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Waller D, Kang M, Gibson S, Brooks F, Medlow S, Steinbeck K, Perry L. Development and implementation of Australian State, territory, and national policy on the health and wellbeing of adolescents and young adults: An exploration of policy actor perspectives using the Consolidated Framework for Implementation Research. Aust N Z J Public Health 2024; 48:100112. [PMID: 38198902 DOI: 10.1016/j.anzjph.2023.100112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/20/2023] [Accepted: 11/21/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES Government policies that support the health and wellbeing of young people (aged 10 to 25) can have important individual and societal impacts. The aim of this study was to explore policy actor perspectives on the development and implementation of Australian government policies focussed on the health and wellbeing of young people. METHODS We utilised a qualitative research design consisting of semi-structured interviews with policy actors with experience working with Australian youth health policies. Our interview guide and analyses were informed by the Consolidated Framework for Implementation Research (CFIR). We interviewed 19 participants from various national, state, and territory bodies. RESULTS Several specific barriers and facilitators to policy development and implementation were identified using the Consolidated Framework for Implementation Research. Key policy development barriers were limited available resources (e.g. staffing and funding) and low relative priority within health and political systems. Key policy implementation barriers were limited available resources, limited policy compatibility with health services, cosmopolitanism issues related to interagency collaboration, and a lack of policy evaluation. Meaningful engagement of young people could also be improved. CONCLUSIONS Although Australian youth health policies are perceived as evidence-based and comprehensively developed, the ability to promote implementation remains stalled. IMPLICATIONS FOR PUBLIC HEALTH The development of policy implementation plans, monitoring and evaluation mechanisms, funding and resources, and a strong commitment to removing barriers to working across multiple departments and systems is required to improve outcomes for young people.
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Affiliation(s)
- Daniel Waller
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia.
| | - Melissa Kang
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia
| | - Sally Gibson
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia
| | - Fiona Brooks
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, 2007, Australia; Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, 0627, New Zealand
| | - Sharon Medlow
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia
| | - Katharine Steinbeck
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006, Australia; The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, 2007, Australia
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Manuel K, Block H, Crotty M, Harvey G, Kurrle SE, Cameron I, Lockwood K, Sherrington C, Pond D, Nguyen TA, Laver K. Implementation of a frailty intervention in the transition from hospital to home: a realist process evaluation protocol for the FORTRESS trial. BMJ Open 2023; 13:e070267. [PMID: 37295839 PMCID: PMC10277088 DOI: 10.1136/bmjopen-2022-070267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/30/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Frailty in Older people: Rehabilitation, Treatment, Research Examining Separate Settings (the FORTRESS study) is a multisite, hybrid type II, stepped wedge, cluster, randomised trial examining the uptake and outcomes of a frailty intervention. The intervention is based on the 2017 Asia Pacific Clinical Practice Guidelines for the Management of Frailty and begins in the acute hospital setting and transitions to the community. The success of the intervention will require individual and organisational behaviour change within a dynamic health system. This process evaluation will examine the multiple variables at play in the context and mechanism of the frailty intervention to enhance understanding of the outcomes of the FORTRESS study and how the outcomes can be translated from the trial into broader practice. METHODS AND ANALYSIS The FORTRESS intervention will recruit participants from six wards in New South Wales and South Australia, Australia. Participants of the process evaluation will include trial investigators, ward-based clinicians, FORTRESS implementation clinicians, general practitioners and FORTRESS participants. The process evaluation has been designed using realist methodology and will occur in parallel to the FORTRESS trial. A mixed-method approach will be used with qualitative and quantitative data collected from interviews, questionnaires, checklists and outcome assessments. Qualitative and quantitative data will be examined for CMOCs (Context, Mechanism, Outcome Configurations) and programme theories will be developed, tested and refined. This will facilitate development of more generalisable theories to inform translation of frailty intervention within complex healthcare systems. ETHICS AND DISSEMINATION Ethical approval for the FORTRESS trial, inclusive of the process evaluation, has been obtained from the Northern Sydney Local Health District Human Research Ethics Committees reference number 2020/ETH01057. Recruitment for the FORTRESS trial uses opt-out consent. Dissemination will be via publications, conferences and social media. TRIAL REGISTRATION NUMBER ACTRN12620000760976p (FORTRESS trial).
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Affiliation(s)
- Kisani Manuel
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Heather Block
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Maria Crotty
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Susan E Kurrle
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ian Cameron
- Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Keri Lockwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dimity Pond
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Tuan A Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Kate Laver
- Flinders Health and Medical Research Institute, Adelaide, South Australia, Australia
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Lam S, Dodd W, Nguyen-Viet H, Unger F, Le TTH, Dang-Xuan S, Skinner K, Papadopoulos A, Harper SL. How can climate change and its interaction with other compounding risks be considered in evaluation? Experiences from Vietnam. EVALUATION (LONDON, ENGLAND : 1995) 2023; 29:228-249. [PMID: 37143891 PMCID: PMC10150254 DOI: 10.1177/13563890231156954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
While evaluations play a critical role in accounting for and learning from context, it is unclear how evaluations can take account of climate change. Our objective was to explore how climate change and its interaction with other contextual factors influenced One Health food safety programs. To do so, we integrated questions about climate change into a qualitative evaluation study of an ongoing, multi-sectoral program aiming to improve pork safety in Vietnam called SafePORK. We conducted remote interviews with program researchers (n = 7) and program participants (n = 23). Based on our analysis, researchers believed climate change had potential impacts on the program but noted evidence was lacking, while program participants (slaughterhouse workers and retailers) shared how they were experiencing and adapting to the impacts of climate change. Climate change also interacted with other contextual factors to introduce additional complexities. Our study underscored the importance of assessing climate factors in evaluation and building adaptive capacity in programming.
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Affiliation(s)
- Steven Lam
- Steven Lam, Department of Population Medicine,
University of Guelph, 50 Stone Rd E, Guelph, ON N1G 2W1, Canada.
| | | | | | - Fred Unger
- International Livestock Research Institute, Vietnam
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Gurung G, Jaye C, Gauld R, Stokes T. Lessons learnt from the implementation of new models of care delivery through alliance governance in the Southern health region of New Zealand: a qualitative study. BMJ Open 2022; 12:e065635. [PMID: 36316079 PMCID: PMC9628683 DOI: 10.1136/bmjopen-2022-065635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To explore the process of implementation of the primary and community care strategy (new models of care delivery) through alliance governance in the Southern health region of New Zealand (NZ). DESIGN Qualitative semistructured interviews were undertaken. A framework-guided rapid analysis was conducted, informed by implementation science theory-the Consolidated Framework for Implementation Research. SETTING Southern health region of NZ (Otago and Southland). PARTICIPANTS Eleven key informants (Alliance Leadership Team members and senior health professionals) who were involved in the development and/or implementation of the strategy. RESULTS The large number of strategy action plans and interdependencies of activities made implementation of the strategy complex. In the inner setting, communication and relationships between individuals and organisations were identified as an important factor for joint and integrated working. Key elements of a positive implementation climate were not adequately addressed to better align the interests of health providers, and there were multiple competing priorities for the project leaders. A perceived low level of commitment from the leadership of both organisations to joint working and resourcing indicated poor organisational readiness. Gaps in the implementation process included no detailed implementation plan (reflected in poor execution), ambitious targets, the lack of a clear performance measurement framework and an inadequate feedback mechanism. CONCLUSIONS This study identified factors for the successful implementation of the PCSS using an alliancing approach in Southern NZ. A key enabler is the presence of a stable and committed senior leadership team working through high trust relationships and open communication across all partner organisations. With alliances, partnerships and networks increasingly held up as models for integration, this evaluation identifies important lessons for policy makers, managers and services providers both in NZ and internationally.
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Affiliation(s)
- Gagan Gurung
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Centre for Health Systems and Technology (CHeST), University of Otago, Dunedin, New Zealand
| | - Chrystal Jaye
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- CARE Research Theme, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Centre for Health Systems and Technology (CHeST), University of Otago, Dunedin, New Zealand
- Otago Business School, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Centre for Health Systems and Technology (CHeST), University of Otago, Dunedin, New Zealand
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