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Carmignani F. Why nanny statism matters: evidence from the first wave of COVID-19. BMC Public Health 2024; 24:1963. [PMID: 39044203 PMCID: PMC11265364 DOI: 10.1186/s12889-024-19477-8] [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: 04/01/2023] [Accepted: 07/14/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND A nanny state imposes restrictions on people's liberty and freedom of action in order to advance their interest and welfare. The extent to which this is desirable, or even ethically acceptable, is debated in the literature. This paper formulates and tests the following hypothesis: the more of a nanny a state has been in the past, the more likely it is that the incumbent government will respond to a new, unknown threat with interventions of a paternalist nature, irrespective of other factors that might contribute to shaping government's response. This hypothesis is then taken to the data using the first wave of COVID-19 as an empirical test. METHODS Data are collected from secondary sources for a sample of 99 countries. Nanny statism is measured by the number of paternalist laws and regulations adopted by a country in the past. The response to COVID is proxied by the time of adoption of control and containment measures and their stringency. The public health outcome is measured by the COVID-19 death toll at the end of June 2020. These variables, plus several controls, are then used to estimate a set of linear and probit regressions and a proportional hazard model of the timing of adoption of control and containment measures. RESULTS An increase in nanny statism by 0.1 (on a scale from 0 to 10) on average increases the probability of adoption of control and containment measures by 0.077 (i.e. 7.7 percentage points). The central tenement of the hypothesis is therefore consistent with the empirical evidence. The linear and probit regressions also show that there is no evidence of a significant effect of nanny statism on the stringency of the measures adopted. Irrespective of stringency, however, early adoption of control and containment measures is found to reduce the death toll of COVID-19 in the first half of 2020: an increase in nanny statism by 0.1 reduces the COVID death toll by approximately 7%. CONCLUSIONS A tradition of nanny statism potentially leads to a more timely and effective public policy response to a new, unknown crisis. Further tests of the hypothesis should look at the relationship between nanny statism and public health outcomes from natural disasters.
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Affiliation(s)
- Fabrizio Carmignani
- School of Business, University of Southern Queensland, Toowoomba, Australia.
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Jakovljevic M, Deceuninck P, Pistollato F, Daskalopoulos E, Bernasconi C, Carausu F, Rosa M, Progri A, Makarieva M, Krstic K. Return on investment in science: twenty years of European Commission funded research in Alzheimer's dementia, breast cancer and prostate cancer. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:51. [PMID: 38880873 PMCID: PMC11181594 DOI: 10.1186/s12962-024-00540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/03/2024] [Indexed: 06/18/2024] Open
Abstract
Alzheimer's disease (AD), breast cancer (BC) and prostate cancer (PC) continue to be high in the research and innovation agenda of the European Commission (EC). This is due to their exceptionally large burden to the national health systems, the profound economic effects of opportunity costs attributable to decreased working ability, premature mortality and the ever-increasing demand for both hospital and home-based medical care. Over the last two decades, the EC has been steadily increasing both the number of proposals being funded and the amounts of financial resources being allocated to these fields of research. This trend has continued throughout four consecutive science funding cycles, namely framework programme (FP)5, FP6, FP7 and Horizon 2020 (H2020). We performed a retrospective assessment of the outputs and outcomes of EC funding in AD, BC and PC research over the 1999-2019 period by means of selected indicators. These indicators were assessed for their ability to screen the past, present and future for an array of causal relationships and long-term trends in clinical, epidemiological and public health sphere, while considering also the broader socioeconomic impact of funded research on the society at large. This analysis shows that public-private partnerships with large industry and university-based consortia have led to some of the most impactful proposals being funded over the analysed time period. New pharmaceuticals, small molecules and monoclonal antibodies alike, along with screening and prevention, have been the most prominent sources of innovation in BC and PC, extending patients' survival and enhancing their quality of life. Unlike oncology, dementia drug development has been way less successful, with only minor improvements related to the quality of supportive medical care for symptoms and more sensitive diagnostics, without any ground-breaking disease-modifying treatment(s). Significant progresses in imaging diagnostics and nanotechnology have been largely driven by the participation of medical device industry multinational companies. Clinical trials funded by the EC were conducted, leading to the development of brand-new drug molecules featuring novel mechanisms of action. Some prominent cases of breakthrough discoveries serve as evidence for the European capability to generate cutting-edge technological innovation in biomedicine. Less productive areas of research may be reconsidered as priorities when shaping the new agenda for forthcoming science funding programmes.
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Affiliation(s)
- Mihajlo Jakovljevic
- UNESCO - The World Academy of Sciences (TWAS), Trieste, Italy.
- Shaanxi University of Technology, Hantai District, Hanzhong, 723099, Shaanxi, China.
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia.
| | | | - Francesca Pistollato
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- Humane Society International, Europe, Av. Des Arts 50, 1000, Bruxelles, Belgium
| | | | | | - Florabela Carausu
- GOPA Worldwide Consultants GmbH, Hindenburgring 18, 61348, Bad Homburg Vor Der Höhe, Germany
| | | | | | | | - Kristijan Krstic
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- Clinic of Physiatrics and Rehabilitation Medicine, University Clinical Centre Kragujevac, Kragujevac, Serbia
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Brubacher LJ, Lovato CY, Sriram V, Cheng M, Berman P. The use of evidence to guide decision-making during the COVID-19 pandemic: divergent perspectives from a qualitative case study in British Columbia, Canada. Health Res Policy Syst 2024; 22:66. [PMID: 38831457 PMCID: PMC11145826 DOI: 10.1186/s12961-024-01146-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The challenges of evidence-informed decision-making in a public health emergency have never been so notable as during the COVID-19 pandemic. Questions about the decision-making process, including what forms of evidence were used, and how evidence informed-or did not inform-policy have been debated. METHODS We examined decision-makers' observations on evidence-use in early COVID-19 policy-making in British Columbia (BC), Canada through a qualitative case study. From July 2021- January 2022, we conducted 18 semi-structured key informant interviews with BC elected officials, provincial and regional-level health officials, and civil society actors involved in the public health response. The questions focused on: (1) the use of evidence in policy-making; (2) the interface between researchers and policy-makers; and (3) key challenges perceived by respondents as barriers to applying evidence to COVID-19 policy decisions. Data were analyzed thematically, using a constant comparative method. Framework analysis was also employed to generate analytic insights across stakeholder perspectives. RESULTS Overall, while many actors' impressions were that BC's early COVID-19 policy response was evidence-informed, an overarching theme was a lack of clarity and uncertainty as to what evidence was used and how it flowed into decision-making processes. Perspectives diverged on the relationship between 'government' and public health expertise, and whether or not public health actors had an independent voice in articulating evidence to inform pandemic governance. Respondents perceived a lack of coordination and continuity across data sources, and a lack of explicit guidelines on evidence-use in the decision-making process, which resulted in a sense of fragmentation. The tension between the processes involved in research and the need for rapid decision-making was perceived as a barrier to using evidence to inform policy. CONCLUSIONS Areas to be considered in planning for future emergencies include: information flow between policy-makers and researchers, coordination of data collection and use, and transparency as to how decisions are made-all of which reflect a need to improve communication. Based on our findings, clear mechanisms and processes for channeling varied forms of evidence into decision-making need to be identified, and doing so will strengthen preparedness for future public health crises.
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Affiliation(s)
- Laura Jane Brubacher
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada.
| | - Chris Y Lovato
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Veena Sriram
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- School of Public Policy and Global Affairs, University of British Columbia, Vancouver, Canada
| | - Michael Cheng
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Peter Berman
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Gronholm PC, Kline S, Lamba M, Lempp H, Mahkmud A, Morales Cano G, Vashisht K, Vera San Juan N, Sunkel C. Exploring perspectives of stigma and discrimination among people with lived experience of mental health conditions: a co-produced qualitative study. EClinicalMedicine 2024; 70:102509. [PMID: 38444431 PMCID: PMC10912051 DOI: 10.1016/j.eclinm.2024.102509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
Background Efforts to understand the mechanisms and consequences of mental health-related stigma and discrimination need to center the perspectives of people affected by these negative impacts, through research efforts that are led or co-led by people with lived experience (PWLE) of mental health conditions. Methods This study used co-production principles to explore global perspectives of stigma and discrimination among people meeting the inclusion criteria of identifying as PWLEs and being willing to share their experiences of stigma and discrimination resulting from a diagnosis of a mental health condition, and who had also participated in anti-stigma activities. Participants were recruited online via a self-selecting snowball sampling method. Qualitative data were collected from respondents via an anonymous global online survey conducted between 12/01/2021 and 02/28/2022. The main outcomes assessed were open-ended, qualitative responses to questions exploring experiences of stigma and discrimination, experiences regarding diagnoses, language/terminology related to mental health, impact of stigma and discrimination, and involvement with anti-stigma interventions. Data were synthesised through digital text network analysis and thematic content analysis. Findings A total of 198 respondents from over 30 countries across Europe, the Americas, Africa, Asia, and Australia/Oceania were included in the study. The results reflected five themes: 1) the role of language and words; 2) the role of media in perpetuating and reducing stigma; 3) societal reactions to mental health conditions and strategies to cope with these; 4) knowledge about activities to reduce stigma and discrimination and their impact; and 5) personal involvement in activities to reduce stigma and discrimination. Interpretation The findings highlight that people with mental health conditions are aware of and experience stigma and discrimination across core domains of daily life. The importance of recognising the key role PWLEs can play in efforts to reduce stigma and discrimination was highlighted, and how they can be appropriately supported to contribute and have their experiential expertise recognised. Meaningful and authentic collaborations between PWLEs and other stakeholders can enhance the quality and relevance of strategies to reduce stigma and discrimination. This is, to our knowledge, the first study of its kind to use a co-production approach to explore experiences and reflections of stigma and discrimination related to mental health from a global perspective. However, the results are not broadly representative of the general PWLE population or suggestive of globally uniform experiences of stigma and discrimination. Funding None.
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Affiliation(s)
- Petra C. Gronholm
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Muskan Lamba
- Global Mental Health Peer Network, Southeast Asia, Delhi, India
| | - Heidi Lempp
- Centre for Rheumatic Disease, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Akerke Mahkmud
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Kriti Vashisht
- Global Mental Health Peer Network, America's Region, TX, USA
| | - Norha Vera San Juan
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Institute for Global Health, University College London, London, UK
- Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK
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Faraji M, Sharifi T, Mohammad-Pour S, Javan-Noughabi J, Aboutorabi A, Yousefi S, Jakovljevic M. Out-of-pocket pharmaceutical expenditure and its determinants among Iranian households with elderly members: a double-hurdle model. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:15. [PMID: 38373969 PMCID: PMC10877920 DOI: 10.1186/s12962-024-00521-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES The population of older adults continues to grow in Iran, with pharmaceutical costs as a leading driver of household health-related costs. The present study was conducted to estimate the out-of-pocket pharmaceutical expenditure and its socioeconomic predictors among households with the elderly in Iran. METHOD This study is a secondary analysis using 2019 national household expenditure and income survey data in Iran. The sample size was 9381 households with at least one member older than 65. The double-hurdle model in STATA 16 was used to examine the association between independent variables and households' out-of-pocket pharmaceutical expenditures. RESULTS The mean out-of-pocket pharmaceutical expenditures for each household with elderly member was $8065 per year. There was a positive association between the (female) gender of the household head, urban residence, employment status, insurance expenditure and a higher level of education of the head of the household with the out-of-pocket pharmaceutical expenditures (P < 0.05). The income of elderly households did not affect these expenditures (P > 0.05). CONCLUSIONS This study showed that the socioeconomic characteristics of elderly families not only influenced their decision to enter the medicine market, but also the rate of medicine purchase. It is helpful to manage and control the pharmaceutical costs among the elderly.
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Affiliation(s)
- Mehran Faraji
- Department of Health Economics, School of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Sharifi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Saeed Mohammad-Pour
- Department of Health Economics, School of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Javan-Noughabi
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ali Aboutorabi
- Department of Health Economics, School of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Yousefi
- Kenneth Levene Graduate School of Business, Faculty of Graduate Studies and Research, University of Regina, Regina, SK, Canada
| | - Mihajlo Jakovljevic
- UNESCO-TWAS, Trieste, 34100, Italy
- Shaanxi University of Technology, Hanzhong, 723099, China
- Department of Global Health Economics and Policy, University of Kragujevac, 34000, Kragujevac, Serbia
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Almalki ZS, Alahmari AK, Alajlan SAA, Alqahtani A, Alshehri AM, Alghamdi SA, Alanezi AA, Alawaji BK, Alanazi TA, Almutairi RA, Aldosari S, Ahmed N. Continuity of care in primary healthcare settings among patients with chronic diseases in Saudi Arabia. SAGE Open Med 2023; 11:20503121231208648. [PMID: 37915839 PMCID: PMC10617268 DOI: 10.1177/20503121231208648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Maintaining continuity of care is one of the most critical components of providing great care in primary health care. This study aimed to explore continuity of care and its predictors in primary healthcare settings among patients with chronic diseases in Saudi Arabia. Method Face-to-face cross-sectional interviews were conducted with patients with chronic diseases who had at least four visits to primary care facilities in Riyadh, Saudi Arabia, between November 1, 2022 and March 3, 2023. We determined patients' continuity of care levels using the Bice-Boxerman continuity of care index. A Tobit regression model was used to determine the effects of several factors on the continuity of care index. Results The interviews were conducted with 193 respondents with chronic diseases of interest. The mean continuity of care index of the entire sample was 0.54. Those with asthma had the highest median continuity of care index at 0.75 (interquartile range, 0.62-0.75), whereas those diagnosed with thyroid disease had a much lower continuity of care index (0.47) (interquartile range, 0.3-0.62). Tobit regression model findings showed that employed respondents with poorer general health had a negative effect on continuity of care index levels. By contrast, a higher continuity of care index was significantly associated with elderly respondents, urban residents, and those diagnosed with dyslipidemia, diabetes, hypertension, or asthma. Conclusions According to our findings, the continuity of care level in Saudi Arabia's primary healthcare setting is low. The data demonstrate how continuity of care varies among study group characteristics and that improving continuity of care among chronic disease patients in Saudi Arabia is multifaceted and challenging, necessitating a coordinated and integrated healthcare delivery approach.
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Affiliation(s)
- Ziyad S Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Abdullah K Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | | | - Abdulhadi Alqahtani
- Clinical Research Specialist, Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed M Alshehri
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Saleh A Alghamdi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Adel A Alanezi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Basil K Alawaji
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Tareq A Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Rawan A Almutairi
- Collage of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Saad Aldosari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Nehad Ahmed
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
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Jarrett JB, Bratberg J, Burns AL, Cochran G, DiPaula BA, Dopp AL, Elmes A, Green TC, Hill LG, Homsted F, Hsia SL, Matthews ML, Ghitza UE, Wu LT, Bart G. Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy. Subst Abus 2023; 44:264-276. [PMID: 37902032 PMCID: PMC10870734 DOI: 10.1177/08897077231203849] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
In the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes. Identified settings for research include independent and chain pharmacies and co-located pharmacies within primary care settings. Specific topics for research included adaptation of pharmacy infrastructure for clinical service provision, strategies for interprofessional collaboration including health service models, drug policy and regulation, pharmacist education about OUD and OUD treatment, including didactic, experiential, and interprofessional curricula, and educational interventions to reduce stigma towards this patient population. Together, expanding these research areas can bring effective MOUD to where it is most needed.
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Affiliation(s)
- Jennie B. Jarrett
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago, USA
| | - Jeffrey Bratberg
- Department of Pharmacy Practice and Clinical Research, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Anne L. Burns
- American Pharmacists Association, Washington, DC, USA (retired)
| | - Gerald Cochran
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Bethany A. DiPaula
- Department of Practice, Sciences, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | | | - Abigail Elmes
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago, USA
| | - Traci C. Green
- COBER on Opioids and Overdose at Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
- Opioid Policy Research Collaborative, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Lucas G. Hill
- The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
| | | | - Stephanie L. Hsia
- Department of Clinical Pharmacy, San Francisco School of Pharmacy, University of California, San Francisco, CA, USA
| | - Michele L. Matthews
- Department of Pharmacy Practice, School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Udi E. Ghitza
- National Institute on Drug Abuse (NIDA), Center for the Clinical Trials Network (CCTN), Bethesda, MD, USA
| | - Li-Tzy Wu
- Duke University School of Medicine, Durham, NC, USA
| | - Gavin Bart
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
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Hansen ABG, Hansen ML, Golubovic S, Bloch P, Lorenzen JK, Almdal TP, Ried-Larsen M, Thorsen IK. Co-creating active communities: processes and outcomes of linking public rehabilitation programs with civic engagement for active living in a Danish municipality. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:83. [PMID: 37710344 PMCID: PMC10503125 DOI: 10.1186/s40900-023-00495-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Increased levels of physical activity are associated with beneficial health effects for people with type 2 diabetes, cardiovascular disease and/or severe obesity; however, transforming knowledge about these effects into action is challenging. The aim of this paper is to explore lessons learnt from a co-creation process in a partnership project involving local stakeholders, including citizens, and researchers. The purpose of the process was to link a public health care institution with civil society organisations in the local community to make it possible for citizens to continue to be physically active after ending their public rehabilitation. Secondarily, this paper aims to develop a conceptual model of the above process. METHODS The study constitutes the first part of Project Active Communities and was based on a partnership between three research institutions and a Danish rural municipality, involving municipal and civil society stakeholders and citizens with type 2 diabetes, cardiovascular disease and/or severe obesity in co-creation of concrete interventions for implementation. The co-creation process was divided into two tracks, one involving citizens (two workshops) and one involving municipal and civil society stakeholders (two workshops). The two tracks were concluded with a final workshop involving all stakeholders, including local politicians. Data sources are focus groups and bilateral meetings, workshop observations, and questionnaires. RESULTS Lessons learnt include the importance of having a flexible timeframe for the co-creation process; giving room for disagreements and matching of mutual expectations between stakeholders; the value of a coordinator in the municipality to achieve acceptance of the project; and the significance of engaging local politicians in the co-creation process to accommodate internal political agendas. We have developed a conceptual model for a co-creation process, where we outline and explain three distinct phases: stakeholder identification and description, co-creation, and prototyping. The model can be adapted and applied to other sectors and settings. CONCLUSIONS This study documents lessons learnt in a co-creation process aiming to link a public health care institution with civil society organisations in the local community. Further, this study has specified productive co-creative processes and documented the various phases in a conceptual model.
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Affiliation(s)
- Anders Blædel Gottlieb Hansen
- Centre for Clinical Research and Prevention, The Intersectoral Prevention Laboratory, Bispebjerg and Frederiksberg Hospital, Hovedvejen, Entrance 5, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
| | - Marie Lønberg Hansen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Section 7641, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Sanja Golubovic
- Centre for Clinical Research and Prevention, The Intersectoral Prevention Laboratory, Bispebjerg and Frederiksberg Hospital, Hovedvejen, Entrance 5, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Paul Bloch
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark
| | | | - Thomas Peter Almdal
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Section 7562, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Section 7641, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ida Kær Thorsen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Section 7641, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Shahabi S, Etemadi M, Hedayati M, Bagheri Lankarani K, Jakovljevic M. Double burden of vulnerability for refugees: conceptualization and policy solutions for financial protection in Iran using systems thinking approach. Health Res Policy Syst 2023; 21:94. [PMID: 37697351 PMCID: PMC10496181 DOI: 10.1186/s12961-023-01041-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 08/05/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION Iran is host to one of the world's largest and longest-standing refugee populations. Although Iran has initiated a basic health insurance scheme for refugees throughout the country since September 2015, the population coverage of this scheme is very low, and various factors have caused a significant percentage of refugees to still lack insurance coverage and often face financial hardships when receiving health services. In response, this study aimed to understand barriers to insurance coverage among refugees in Iran and propose effective policies that can address persistent gaps in financial protection. METHODS This qualitative study was conducted in two phases. First, a review of policy documents and interviews with participants were conducted to investigate the common barriers and facilitators of effective insurance coverage for refugees in Iran. Then, a systems thinking approach was applied to visualize the common variables and interactions on the path to achieving financial protection for refugees. RESULTS Findings showed that various factors, such as (1) household-based premium for refugees, (2) considering a waiting time to be eligible for insurance benefits, (3) determining high premiums for non-vulnerable groups and (4) a deep difference between the health services tariffs of the public and private service delivery sectors in Iran, have caused the coverage of health insurance for non-vulnerable refugees to be challenging. Furthermore, some policy solutions were found to improve the health insurance coverage of refugees in Iran. These included removing household size from premium calculations, lowering current premium rates and getting monthly premiums from non-vulnerable refugees. CONCLUSIONS A number of factors have caused health insurance coverage to be inaccessible for refugees, especially non-vulnerable refugees in Iran. Therefore, it is necessary to adopt effective policies to improve the health financing for the refugee with the aim of ensuring financial protection, taking into account the different actors and the interactions between them.
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Affiliation(s)
- Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manal Etemadi
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Maryam Hedayati
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, Saint Petersburg, Russia
- Department of Global Health Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
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10
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Nojomi M, Goharinezhad S, Saraei R, Goharinejad S, Ramezani G, Aalaa M. Exploring the attitudes of general medical students toward older adult's care in a lower middle-income country: implications for medical education. BMC MEDICAL EDUCATION 2023; 23:649. [PMID: 37684593 PMCID: PMC10492309 DOI: 10.1186/s12909-023-04626-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE The motivation for this study stemmed from the growing population of older adults and the increasing demand for healthcare professionals who possess the necessary skills and knowledge to provide quality care to this demographic. By exploring the attitudes, perceptions, and beliefs of medical students towards older adult care, the study aimed to identify gaps in their training and areas where improvements can be made to better equip them for this critical aspect of healthcare. METHOD This study was a qualitative thematic analysis. The participants of this research were selected from among the general medicine internship students of Iran University of Medical Sciences by purposive sampling method. In-depth individual semi-structured interviews were used to collect data. Sampling continued until data saturation. The interviews were recorded, transcribed, and analyzed using a hybrid approach of inductive and deductive thematic analysis. Using this approach, the analysis of the data became more adaptable and open-ended, free from the restrictions of pre-existing theoretical frameworks. MAXQDA 22 was used to analyze qualitative data. RESULTS A total of 27 medical students were interviewed semi-structured, and audio files were transcribed immediately after the interview. In the process of reading the interviews carefully and separating the conceptual units into codes, 167 primary codes were obtained, and these codes were divided into five main categories under the title of root factors after constant comparison analysis. Five main themes are including discrimination in service delivery, a lack of inter-professional training, interpersonal communication skills, inadequate infrastructure and human resources, and enhancing attitudes towards older person care through experiential learning. CONCLUSION This study sheds light on the attitudes and perceptions of medical students toward older adult care in a lower-middle-income country. The findings reveal that there are significant gaps in their training and preparation for providing quality care to this demographic profile. The four main categories identified as root factors highlight key areas where improvements can be made in medical education. It is recommended that medical schools in low and middle-income countries consider incorporating these themes into their curricula to better equip future healthcare professionals with the necessary skills and knowledge to provide quality care to older adults.
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Affiliation(s)
- Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Salime Goharinezhad
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Rasoul Saraei
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Goharinejad
- Faculty of Healthcare Science, Deggendorf Institute of Technology, Pfarrkirchen, Germany
| | - Ghobad Ramezani
- Education Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Aalaa
- Department of e-Learning in Medical Education, Center of Excellence for e-Learning in Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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11
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Torabi ZA, Rezvani MR, Hall CM, Allam Z. On the post-pandemic travel boom: How capacity building and smart tourism technologies in rural areas can help - evidence from Iran. TECHNOLOGICAL FORECASTING AND SOCIAL CHANGE 2023; 193:122633. [PMID: 37223653 PMCID: PMC10195188 DOI: 10.1016/j.techfore.2023.122633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/30/2023] [Accepted: 05/07/2023] [Indexed: 05/25/2023]
Abstract
While there have been numerous studies investigating the impact of the COVID-19 pandemic on tourism, few research projects have examined the impact of the outbreak on using smart tourism technologies (STT), especially in developing countries. This study adopted thematic analysis, with data collected using in-person interviews. The participants for the study were selected using the snow-balling technique. We explored the process of developing smart technologies during the pandemic and its impact on smart rural tourism technology development upon travel restart. The subject was investigated by focusing on five selected villages in central Iran which have tourism dependent economies. Overall, the results indicated that the pandemic partially changed the government's resistance towards the fast development of smart technologies. Thus, the role of smart technologies in curbing the virus spread was officially recognized. This change of policy led to the implementation of Capacity Building (CB) programs to improve digital literacy and minimize the digital gap that exists between urban and rural areas in Iran. Implementing CB programs during the pandemic directly and indirectly contributed to the digitalization of rural tourism. Implementing such programs enhanced tourism stakeholders' individual and institutional capacity to gain access to and creatively use STT in rural area. The results of this study improve our understanding and knowledge of the impact of crises on the degree of acceptability and use of STT in traditional rural societies.
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Affiliation(s)
- Zabih-Allah Torabi
- Department of Geography and rural planning, Tarbiat Modares University, Tehran, Iran
| | | | - C Michael Hall
- Department of Management, Marketing, and Tourism, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand
- The College of Hotel & Tourism Management, Kyung Hee University, Republic of Korea
- Geography Research Unit, University of Oulu, Oulu, Finland
- School of Business and Economics, Linneaus University, Kalmar, Sweden
- Department of Service Management and Service Studies, Lund University, Helsingborg, Sweden
- CRiC, Taylor's University, Kuala Lumpur, Malaysia
| | - Zaheer Allam
- Chaire Entrepreneuriat Territoire Innovation (ETI), IAE Paris-Sorbonne Business School, Université Paris 1 Panthéon-Sorbonne, France
- Curtin Mauritius, Charles Telfair Institute, Moka, Mauritius
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12
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Devkota HR, Baral YR, Khanal B, Adhikary P. How effectively are social accountability mechanisms being applied in mental health services within the newly federalized health system of Nepal? A multi-stakeholder qualitative study. BMC Health Serv Res 2023; 23:762. [PMID: 37461026 DOI: 10.1186/s12913-023-09765-1] [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: 10/12/2022] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The burden of mental health problems and inequalities in healthcare has emerged as critical issues, in Nepal. Strengthened citizen-driven social accountability (SA) is an effective strategy for building equitable health systems and providing quality healthcare services to all, yet SA in mental health is an under-researched area in Nepal. OBJECTIVE This study explores changes in mental health service delivery in the re-configured federal health system and discusses the functioning and effectiveness of SA in the federalized context of Nepal. METHOD This case study research used a qualitative approach to data collection. We conducted Key Informant Interviews (KIIs), and Focus Group Discussions (FGDs) with local stakeholders including people with experience of mental health problems. The audio-recorded interviews and discussions were transcribed and analyzed using a thematic content method. RESULTS A total of 49 participants were recruited, and 17 participated in interviews and 32 participated in six focus group discussions. From the data, eight themes emerged: Policy challenges in mental health, Governance and service delivery, Tokenism in the application of social accountability processes, Weak role of key actors in promoting accountability, Complaints and response, Discriminatory health and welfare system, Public attitudes and commitment towards mental health, and No differences experienced by the change to a federal system. It was found that existing health policies in Nepal inadequately cover mental health issues and needs. The prevailing laws and policies related to mental health were poorly implemented. There is a lack of clarity at different levels of government about the roles and responsibilities in the delivery of mental health services. Poor intra- and inter-governmental coordination, and delays in law-making processes negatively impacted on mental health service delivery. SA mechanisms such as social audits and public hearings exist within government health systems, however, application of these in mental health services was found poor. Rights-holders with mental health problems had not experienced any change in the provision of healthcare services for them even after the federalization. CONCLUSION Mental health is insufficiently addressed by the health policies in Nepal, and SA mechanisms appeared to be rarely institutionalized to promote good governance and provide effective healthcare services to vulnerable populations. The provision of more equitable services and honest implementation of SA tools may foster greater accountability and thereby better service delivery for people with mental health problems.
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Affiliation(s)
- Hridaya Raj Devkota
- Institute for Social and Environmental Research Nepal (ISER-N), Bharatpur-15, Chitwan, Nepal.
| | - Yuba Raj Baral
- Manamohan Memorial Institute of Health Science (MMIHS), Kathmandu, Nepal
| | - Bindu Khanal
- Padmakanya Campus, Tribhuvan University, Kathmandu, Nepal
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Sahoo PM, Rout HS, Jakovljevic M. Contemporary Universal Health Coverage in India - The Case of Federal State of Odisha (Orissa). Risk Manag Healthc Policy 2023; 16:1131-1143. [PMID: 37384257 PMCID: PMC10293795 DOI: 10.2147/rmhp.s406491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023] Open
Abstract
Purpose The present study assessed the awareness of the public about Biju Swasthya Kalyan Yojana (BSKY), which is a flagship public-funded health insurance scheme of the Government of Odisha. The study also identified its determinants and examined utilisation of the scheme among households in Khordha district of Odisha. Materials and Methods Primary data were collected from randomly chosen 150 households using a pretested structured questionnaire from Balipatana block of Khordha district, Odisha. Descriptive statistics and binomial logistic regression were used to substantiate the objectives. Results The study found that even though 56.70% of the sample households had heard about BSKY, procedure-specific awareness was low. State government organised BSKY health insurance camp was found to be a major source of knowledge among the sample. The regression model had an R2 of 0.414. The Chi2 value showed that the model with predictor variables was a good fit. Caste, gender, economic category, health insurance, and awareness about insurance were significant determinants of BSKY awareness. A majority (79.30%) of the sample had the scheme card with them. However, only 12.60% of the cardholders used the card and only 10.67% received benefits. Mean out-of-pocket expenditure (OOPE) faced by the beneficiaries is Rs. 15743.59. Among the beneficiaries, 53.80% financed the OOPE from their savings, 38.50% by borrowing, and 7.70% financed the OOPE by both means. Conclusion The study found that even though majority of people had heard about BSKY, they were not aware of its nature, features, and operational procedures. The trend of low benefit received and higher OOPE among the scheme beneficiaries hampers the economic health of the poor. Finally, the study highlighted the need to increase the magnitude of scheme coverage and administrative efficiency.
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Affiliation(s)
- Pragyan Monalisa Sahoo
- Department of Analytical & Applied Economics, Utkal University, Bhubaneswar, Odisha, India
| | - Himanshu Sekhar Rout
- Department of Analytical and Applied Economics & RUSA Centre of Excellence in Public Policy and Governance, Utkal University, Vani Vihar, Bhubaneswar-751 004, Odisha, India
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St Petersburg, Russia
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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Ogundipe A, Sim TF, Emmerton L. The case to improve technologies for pharmacists' prescribing. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:113-115. [PMID: 36378546 DOI: 10.1093/ijpp/riac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Ayomide Ogundipe
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Tin Fei Sim
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Lynne Emmerton
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
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Kork AA, Antonini C, García-Torea N, Luque-Vílchez M, Costa E, Senn J, Larrinaga C, Bertorello D, Brichetto G, Zaratin P, Andreaus M. Collective health research assessment: developing a tool to measure the impact of multistakeholder research initiatives. Health Res Policy Syst 2022; 20:49. [PMID: 35501895 PMCID: PMC9063051 DOI: 10.1186/s12961-022-00856-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/12/2022] [Indexed: 11/27/2022] Open
Abstract
Background The need to more collaboratively measure the impact of health research and to do so from multidimensional perspectives has been acknowledged. A scorecard was developed as part of the Collective Research Impact Framework (CRIF), to engage stakeholders in the assessment of the impacts of health research and innovations. The purpose of this study was to describe the developmental process of the MULTI-ACT Master Scorecard (MSC) and how it can be used as a workable tool for collectively assessing future responsible research and innovation measures. Methods An extensive review of the health research impact literature and of multistakeholder initiatives resulted in a database of 1556 impact indicators. The MSC was then cocreated by engaging key stakeholders and conducting semi-structured interviews of experts in the field. Results The MSC consists of five accountability dimensions: excellence, efficacy, economic, social and patient-reported outcomes. The tool contains 125 potential indicators, classified into 53 impact measurement aspects that are considered the most relevant topics for multistakeholder research and innovation initiatives when assessing their impact on the basis of their mission and their stakeholders’ interests. The scorecard allows the strategic management of multistakeholder research initiatives to demonstrate their impact on people and society. The value of the tool is that it is comprehensive, customizable and easy to use. Conclusions The MSC is an example of how the views of society can be taken into account when research impacts are assessed in a more sustainable and balanced way. The engagement of patients and other stakeholders is an integral part of the CRIF, facilitating collaborative decision-making in the design of policies and research agendas. In policy making, the collective approach allows the evaluation perspective to be extended to the needs of society and towards responsible research and innovation. Multidimensionality makes research and innovations more responsive to systemic challenges, and developing more equitable and sustainable health services. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00856-9.
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Affiliation(s)
- Anna-Aurora Kork
- Faculty of Social Sciences, Tampere University, Tampere, Finland.
| | - Carla Antonini
- Department of Accounting, Universidad Autónoma de Madrid, Madrid, Spain
| | - Nicolás García-Torea
- Department of Economy and Business Administration, Universidad de Burgos, Burgos, Spain
| | - Mercedes Luque-Vílchez
- Department of Agriculture Economy, Finance and Accounting, Universidad de Córdoba, Córdoba, Spain.,European Financial Reporting Advisory Group (EFRAG), Brussels, Belgium
| | - Ericka Costa
- Department of Economic and Management, University of Trento, Trento, Italy
| | | | - Carlos Larrinaga
- Department of Economy and Business Administration, Universidad de Burgos, Burgos, Spain
| | | | | | - Paola Zaratin
- FISM-Italian Multiple Sclerosis Society Foundation, Genoa, Italy
| | - Michele Andreaus
- Department of Economic and Management, University of Trento, Trento, Italy
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