The Australian Rural Health Research Collaboration: building collaborative population health research in rural and remote NSW

The health problems faced by rural and remote communities are complex and not amenable to simple or short-term solutions. The Australian Rural Health Research Collaboration, which comprises rural research centres, area health services and policy makers in NSW, investigates these problems. Founded in 2002, it has grown to become the leading rural research collaboration in Australia. It aims to: conduct high quality research; build the capacity of researchers and clinicians; and encourage the translation of research evidence into practice for the benefit of rural and remote communities. The success of the Collaboration is illustrated by the increase in research outputs, funds generated, the strength of the relationships between partners and the ability to address complex research problems such as the mental health of rural and remote communities often deemed too difficult or expensive to include in metropolitan-based research. Keys to success have been the inclusive public health ethos, the participation of senior researchers and service managers, the critical mass of researchers achieved through collaboration and effective leadership and governance. This demonstrates the value of supporting cooperative research and capacity building in rural and remote areas where the size of research groups is small and where effective multi-disciplinary and co-operative research can pay dividends.     

Health in All local Policies: Lessons learned on intersectoral collaboration in a community‐based health promotion network in Denmark

Health promotion increasingly involves collaboration with civil society organisations and the private sector rather than being implemented exclusively by public sector stakeholders. Health in All Policies (HiAP) is an approach that promotes health in policy‐making across public sectors. This study explored intersectoral integration and collaboration for health promotion at a local community level through a qualitative single case study of a local community network in Denmark: the Husum Health Network. The paper describes and discusses strengths, weaknesses, and challenges of HiAP‐inspired local efforts to build alliances and supportive environments for health within an inter‐organisational community‐based network. The data were generated from participant observations made at 11 meetings and events organised by the network partners and nine qualitative, semi‐structured interviews with Husum Health Network partners conducted from August 2014 to February 2015. The data were analysed using a theoretical framework introduced by Axelsson and Axelsson (2006) to characterise aspects of integration and differentiation between organisations. With high levels of structural and functional differentiation between the partners, the network provided an opportunity to exercise inter‐organisational integration at the local level. Integration was fostered by knowledge sharing, face‐to‐face interaction, and communal events. However, the loose structure of the network was a challenge to its sustainability and achievement. We argue that Health in All local Policies is a meaningful concept in the context of local community development only when referring to the polices and strategies of all stakeholder organisations involved in decision‐making and agenda setting, and not just local government institutions.     

Foreword: Lesson learning about getting research into policy and practice

FOREWORD: The UK Department for International Development (DFID) is committed to investing in research to combat poverty, reduce high mortality and morbidity in resource poor contexts and support progress towards meeting the Millennium Development Goals. Research helps us to identify what works, what does not work and how to understand the local context when introducing new ways of working. There is no point doing research if the findings do not get into policy and practice. DFID strongly encourages all research programmes to consider research uptake activities as an integral part of the research.This special supplement draws on the work of the Sexual Health HIV Evidence into Practice (SHHEP) initiative. SHHEP is a collaboration across four DFID Research Programme Consortia (RPC) that undertake research and action on HIV and Sexual and Reproductive Health in resource poor contexts. Each consortium consists of 5 or more research, advocacy or service provider institutions from the south and the north working together over a five year period on critical areas of sexual and reproductive health. The essence of SHHEP is to share learning on research uptake and research engagement in Sexual and Reproductive Health, including HIV. The group has formulated a range of targeted mechanisms to communicate health research to different audiences and spearhead change, and were finalists for the British Medical Journal 2010 Getting Research into Practice (GRiP) prize.The papers in this special supplement focus on lesson learning on getting research into policy and practice. They highlight the range of methodologies and approaches researchers and communication specialists have used in different contexts to try to ensure research does not simply gather dust on library shelves but feeds into and is relevant to policy and practice in different contexts (for example South Africa, Swaziland, Tanzania, Uganda, Malawi, Ghana, Bangladesh) and on a diversity of topic areas (Gender based violence, sexualities, orphans and vulnerable children, HIV care and treatment including male circumcision, cotrimoxazole and links with nutrition).The work reported in this supplement provides examples of approaches that have been tried and from which other researchers can learn. They demonstrate that getting research into policy and practice is complex, dynamic and multi-faceted; and a wide range of context and issue specific conceptual and practical approaches have to be used. I hope that the innovative approaches and promising ways forward, presented in these papers, will inspire and motivate others.Professor Christopher WhittyDirector Research and Evidence DivisionDepartment for International DevelopmentDr Sue KinnHead of Health ResearchDepartment for International Development.     

Academic collaborative centres for health promotion in the Netherlands: building bridges between research, policy and practice

A logical and promising next step for the development of an effective infrastructure for health promotion in the Netherlands are Academic Collaborative Centres (ACCs). Their aims are to bridge the gap between research, policy and practice; make better use of available knowledge and strengthen the evidence base for health promotion practice. To understand their position, they must be seen in light of the strong growth in health promotion in the Netherlands. Since the 1970s, the emphasis in health promotion has shifted from simple unidimensional interventions to much more comprehensive and integrated programmes. Comprehensive research programmes, which explicitly involve actual practice and policy, are also thus called for. These developments are described in this article. There is considerable and widespread enthusiasm about the establishment of ACCs in the Netherlands. Experiences from the first 5 years of collaboration between research, policy and practice within the ACCs, however, shows research to still have the dominant position. The different groups of stakeholders in the public health infrastructure are also shown to perceive and appreciate the current infrastructure rather differently. These findings are similar to results found in the USA. The predominance of research has recently led the Netherlands Organization for Health Research and Development (ZonMw) to impose stricter criteria and guidelines for the funding of such centres. These measures are aimed at eliciting a shift of power from science to practice. They seem to be a promising contribution to bridging the gap between research, policy and practice.     

Evidence-based advocacy. the Australian Research Alliance for Children and Youth (ARACY)

The Australian Research Alliance for Children and Youth (ARACY) was established in 2002 by leading stakeholders from three sectors - research, government policy, and professional practice - concerned to tackle the major issues affecting the wellbeing of Australia's children and young people. This is a network-based organisation, with major emphasis on collaboration across these three sectors. Strong emphasis is placed on promoting an evidence-based approach, focussing on a manageable number of key topics, building and disseminating the knowledge base, and translating knowledge into positive solutions that have support across these sectors. This network approach is making a difference in attracting support for evidence-based advice about effective early intervention in areas of particular concern for the wellbeing of young people, such as mental health, drugs and alcohol use, juvenile justice, and vocational skills training.     

Community Stakeholders’ Perceptions of Major Factors Influencing Childhood Obesity,the Feasibility of Programs Addressing Childhood Obesity,and Persisting Gaps

Prior research has identified numerous factors contributing to increased rates of childhood obesity. However, few studies have focused explicitly on the experience of community stakeholders in low-income communities. This study sought to capture the perspectives of these on-the-ground experts regarding major factors contributing to childhood obesity as well as gaps in current prevention and control efforts. We conducted semi-structured interviews with 39 stakeholders from different community sectors (e.g., healthcare providers, childcare providers, teachers). Data were drawn from the Massachusetts Childhood Obesity Research Demonstration project, a multi-level, multi-sector intervention designed to reduce childhood obesity being implemented in two low-income communities in Massachusetts. Interviews were conducted at baseline, transcribed, coded using grounded theory approach, and analyzed in NVivo 10.0. The vast majority of stakeholders had recently participated in obesity prevention strategies, and nearly all of them identified gaps in prevention efforts either within their organizations or in the broader community. In addition to factors previously identified in the literature, several themes emerged including the need to change policies to increase physical activity during school, offer healthier snacks in schools and afterschool programs, and increase communication and collaboration within the community in prevention efforts. Community stakeholders can impact the success of interventions by bridging the gap between science and lived experience. The results of this study can guide future research by highlighting the importance of including stakeholders’ frontline experiences with target populations, and using information on identified gaps to augment intervention planning efforts.     

Collaboration and involvement of persons with lived experience in planning Canada's At Home/Chez Soi project

Planning the implementation of evidence‐based mental health services entails commitment to both rigour and community relevance, which entails navigating the challenges of collaboration between professionals and community members in a planning environment which is neither ‘top‐down’ nor ‘bottom‐up’. This research focused on collaboration among different stakeholders (e.g. researchers, service‐providers, persons with lived experience [PWLE]) at five project sites across Canada in the planning of At Home/Chez Soi, a Housing First initiative for homeless people with mental health problems. The research addressed the question of what strategies worked well or less well in achieving successful collaboration, given the opportunities and challenges within this complex ‘hybrid’ planning environment. Using qualitative methods, 131 local stakeholders participated in key informant or focus group interviews between October 2009 and February 2010. Site researchers identified themes in the data, using the constant comparative method. Strategies that enhanced collaboration included the development of a common vision, values and purpose around the Housing First approach, developing a sense of belonging and commitment among stakeholders, bridging strategies employed by Site Co‐ordinators and multiple strategies to engage PWLE. At the same time, a tight timeline, initial tensions, questions and resistance regarding project and research parameters, and lack of experience in engaging PWLE challenged collaboration. In a hybrid planning environment, clear communication and specific strategies are required that flow from an understanding that the process is neither fully participatory nor expert‐driven, but rather a hybrid of both.     

Knowledge synthesis, translation and exchange in public health and health promotion: the role of a Cochrane Review Group

The Cochrane Collaboration is an international non-profit organisation that aims to produce high quality systematic reviews of the effectiveness of health interventions. This work is conducted by 51 Review Groups that span a range of topics (e.g. pregnancy and childbirth, HIV/AIDS). The role of Fields within the Collaboration has been to actively engage relevant stakeholders internationally to improve the quality and relevance of reviews. Since the inception in 1996 of the Cochrane Public Health and Health Promotion Field, the Cochrane Collaboration has begun to embrace reviews related to public health and health promotion and is adapting to the changing needs of end-users. The introduction of a Cochrane health promotion and public health review group will help ensure that reviews will be oriented towards building evidence for equity and reducing inequalities and best meet the needs of decision-makers, practitioners and consumers. Our role as a Field has led to us working with a range of partners including reviewers, researchers, practitioners and consumers. Knowledge synthesis, translation and exchange (KST&E) has emerged as an issue in need of further exploration for practice to influence decision-makers and for policy to influence practitioners. 2007 will be an exciting year for evidence-informed Health Promotion and Public Health (HPPH) both within the Cochrane Collaboration and for our partners in policy, practice and research.     

Models for evolving community health information networks

Community stakeholders, from hospital systems to independent physicians, from self-insured employers to managed health plans, from government agencies to consumers, require access to health information across the continuum of care. As the information highways for organizations and communities, health information networks and community health information networks have become the vehicles to address this growing health information imperative. Research identified more than 500 health information networks in all 50 states and most metropolitan markets. Health information networks vary widely in their definition, strategy, and operational status. Despite tumultuous change with both successes and failures, health information networks are indeed affecting health care delivery within enterprises and local communities, across regions, and on a national scale.     

Advancing Indigenous primary health care policy in Alberta,Canada

For Indigenous people worldwide, accessing Primary Health Care (PHC) services responsive to socio-cultural realities is challenging, with institutional inequities in healthcare and jurisdictional barriers encumbering patients, providers, and decision-makers. In the Canadian province of Alberta, appropriate Indigenous health promotion, disease prevention, and primary care health services are needed, though policy reform is hindered by complex networks and competing interests between: federal/provincial funders; reserve/urban contexts; medical/allied health professional priorities; and three Treaty territories each structuring fiduciary responsibilities of the Canadian government.In 2015, the Truth and Reconciliation Commission (TRC) of Canada released a final report from over six years spent considering impacts of the country's history of Indian residential schools, which for more than a century forcibly removed thousands of children from their families and communities. The TRC directed 94 calls to action to all levels of society, including health systems, to address an historical legacy of cultural assimilationism against Indigenous peoples. To address TRC calls that Indigenous health disparities be recognized as resulting from previous government policies, and to integrate Indigenous leadership and perspectives into health systems, PHC decision-makers, practitioners, and scholars in the province of Alberta brought together stakeholders from across Canada. The gathering detailed here explored Indigenous PHC models from other Canadian provinces to collaboratively build relationships for policy reform and identify opportunities for PHC innovations within Alberta.     

Collaborative HIV Prevention Research in Minority Communities Program: a model for developing investigators of color

The Collaborative HIV Prevention Research in Minority Communities Program was developed to address the simultaneous overrepresentation of communities of color among those with HIV and under-representation of researchers of color at the National Institutes of Health. The program is designed to help scientists develop their programs of research and obtain significant research funding. The 27-month program has the following elements: small grant funding, a structured summer program, individualized long-term research collaboration, access to behavioral science expertise, and internal peer review of all products. To date, the 19 program participants, eight of whom have not completed the program, have received almost $11,000,000 in research funding and have conducted culturally specific research with communities of color. In addition, a network of HIV prevention investigators of color has been created. Institutes throughout the National Institutes of Health (NIH) and other entities could use this model to develop investigators of color, improve the quality of research with communities of color, and begin to address health disparities.     

Local health policy development processes in the Netherlands: an expanded toolbox for health promotion

Although much research has been done on the existence and formation of risk and issue based health policies, there is only little insight in health policy development processes in a broader context. This hampers intervention in these policy processes to adequately develop integrated and effective health policies. Legislation in the Netherlands requires municipalities to develop and implement local health policies. These policies are supposed to aim at the promotion of health across sectors and with a strong community involvement. Health policy development processes have been studied in four Dutch municipalities. For each case, we identified a range of stakeholders and monitored the change or stability of their characteristics over 3 years. In addition, for each case, three overlaying maps of networks were made addressing communication and collaboration actions within the defined set of stakeholders. We point out a number of barriers which impede integrated policy development at the local level: the importance given to local health policy, the medical approach to health development, the organizational self-interest rather than public health concern, the absence of policy entrepreneurial activity. Furthermore, this article advocates the use of complementary theoretical frameworks and the expansion of the methodological toolbox for health promotion. The value of stakeholder and network analysis in the health promotion domain, at this stage, is two-fold. First, mapping relevant actors, their positions and connections in networks provides us with insight into their capacity to participate and contribute to health policy development. Second, these new tools contribute to a further understanding of policy entrepreneurial roles to be taken up by health promotion professionals and health authorities in favour of the socio-environmental approach to health. Notwithstanding the value of this first step, more research is required into both the practical application as well as in the theoretical connections with, for example, Multiple Streams theory.     

The Creation of the Federal MCH Extramural Research Program, 1950–1969: Lessons for Today

On April 9, 1912, the law establishing the Children’s Bureau was signed by President William Howard Taft. The original mission of the Children’s Bureau was to “investigate and report … upon all matters pertaining to the welfare of children and child life among all classes of our people.” This paper focuses on the transitional years from roughly 1950 to 1969, when the Children’s Bureau’s investigative mandate was transformed from a set of intramural activities that viewed maternal and child health research as part of a larger effort cutting across investigative, programmatic, and policy goals, and across different domains of the child’s life, to an extramural research program focused specifically on maternal and child health. Discussion focuses on the mission of the Maternal and Child Health (MCH) Research Program, housed now within the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA), of the U.S. Department of Health and Human Services.     

Grading Evidence to Support Legislative and Budget Proposals—Veterans Health Administration’s Key to Implementing the Evidence Act

ObjectivesThe Foundations for Evidence-Based Policymaking Act of 2018 requires cabinet-level agencies to use evidence to justify and support budget and policy making. As investigators from the Quality Enhancement Research Initiative (QUERI) program, we were tasked with assisting Veterans Health Administration (VHA) leadership with the implementation of the Evidence-Based Policymaking Act of 2018. Through meetings with stakeholders, we identified a gap in the review process for legislative and budget proposals; no systematic process existed to evaluate the supporting evidence base for proposals.MethodsHere, we describe the development, refinement, and use of a checklist to assess the strength of evidence included in VHA legislative and budget proposals for changes to care delivery; clinical, research, and administrative operations; and staffing and workforce issues.ResultsThe evidence assessment checklist is now part of the regular review process for VHA legislative and budget proposals. It is also being adapted for use elsewhere within the Department of Veterans Affairs. The checklist has provided a framework for briefings and training on best practices for using evidence to guide policy and budget decisions.ConclusionIncluding evidence reviews in the legislative and budget proposal prioritization process may be an effective institutional arrangement to promote the use of evidence to inform high-level health policy decisions and to build a “culture of evidence” within the government.     

Healthy bi-regional connection: The EU-LAC Health initiative has promoted equitable and collaborative health research and innovation

The European Union and Latin America and the Caribbean regions have enjoyed privileged relations since the first bi-regional Summit of Heads of State and Government, held in Rio de Janeiro, Brazil, in 1999, and the lunching of a Strategic Partnership. Health research stands as one of the major areas of research and development expenditure in both regions and has also been the focus of roughly 30% of all bilateral cooperation agreements and programmes.EU-LAC Health, a project funded by the European Union from 2011 to 2017, had the main objective to develop a consensus roadmap to enhance and coordinate the bi-regional collaboration between the European Union member states and Latin America and Caribbean countries in health research. From April 2013, EU-LAC Health has also supported the Working Group on Health created and designated by decision-makers at the highest political level to implement a bi-regional Join Initiative on Research and Innovation.This article collects and summarises the context, methodology (series of workshops, surveys and iterative deskwork by multiple bi-regional stakeholders) of this project, as well as the main outputs of (1) definition of a strategic roadmap, containing a scientific research agenda, to guide policy-makers in equitable and collaborative health research and innovation; (2) launching of the Joint Initiative on Health Research and Innovation, with the vision of being the reference body on the bi-regional health research and innovation collaboration; and (3) funding of 13 bi-regional health research and innovation projects.EU-LAC Health represents a successful example of bi-regional collaboration and the emerging networks and expertise gathered during the lifetime of the project have the potential to tackle common health challenges affecting the quality of life of citizens from the two regions and beyond. The project has also paved the way for more specific bi-regional initiatives such as a new initiative for bi-regional collaboration in personalised medicine that is being arranged by the partnership. Furthermore, it can inspire future initiatives for bi-regional research collaboration on other fields.     

Stakeholder Engagement in Designing Attributes for a Discrete Choice Experiment With Policy Implications: An Example of 2 Swiss Studies on Healthcare Delivery

ObjectivesThe use of discrete choice experiments (DCEs) has become increasingly popular in health policy development by involving and analyzing the preferences of target groups for different aspects of the policy intervention. In this article, we aim to contribute to the standardization of the process of attribute and attribute level development for DCEs with policy relevance. To do so, we propose and empirically illustrate a framework tool for the development and reporting of attributes and attribute levels, with the systematic engagement of relevant stakeholders.MethodsThe framework tool was kept general to allow its use as a standard reporting approach on the development process of a DCE, involving relevant stakeholders at each stage. The proposed 3-stage process consists of (1) collection, (2) selection, and (3) refinement of the DCE attributes and attribute levels. The application of the framework tool is illustrated by 2 projects, Health2040 and COCONUTS—both concerning the preferences of the Swiss population for the future organization of healthcare.ResultsBy engaging stakeholders, we identified and included attributes and attribute levels that would not have been identified solely through the existing literature. In addition, including multiple stakeholders from different professional backgrounds ensured that the selected attributes and attribute levels were policy relevant, were applicable in practice, and reflected the opinions of multiple actors in healthcare.ConclusionThe proposed framework helps to strengthen the standardization of the reporting on attribute and attribute level development with stakeholder engagement and to guide future research teams designing a DCE with policy implications.     

The Indigenous primary health care and policy research network: Guiding innovation within primary health care with Indigenous peoples in Alberta

In 2015, the Truth and Reconciliation Commission of Canada released its Final Report with 94 Calls to Action, several of which called upon the health care sector to reform based on the principles of reconciliation. In the province of Alberta, Canada, numerous initiatives have arisen to address the health legacy Calls to Action, yet there is no formal mechanism to connect them all. As such, these initiatives have resulted in limited improvements overall. Recognizing the need for clear leadership, responsibility, and dedicated funding, stakeholders from across Alberta were convened in the Spring of 2019 for two full-day roundtable meetings to provide direction for a proposed Canadian Institutes of Health Research Network Environment for Indigenous Health Research that focused on primary health care and policy research. The findings from these roundtable meetings were synthesized and integrated into the foundational principles of the Indigenous Primary Health Care and Policy Research (IPHCPR) Network. The IPHCPR Network has envisioned a renewed and transformed primary health care system to achieve Indigenous health equity, aligned with principles and health legacy Calls to Action advocated by the Truth and Reconciliation Commission of Canada.     

'Health's a difficult beast': the interrelationships between domestic violence, women's health and the health sector. An Australian case study

This paper reports on the Australian component of a five nation study undertaken in Australia, Canada, Thailand, Bangladesh and Afghanistan examining policy networks that address women's health and domestic violence. It examines the relationship between health and domestic violence in Western Australia and analyses the secondary role assumed by health. The study adopted a qualitative research paradigm and semi-structured interviews. Snowball sampling was used to identify relevant and significant stakeholders and resulted in a final sample of 30 individuals representing three key areas: the 'health policy community', the 'domestic violence prevention community' and 'other interested stakeholders', that is, those who have an interest in, but who are not involved in, domestic violence prevention work. Results suggest that the secondary positioning of health is associated with the historical 'championing' of the issue in the women's movement; limited linkages between the health policy community and the domestic violence prevention community and within the health policy community itself; the 'fit' between domestic violence and the Western Australian Health Department mandate; and the mis-match between domestic violence and the medical model. The conclusion indicates a need for collaboration based on effective links across the domestic violence community and the health policy community.     

From NIH to Texas schools: policy impact of the Coordinated Approach to Child Health (CATCH) program in Texas

Editor's Note: Active Living Research has awarded the third annual Translating Research to Policy Award to the Michael and Susan Dell Center for Advancement of Healthy Living's Coordinated Approach to Child Health (CATCH) program.?The purpose of the award is to recognize innovative teams or individuals representing research, policy, and/or advocacy who have had success in catalyzing policy or environmental change of relevance to youth physical activity, sedentary behavior, and obesity prevention. The goal is to celebrate achievements, understand how success occurs, and share these stories so others will be inspired to use or adapt new and effective approaches. The commentary that follows describes the work that is being recognized by the Award. Active Living Research commends the awardees on their success in changing policy, and we commend this as a model to others.     

Path to impact: A report from the Bill and Melinda Gates Foundation convening on maternal immunization in resource-limited settings; Berlin – January 29–30, 2015

Global initiatives such as the Millennium Development Goals have led to major improvements in the health of women and children, and significant reductions in childhood mortality. Worldwide, maternal mortality has decreased by 45% and under-five mortality has fallen by over 50% over the past two decades [1]. However, improvements have not been achieved evenly across all ages; since 1990, under-five mortality has declined by ∼5% annually, but the average decrease in neonatal mortality is only ∼3% per year.Against this background, the Bill and Melinda Gates Foundation (BMGF) convened a meeting in Berlin on January 29–30, 2015 of global health stakeholders, representing funders, academia, regulatory agencies, non-governmental organizations, vaccine manufacturers, and Ministries of Health from Africa and Asia. The topic of discussion was the potential of maternal immunization (MI) to achieve further improvements in under-five morbidity and mortality rates in children, and particularly neonates and young infants, through targeting infectious diseases that are not preventable by other interventions in these age groups. The meeting focused on effective and appropriately priced MI vaccines against influenza, pertussis, and tetanus, as well as against respiratory syncytial virus, and the group B Streptococcus, for which no licensed vaccines currently exist.The primary goals of the BMGF 2015 convening were to bring together the global stakeholders in vaccine development, policy and delivery together with the Maternal, Newborn and Child Health (MNCH) community, to get recognition that MI is a strategy shared between these groups and so encourage increased collaboration, and obtain alignment on the next steps toward achieving a significant health impact through implementation of a MI program.