How do we know if we are making a difference with our program or community initiative?

In this article, the authors discuss issues related to knowing if health workers are making a difference with their community initiatives or programs being delivered in a community setting. Issues relating to the choice of evaluation questions, relevance of data sets used to answer those questions, and the rigor by which the answer can be evaluated--and the ability to generalize to other communities or populations--are explored. Finally, relevant resources to help you pursue these issues are provided.     

How much do doctors know about consent and capacity?

To assess knowledge of capacity issues across different medical specialties we conducted a cross-sectional survey with a structured questionnaire at academic meetings, lectures and conferences. Of 190 individuals who received the questionnaire 129 (68%) responded-35 general practitioners, 31 psychiatrists, 29 old-age physicians [corrected] and 34 final year medical students. Correct answers on capacity to consent to or refuse medical treatment were given by 58% of the psychiatrists, 34% of the geriatricians, 20% of the general practitioners and 15% of the students. 15% of all respondents wrongly believed that a competent adult could lawfully be treated against his or her will, with no obvious differences by specialty. As judged by this survey, issues of capacity and consent deserve more attention in both undergraduate and postgraduate medical education.     

What more do we need to know for a world without violence?

Violence, a universal health issue, presents serious implications for general health and interpersonal relations. Roots of violence appear in early childhood and instances of extreme violence may become apparent in adolescence. Serious antisocial behavior in adolescence is a predictor of violence in later age. Risk factors for violent behavior could be categorized as individual and environmental. Environmental risk factors can be familial, social, and chemical environmental. Maltreatment in childhood is an important predictor of violent behavior in later age. The presence of mental illness is another important predictor of violence. Contemporary television has a visual and auditory power to promote violence with all its elements. Computers are another field where children confront violence. For identification of individuals who have an increased propensity or susceptibility, for violent behavior, research has suggested that polymorphisms related to certain genes might be important. However, we should emphasize that the expression of such behavior would always depend on interactions between various genes, environmental factors, and genetic-environmental interactions. Experiments in rhesus monkeys have shown that optimal early social experiences might overcome the deleterious effects of susceptible alleles. The effective prevention of violence should consist of interventions that aim to reduce the number of risk factors during early childhood, such as home visitation programs and giving individuals the skills and opportunities for engaging in positive behaviors during school years and adolescence, coupled with the identification of new barriers and reassessment of needs.     

Models of service support for parents of disabled children. What do we know? What do we need to know?

Research carried out over a number of years provides a consistent picture of the experiences and needs of parents of disabled children. Recent studies, based on models of stress and coping, have identified factors which relate to high or low levels of parental distress. Whilst this research can provide useful information for service development, there appears to have been little change over the years in parents' reports of unmet need. It is clear that parental need covers a wide range of aspects of family life and holistic models of service support are required. Although evaluation studies which identify models of services that can change this situation are few, there are positive examples of models of support. The paper reviews the findings of such evaluation and identifies a number of important characteristics of effective service models.     

Measuring inequalities in health: What do we know? What do we need to know?

We argue that policy analysis aiming at curving inequalities in health calls for a better understanding of what we know about its measurement pathways. Assuming that health is a good that individuals trade off against other goods, unavoidable health inequalities result when after controlling for unavoidable factors (e.g., age and gender), differences in socioeconomic status of an individual systemically engender differences in health outcomes. However, the measurement of such inequality and underpinning reasons behind are not suggestive of a clear picture. In reviewing the literature, we conclude that it is unclear what the evidence suggests about the reasons for health inequalities as well as the best possible instruments to measure both inequality and socioeconomic health gradients. We provide an evaluation of the different sources of health inequity and we draw upon measurement issues and their policy significance.