Self-management Support for Patients with Atopic Dermatitis: A Qualitative Interview Study

Patients with a chronic skin disease, eg, atopic dermatitis, need self-management skills to increase their quality of life. We explored patients' needs for self-management support from healthcare professionals and how these needs can be met in a dermatology setting. Interpretive description methodology was chosen for iterative data collection and analysis of qualitative interviews with patients with atopic dermatitis. Two mutually dependent themes were found to be supportive of patients' self-management. Personal and disease-related recognition was fundamental to successful support. However, guidance for agenda-setting from healthcare professionals was also needed on the wide range of topics that could be covered in the consultation based on individual needs. Patients need self-management support in addition to what can be found with family, friends, or peers. It is crucial that the support is delivered with an appreciative approach by healthcare professionals with profound knowledge of atopic dermatitis. Equally important is guidance towards agenda-setting, a way to co-construct the consultation with a clear focus on the specific patient's needs.

Newspaper depiction of mental illness in Nigeria

Mental illness is fast becoming a leading cause of global disease burden, yet this aspect of public health remains highly neglected in Nigeria. The public relies on newspapers for diverse information needs and the way newspapers portray mental illness-related issues tends to sway public perception of such ailments. This study examined the level of media attention and prime discursive resources utilized by newspapers to depict mental illness-related issues from 2015 to 2019. Using a qualitative approach and ethnographic design, the study analyzed the manifest contents of three major Nigerian national newspapers selected through a multistage sampling technique. Data collection was done using a coding spreadsheet that reflected relevant content categories and units of analysis. Of the 920 health articles analyzed, only 79 (8.6%) articles discussed mental illness. Also, 84.8% of all mental illness-related articles were tucked in the inside pages of the newspapers and 58.2% of the stories were reported using the conventional straight news. The negative themes of suicide (36.7%) and substance abuse (32.9%) were the prime discursive resources that echoed in many of the analyzed articles. Overall, mental illness-related issues were grossly under-reported by Nigerian newspapers when compared to other health issues, and wrong media depiction of the problem remains a risk factor. Hence, Nigerian newspapers must strive toward setting better agenda that will actuate necessary policy actions from health stakeholders by providing adequate coverage and positive representation of mental illness-related issues.

Agenda-setting in first sessions of business coaching-a focus on coaches' practices to manage the agenda and establish the working alliance

Introduction

Agenda-setting is a central communicative task for professionals and a joint activity of all participants particularly at the onset of helping interactions such as coaching. Agreeing on goal(s) and assigning tasks alongside establishing a trustful bond prepare the ground for the success of the interaction. The professional agent initiates and sets the agenda as part of their professional role and responsibility, i.e., based on their professional epistemic and deontic authority. Concurrently, by orienting to clients' epistemic authority and by yielding power, control, and agency to clients to co-manage the ensuing interaction, agenda-setting is the first opportunity for client-centeredness, which is a central characteristic and success factor for the working alliance in coaching.

Procedure and Methods

We take first steps in filling a research gap by providing a first analysis of the interactional unfolding of agenda-setting in coaching and by showcasing that and how agenda-setting as a joint activity of coach and client contributes to their working alliance. More precisely, we investigate agenda-management practices in five first sessions of business coaching to (1) document and analyze how the joint activity 'agenda-setting' is implemented via various (coach-initiated) social actions, (2) detail their contribution to establishing the working alliance, and (3) to interpret the emerging practices of agenda-management against the concept of 'client-centeredness'. For the analysis, we draw on conceptual and methodological resources from interactional linguistics alongside linguistic pragmatics and conversation analysis.

Results

We found 117 instances of 'agenda-setting' in our data which can be assigned to the seven social actions "Delivering Agenda Information", "Requesting Agenda Information", "Requesting Agenda Agreement", "Requesting Agenda Action", "Suggesting Agenda Action", "Offering Agenda Action" and "Proposing Agenda Action".

Discussion

The social actions display that agenda-setting serves to establish a common ground regarding goals, tasks and the relational bond of coach and client, and (after this has been achieved) to negotiate future coaching actions. Thus, the joint activity of 'doing' agenda-setting can be shown to be 'doing' working alliance at the same time.

Using evidence in mental health policy agenda-setting in low- and middle-income countries: a conceptual meta-framework from a scoping umbrella review

The purpose of this article is to close the gap in frameworks for the use of evidence in the mental health policy agenda-setting in low- and middle-income countries (LMICs). Agenda-setting is important because mental health remains a culturally sensitive and neglected issue in LMICs. Moreover, effective evidence-informed agenda-setting can help achieve, and sustain, the status of mental health as a policy priority in these low-resource contexts. A scoping 'review of reviews' of evidence-to-policy frameworks was conducted, which followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Nineteen reviews met the inclusion criteria. A meta-framework was developed from analysis and narrative synthesis of these 19 reviews, which integrates the key elements identified across studies. It comprises the concepts of evidence, actors, process, context and approach, which are linked via the cross-cutting dimensions of beliefs, values and interests; capacity; power and politics; and trust and relationships. Five accompanying questions act as a guide for applying the meta-framework with relevance to mental health agenda-setting in LMICs. This is a novel and integrative meta-framework for mental health policy agenda-setting in LMICs and, as such, an important contribution to this under-researched area. Two major recommendations are identified from the development of the framework to enhance its implementation. First, given the paucity of formal evidence on mental health in LMICs, informal evidence based on stakeholder experience could be better utilized in these contexts. Second, the use of evidence in mental health agenda-setting in LMICs would be enhanced by involving a broader range of stakeholders in generating, communicating and promoting relevant information.

Agenda-setting by young adults with type 1 diabetes and associations with emotional well-being/social support: results from an observational study

BACKGROUND

The Diabetes Psychosocial Assessment Tool (DPAT) was developed to assess the psychosocial well-being of young adults with type 1 diabetes in clinical practice. The DPAT includes three validated questionnaires (assessing diabetes distress, anxiety/depressive symptoms and emotional well-being) and an agenda-setting tool. It is currently used by the Queensland Statewide Diabetes Clinical Network (available at Clinical Excellence Queensland).

AIMS

To describe agenda items set by young adults with type 1 diabetes and investigate their association with emotional well-being/social support.

METHODS

The DPAT was completed by young adults attending routine diabetes outpatient appointments at the Mater Hospital (Brisbane) between November 2016 and January 2020. For the current analysis, data included responses on agenda-setting and outcomes from three validated questionnaires.

RESULTS

Responses of 277 young adults (15-26 years) were analysed. Ninety-four (34%) reported one to three agenda item(s). Common agenda items were diabetes technology and medications, but other topics raised included pregnancy, body image and eating concerns. Participants with moderate diabetes distress or anxiety symptoms were more likely to list at least one agenda item (P = 0.006; P = 0.002), as were females and older participants.

CONCLUSION

Several agenda items for young adults with type 1 diabetes were identified and were more likely to be raised by those with elevated diabetes distress and anxiety symptoms. The DPAT is a valuable and convenient tool that can be easily applied in routine clinical practice to enable clinicians to understand the concerns of the young adult population and deliver personalised medicine to optimise long-term outcomes.

International media coverage promotes donations to a climate disaster

The Australian bushfires in 2019-20 triggered massive amounts of charitable giving from the community. This study applied agenda-setting theory to examine if and how disaster news coverage influenced public donations in response to the crisis. A survey of 949 Australians found that people perceived news coverage of the event to be a strong influence on the amount they donated to bushfire appeals, over and above past giving levels. Furthermore, media coverage was more influential in participants' charity selection than both peer influence and direct communications from the charities. Next, a textual analysis of international news coverage of the event (N = 30,239 unique articles) was conducted. Compared to a control corpus of text, news coverage of the disaster used words related to 'money' and 'support' at disproportionately high frequencies. Together, the studies suggest that the media plays an agenda-setting role in determining how and to what extent people give to disaster appeals.

Participation in healthcare consultations: A qualitative study from the perspectives of persons diagnosed with hand osteoarthritis

INTRODUCTION

Scarce health resources and differing views between persons with hand osteoarthritis (OA) and health professionals concerning care preferences contribute to sustaining a gap between actual needs and existing clinical guidelines for hand OA. The aim of this study is to explore the experiences of persons diagnosed with hand OA in their encounters with health services and how those experiences influence negotiations and decision-making in hand OA care.

METHODS

Data from 21 qualitative interviews with persons diagnosed with hand OA were collected, transcribed verbatim and analysed using reflexive thematic analysis.

RESULTS

Three main themes were developed: symptoms are perceived as ordinary ageing in everyday life, consultations are shaped by trust in healthcare and the responsibilities of prioritisation and self-care govern interactions.

CONCLUSION

Ideas of ageing, professional knowledge and self-management dominate hand OA health encounters and contribute to shaping illness perceptions, preferences and opportunities to negotiate decisions in consultations.

PATIENT OR PUBLIC CONTRIBUTION

Two patient research partners with hand OA are members of the study project group. One of them is also a co-author of this manuscript.

How Did the COVID-19 Pandemic Increase Salience of Intimate Partner Violence on the Policy Agenda?

Belgian authorities, like most authorities in European countries, resorted to unprecedented measures in response to the spread of the COVID-19 pandemic between March 2020 and May 2022. This exceptional context highlighted the issue of intimate partner violence (IPV) in an unprecedented way. At a time when many other issues are being put on hold, IPV is being brought to the fore. This article investigated the processes that have led to increasing political attention to domestic violence in Belgium. To this end, a media analysis and a series of semi-structured interviews were conducted. The materials, collected and analyzed by mobilizing the framework of Kingdon's streams theory, allowed us to present the agenda-setting process in its complexity and the COVID-19 as a policy window. The main policy entrepreneurs were NGOs and French-speaking feminist women politicians. Together, they rapidly mobilized sufficient resources to implement public intervention that had already been proposed in the preceding years, but which had been waiting for funding. By doing so, they responded during the peak of the pandemic to requests and needs that had already been expressed in a "non-crisis" context.

A comparison between online social media discussions and vaccination rates: A tale of four vaccines

The recent COVID-19 pandemic has brought the debate around vaccinations to the forefront of public discussion. In this discussion, various social media platforms have a key role. While this has long been recognized, the way by which the public assigns attention to such topics remains largely unknown. Furthermore, the question of whether there is a discrepancy between people's opinions as expressed online and their actual decision to vaccinate remains open. To shed light on this issue, in this paper we examine the dynamics of online debates among four prominent vaccines (i.e., COVID-19, Influenza, MMR, and HPV) through the lens of public attention as captured on Twitter in the United States from 2015 to 2021. We then compare this to actual vaccination rates from governmental reports, which we argue serve as a proxy for real-world vaccination behaviors. Our results demonstrate that since the outbreak of COVID-19, it has come to dominate the vaccination discussion, which has led to a redistribution of attention from the other three vaccination themes. The results also show an apparent discrepancy between the online debates and the actual vaccination rates. These findings are in line with existing theories, that of agenda-setting and zero-sum theory. Furthermore, our approach could be extended to assess the public's attention toward other health-related issues, and provide a basis for quantifying the effectiveness of health promotion policies.

Eliciting patients' healthcare goals and concerns: Do questions influence responses?

There is increasing interest in asking patients questions before their visits to elicit goals and concerns, which is part of the move to support the concept of coproducing care. The phrasing and delivery of such questions differs across settings and is likely to influence responses. This report describes a study that (i) used a three-level model to categorize the goals and concerns elicited by two different pre-visit questions, and (ii) describes associations between responses elicited and the phrasing and delivery of the two questions. The questions were administered to patients with rheumatic disease, and patients with inflammatory bowel disease (IBD). Paper-based responses from 150 patients with rheumatic disease and 338 patients with IBD were analyzed (163 paper, 175 electronic). The goals and concerns elicited were primarily disease or symptom-specific. The specific goal and concern examples featured in one pre-visit question were more commonly reported in responses to that question, compared to the question without examples. Questions completed electronically before the visit were associated with longer responses than those completed on paper in the waiting room. In conclusion, how and when patients' goals and concerns are elicited appears to have an impact on responses and warrants further investigation.

The emergence of the national medical assistance scheme for the poorest in Mali

Universal health coverage is high up the international agenda. The majority of the West Africa's countries are seeking to define the content of their compulsory, contribution-based medical insurance system. However, very few countries apart from Mali have decided to develop a national policy for poorest population that is not based on contributions. This qualitative research examines the historical process that has permitted the emergence of this public policy. The research shows that the process has been very long, chaotic and suspended for long periods. One of the biggest challenges has been that of intersectoriality and the social construction of the poorest to be targeted by this public policy, as institutional tensions have evolved in accordance with the political issues linked to social protection. Eventually, the medical assistance scheme for the poorest saw the light of day in 2011, funded entirely by the government. Its emergence would appear to be attributable not so much to any new concern for the poorest in society but rather to a desire to give the social protection policy engaged in a guarantee of universality. This policy nonetheless remains an innovation within French-speaking West Africa.

COVID-19 and Long-Term Care Policy for Older People in Canada

Older people are especially vulnerable to COVID-19, including and especially people living in long-term care facilities. In this Perspective, we discuss the impact of the COVID-19 pandemic on long-term care policy in Canada. More specifically, we use the example of recent developments in Quebec, where a tragedy in a specific facility is acting as a dramatic "focusing event". It draws attention to the problems facing long-term care facilities, considering existing policy legacies and the opening of a "policy window" that may facilitate comprehensive reforms in the wake of the COVID-19 pandemic.

Building the technological European Community through education: European mobility and training programmes in the 1980s

The Community Action Programme for Education and Training for Technology (COMETT) played a key role in paving the way for increased cooperation between the member states of the European Community (EC) in the field of education and in the promotion of intra-Europe mobility. In this article, COMETT is considered as a non-traditional education and training programme for solving economic challenges in the context of technological change that was focused on the training of a highly skilled workforce. The process of setting the agenda for COMETT is studied through an analysis of official EC policy documents and archival material from the EU's historical archives in Florence. Our analysis suggests that the challenge posed by new information technologies acted as a catalyst for a new approach to education governance that was based on closer cooperation between European universities and industry. Promoting intra-Europe mobility among highly skilled workers and students was a key part of the programme, which defined an economic and social strategy for Europe in response to technological change. Educational and social goals were secondary in the design and implementation of the COMETT programme, which, first and foremost, was motivated by the EC agenda to boost the competitiveness of European industry.

'Never let a crisis go to waste': post-Ebola agenda-setting for health system strengthening in Guinea

Introduction

Guinea is a country with a critical deficit and maldistribution of healthcare workers along with a high risk of epidemics' occurrence. However, actors in the health sector have missed opportunities for more than a decade to attract political attention. This article aims to explain why this situation exists and what were the roles of actors in the agenda-setting process of the post-Ebola health system strengthening programme. It also assesses threats and opportunities for this programme's sustainability.

Methods

We used Kingdon’s agenda-setting methodological framework to explain why actors promptly focused on the health sector reform after the Ebola outbreak. We conducted a qualitative explanatory study using a literature review and key informant interviews.

Results

We found that, in the problem stream, the Ebola epidemic caused considerable fear among national as well as international actors, a social crisis and an economic system failure. This social crisis was entertained by communities’ suspicion of an 'Ebola-business'. In response to these problems, policy actors identified three sets of solutions: the temporary external funds generated by the Ebola response; the availability of experienced health workers in the Ebola control team; and the overproduction of health graduates in the labour market. We also found that the politics agenda was dominated by two major factors: the global health security agenda and the political and financial interests of national policy actors. Although the opening of the policy window has improved human resources, finance and logistics, and infrastructures pillars of the health system, it, however, disproportionally focuses on epidemic preparedness and response. and neglects patients’ financial affordability of essential health services.

Conclusion

Domestic policy entrepreneurs must realise that agenda-setting of health issues in the Guinean context strongly depends on the construction of the problem definition and how this is influenced by international actors.

Regulating the Fast-Food Landscape: Canadian News Media Representation of the Healthy Menu Choices Act

With the rapid rise of fast food consumption in Canada, Ontario was the first province to legislate menu labelling requirements via the enactment of the Healthy Menu Choice Act (HMCA). As the news media plays a significant role in policy debates and the agenda for policymakers and the public, the purpose of this mixed-methods study was to clarify the manner in which the news media portrayed the strengths and critiques of the Act, and its impact on members of the community, including consumers and stakeholders. Drawing on data from Canadian regional and national news outlets, the major findings highlight that, although the media reported that the HMCA was a positive step forward, this was tempered by critiques concerning the ineffectiveness of using caloric labelling as the sole measure of health, and its predicted low impact on changing consumption patterns on its own. Furthermore, the news media were found to focus accountability for healthier eating choices largely on the individual, with very little consideration of the role of the food industry or the social and structural determinants that affect food choice. A strong conflation of health, weight and calories was apparent, with little acknowledgement of the implications of menu choice for chronic illness. The analysis demonstrates that the complex factors associated with food choice were largely unrecognized by the media, including the limited extent to which social, cultural, political and corporate determinants of unhealthy choices were taken into account as the legislation was developed. Greater recognition of these factors by the media concerning the HMCA may evoke more meaningful and long-term change for health and food choices.

Scoping Review of Climate Change and Health Research in the Philippines: A Complementary Tool in Research Agenda-Setting

The impacts of climate change on human health have been observed and projected in the Philippines as vector-borne and heat-related diseases have and continue to increase. As a response, the Philippine government has given priority to climate change and health as one of the main research funding topics. To guide in identifying more specific research topics, a scoping review was done to complement the agenda-setting process by mapping out the extent of climate change and health research done in the country. Research articles and grey literature published from 1980 to 2017 were searched from online databases and search engines, and a total of 34 quantitative studies were selected. Fifty-three percent of the health topics studied were about mosquito-borne diseases, particularly dengue fever. Seventy-nine percent of the studies reported evidence of positive associations between climate factors and health outcomes. Recommended broad research themes for funding were health vulnerability, health adaptation, and co-benefits. Other notable recommendations were the development of open data and reproducible modeling schemes. In conclusion, the scoping review was useful in providing a background for research agenda-setting; however, additional analyses or consultations should be complementary for added depth.

The hepatitis C infection in Iran: a policy analysis of agenda-setting using Kingdon's multiple streams framework

Background

Hepatitis C virus (HCV) infection causes a large number of deaths annually worldwide. Policies play an important role in regulating healthcare agendas and prioritising of health-related issues. Understanding these priorities is very important in health. The objective of this study was to investigate HCV-related issues and their influence on agenda-setting in Iran.

Methods

A qualitative design was used. Data were collected by carrying out a review of documents and interviews. A comprehensive search was conducted to identify documents related to HCV-related policies in Iran. Semi-structured interviews were conducted with both purposive and snowball sampling of 14 interviewees related to the HCV programme in Iran, including government officials, civil society, development partnership members and academicians. Documents and interview data were analysed manually and using MAXQDA Version 10 software. Kingdon’s multiple streams framework was used to guide data analysis.

Results

The factors which influenced HCV-related agenda-setting were lack of proper information of the HCV epidemiology before the 1990s, lack of diagnostic facilities, neighbouring countries with high HCV prevalence, the stigma of HCV, high prevalence in prisoners, international evidence and high costs generated by HCV. The factors related to policy were effective treatment methods, drug production inside Iran, Iran Hepatitis Network, support outside government group elites and academicians. The factors related to political will were international influence, changes in the government and parliament support.

Conclusion

The findings of this study showed that there are various national and international factors that play a role in shaping HCV-related policies. It seems that, if HCV is put into the agenda, it can be eliminated in Iran by 2030 by supporting and implementing appropriate programmes from decision- and policy-makers.

Kenya's Health in All Policies strategy: a policy analysis using Kingdon's multiple streams

BACKGROUND

Health in All Policies (HiAP) is an intersectoral approach that facilitates decision-making among policy-makers to maximise positive health impacts of other public policies. Kenya, as a member of WHO, has committed to adopting HiAP, which has been included in the Kenya Health Policy for the period 2014-2030. This study aims to assess the extent to which this commitment is being translated into the process of governmental policy-making and supported by international development partners as well as non-state actors.

METHODS

To examine HiAP in Kenya, a qualitative case study was performed, including a review of relevant policy documents. Furthermore, 40 key informants with diverse backgrounds (government, UN agencies, development agencies, civil society) were interviewed. Analysis was carried out using the main dimensions of Kingdon's Multiple Streams Approach (problems, policy, politics).

RESULTS

Kenya is facing major health challenges that are influenced by various social determinants, but the implementation of intersectoral action focusing on health promotion is still arbitrary. On the policy level, little is known about HiAP in other government ministries. Many health-related collaborations exist under the concept of intersectoral collaboration, which is prominent in the country's development framework - Vision 2030 - but with no specific reference to HiAP. Under the political stream, the study highlights that political commitment from the highest office would facilitate mainstreaming the HiAP strategy, e.g. by setting up a department under the President's Office. The budgeting process and planning for the Sustainable Development Goals were found to be potential windows of opportunity.

CONCLUSION

While HiAP is being adopted as policy in Kenya, it is still perceived by many stakeholders as the business of the health sector, rather than a policy for the whole government and beyond. Kenya's Vision 2030 should use HiAP to foster progress in all sectors with health promotion as an explicit goal.

#ec: Findings and implications from a quantitative content analysis of tweets about emergency contraception

Twitter, a popular social media, helps users around the world quickly share and receive information. The way in which Twitter frames health issues - especially controversial issues like emergency contraception (EC) - can influence public opinion. The current study analyzed all English-language EC-related tweets from March 2011 (n = 3535). Variables measured user characteristics (e.g. gender), content (e.g. news, humor), Twitter-specific strategy (e.g. retweet), and certain time periods (e.g. weekends). The analysis applied chi-square and regression analyses to the variables. Tweets most frequently focused on content related to news (27.27%), accessing EC (27.27%), and humor (25.63%). Among tweets that were shared, however, the most common content included humor, followed by personal/vicarious experience. Although only 5.54% of shared tweets mentioned promiscuity, this content category had the strongest odds for being shared (OR = 1.51; p = 0.031). The tweet content with lowest odds of being shared were side effects (OR = 0.24; p < 0.001), drug safety (OR = 0.44; p < 0.001), and news (OR = 0.44; p < 0.001). Tweets with the greatest odds of having been sent on a weekend sought advice (OR = 1.94; p = 0.012), addressed personal or vicarious experience (OR = 1.91; p < 0.001), or contained humor (OR = 1.56; p < 0.001). Similar patterns occurred in tweets sent around St. Patrick's Day. Only a few differences were found in the ways in which male and female individuals discussed EC on Twitter. In particular, when compared to males, females mentioned birth control (p = 0.002), EC side effects (p = 0.024), and issues related to responsibility (p = 0.003) more often than expected. Study findings offer timely and practical suggestions for public health professionals wanting to communicate about EC via Twitter.

Putting newborn hearing screening on the political agenda in Belgium: local initiatives toward a community programme - a qualitative study

BACKGROUND

The Kingdon model, based on the convergence of three streams (problem, policy, and politics) and the opening of a policy window, analyses the process by which a health issue is placed on the political agenda. We used this model to document the political agenda-setting process of the newborn hearing screening programme in Belgium.

METHODS

A qualitative study based on a document review and on semi-directed interviews was carried out. The interviews were conducted with nine people who had played a role in putting the issue in question on the political agenda, and the documents reviewed included scientific literature and internal reports and publications from the newborn hearing screening programme. The thematic analysis of the data collected was carried out on the basis of the Kingdon model's three streams.

RESULTS

The political agenda-setting of this screening programme was based on many factors. The problem stream included factors external to the context under study, such as the technological developments and the contribution of the scientific literature which led to the recommendation to provide newborn hearing screening. The two other streams (policy and politics) covered factors internal to the Belgian context. The fact that it was locally feasible with financial support, the network of doctors convinced of the need for newborn hearing screening, the drafting of various proposals, and the search for financing were all part of the policy stream. The Belgian political context and the policy opportunities concerning preventive medicine were identified as significant factors in the third stream. When these three streams converged, a policy window opened, allowing newborn hearing screening onto the political agenda and enabling the policy decision for its introduction.

CONCLUSIONS

The advantage of applying the Kingdon model in our approach was the ability to demonstrate the political agenda-setting process, using the three streams. This made it possible to identify the many factors involved in the process. However, the roles of the stakeholders and of the context were somewhat inexplicit in this model.