The health impacts of ambient air pollution in Australia: a systematic literature review.

Ambient (outdoor) air pollution is a key risk factor for health for which effective policy plays an important preventative role. Australian federal and related state air quality standards have historically relied on international evidence for guidance, which may not accurately reflect the Australian context. However, there has been a large increase in Australian epidemiological studies over recent years. The aim of this study is to provide an updated systematic literature review of peer-reviewed epidemiological studies that examined the health impacts of outdoor air pollution in Australia, including short- and long-term exposure. Following PRISMA guidelines, we conducted a systematic literature review. Broad search terms were applied to two databases (PubMed and Web of Science) and Google Scholar. Quality assessment and risk of bias were assessed using standard metrics. Included studies were summarised by tabulating key study characteristics, grouped by health outcomes. In total, 72 studies were included in the review. Sixty-four (89%) studies used daily or hourly pollutant concentrations to examine short-term exposure impacts, of which 59 (92%) revealed significant associations with one or more health outcomes, including cardio-respiratory, all-cause mortality or morbidity and birth outcomes. Eight (11%) studies used annual average pollutant concentrations to investigate the long-term exposure finding significant associations with asthma, reduced lung function, atopy and cardio-respiratory mortality across five studies. The remaining three studies found no significant association with asthma, mortality and a range of self-reported diseases, respectively. Ambient air pollution has substantial health impacts in Australia. The body of domestic evidence has increased markedly since national air quality standards were first set in the 1990s, which could be drawn on by policy-makers when revising the existing standards, or considering new standards.

An analysis of policy success and failure in formal evaluations of Australia's national mental health strategy (1992-2012).

BACKGROUND: Heightened fiscal constraints, increases in the chronic disease burden and in consumer expectations are among several factors contributing to the global interest in evidence-informed health policy. The present article builds on previous work that explored how the Australian Federal Government applied five instruments of policy, or policy levers, to implement a series of reforms under the Australian National Mental Health Strategy (NMHS). The present article draws on theoretical insights from political science to analyse the relative successes and failures of these levers, as portrayed in formal government evaluations of the NMHS. METHODS: Documentary analysis of six evaluation documents corresponding to three National Mental Health Plans was undertaken. Both the content and approach of these government-funded, independently conducted evaluations were appraised. RESULTS: An overall improvement was apparent in the development and application of policy levers over time. However, this finding should be interpreted with caution due to variations in evaluation approach according to Plan and policy lever. Tabulated summaries of the success and failure of each policy initiative, ordered by lever type, are provided to establish a resource that could be consulted for future policy-making. CONCLUSIONS: This analysis highlights the complexities of health service reform and underscores the limitations of narrowly focused empirical approaches. A theoretical framework is provided that could inform the evaluation and targeted selection of appropriate policy levers in mental health.

How do we define the policy impact of public health research? A systematic review.

BACKGROUND: In order to understand and measure the policy impact of research we need a definition of research impact that is suited to the task. This article systematically reviewed both peer-reviewed and grey literature for definitions of research impact to develop a definition of research impact that can be used to investigate how public health research influences policy. METHOD: Keyword searches of the electronic databases Web of Science, ProQuest, PubMed, EMBASE, CINAHL, Informit, PsycINFO, The Cochrane Database of Systematic Reviews and Google Scholar were conducted between August 2015 and April 2016. Keywords included 'definition' and 'policy' and 'research impact' or 'research evidence'. The search terms 'health', public health' or 'mental health' and 'knowledge transfer' or 'research translation' were used to focus the search on relevant health discipline approaches. Studies included in the review described processes, theories or frameworks associated with public health, health services or mental health policy. RESULTS: We identified 108 definitions in 83 publications. The key findings were that literature on research impact is growing, but only 23% of peer-reviewed publications on the topic explicitly defined the term and that the majority (76%) of definitions were derived from research organisations and funding institutions. We identified four main types of definition, namely (1) definitions that conceptualise research impacts in terms of positive changes or effects that evidence can bring about when transferred into policies (example Research Excellence Framework definition), (2) definitions that interpret research impacts as measurable outcomes (Research Councils UK), and (3) bibliometric and (4) use-based definitions. We identified four constructs underpinning these definitions that related to concepts of contribution, change, avenues and levels of impact. CONCLUSION: The dominance of bureaucratic definitions, the tendency to discuss but not define the concept of research impact, and the heterogeneity of definitions confirm the need for conceptual clarity in this area. We propose a working definition of research impact that can be used in a range of health policy contexts.

Establishing and Governing e-Mental Health Care in Australia: A Systematic Review of Challenges and A Call For Policy-Focussed Research.

BACKGROUND: Growing evidence attests to the efficacy of e-mental health services. There is less evidence on how to facilitate the safe, effective, and sustainable implementation of these services. OBJECTIVE: We conducted a systematic review on e-mental health service use for depressive and anxiety disorders to inform policy development and identify policy-relevant gaps in the evidence base. METHODS: Following the PRISMA protocol, we identified research (1) conducted in Australia, (2) on e-mental health services, (3) for depressive or anxiety disorders, and (4) on e-mental health usage, such as barriers and facilitators to use. Databases searched included Cochrane, PubMed, PsycINFO, CINAHL, Embase, ProQuest Social Science, and Google Scholar. Sources were assessed according to area and level of policy relevance. RESULTS: The search yielded 1081 studies; 30 studies were included for analysis. Most reported on self-selected samples and samples of online help-seekers. Studies indicate that e-mental health services are predominantly used by females, and those who are more educated and socioeconomically advantaged. Ethnicity was infrequently reported on. Studies examining consumer preferences found a preference for face-to-face therapy over e-therapies, but not an aversion to e-therapy. Content relevant to governance was predominantly related to the organizational dimensions of e-mental health services, followed by implications for community education. Financing and payment for e-services and governance of the information communication technology were least commonly discussed. CONCLUSIONS: Little research focuses explicitly on policy development and implementation planning; most research provides an e-services perspective. Research is needed to provide community and policy-maker perspectives. General population studies of prospective treatment seekers that include ethnicity and socioeconomic status and quantify relative preferences for all treatment modalities are necessary.

An analysis of policy levers used to implement mental health reform in Australia 1992-2012.

BACKGROUND: Over the past two decades, mental health reform in Australia has received unprecedented government attention. This study explored how five policy levers (organisation, regulation, community education, finance and payment) were used by the Australian Federal Government to implement mental health reforms. METHODS: Australian Government publications, including the four mental health plans (published in 1992, 1998, 2003 and 2008) were analysed according to policy levers used to drive reform across five priority areas: [1] human rights and community attitudes; [2] responding to community need; [3] service structures; [4] service quality and effectiveness; and [5] resources and service access. RESULTS: Policy levers were applied in varying ways; with two or three levers often concurrently used to implement a single initiative or strategy. For example, changes to service structures were achieved using various combinations of all five levers. Attempts to improve service quality and effectiveness were instead made through a single lever-regulation. The use of some levers changed over time, including a move away from prescriptive, legislative use of regulation, towards a greater focus on monitoring service standards and consumer outcomes. CONCLUSIONS: Patterns in the application of policy levers across the National Mental Health Strategy, as identified in this analysis, represent a novel way of conceptualising the history of mental health reform in Australia. An improved understanding of the strategic targeting and appropriate utilisation of policy levers may assist in the delivery and evaluation of evidence-based mental health reform in the future.

Can automated content analysis be used to assess and improve the use of evidence in mental health policy? A systematic review.

BACKGROUND: This review assesses the utility of applying an automated content analysis method to the field of mental health policy development. We considered the possibility of using the Wordscores algorithm to assess research and policy texts in ways that facilitate the uptake of research into mental health policy. METHODS: The PRISMA framework and the McMaster appraisal tools were used to systematically review and report on the strengths and limitations of the Wordscores algorithm. Nine electronic databases were searched for peer-reviewed journal articles published between 2003 and 2016. Inclusion criteria were (1) articles had to be published in public health, political science, social science or health services disciplines; (2) articles had to be research articles or opinion pieces that used Wordscores; and (3) articles had to discuss both strengths and limitations of using Wordscores for content analysis. RESULTS: The literature search returned 118 results. Twelve articles met the inclusion criteria. These articles explored a range of policy questions and appraised different aspects of the Wordscores method. DISCUSSION: Following synthesis of the material, we identified the following as potential strengths of Wordscores: (1) the Wordscores algorithm can be used at all stages of policy development; (2) it is valid and reliable; (3) it can be used to determine the alignment of health policy drafts with research evidence; (4) it enables existing policies to be revised in the light of research; and (5) it can determine whether changes in policy over time were supported by the evidence. Potential limitations identified were (1) decreased accuracy with short documents, (2) words constitute the unit of analysis and (3) expertise is needed to choose 'reference texts'. CONCLUSIONS: Automated content analysis may be useful in assessing and improving the use of evidence in mental health policies. Wordscores is an automated content analysis option for comparing policy and research texts that could be used by both researchers and policymakers.

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.