Governance structure and public health provision.

PURPOSE: A key question in the provision of public health concerns how that provision is governed. The purpose of this paper is to examine the governance structure of a public health board and its perceived impact on the efficacy of clinical operations. DESIGN/METHODOLOGY/APPROACH: Structural issues examined the level of centralisation and public participation, and whether governance should occur through elected boards or appointed managers. These issues were examined through multiple lenses. First was the intention of the structure, examining the issues identified by parliament when the new structure was created. Second, the activities of the board were examined through an analysis of board meetings. Finally, hospital clinicians were surveyed through semi-structured interviews with both quantitative and qualitative questioning. FINDINGS: A contradiction was revealed between intention, perception and actual activities. This raises concerns over whether the public are significantly informed to elect the best-skilled appointees to governance positions. PRACTICAL IMPLICATIONS: This research holds implications for selecting governance structures of public health providers. ORIGINALITY/VALUE: Few studies have looked at the role of a publicly elected healthcare governance structure from the perspective of the clinicians. Hence, this study contributes to the literature on healthcare structure and its impact on clinical operations, by including a clinician's perspective. However, this paper goes beyond the survey and also considers the intention of the structure as proposed by parliament, and board activities or what the board actually does. This enables a comparison of intention with outcomes and perception of those outcomes.

Comparative analysis of smoking cessation smartphone applications available in 2012 versus 2014.

BACKGROUND AND AIMS: Smartphone applications (apps) offer a potentially cost-effective and a wide-reach aid to smoking cessation. In 2012, a content analysis of smoking cessation apps suggested that most apps did not adopt behaviour change techniques (BCTs), which according to previous research had suggested would promote higher success rates in quitting smoking. This study examined whether or not, this situation had changed by 2014 for free smoking cessation apps available in the Apple App Store. It also compared the use of engagement and ease-of-use features between the two time points. METHODS: 137 free apps available in the Apple App Sore in 2014 were coded using an established framework for the presence or absence of evidence-based BCTs, and engagement and ease-of-use features. The results from the 2014 data were compared with a similar exercise conducted on 83 free apps available in 2012. RESULTS: BCTs supporting identity change, rewarding abstinence and advising on changing routines were less prevalent in 2014 as compared with 2012 (14.6% vs. 42.2%, 18.2% vs. 48.2%, and 17.5% vs. 24.1%, respectively). Advice on coping with cravings and advice on the use of stop-smoking medication were more prevalent in 2014 as compared with 2012 (27.7% vs. 20.5% and 14.6% vs 3.6%, respectively). The use of recognised engagement features was less common in 2014 than in 2012 (45.3% vs. 69.6%) while ease-of-use features remained very high (94.5% vs. 82.6%). CONCLUSION: There was little evidence of improvement in the use of evidence-based BCTs in free smoking cessation iPhone-based apps between 2012 and 2014.