Understanding the unintended consequences of public health policies: the views of policymakers and evaluators.

BACKGROUND: Public health policies sometimes have unexpected effects. Understanding how policies and interventions lead to outcomes is essential if policymakers and researchers are to intervene effectively and reduce harmful and other unintended consequences (UCs) of their actions. Yet, evaluating complex mechanisms and outcomes is challenging, even before considering how to predict assess and understand outcomes and UCs when interventions are scaled up. We aimed to explore with UK policymakers why some policies have UCs, and how researchers and policymakers should respond. METHODS: We convened a one-day workshop with 14 people involved in developing, implementing or evaluating social and public health policies, and/or evaluating possible unintended effects. This included senior evaluators, policymakers from government and associated agencies, and researchers, covering policy domains from public health, social policy, poverty, and international development. RESULTS: Policymakers suggested UCs happen for a range of reasons: poor policy design, unclear articulation of policy mechanisms or goals, or unclear or inappropriate evidence use, including evaluation techniques. While not always avoidable, it was felt that UCs could be partially mitigated by better use of theory and evidence, better involvement of stakeholders in concurrent design and evaluation of policies, and appropriate evaluation systems. CONCLUSIONS: UCs can be used to explore the mechanisms underpinning social change caused by public health policies. Articulating these mechanisms is essential for truly evidence-informed decision-making, to enable informed debate about policy options, and to develop evaluation techniques. Future work includes trying to develop a holistic stakeholder-led evaluation process.

Support for adults with autism spectrum disorder without intellectual impairment: Systematic review.

Adults with autism spectrum disorder without intellectual impairment may benefit from a range of support services. This article presents the results of a systematic review assessing the effectiveness of supportive interventions for adults with autism spectrum disorder without intellectual impairment. A total of 32 studies were included; most focused on younger male participants. Although evidence was lacking for most types of intervention, employment programmes and social skills training were found to be effective for more proximal outcomes such as social skills. Evidence that any intervention improves mental health or well-being was very limited. Most interventions focused on mitigating specific deficits, rather than on providing broader support. Further research is needed on the effectiveness of supportive interventions such as advocacy and mentoring.

Crime, fear of crime, environment, and mental health and wellbeing: mapping review of theories and causal pathways.

This paper presents the findings from a review of the theoretical and empirical literature on the links between crime and fear of crime, the social and built environment, and health and wellbeing. A pragmatic approach was employed, with iterative stages of searching and synthesis. This produced a holistic causal framework of pathways to guide future research. The framework emphasises that crime and fear of crime may have substantial impacts on wellbeing, but the pathways are often highly indirect, mediated by environmental factors, difficult to disentangle and not always in the expected direction. The built environment, for example, may affect health via its impacts on health behaviours; via its effects on crime and fear of crime; or via the social environment. The framework also helps to identify unexpected factors which may affect intervention success, such as the risk of adverse effects from crime prevention interventions as a result of raising awareness of crime.