Exploring the Intention to Engage in Policy Practice: The Role of Values and Career Motivations.

This study expands knowledge on what motivates engagement in policy practice (PP) by exploring the place of personal values, which reflect individuals' general motivations and context-specific motivations-the motivations to study social work-in predicting the intention to incorporate PP into their practice. The sample of this cross-sectional study comprised 280 BSW students in Israel, and the study employed the Portrait Values Questionnaire-Refined, Social Work Career Influence Questionnaire, and the PP Intention Scale. Path analysis showed that personal values were associated with PP intention both directly and indirectly through the motivations to study social work. However, the mechanisms differ for self-transcendence versus self-enhancement and openness to change versus conservation values. A stronger PP intention was associated with a higher preference for openness to change versus conservation values mediated by the social change motivation to study social work. The total effect of the preference for self-enhancement versus self-transcendence values on PP intention was nonsignificant. This resulted from the contradiction between the negative direct and positive indirect effects (through the social change motivation) of these values on PP intention. The study results underscore the place of personal values and motivations to study social work in explaining PP intention.

Illuminating the nutrition-related policy-practice gaps in colorectal cancer survivorship.

PURPOSE: Colorectal cancer (CRC) is among the three most commonly diagnosed cancers globally, after breast and lung cancer, with an estimated 2 million new cases each year, comprising ten per cent of all cancers worldwide. CRC has a complex aetiology associated with several nutrition-related risk factors. Cancer survivors frequently report alterations to their dietary habits and nutritional intake, with related adverse impacts on health-related quality of life (QOL). Whilst nutrition-related factors are recognised as survivor priorities and embedded in survivor care policies, dietary support is frequently not the standard of care in practice. METHODS AND RESULTS: In this Commentary, we present details of a critical policy-practice gap for CRC survivors across the spectrum of nutrition care that we have seen growing in the literature, in hospitals, community and private practice. CONCLUSION: As these nutrition concerns can adversely impact QOL and morbidity and mortality risks, we hope to raise awareness of these issues to provide a basis of future work in this area, so that policymakers and clinicians can improve support and outcomes for CRC survivors and their families.

Testing the contextual Interaction theory in a UHC pilot district in South Africa.

BACKGROUND: World-wide, there is growing universal health coverage (UHC) enthusiasm. The South African government began piloting policies aimed at achieving UHC in 2012. These UHC policies have been and are being rolled out in the ten selected pilot districts. Our study explored policy implementation experiences of 71 actors involved in UHC policy implementation, in one South African pilot district using the Contextual Interaction Theory (CIT) lens. METHOD: Our study applied a two-actor deductive theory of implementation, Contextual Interaction Theory (CIT) to analyse 71 key informant interviews from one National Health Insurance (NHI) pilot district in South Africa. The theory uses motivation, information, power, resources and the interaction of these to explain implementation experiences and outcomes. The research question centred on the utility of CIT tenets in explaining the observed implementation experiences of actors and outcomes particularly policy- practice gaps. RESULTS: All CIT central tenets (information, motivation, power, resources and interactions) were alluded to by actors in their policy implementation experiences, a lack or presence of these tenets were explained as either a facilitator or barrier to policy implementation. This theory was found as very useful in explaining policy implementation experiences of both policy makers and facilitators. CONCLUSION: A central tenet that was present in this context but not fully captured by CIT was leadership. Leadership interactions were revealed as critical for policy implementation, hence we propose the inclusion of leadership interactions to the current CIT central tenets, to become motivation, information, power, resources, leadership and interactions of all these.

Updates in Pediatric Tuberculosis in International Settings.

Childhood tuberculosis (TB) has been underreported and underrepresented in TB statistics across the globe. Contributing factors include health system barriers, diagnostic barriers, and community barriers leading to an underdetected epidemic of childhood tuberculosis. Despite considerable progress in childhood TB management, there is a concerning gap in policy and practice in high-burden countries leading to missed opportunities for active case detection, early diagnosis and treatment of TB exposure, and infection and disease in children regardless of human immunodeficiency virus status. Bridging this gap requires multisectoral coordination and political commitment along with an eye to research and innovation with potential to scale.

From insight network to open policy practice: practical experiences.

BACKGROUND: Evidence-informed decision-making and better use of scientific information in societal decisions has been an area of development for decades but is still topical. Decision support work can be viewed from the perspective of information collection, synthesis and flow between decision-makers, experts and stakeholders. Open policy practice is a coherent set of methods for such work. It has been developed and utilised mostly in Finnish and European contexts. METHODS: An overview of open policy practice is given, and theoretical and practical properties are evaluated based on properties of good policy support. The evaluation is based on information from several assessments and research projects developing and applying open policy practice and the authors' practical experiences. The methods are evaluated against their capability of producing quality of content, applicability and efficiency in policy support as well as how well they support close interaction among participants and understanding of each other's views. RESULTS: The evaluation revealed that methods and online tools work as expected, as demonstrated by the assessments and policy support processes conducted. The approach improves the availability of information and especially of relevant details. Experts are ambivalent about the acceptability of openness - it is an important scientific principle, but it goes against many current research and decision-making practices. However, co-creation and openness are megatrends that are changing science, decision-making and the society at large. Against many experts' fears, open participation has not caused problems in performing high-quality assessments. On the contrary, a key challenge is to motivate and help more experts, decision-makers and citizens to participate and share their views. Many methods within open policy practice have also been widely used in other contexts. CONCLUSIONS: Open policy practice proved to be a useful and coherent set of methods. It guided policy processes toward a more collaborative approach, whose purpose was wider understanding rather than winning a debate. There is potential for merging open policy practice with other open science and open decision process tools. Active facilitation, community building and improving the user-friendliness of the tools were identified as key solutions for improving the usability of the method in the future.

Predictors of hospital-based registered nurses' engagement in on-the-job policy activities.

Nurses have been urged to participate in public policy-formulation processes as an integral part of their professional role through collective and personal policy activities. However, there is only limited empirical data on this participation. This cross-sectional study examined the level and the predictors of the personal policy activities of 200 Israeli hospital-based registered nurses undertaken in their work setting and aimed at furthering hospital, local or national policies. The nurses completed questionnaires that examined policy activities, policy skills, political interest, political efficacy, political and professional network involvement, and organizational support for policy activities. The overall engagement of nurses in on-the-job policy activities was limited and focused primarily on their immediate surroundings, their departments and their hospitals, and much less on local or national policies. The most common policy activities were internal and indirect and included receiving feedback from patients to improve nursing care policy and calling colleagues' attention to policy issues. Positive significant correlations emerged between motivational and organizational factors and personal policy activities, and these contributed 55% to the explained variance. The findings enhance the relevance of integrating motivational and organizational factors in understanding the policy activity of nurses. As such, increasing personal involvement of hospital nurses in policy formulation processes requires professional training that seeks to improve nurses' policy skills, to enhance their political interest and efficacy, and to encourage their involvement in political and professional networks. In addition, hospitals need to cultivate an organizational culture that supports personal policy activities by nurses.

Intrafamilial Child Sexual Abuse: A Unique Silent Epidemic. Perspectives of Victim-Friendly Court Professionals in Marondera District, Zimbabwe.

Intrafamilial child sexual abuse is the commonest, though the under-reported, form of child sexual abuse in Marondera District and Zimbabwe generally. However, little is known about what drives it and what practitioners know about it. This study explored the factors associated with the incidence of intrafamilial child sexual abuse in Marondera based on perceptions of Victim-Friendly Court professionals in the district. A semi-structured questionnaire was administered to twenty-five professionals from thirteen agencies implementing the Victim-Friendly Court initiative in Marondera. Relevant court records of intrafamilial child sexual abuse cases were also reviewed. Data were analyzed using thematic analysis, descriptive statistics and document analysis. The study revealed that intrafamilial child sexual abuse in Marondera is associated with very subtle structural factors which put children at risk of abuse, prevent children, families, and communities from reporting, and reduce the accessibility of formal systems of social control. There are 'conflicts' between normative/legal and traditional socio-cultural value systems such that there is no shared understanding of the fundamental issues driving this phenomenon. Policy/practice responses need to take cognizance of these peculiarities. As a basic first step, a comprehensive national prevalence study is required. Further in-depth research of the socio-cultural determinants of intrafamilial child sexual abuse is also recommended.

Wrestling with the complexity of evaluation for organizations at the boundary of science, policy, and practice.

Boundary organizations are situated between science, policy, and practice and have a goal of supporting communication and collaboration among these sectors. They have been promoted as a way to improve the effectiveness of conservation efforts by building stronger relationships between scientists, policy makers, industry, and practitioners (Cook et al. 2013). Although their promise has been discussed in theory, the work of and expectations for boundary organizations are less defined in practice. Biodiversity conservation is characterized by complexity, uncertainty, dissent, and tight budgets, so boundary organizations face the challenging task of demonstrating their value to diverse stakeholders. We examined the challenges boundary organizations face when seeking to evaluate their work and thus aimed to encourage more productive conversations about evaluation of boundary organizations and their projects. Although no off-the-shelf solution is available for a given boundary organization, we identified 4 principles that will support effective evaluation for boundary organizations: engage diverse stakeholders, support learning and reflection, assess contribution to change, and align evaluation with assumption and values.

Working with Stories: Street-Level Bureaucrats and Their Work with Individuals with Psychiatric Disability Exposed to Interpersonal Violence.

The focus of our attention is the meeting between street-level bureaucrats and individuals with psychiatric disability exposed to interpersonal violence. Based on 11 interviews, we illustrate how stories are understood, used, and made meaningful to the street-level bureaucrat. The contribution of this article is first of all that of being a framework, from a storytelling point of view, for the work and organizational experiences of street-level bureaucrats. Second, by paying attention to the story part of these relationships, we can better understand the situation of individuals with psychiatric disability exposed to interpersonal violence given their interaction with different street-level bureaucrats.

International consultation on long-term global health research priorities, research capacity and research uptake in developing countries.

BACKGROUND: In recognition of the need for long-term planning for global health research, and to inform future global health research priorities, the United Kingdom Department for International Development (DfID) carried out a public consultation between May and June 2015. The consultation aimed to elicit views on the (1) the long-term future global health research priorities; (2) areas likely to be less important over time; (3) how to improve research uptake in low-income countries; and (4) how to build research capacity in low-income countries. METHODS: An online consultation was used to survey a wide range of participants on global health research priorities. The qualitative data was analysed using a thematic analysis, with frequency of codes in responses tabulated to approximate relative importance of themes and sub-themes. RESULTS: The public consultation yielded 421 responses. The survey responses confirmed the growing importance of non-communicable disease as a global health research priority, being placed above infectious diseases. Participants felt that the key area for reducing funding prioritisation was infectious diseases. The involvement of policymakers and other key stakeholders was seen as critical to drive research uptake, as was collaboration and partnership. Several methods to build research capacity in low-income countries were described, including capacity building educational programmes, mentorship programmes and research institution collaboration and partnership. CONCLUSIONS: The outcomes from this consultation survey provide valuable insights into how DfID stakeholders prioritise research. The outcomes from this survey were reviewed alongside other elements of a wider DfID consultation process to help inform long-term research prioritisation of global health research. There are limitations in this approach; the opportunistic nature of the survey's dissemination means the findings presented may not be representative of the full range of stakeholders or views.

Policy Help Needed, Experience Required: Preparing Practitioners to Effectively Engage in Policy.

OBJECTIVES: There is a shift toward a "health in all policies" approach in public health; however, most practitioners are not equipped with the necessary knowledge or skills to engage in and practice policy. This study explores how public health professionals can become policy practitioners and better engage in the policy process. This article also provides recommendations for training programs on how to increase students' policy-related knowledge and skills. METHOD: We conducted in-depth interviews with 10 public health policy experts in the United States spanning academic, governmental, advocacy, and practice settings. Key informants provided perspectives regarding strengths and skill sets that practitioners need to better position themselves to do policy-relevant work and opportunities for public health programs to improve training. The research team conducted thematic analyses to determine commonality among expert responses. RESULTS: Informants identified a number of strengths and skills that either support or impede practitioners' ability to conduct policy work and proposed recommendations for public health curricula to integrate policy-related coursework or practical experiences to prepare practitioners for policy careers. CONCLUSION: Public health professionals need to become more politically astute to practice and advance public health policy. To facilitate the development of such skills, public health training and pedagogy must integrate policy practice into traditional public health coursework, include new policy-focused courses, and provide opportunities for real-world policy experience.

Regulatory Anatomy: How "Safety Logics" Structure European Transplant Medicine.

This article proposes the term "safety logics" to understand attempts within the European Union (EU) to harmonize member state legislation to ensure a safe and stable supply of human biological material for transplants and transfusions. With safety logics, I refer to assemblages of discourses, legal documents, technological devices, organizational structures, and work practices aimed at minimizing risk. I use this term to reorient the analytical attention with respect to safety regulation. Instead of evaluating whether safety is achieved, the point is to explore the types of "safety" produced through these logics as well as to consider the sometimes unintended consequences of such safety work. In fact, the EU rules have been giving rise to complaints from practitioners finding the directives problematic and inadequate. In this article, I explore the problems practitioners face and why they arise. In short, I expose the regulatory anatomy of the policy landscape.

"Should I Buy or Should I Grow?" How drug policy institutions and drug market transaction costs shape the decision to self-supply with cannabis in the Netherlands and the Czech Republic.

BACKGROUND: This paper uses the framework of institutional economics to assess the impact of formal and informal institutions that influence the transaction costs on the cannabis market, and users' decisions to self-supply in the Czech Republic and the Netherlands, two countries with seemingly identical policies towards cannabis cultivation. METHODS: A comparative analysis was conducted using secondary qualitative and quantitative data in four areas that were identified as relevant to the decision to cultivate cannabis: (i) the rules of the game - cannabis cultivation policy; (ii) "playing the game" - implementation of cannabis cultivation policy, (iii) informal institutions - cannabis cultivation culture, and (iv) the transaction costs of the cannabis market - availability, quality, and relative cannabis prices adjusted by purchasing power parity. RESULTS: Although the two policies are similar, their implementation differs substantially. In the Czech Republic, law enforcement has focused almost exclusively on large-scale cultivation. This has resulted in a competitive small-scale cultivation market, built upon a history of cannabis self-supply, which is pushing cannabis prices down. In the Netherlands, the costs of establishing one's own self-supply have historically outweighed the costs associated with buying in coffee shops. Additionally, law enforcement has recently pushed small-scale growers away from the market, and a large-scale cannabis supply, partly controlled by organised criminal groups, has been established that is driving prices up. The Czech cannabis prices have become relatively lower than the Dutch prices only recently, and the decision to buy on the market or to self-supply will be further shaped by the transactions costs on both markets, by policy implementation and by the local culture. CONCLUSIONS: The ability to learn from the impacts of cannabis cultivation policies conducted within the framework of UN drug treaties is particularly important at a time when increasing numbers of countries are seeking more radical reforms of their cannabis policy.

Beyond two communities - from research utilization and knowledge translation to co-production?

In recent public health discourse, the relations between researchers, policy makers, and professionals are often described as 'gaps', illustrating the (cultural) differences between these domains. Such descriptions seem to be part of a 'two communities'-logic: a perception that researchers and policy makers or professionals stem from strictly separated worlds, with distinctive logics, rationales and incentives. In this paper, the author will argue that this prevalent conceptual framework of 'two communities', whilst having been extremely helpful in theorizing the difficulties of connecting policy needs with research findings, bears several important limitations when analysing structural collaboratives between researchers and policy makers or professionals. The paper outlines several problematic assumptions and neglected elements that are generally perceivable within this tradition, such as the analytical a priori separation of research, policy and practice domains and the overemphasis on both the heterogeneity between domains and the homogeneity within these domains. Inductively developed insights from the field of science and technology studies (STS) show that the boundaries between research and policy are often much more fluid (and largely rhetorical) than the two communities tradition seems to acknowledge. What needs to be analysed is not only how the boundaries can be bridged, but how - and at what moments - these boundaries are maintained, redrawn or re-established - and for what purposes. This paper focuses on these questions by utilizing the alternative conceptual framework of coproduction. It draws on long term qualitative research to structural collaborations (the Dutch Academic Collaborative Centres for Public Health) to illustrate these points.

Women's health and behavioral health issues in health care reform.

As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.

Full immersion in the mainstream: how years of promise for mental health and substance use disorders came to fruition with the Affordable Care Act.

With passage of the Patient Protection and Affordable Care Act (ACA), the behavioral health community has achieved entry into the mainstream of U.S. health care. Passage of the law was the culmination of a long effort by advocates. At the same time, findings from research and practice have informed the nation's understanding that behavioral health is integral to health. The primary task before the behavioral health community now is to ensure that the advances of recent years are secured through implementation of the ACA and approaches to service delivery that emphasize integrated care.

Lessons learned from a Maryland citizen advocacy group's experience in impacting health reform: the seven Cs of effective citizen advocacy.

The Affordable Care Act and the Mental Health Parity and Addiction Equity Act, in conjunction with state reform efforts, provide opportunities for increased access to mental health care, but advocates must engage throughout the process to ensure consumers' needs are met. This article describes the advocacy experiences of the Mental Health Association of Maryland (MHAMD) and provides a historical perspective for current advocacy efforts. It discusses current health care reform initiatives in Maryland, similar to other states' efforts, and highlights critical issues of concern for advocates. Using examples from MHAMD's recent experience, 7 effective advocacy strategies are illustrated.

Preventive therapy in children exposed to Mycobacterium tuberculosis: problems and solutions.

Young children living with a tuberculosis patient are at high risk of Mycobacterium tuberculosis infection and disease. WHO guidelines promote active screening and isoniazid (INH) preventive therapy (PT) for such children under 5 years, yet this well-established intervention is seldom used in endemic countries. We review the literature regarding barriers to implementation of PT and find that they are multifactorial, including difficulties in screening, poor adherence, fear of increasing INH resistance and poor acceptability among primary caregivers and healthcare workers. These barriers are largely resolvable, and proposed solutions such as the adoption of symptom-based screening and shorter drug regimens are discussed. Integrated multicomponent and site-specific solutions need to be developed and evaluated within a public health framework to overcome the policy-practice gap and provide functional PT programmes for children in endemic settings.