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International Journal For Equity in... Nov 2023Social participation, also termed stakeholder voice, is an important component of health system governance. Increased interactions between the community and policy... (Review)
Review
Assessing the interactions of people and policy-makers in social participation for health: an inventory of participatory governance measures from a rapid systematic literature review.
Social participation, also termed stakeholder voice, is an important component of health system governance. Increased interactions between the community and policy makers could facilitate a more responsive health system that targets the needs of the community better. Recently, the World Health Organization (WHO) published a handbook on social participation that identified five key themes for ministries of health to consider when engaging the input of the community. In this rapid systematic literature review, we aimed to identify quantitative and qualitative measures that have been used to assess aspects of social participation involving people and policy makers. We identified 172 measures from 48 studies from countries in all six WHO regions. These measures were categorized by all five themes from the handbook on social participation and these measures are linked to 27 concepts. This rapid review found that the focus of measures is largely on the existence of participation-be it by the general population or specific vulnerable groups-rather than on the quality of their participation. The measures in this inventory may be useful for ministries of health and other key stakeholders to use when developing methods to assess and encourage social participation in their context.
Topics: Humans; Social Participation; Government Programs; Policy; Administrative Personnel
PubMed: 37978389
DOI: 10.1186/s12939-023-01918-2 -
Sports Health 2020Cannabis use has increased, in large part due to decriminalization. Despite this increase in usage, it remains unclear what proportion of athletes use cannabis and what...
CONTEXT
Cannabis use has increased, in large part due to decriminalization. Despite this increase in usage, it remains unclear what proportion of athletes use cannabis and what effect it has on athletic performance and recovery.
OBJECTIVE
To systematically review cannabis use among athletes, including epidemiology, effect on performance and recovery, and regulations for use in sport.
DATA SOURCES
PubMed, MEDLINE, and EMBASE databases were queried from database inception through November 15, 2018. A hand search of policies, official documents, and media reports was performed for relevant information.
STUDY SELECTION
All studies related to cannabis use in athletes, including impact on athletic performance or recovery, were included.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
Demographic and descriptive data of included studies relating to epidemiology of cannabis use in athletes were extracted and presented in weighted means or percentages where applicable.
RESULTS
Overall, 37 studies were included, of which the majority were cross-sectional studies of elite and university athletes. Among 11 studies reporting use among athletes (n = 46,202), approximately 23.4% of respondents reported using cannabis in the past 12 months. Two studies found a negative impact on performance, while another 2 studies found no impact. There was no literature on the influence of cannabis on athletic recovery. Across athletic organizations and leagues, there is considerable variability in acceptable thresholds for urine tetrahydrocannabinol levels (>15 to 150 ng/mL) and penalties for athletes found to be above these accepted thresholds.
CONCLUSION
Overall, these results suggest that approximately 1 in 4 athletes report using cannabis within the past year. Based on the available evidence, cannabis does not appear to positively affect performance, but the literature surrounding this is generally poor. Given the variability in regulation across different sport types and competition levels, as well as the growing number of states legalizing recreational cannabis use, there is a need to improve our understanding of the effects of cannabis use on the athlete and perhaps adopt a clearer and overarching policy for the use of cannabis by athletes in all sports and at all levels.
Topics: Athletic Performance; Dronabinol; Humans; Marijuana Abuse; Marijuana Smoking; Organizational Policy; Sports; Substance Abuse Detection
PubMed: 32023171
DOI: 10.1177/1941738120901670 -
ESMO Open Apr 2024Patients with cancer in low- and middle-income countries experience worse outcomes as a result of the limited capacity of health systems to deliver comprehensive cancer... (Review)
Review
BACKGROUND
Patients with cancer in low- and middle-income countries experience worse outcomes as a result of the limited capacity of health systems to deliver comprehensive cancer care. The health workforce is a key component of health systems; however, deep gaps exist in the availability and accessibility of cancer care providers.
MATERIALS AND METHODS
We carried out a systematic review of the literature evaluating the strategies for capacity building of the cancer workforce. We studied how the policy strategies addressed the availability, accessibility, acceptability, and quality (AAAQ) of the workforce. We used a strategic planning framework (SWOT: strengths, weaknesses, opportunities, threats) to identify actionable areas of capacity building. We contextualized our findings based on the WHO 2030 Global Strategy on Human Resources for Health, evaluating how they can ultimately be framed in a labour market approach and inform strategies to improve the capacity of the workforce (PROSPERO: CRD42020109377).
RESULTS
The systematic review of the literature yielded 9617 records, and we selected 45 eligible papers for data extraction. The workforce interventions identified were delivered mostly in the African and American Regions, and in two-thirds of cases, in high-income countries. Many strategies have been shown to increase the number of competent oncology providers. Optimization of the existing workforce through role delegation and digital health interventions was reported as a short- to mid-term solution to optimize cancer care, through quality-oriented, efficiency-improving, and acceptability-enforcing workforce strategies. The increased workload alone was potentially detrimental. The literature on retaining the workforce and reducing brain drain or attrition in underserved areas was commonly limited.
CONCLUSIONS
Workforce capacity building is not only a quantitative problem but can also be addressed through quality-oriented, organizational, and managerial solutions of human resources. The delivery of comprehensive, acceptable, and impact-oriented cancer care requires an available, accessible, and competent workforce for comprehensive cancer care. Efficiency-improving strategies may be instrumental for capacity building in resource-constrained settings.
Topics: Humans; Capacity Building; Neoplasms; Health Workforce; Health Policy; Comprehensive Health Care; Medical Oncology; Delivery of Health Care
PubMed: 38507895
DOI: 10.1016/j.esmoop.2024.102946 -
BMC Public Health Apr 2021In 2016, the "Act on Support for Overseas Expansion of Healthcare System and Attraction of International Patients" was enacted by the South Korean government in an...
BACKGROUND
In 2016, the "Act on Support for Overseas Expansion of Healthcare System and Attraction of International Patients" was enacted by the South Korean government in an attempt to accelerate growth of its medical tourism industry. However, only a few years after its implementation, the benefits are not well understood, nor have the positive or negative impacts of expanding Korea's medical tourism sector been properly evaluated.
OBJECTIVE
We aimed to systematically review and summarize existing literature describing South Korea's medical tourism policy and legislative history, while also assessing the impact of this domestic policy approach on the country's public health systems.
METHODS
A bilingual systematic literature review was conducted per PRISMA guidelines for all South Korean medical tourism legislative and policy literature using MeSH terms and other related keywords in two academic databases, PubMed and JSTOR. Published studies were included if they directly addressed South Korean medical tourism policy. To supplement results from the peer-review, the grey literature was also searched using Google search engine for relevant policy documents, information from government websites, and national statistics on medical tourism-related data.
RESULTS
This review included 14 peer-reviewed journal articles and 9 websites. The majority of literature focused on the legislative history of South Korea's pro-medical tourism policy, economic considerations associated with industry growth, and the specific experiences of medical tourists. There was a lack of studies, analytical or commentary-based, conducting in-depth analysis of the healthcare impact of these policies or comparing benefits and costs compared to other medical tourism destinations. Proponents of medical tourism continue to advocate the government for increased deregulation and investment in the sector.
CONCLUSION
This systematic review suggests that policy decisions may prioritize economic growth offered by medical tourism over negative effects on the healthcare workforce, access and equity, and its potential to undermine Universal Health Coverage. South Korea continues to examine ways to further amend the Act and grow this sector, but these actions should be taken with caution by critically examining how other countries have adapted their policymaking based on the real-world costs associated with medical tourism.
Topics: Humans; Medical Tourism; Policy; Public Health; Republic of Korea; Tourism
PubMed: 33823817
DOI: 10.1186/s12889-021-10642-x -
Journal of Preventive Medicine and... Jun 2022Health policy can be defined as an agreement and consensus on a health-related program and set of actions taken to achieve the goals expected by programs in the area of...
BACKGROUND
Health policy can be defined as an agreement and consensus on a health-related program and set of actions taken to achieve the goals expected by programs in the area of policy. Policy analysis involves a wide range of methods, techniques, and tools in a way to reach awareness of the impacts of the developed and implemented policies. Whereas policy analysis in developed countries has a long history, in developing countries, it is instead in its first developing stages. Our paper aimed to collect systematically the studies using health policy triangle framework in doing analysis in one of the health policy issues in the Eastern Mediterranean region organization.
METHODS
To conduct our literature search, ISI/Web of Science, PubMed/MEDLINE, Embase, The Cochrane Library, Global Health Database, Scopus, as well as Google Scholar from 2003 up to June 2020 were systematically mined. To evaluate the methodological quality of the included studies, the Critical Appraisal Skills Program checklist was used.
RESULTS
We selected 30 studies, conducted between 2011 and 2020. According to the findings of these studies, in the Eastern Mediterranean region, organization region, and the role of evidence-based research in policy-making has been repeatedly emphasized, but its use in health program decision-making has been limited, and health research systems in Eastern Mediterranean region organization are still under scrutiny. There is still a gap between evidence-based research in health systems and its use in policy-making.
DISCUSSION
Based on the present systematic review, studies based on policy analysis should focus on all the elements of health policies and provide evidence to inform decisions that can strengthen health systems, improve health and improve existing inequalities.
Topics: Global Health; Health Policy; Health Promotion; Humans; Morals; Policy Making
PubMed: 35968073
DOI: 10.15167/2421-4248/jpmh2022.63.2.2450 -
International Journal of Environmental... Sep 2022Nitrous oxide (NO) is a dissociative anaesthetic that is sometimes used recreationally. The prevalence of NO use is difficult to quantify but appears to be increasing.... (Review)
Review
BACKGROUND
Nitrous oxide (NO) is a dissociative anaesthetic that is sometimes used recreationally. The prevalence of NO use is difficult to quantify but appears to be increasing. Research on NO harms and application of harm reduction strategies are limited. The aim of this mixed method systematic review was to collate and synthesise the disparate body of research on recreational nitrous oxide use to inform harm reduction approaches tailored for young people.
METHODS
To identify publications reporting the recreational use of NO, a search of public health, psychology and social science databases was conducted. Databases included . Grey literature and Google advanced search were also used. Due to limited published literature on the recreational use of NO, no limit was placed on publication date or study type. A thematic synthesis extracted descriptive and analytical themes from the selected studies. Quality appraisal was conducted using the CASP Tool for Qualitative studies and the Joanna Briggs Institute case report assessment tool.
RESULTS
The search retrieved 407 reports. Thirty-four were included in the final analysis, including sixteen case reports. The included studies were primarily concerned with raising awareness of the apparently increasing use and subsequently increasing harms of recreational NO use. There was limited reference to policy or legislative responses in any published studies, no suggestions for harm reduction strategies or application of service level responses. In general, individuals lack awareness of NO-related harms.
CONCLUSION
The review found three key areas that deserve further consideration including: (1) policy, (2) service delivery, and (3) harm associated with NO use. We recommend a top-down (policy) and bottom-up (services delivery/services users) approach to harm reduction for NO use which also includes further consultation and research with both groups. Future research could explore young people's experience of NO use including benefits and problems to inform contextually relevant harm reduction strategies.
Topics: Adolescent; Anesthetics, Dissociative; Humans; Nitrous Oxide; Policy; Prevalence; Qualitative Research
PubMed: 36141850
DOI: 10.3390/ijerph191811567 -
Health Policy and Planning Jul 2020Because health systems are conceptualized as social systems, embedded in social contexts and shaped by human agency, values are a key factor in health system change. As...
Because health systems are conceptualized as social systems, embedded in social contexts and shaped by human agency, values are a key factor in health system change. As such, health systems software-including values, norms, ideas and relationships-is considered a foundational focus of the field of health policy and systems research (HPSR). A substantive evidence-base exploring the influence of software factors on system functioning has developed but remains fragmented, with a lack of conceptual clarity and theoretical coherence. This is especially true for work on 'social values' within health systems-for which there is currently no substantive review available. This study reports on a systematic mixed-methods evidence mapping review on social values within HPSR. The study reaffirms the centrality of social values within HPSR and highlights significant evidence gaps. Research on social values in low- and middle-income country contexts is exceedingly rare (and mostly produced by authors in high-income countries), particularly within the limited body of empirical studies on the subject. In addition, few HPS researchers are drawing on available social science methodologies that would enable more in-depth empirical work on social values. This combination (over-representation of high-income country perspectives and little empirical work) suggests that the field of HPSR is at risk of developing theoretical foundations that are not supported by empirical evidence nor broadly generalizable. Strategies for future work on social values in HPSR are suggested, including: countering pervasive ideas about research hierarchies that prize positivist paradigms and systems hardware-focused studies as more rigorous and relevant to policy-makers; utilizing available social science theories and methodologies; conceptual development to build common framings of key concepts to guide future research, founded on quality empirical research from diverse contexts; and using empirical evidence to inform the development of operationalizable frameworks that will support rigorous future research on social values in health systems.
Topics: Developing Countries; Empirical Research; Health Policy; Health Services; Health Services Research; Humans; Social Values
PubMed: 32374881
DOI: 10.1093/heapol/czaa038 -
Journal of Urban Health : Bulletin of... Jun 2020Global initiatives have raised awareness of the need for cross-departmental and cross-sectoral activities to support urban health, sustainability, and equity, with...
Global initiatives have raised awareness of the need for cross-departmental and cross-sectoral activities to support urban health, sustainability, and equity, with respective indicators routinely used as a way to catalyze and monitor action toward pre-defined goals. Despite the existence of at least 145 urban health indicator (UHI) tools globally, there has been very little research on the use of indicators by policy- and decision-makers; more attention has been devoted to their development and validation. This paper describes the second part of a two-part systematic review of the characteristics (part A) and use (part B, this part) of UHI tools by municipal built environment policy- and decision-makers. Part B is a narrative synthesis of studies on the use of UHI tools. This PRISMA-P compliant review follows a mixed methods sequential explanatory design. The search was conducted using seven bibliographic databases, grey literature searches, and key journal hand searches. Ten studies describing the use of ten UHI tools in seven countries were included in the narrative synthesis, resulting in development of a theory of change (ToC). We found that both expert-led and participatory indicator projects can be underpinned by research evidence and residents' knowledge. Our findings contradict the dominant view of indicator use in policy-making as a linear process, highlighting a number of technical, organizational, political, knowledge, and contextual factors that affect their use. Participatory UHI tools with community involvement were generally more effective at supporting "health in all policies" and "whole-of-society" approaches to governing healthy cities than expert-led processes. UHI tool producers proposed a range of techniques to address urban health complexity characteristics. Finally, in combining data from both parts of the review, we found that potentially important UHI tool features, such as neighbourhood-scale data, were influential in the use of indicators by built environment policy- and decision-makers.
Topics: Built Environment; City Planning; Health Status Indicators; Humans; Policy Making; Public Policy; Urban Health
PubMed: 31482385
DOI: 10.1007/s11524-019-00378-w -
Midwifery Aug 2022Policy implementation can be affected by what individuals believe to be right and wrong. When implementing abortion policies, providers' moral beliefs can be relevant in... (Review)
Review
INTRODUCTION
Policy implementation can be affected by what individuals believe to be right and wrong. When implementing abortion policies, providers' moral beliefs can be relevant in the success of the implementation process. Considering that midwives and nurses are direct providers of abortion care, exploring their experiences related to abortion policy implementation could provide helpful information to prevent policy failure.
METHODS
Systematic integrative review. The studies were identified through an electronic search strategy and the screening of the reference lists of all selected articles. Studies were retrieved from eight medical and social sciences databases. Thirty-one studies focused on midwives' and nurses' experiences of implementing abortion policies, irrespective of setting or age of study were included in this review. Studies included used qualitative, quantitative and mixed methods. Study quality was appraised using the Mixed Method Appraisal Tool version 2018. No study was excluded from this review based on its quality appraisal.
RESULTS
In terms of their quality, most studies included in this review were conducted appropriately. Three superordinate themes represent the main elements that challenge midwives and nurses when providing abortion care. The first superordinate theme identified that many midwives and nurses believed fetuses are sentient beings, making them worthy of compassionate treatment. The next superordinate theme was focused on preferences and expectations about abortion care. Finally, the third superordinate theme illustrates midwives' and nurses' experiences with other team members, highlights their creativity when challenged with insufficient resources and provides a glimpse of the numerous techniques used for coping with work-related stress.
CONCLUSION
Midwives and nurses worldwide face multiple challenges when providing abortion care. Guidelines aiming to support policy implementation should consider how abortion affects healthcare providers and suggest appropriate measures to reduce these and other barriers. Midwives and nurses technical and ethical competencies for abortion provision should be strengthened.
Topics: Abortion, Induced; Attitude of Health Personnel; Female; Health Personnel; Humans; Midwifery; Nurses; Policy; Pregnancy; Qualitative Research
PubMed: 35613486
DOI: 10.1016/j.midw.2022.103363 -
Bulletin of the World Health... Dec 2017To systematically review published studies of interventions to reduce people's intake of dietary trans-fatty acids (TFAs). (Review)
Review
OBJECTIVE
To systematically review published studies of interventions to reduce people's intake of dietary trans-fatty acids (TFAs).
METHODS
We searched online databases (CINAHL, the CRD Wider Public Health database, Cochrane Database of Systematic Reviews, Ovid®, MEDLINE®, Science Citation Index and Scopus) for studies evaluating TFA interventions between 1986 and 2017. Absolute decrease in TFA consumption (g/day) was the main outcome measure. We excluded studies reporting only on the TFA content in food products without a link to intake. We included trials, observational studies, meta-analyses and modelling studies. We conducted a narrative synthesis to interpret the data, grouping studies on a continuum ranging from interventions targeting individuals to population-wide, structural changes.
RESULTS
After screening 1084 candidate papers, we included 23 papers: 12 empirical and 11 modelling studies. Multiple interventions in Denmark achieved a reduction in TFA consumption from 4.5 g/day in 1976 to 1.5 g/day in 1995 and then virtual elimination after legislation banning TFAs in manufactured food in 2004. Elsewhere, regulations mandating reformulation of food reduced TFA content by about 2.4 g/day. Worksite interventions achieved reductions averaging 1.2 g/day. Food labelling and individual dietary counselling both showed reductions of around 0.8 g/day.
CONCLUSION
Multicomponent interventions including legislation to eliminate TFAs from food products were the most effective strategy. Reformulation of food products and other multicomponent interventions also achieved useful reductions in TFA intake. By contrast, interventions targeted at individuals consistently achieved smaller reductions. Future prevention strategies should consider this effectiveness hierarchy to achieve the largest reductions in TFA consumption.
Topics: Animals; Diet; Dietary Fats; Female; Food Labeling; Humans; Marketing; Nutrition Policy; Trans Fatty Acids
PubMed: 29200523
DOI: 10.2471/BLT.16.189795