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Tieu M, Lawless M, Hunter SC, Pinero de Plaza MA, Darko F, Mudd A, Yadav L, Kitson A. Wicked problems in a post-truth political economy: a dilemma for knowledge translation. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2023; 10:280. [PMID: 37305353 PMCID: PMC10238234 DOI: 10.1057/s41599-023-01789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023]
Abstract
The discipline of knowledge translation (KT) emerged as a way of systematically understanding and addressing the challenges of applying health and medical research in practice. In light of ongoing and emerging critique of KT from the medical humanities and social sciences disciplines, KT researchers have become increasingly aware of the complexity of the translational process, particularly the significance of culture, tradition and values in how scientific evidence is understood and received, and thus increasingly receptive to pluralistic notions of knowledge. Hence, there is now an emerging view of KT as a highly complex, dynamic, and integrated sociological phenomenon, which neither assumes nor creates knowledge hierarchies and neither prescribes nor privileges scientific evidence. Such a view, however, does not guarantee that scientific evidence will be applied in practice and thus poses a significant dilemma for KT regarding its status as a scientific and practice-oriented discipline, particularly within the current sociopolitical climate. Therefore, in response to the ongoing and emerging critique of KT, we argue that KT must provide scope for relevant scientific evidence to occupy an appropriate position of epistemic primacy in public discourse. Such a view is not intended to uphold the privileged status of science nor affirm the "scientific logos" per se. It is proffered as a counterbalance to powerful social, cultural, political and market forces that are able to challenge scientific evidence and promote disinformation to the detriment of democratic outcomes and the public good.
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Affiliation(s)
- Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
- College of Humanities, Arts and Social Sciences, Flinders University, Bedford Park, SA Australia
| | - Michael Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
| | - Sarah C. Hunter
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
| | - Maria Alejandra Pinero de Plaza
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
| | - Francis Darko
- College of Humanities, Arts and Social Sciences, Flinders University, Bedford Park, SA Australia
| | - Alexandra Mudd
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Lalit Yadav
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA Australia
- Caring Futures Institute, Flinders University, Bedford Park, SA Australia
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O'Doherty KC, Crann S, Bucci LM, Burgess MM, Chauhan A, Goldenberg MJ, McMurtry CM, White J, Willison DJ. Deliberation on Childhood Vaccination in Canada: Public Input on Ethical Trade-Offs in Vaccination Policy. AJOB Empir Bioeth 2021; 12:253-265. [PMID: 34328070 DOI: 10.1080/23294515.2021.1941416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Policy decisions about childhood vaccination require consideration of multiple, sometimes conflicting, public health and ethical imperatives. Examples of these decisions are whether vaccination should be mandatory and, if so, whether to allow for non-medical exemptions. In this article we argue that these policy decisions go beyond typical public health mandates and therefore require democratic input. METHODS We report on the design, implementation, and results of a deliberative public forum convened over four days in Ontario, Canada, on the topic of childhood vaccination. RESULTS 25 participants completed all four days of deliberation and collectively developed 20 policy recommendations on issues relating to mandatory vaccinations and exemptions, communication about vaccines and vaccination, and AEFI (adverse events following immunization) compensation and reporting. Notable recommendations include unanimous support for mandatory childhood vaccination in Ontario, the need for broad educational communication about vaccination, and the development of a no-fault compensation scheme for AEFIs. There was persistent disagreement among deliberants about the form of exemptions from vaccination (conscience, religious beliefs) that should be permissible, as well as appropriate consequences if parents do not vaccinate their children. CONCLUSIONS We conclude that conducting deliberative democratic processes on topics that are polarizing and controversial is viable and should be further developed and implemented to support democratically legitimate and trustworthy policy about childhood vaccination.
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Affiliation(s)
| | - Sara Crann
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Lucie Marisa Bucci
- Immunize Canada, c/o Canadian Public Health Association, Ottawa, Ontario, Canada
| | - Michael M Burgess
- W. Maurice Young Centre for Applied Ethics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Apurv Chauhan
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Maya J Goldenberg
- Department of Philosophy, University of Guelph, Guelph, Ontario, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Jessica White
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Donald J Willison
- Department of Psychology, University of Guelph, Guelph and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
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Donadel M, Panero MS, Ametewee L, Shefer AM. National decision-making for the introduction of new vaccines: A systematic review, 2010-2020. Vaccine 2021; 39:1897-1909. [PMID: 33750592 PMCID: PMC10370349 DOI: 10.1016/j.vaccine.2021.02.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Competing priorities make using a transparent and evidence-based approach important when deciding to recommend new vaccines. We conducted a literature review to document the processes and frameworks for national decision-making on new vaccine introductions and explored which key features have evolved since 2010. METHODS We searched literature published on policymaking related to vaccine introduction from March 2010 to August 2020 in six databases. We screened articles for eligibility with the following exclusion criteria: non-human or hypothetical vaccines, the sole focus on economic evaluation or decision to adopt rather than policy decision-making. We employed nine broad categories of criteria from the 2012 review for categorization and abstracted data on the country, income level, vaccine, and other relevant criteria. RESULTS Of the 3808 unique references screened, 116 met eligibility criteria and were classified as: a) framework of vaccine adoption decision-making (27), b) studies that analyse empirical data on or examples of vaccine adoption decision-making (45), c) theoretical and empirical articles that provide insights into the vaccine policymaking process (44 + 17 already included in the previous categories). Commonly reported criteria for decision-making were the burden of disease; vaccine efficacy/effectiveness, safety; impact on health and non-health outcomes; economic evaluation and cost-effectiveness of alternative interventions. Programmatic and acceptability aspects were not as often considered. Most (50; 82%) of the 61 articles describing the process of vaccine introduction policymaking highlighted the role of country, regional, or global evidence-informed recommendations and a robust national governance as enabling factors for vaccine adoption. CONCLUSIONS The literature on vaccine adoption decision-making has expanded since 2010. We found that policymakers and expert advisory committee members (e.g., National Immunization Technical Advisory Group [NITAG]) increasingly value the interventions based on economic evaluations. The results of this review could guide discussions on evidence-informed immunization decision-making among country, sub-regional, and regional stakeholders.
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Affiliation(s)
- Morgane Donadel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Maria Susana Panero
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lynnette Ametewee
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Abigail M Shefer
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Crotty M, Gnanamanickam ES, Cameron I, Agar M, Ratcliffe J, Laver K. Are people in residential care entitled to receive rehabilitation services following hip fracture? Views of the public from a citizens' jury. BMC Geriatr 2020; 20:172. [PMID: 32397994 PMCID: PMC7216485 DOI: 10.1186/s12877-020-01575-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/30/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Access to rehabilitation services for people living in residential care facilities is frequently limited. A randomised trial of a hospital outreach hip fracture rehabilitation program in residential care facilities has demonstrated improvements in mobility at four weeks and quality of life at 12 months but was not considered cost-effective by standard health economic metrics. The current study aimed to explore the general public's views on issues involved in the allocation of rehabilitation resources for residents of care facilities. METHODS A citizens' jury comprising 13 purposively sampled members of the general public, representative of the South Australian age, gender and household income profile. The jury considered the questions "Should there be an investment of physical rehabilitation services in residential care for older people following a hip fracture? If so, what is the best way of providing this service (considering funding, models of service delivery and equity)?" Deliberations were in the context of a state-wide health reform program. The jury was conducted over two days with an experienced independent facilitator, addressing questions developed by a steering group of research academics and clinicians. RESULTS The mean age of the citizens' jury members was 43 (range 26 to 61). Eleven members voted for investment in outreach hospital rehabilitation services in residential aged care. All jurors agreed a number of strategies in addition to investment should be implemented, including health care planning and decision making, increased emphasis on hip fracture prevention, training of aged care staff in rehabilitation and routine provision of hospital discharge summaries to families. The jury further advocated for an increased focus on rehabilitation in residential care, potentially through accreditation criteria, increasing health literacy of residents and families, implementation of age friendly environment strategies and improving connections of care facilities with community, hospital and tertiary services. CONCLUSIONS This citizens' jury representative of the general public recommends that regardless of dementia and frailty, people who live in residential care and are walking and fracture their hips should have access to hospital outreach rehabilitation and recovery services.
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Affiliation(s)
- Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia. .,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, Australia.
| | - Emmanuel S Gnanamanickam
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, Australia.,Health Economics and Social Policy Group, Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Meera Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical research and Translation) Centre, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Julie Ratcliffe
- Health Economics and Matthew Flinders Fellow, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Kate Laver
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, Australia
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Gansen F, Klinger J. Reasoning in the valuation of health-related quality of life: A qualitative content analysis of deliberations in a pilot study. Health Expect 2020; 23:405-413. [PMID: 31868289 PMCID: PMC7104633 DOI: 10.1111/hex.13011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/22/2019] [Accepted: 11/27/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Group deliberation can be a pathway to understanding reasons behind judgement decisions. This pilot study implemented a deliberative process to elicit public values about health-related quality of life. In this study, participants deliberated scales and weights for a German adaption of the Short-Form Six-Dimension (SF-6D) Version 2 from a public perspective. OBJECTIVE This article examines the reasons participants stated for health state valuations and investigates the feasibility of eliciting public reasons for judgement decisions in a deliberative setting. METHODS The 1-day deliberation was guided by MACBETH as a method of multi-criteria decision analysis and involved qualitative comparisons of SF-6D health states and dimensions. Participants deliberated in parallel small groups and a subsequent plenary assembly. A qualitative content analysis was conducted to assess the value judgements and reasons behind them. RESULTS A total of 34 students participated in the study. Common reasoning was the level of impairment, marginal benefit, possibility of adjustment and expectation satisfaction. While the small groups agreed on scales for the SF-6D dimensions, the plenary assembly did not reach consensus on one scale and dimension weights. When dimensions were prioritized, these were pain and mental health. CONCLUSIONS While no consented value set was derived, this pilot study presents a promising approach for eliciting public reasoning behind judgements on health state values. Furthermore, it demonstrates that participants consider diverse motives when valuing health-related quality of life.
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Affiliation(s)
- Fabia Gansen
- Department of Health Care ManagementInstitute of Public Health and Nursing Research, Health SciencesUniversity of BremenBremenGermany
| | - Julian Klinger
- Department of Health Care ManagementInstitute of Public Health and Nursing Research, Health SciencesUniversity of BremenBremenGermany
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