and discrimination in law and policy. The lack of common definitions and variability in scope and structure of HIV-related frameworks and measures creates challenges in understanding what is being addressed and measured, both in relation to stigma and efforts to mitigate or reduce its harmful effects. Having comparable data is essential for tracking change over time within and between interventions.
CONCLUSIONS
This systematic review provides an evidence base of current understandings of HIV-related stigma and discrimination and how further conceptual clarification and increased adaptation of existing tools might help overcome challenges across the HIV care continuum. With people living with HIV at the centre, experts from different stakeholder groups could usefully collaborate to guide a more streamlined approach for the field. This can help to achieve global targets and understand, measure and help mitigate the impact of different types of HIV-related stigma on people's health and quality of life.
Topics: Delivery of Health Care; HIV Infections; Humans; Policy; Quality of Life; Social Stigma
PubMed: 35818866
DOI: 10.1002/jia2.25915 -
International Journal of Technology... Dec 2021This study aims to identify and codify the facilitators and barriers to help implementing partners institutionalize health technology assessment (HTA) successfully and...
OBJECTIVE
This study aims to identify and codify the facilitators and barriers to help implementing partners institutionalize health technology assessment (HTA) successfully and navigate complex systems for health-related policy making.
METHODS
We searched for peer-reviewed and gray literature articles examining HTA programs globally using six databases. Keywords used as a guide for capturing articles included "health technology assessment," "barrier," and "facilitator" and their synonyms. Search results were scrutinized for duplicates and screened through a review of titles and abstracts. A full-text review was conducted exploring articles' coverage of twenty-seven evaluation criteria across four primary areas of interest: barriers/facilitators, motivations, guidelines, and institutional frameworks.
RESULTS
A total of 18,599 records were identified for duplication check, title, and abstract review. A total of 1,594 articles underwent full-text review, leading to a final synthesis of 262 studies. We found that ninety-seven articles discussed barriers/facilitators, with fifty-three of those discussing local capacity and unavailable human resources. Out of the sixty-six articles discussing motivations, forty-two cited the interest in supporting the decision-making process for, and promoting, appropriate resource allocation. Of the sixty-one articles that discussed guidelines and institutional framework, twenty-one articles described HTA as an independent national unit, and sixteen described their HTA unit as a unit within the Ministry of Health (MOH).
CONCLUSIONS
This systematic review unpacks the dynamic and relevant contexts for understanding the HTA institutionalization process to help policy makers and practitioners achieve tangible progress in confronting the most critical issues facing priority setting and HTA institutionalization.
Topics: Humans; Health Policy; Decision Making; Technology Assessment, Biomedical; Policy Making; Biomedical Technology
PubMed: 36317684
DOI: 10.1017/S0266462321000623 -
Health Policy (Amsterdam, Netherlands) Jul 2020A small number of regenerative medicines (RMs) have received market authorization (MA) worldwide, relative to the large number of clinical trials currently being... (Review)
Review
BACKGROUND
A small number of regenerative medicines (RMs) have received market authorization (MA) worldwide, relative to the large number of clinical trials currently being conducted. Regulatory issues constitute one major challenge for the MA of RMs.
OBJECTIVE
This study aimed to systematically review the regulation of RMs internationally, to identify the regulatory pathways for approved RMs, and to detail expedited programs to stimulate MA process.
METHODS
Official websites of regulatory authorities in 9 countries (United States (US), Japan, South Korea, Australia, Canada, New Zealand, Singapore, China, and India) and the European Union (EU) were systematically browsed, and was complemented by a systematic literature review in Medline and Embase database.
RESULTS
Specific RM legislation/frameworks were available in the EU, US, Japan, South Korea and Australia. A risk-based approach exempting eligible RMs from MA regulations were adopted in the EU and 6 countries. All investigated regions have established accelerated review or approval programs to facilitate the MA of RMs. 55 RMs have received MA in 9 countries and the EU. Twenty-three RMs received Priority Medicine designation, 32 RMs received Regenerative Medicine Advanced Therapy designation, and 11 RMs received SAKIGAKE (fore-runner initiative) designation.
CONCLUSION
Regulators have adopted proactive strategies to facilitate RM approval. However, addressing the discrepancies in regulatory requirements internationally remains challenging.
Topics: Australia; Canada; China; Humans; Japan; New Zealand; Policy; Regenerative Medicine; Republic of Korea; Singapore; United States
PubMed: 32499078
DOI: 10.1016/j.healthpol.2020.05.004 -
JBI Evidence Synthesis Feb 2022The objective of this review was to identify and synthesize the best available evidence to address two questions. From the perspectives of individuals with chronic... (Review)
Review
Barriers to and facilitators of labor market engagement for individuals with chronic physical illnesses in their experiences with work disability policy: a qualitative systematic review.
OBJECTIVE
The objective of this review was to identify and synthesize the best available evidence to address two questions. From the perspectives of individuals with chronic physical illnesses: i) what are the barriers in work disability policies with respect to labor market engagement? and ii) what are the facilitators in work disability policies with respect to labor market engagement?
INTRODUCTION
Chronic physical illnesses have a high and increasing prevalence worldwide and are associated with significant disability in the working-age population. Individuals with chronic illnesses and disability have low employment and high unemployment rates, and low wages. Work disability policies have an important role in reducing negative labor market impacts, but inadequate policies may also pose barriers to work engagement.
INCLUSION CRITERIA
This review included studies of individuals who were of working age, had one or more chronic physical illness, and had experience relevant to disability policy and work engagement. The phenomena of interest were perceived barriers and perceived facilitators in work disability policies with respect to labor market engagement. The context was any study setting globally. Studies considered for this review had qualitative data from a variety of methodologies.
METHODS
This review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. A literature search involved academic databases (ie, CINAHL Plus, MEDLINE, PsycINFO, AgeLine, SocINDEX, Social Work Abstracts, Sociological Abstracts, Social Services Abstracts) for published studies; gray literature sources (ie, ProQuest Dissertations and Theses, MedNar, Google Scholar, OpenGrey, OAIster, Google, and relevant websites) for unpublished studies; and reference lists of retrieved records. No language, date, or country limiters were applied to the searches. Retrieved records from the database and gray literature searches were screened, with potentially relevant records then examined in full against the inclusion criteria. Eligible studies were critically appraised for methodological quality and those included in this review were subjected to data extraction of descriptive details and the study findings that were relevant to the review questions. Study findings were synthesized and were assigned confidence scores.
RESULTS
Forty-four studies of various qualitative designs and varied methodological quality (from low to high) were included in this review. The study samples represented a number of different chronic physical illnesses. There were 301 credible and unequivocal study findings, which were aggregated into 20 categories and 5 synthesized findings. Persons with chronic physical illnesses perceived barriers and facilitators relevant to the adequacy of disability policies in meeting their needs for returning to work after leave due to illness and for sustaining ongoing work engagement. They also perceived barriers and facilitators relevant to stakeholders' communication, help, and support respecting workers' efforts toward work engagement.
CONCLUSION
Although confidence in the synthesized findings is low due to limitations in the methods and research findings across primary studies, the evidence suggests that both the adequacy and implementation of work disability policies need to be improved to meet the needs of workers with chronic physical illnesses, for their labor market engagement.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO CRD42016033476.
Topics: Chronic Disease; Delivery of Health Care; Humans; Policy; Qualitative Research
PubMed: 34669686
DOI: 10.11124/JBIES-20-00482 -
PloS One 2019In 2011, South Africa committed to promoting exclusive breastfeeding (EBF) for six months for all mothers, regardless of HIV status, in line with World Health...
BACKGROUND
In 2011, South Africa committed to promoting exclusive breastfeeding (EBF) for six months for all mothers, regardless of HIV status, in line with World Health Organization recommendations. This was a marked shift from earlier policies, and with it, average EBF rates increased from less than 10% in 2011 to 32% by 2016.
OBJECTIVES
The aim of this mixed-methods systematic review was to describe EBF practices in South Africa and their multi-level influences over four policy periods.
METHODS
We applied PRISMA guidelines according to a published protocol (Prospero: CRD42014010512). We searched seven databases [Africa-Wide, PubMed, Popline, PsychINFO, CINAHL, Global Health, and The Cochrane Library] and conducted hand searches for eligible articles (all study designs, conducted in South Africa and published between 1980-2018). The quality of articles was assessed using published tools, as appropriate. Separate policy analysis was conducted to delineate four distinct policy periods. We compared EBF rates by these periods. Then, applying a three-level ecological framework, we analysed EBF influences concurrently by method. Finally, the findings were synthesized to compare breastfeeding influences by policy period, maintaining an ecological framework.
RESULTS
From an initial sample of 20,226 articles, 72 unique articles were reviewed, three of which contributed to both quantitative and qualitative analysis. Despite the large sample, several provinces were poorly represented (if at all) and many studies were assessed as low to moderate quality. Despite these limitations, our historical lens enabled us to explore why South African progress on increasing EBF practices has been slow. The review reflects a context that increasingly supports EBF, but falls short in accounting for family, community, and workplace influences. The findings also highlight the unintended damage caused by rapidly adopting and introducing global guidelines to an unsupported health workforce.
CONCLUSIONS
From a South African perspective, we identified geographic and methodological biases, as well as gaps in our understanding and potential explanations of inequities in EBF. Our recommendations relate to policy, programming, and research to inform changes that would be required to further improve EBF practice rates in South Africa. While our review is South Africa-specific, our findings have broader implications for investing in multi-level interventions and limiting how often infant feeding guidelines are changed.
Topics: Breast Feeding; Databases, Factual; Guidelines as Topic; Health Policy; Health Workforce; Humans; Infant; South Africa
PubMed: 31626658
DOI: 10.1371/journal.pone.0224029 -
BMC Health Services Research Jul 2014Wheelchairs for disabled children (≤ 18 years) can provide health, developmental and social benefits. World Health Organisation and United Kingdom Government reports... (Review)
Review
BACKGROUND
Wheelchairs for disabled children (≤ 18 years) can provide health, developmental and social benefits. World Health Organisation and United Kingdom Government reports demonstrate the need for improved access to wheelchairs both locally and internationally. The use of health economics within this field is lacking. Provision of wheelchairs based on cost-effectiveness evidence is not currently possible. We conducted the first systematic review in this field to incorporate evidence of effectiveness, service user perspectives, policy intentions and cost-effectiveness in order to develop a conceptual framework to inform future research and service development.
METHODS
We used an adapted EPPI-Centre mixed-method systematic review design with narrative summary, thematic and narrative synthesis. 11 databases were searched. Studies were appraised for quality using one of seven appropriate tools. A conceptual framework was developed from synthesised evidence.
RESULTS
22 studies and 14 policies/guidelines were included. Powered wheelchairs appear to offer benefits in reduced need for caregiver assistance; improved communicative, personal-social and cognitive development; and improved mobility function and independent movement. From 14 months of age children can learn some degree of powered wheelchair driving competence. However, effectiveness evidence was limited and low quality. Children and parents placed emphasis on improving social skill and independence. Participation in wider society and development of meaningful relationships were key desired outcomes. Policy intentions and aspirations are in line with the perspectives of children and parents, although translation of policy recommendations into practice is lacking.
CONCLUSIONS
There is a distinct lack of high quality effectiveness and economic evidence in this field. Social and health needs should be seen as equally important when assessing the mobility needs of disabled children. Disabled children and parents placed highest priority on independence and psychosocial outcomes of wheelchair interventions. Translation of policy and guidelines into practice is lacking and more effective implementation strategies are required to improve services and outcomes. Future research should focus on outcome measure development, developing economic evaluation tools and incorporating these into high quality studies to address known research gaps. The novel conceptual framework maps current gaps in evidence and outlines areas for development.
Topics: Child; Cost-Benefit Analysis; Disabled Children; Evidence-Based Medicine; Health Policy; Health Services Needs and Demand; Humans; Wheelchairs
PubMed: 25034517
DOI: 10.1186/1472-6963-14-309