From theory to practice: improving the impact of health services research

Background  

While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers.     

Applying operations research to health planning: locating health centres in Zambia

Accessibility to health care facilities, particularly in ruralareas with dispersed populations, is a major concern of primaryhealth care policies. The physical accessibility of rural healthcare facilities is often assessed in terms of their locationrelative to those who will use them. However, the final choiceof location for a facility will often depend on a trade-offbetween many criteria including not only its physical accessibilityfor the users, but also its costs to the provider, its politicalvalue to local leaders, etc. In this paper a technique willbe presented which can help health policy-makers and plannersin deciding on the optimum location for rural health facilitiesby taking into account the different criteria of these variousinterest groups. The technique is intended to help in a prospectiveevaluation of alternative feasible locations; it is thereforeappropriate for operations research. Two examples are takenfrom Zambia to illustrate how the approach could be used inchoosing the most suitable location for upgrading a rural healthcentre in a district.     

Growing the field of health impact assessment in the United States: an agenda for research and practice

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States.Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the public's health.     

Decision making for health care managers and supervisors: theory into practice

Health care managers and supervisors make decisions throughout the day. Often, they use the common steps of decision making. This article describes common decision theories that underpin the steps. The article includes specific examples of applications of the theories and a glossary of terms. Experienced and novice health care managers and supervisors can improve their decision making by matching concepts from the decision theories to their problems.     

From evidence-based practice making to practice-based evidence making: creating communities of (research) and practice

Models of research translation frequently emphasize independent roles for research producers and intended users. This article describes a novel approach for enhancing exchange between researchers and practitioners. The framework is based on Wenger's notion of Communities of Practice (CoP) where knowledge is regarded as a social enterprise at the center of member interactions. Research-based practices and policies emerge when research producers and users mutually engage one another about specific health promotion problems through negotiation and by creating and sharing technical standards and other resources. CoPs are more than loose networks or task-oriented teams. They aim to create both social and intellectual capital through mutual negotiation, reciprocity, trust, and cohesion. A Consortium of Quitline Operators across North America and a Canadian project to enhance research capacity for tobacco control research serve as examples of how the model has been successfully operationalized.     

Supporting health impact assessment in practice

Health impact assessment (HIA) is a process that aims to predict potential positive and negative effects of project, programme or policy proposals on health and health inequalities. It is recommended by national government and internationally. Supporting health impact assessment is one of the roles of English Public Health Observatories. The few centres in England with accredited health impact training centres have inadequate resources to meet demand. Currently, the London Health Observatory is providing the bulk of the training nationally. Some Public Health Observatories are currently investigating the preferences for support of those commissioning or conducting health impact assessment within their regions. The availability of published guidance on how to conduct health impact assessments has increased substantially over the past few years. The Department of Health has funded a research project led by the London Health Observatory to develop advice for reviewing evidence for use in health impact assessment. Completed health impact assessments can be useful resources. Evaluation of the process and impact of health impact assessment is important in order to demonstrate its usefulness and to learn lessons for the future. The focus for Public Health Observatories is to train and support others to conduct health impact assessment according to good practice, rather than undertaking health impact assessments themselves. The aim is to create sufficient skilled capacity around the country to undertake health impact assessments. The London Health Observatory plans to share its support models and to roll out a train the trainer programme nationally to enable effective local delivery of their national health impact assessment programme.     

Prostate cancer screening decision making under controversy: implications for health promotion practice

Prostate cancer is a major health problem for U.S. men and is characterized by paradoxes and controversies. Despite the wide availability of the prostate-specific antigen (PSA) test, prostate cancer screening remains a controversial practice mainly because the direct impact of screening on mortality is not yet proven. As the relative value of screening, early detection, and treatment strategies continue to be debated, glaring racial-ethnic disparities persist with African American men experiencing excess morbidity and mortality and demonstrating the lowest screening rates among racial-ethnic groups. Given the prevailing controversy, uncertainty, and known disparities, how can health education messages be framed to assist men and their family members? This article highlights the ethnic disparities, paradoxes, and controversies of prostate cancer and identifies critical challenges and opportunities for health educators and clinical practitioners. Implications for health promotion communications and informed decision making in this era of uncertainty are discussed.     

Integrating research with practice: the psychosocial impact of breast cancer

Social workers collecting data in this study of the psychosocial impact of breast cancer not only gained insights into clinical efforts and program planning, but also had opportunities for clinical intervention. Empirical results from the study, as well as practice models implemented based on these results, are presented. This model integrating research with practice holds considerable potential for enhancing social work practice.     

Use of health impact assessment in incorporating health considerations in decision making

STUDY AIM: The aim of this project is to identify from a range of sources the factors associated with the success of a health impact assessment (HIA) in integrating health considerations into the final decision and implementation of a planned policy, programme, or project. DESIGN: Three methods were adopted: (a) a review of HIA case studies; (b) a review of commentaries, reviews and discussion papers relating to HIA and decision making; and (c) an email survey of a purposive sample of HIA academics, HIA practitioners, and policymakers. Information was captured on the following characteristics: information on the year undertaken; geopolitical level; setting; sector; HIA type; methods and techniques used; identification of assessors. MAIN RESULTS: Two groups of factors were identified relating to the decision making environment and to the technical conduct of the HIA. With regard to the environment, striking a balance between decision maker ownership and HIA credibility; organisational, statutory and policy commitment to HIA, and the provision of realistic, non-controversial recommendations were cited as enablers to the integration of HIA findings into the decision making process. Barriers included a lack of knowledge of the policymaking environment by those conducting HIA. Regarding factors relating to the conduct of the HIA: use of a consistent methodological approach; inclusion of empirical evidence on health impacts; timing of the HIA congruent with the decision making process; involvement of expert HIA assessors; and shaping of recommendations to reflect organisational priorities were cited as enablers while lack of a standardised methodology; lack of resources and use of jargon were cited as barriers. CONCLUSIONS: The findings emphasise the importance of considering the politico-administrative environment in which HIA operates. The extent to which HIA fits the requirements of organisations and decision makers may be as important as the technical methods adopted to undertake it.     

跨学科卫生政策研究的方法学与实践探索

卫生政策是由政府主导的针对卫生体系制度、组织、服务、筹资等方面的策略、措施和行动,其受到来自卫生体系外部的诸如政治、经济、社会等方面的影响。卫生政策研究的任务是将隐含在卫生系统内外复杂的动力机制、因果关系、利益链条和影响因素等做出较为合理的解释,并将这些知识转化为高质量的证据,供卫生政策制定者和实施者参考。     

Ethnicity in Dutch health research: situating scientific practice

Objective: A growing body of work is examining the role health research itself plays in the construction of ‘ethnicity.’ We discuss the results of our investigation as to how the political, social, and institutional dynamics of the context in which health research takes place affect the manner in which knowledge about ethnicity and health is produced.

Design: Qualitative content analysis of academic publications, interviews with biomedical and health researchers, and participant observation at various conferences and scientific events.

Results: We identified four aspects related to the context in which Dutch research takes place that we have found relevant to biomedical and health-research practices. Firstly, the ‘diversity’ and ‘inclusion’ policies of the major funding institution; secondly, the official Dutch national ethnic registration system; a third factor was the size of the Netherlands and the problem of small sample sizes; and lastly, the need for researchers to use meaningful ethnic categories when publishing in English-language journals.

Conclusions: Our analysis facilitates the understanding of how specific ethnicities are constructed in this field and provides fruitful insight into the socio-scientific co-production of ethnicity, and specifically into the manner in which common-sense ethnic categories and hierarchies are granted scientific validity through academic publication and, are subsequently, used in clinical guidelines and policy.     

Public health policy research: making the case for a political science approach

The past few years have seen the emergence of claims that the political determinants of health do not get due consideration and a growing demand for better insights into public policy analysis in the health research field. Several public health and health promotion researchers are calling for better training and a stronger research culture in health policy. The development of these studies tends to be more advanced in health promotion than in other areas of public health research, but researchers are still commonly caught in a na?ve, idealistic and narrow view of public policy. This article argues that the political science discipline has developed a specific approach to public policy analysis that can help to open up unexplored levers of influence for public health research and practice and that can contribute to a better understanding of public policy as a determinant of health. It describes and critiques the public health model of policy analysis, analyzes political science's specific approach to public policy analysis, and discusses how the politics of research provides opportunities and barriers to the integration of political science's distinctive contributions to policy analysis in health promotion.     

Psychosocial hazards and seafarer health: priorities for research and practice

This paper discusses the changing nature of work and the emergence and prevalence of psychosocial hazards. It addresses their effect on worker health with particular emphasis on the issue of work-related stress. It then considers how these hazards affect seafarer health in the light of current working conditions in the maritime sector. Finally, specific recommendations are made for future directions for research and practice in relation to these issues.     

Conceptual models for health education research and practice

Although conceptual models are frequently used to illustrate research questions under investigation, there is a paucity of articles about how to develop conceptual models or their importance to health education research and practice. A number of uses of the term model exist. Therefore, we describe a conceptual model developed to guide health education research or practice as a diagram of proposed causal linkages among a set of concepts believed to be related to a specific public health problem. Although informed by the multicausal models of public health, the conceptual models we describe differ from those models in that they do not incorporate all factors correlated with an endpoint of interest. Rather they show only the small part of the causal web selected for study. Conceptual models differ from theory in that they are not usually concerned with global classes of behavior but with specific types of behavior in specific contexts. They often are informed by more than one theory, as well as by empirical findings. Because of the usefulness of conceptual models in narrowing both research questions and the targets of intervention, we advocate the inclusion of the model development process in public health education research methods courses.