Associations between Food Policy Councils and Policies That Support Healthy Food Access: A National Survey of Community Policy Supports.

Food policy councils (FPCs) are one form of community coalition that aims to address challenges to local food systems and enhance availability, accessibility, and affordability of healthy foods for local residents. We used data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living, a nationally representative survey of US municipalities (n = 2029), to examine the prevalence of FPCs and cross-sectional associations between FPCs and four types of supports for healthy food access (approaches to help food stores, practices to support farmers markets, transportation-related supports, and community planning documents). Overall, 7.7% of municipalities reported having a local or regional FPC. FPCs were more commonly reported among larger municipalities with ≥50,000 people (29.2%, 95% Confidence Interval (CI): 21.6, 36.8) and western region municipalities (13.2%, 95% CI: 9.6, 16.8). After multivariable adjustment, municipalities with FPCs had significantly higher odds of having all four types of supports, compared to those without FPCs (adjusted odds ratio (aOR) range: 2.4-3.4). Among municipalities with FPCs (n = 156), 41% reported having a local government employee or elected official as a member, and 46% had a designated health or public health representative. Although FPCs were uncommon, municipalities that reported having a local or regional FPC were more likely to report having supports for healthy food access for their residents.

Conselho de saúde e efetividade participativa: estudo sobre avaliação de desempenho / Health councils and participatory effectiveness: a performance assessment study / Consejo de salud y efectividad participativa: estudio sobre la evaluación de desempeño

Resumo: O artigo tem por objetivo apresentar e analisar os resultados de um modelo de avaliação de desempenho de conselhos de saúde. O referencial teórico metodológico está fundamentado no método spidergram, adaptado à realidade dos conselhos de saúde. A matriz avaliativa considerou cinco dimensões de maior influência sobre a participação: autonomia, organização, representatividade, envolvimento comunitário e influência política. Com base na avaliação dos indicadores, foi estimado o valor de desempenho de cada dimensão e localizado no gráfico de cinco eixos. A aplicação da matriz foi realizada no Conselho de Saúde de Vitória da Conquista, Bahia, Brasil. Utilizou-se análise de documentos, observação das reuniões e entrevistas com 18 conselheiros como técnicas de coleta de dados. Os resultados demonstram nível avançado de autonomia do conselho com condições estruturais adequadas, porém, com limitações na independência financeira. A dimensão organização atingiu nível máximo de desempenho com a realização regular de reuniões, disponibilidade de informações para os conselheiros e funcionamento das comissões temáticas. A representatividade foi a dimensão de pior desempenho, demostrado pela frágil relação dos representantes com as entidades. A dimensão envolvimento comunitário apresentou nível avançado, com elevada participação de conselheiros e não conselheiros às reuniões e perfil de atuação propositivo. A dimensão influência política obteve nível intermediário. Constatou-se elevada influência dos representantes sociais no processo deliberativo e diminuta capacidade de acompanhamento das políticas. A matriz utilizada mostrou-se adequada e viável para a avaliação de desempenho dos conselhos de saúde.

Abstract: The article aims to analyze the results of a performance assessment model for health councils. The theoretical and methodological frame of reference was the spider graph method, adapted to the reality of health councils. The assessment matrix considered five dimensions with the greatest influence on participation: autonomy, organization, representativeness, community involvement, and political influence. Based on assessment of the indicators, we estimated the performance value for each dimension and located it on the five-axis graph. The matrix was applied to the Health Council in Vitória da Conquista, Bahia State, Brazil. We used document analysis, observation of meetings, and interviews with 18 council members as the data collection techniques. The results show an advanced level of the council's autonomy with adequate structural conditions, but with limitations in financial independence. The organizational dimension reached the maximum level of performance, with regular meetings, availability of information for council members, and functioning of thematic commissions. Representativeness was the dimension with the worst performance, displayed by the weak relationship between the representatives and the organizations. The community involvement dimension displayed an advanced level with high participation by council and non-council members in the meetings and action with numerous proposals. The political influence dimension showed intermediate performance. We observed greater influence by the social representatives on the decision-making process and low capacity for follow-up on policies. The matrix proved adequate and feasible for performance assessment of health councils.

Resumen: El objetivo de este artículo es presentar y analizar los resultados de un modelo de evaluación de desempeño en consejos de salud. El marco referencial teórico metodológico se fundamentó en el método spidergram, adaptado a la realidad de los consejos de salud. La matriz evaluativa consideró las cinco dimensiones de mayor influencia sobre la participación: autonomía, organización, representatividad, implicación comunitaria e influencia política. A partir de la evaluación de los indicadores, se estimó el valor del desempeño de cada dimensión y se localizó en el gráfico con cinco ejes. La aplicación de la matriz se realizó en el Consejo de Salud de Vitória da Conquista, Bahia, Brasil. Se realizó un análisis de documentación, observación de reuniones y entrevistas con 18 consejeros, así como técnicas de recogida de datos. Los resultados demuestran un nivel avanzado de autonomía del consejo con condiciones estructurales adecuadas, aunque con limitaciones en la independencia financiera. La dimensión organización alcanzó el nivel máximo de desempeño con la realización regular de reuniones, disponibilidad de información para los consejeros y funcionamiento de las comisiones temáticas. La representatividad fue la dimensión de peor desempeño, demostrada por la frágil relación de los representantes con las entidades. La dimensión implicación comunitaria presentó un nivel avanzado con una elevada participación de consejeros y no consejeros en las reuniones y perfil de actuación propositivo. La dimensión influencia política obtuvo un nivel intermedio. Se constató una elevada influencia de los representantes sociales en el proceso deliberativo y una diminuta capacidad de seguimiento de las políticas. La matriz utilizada se mostró adecuada y útil para la evaluación de desempeño en los consejos de salud.

[Health councils and participatory effectiveness: a performance assessment study]. / Conselho de saúde e efetividade participativa: estudo sobre avaliação de desempenho.

The article aims to analyze the results of a performance assessment model for health councils. The theoretical and methodological frame of reference was the spider graph method, adapted to the reality of health councils. The assessment matrix considered five dimensions with the greatest influence on participation: autonomy, organization, representativeness, community involvement, and political influence. Based on assessment of the indicators, we estimated the performance value for each dimension and located it on the five-axis graph. The matrix was applied to the Health Council in Vitória da Conquista, Bahia State, Brazil. We used document analysis, observation of meetings, and interviews with 18 council members as the data collection techniques. The results show an advanced level of the council's autonomy with adequate structural conditions, but with limitations in financial independence. The organizational dimension reached the maximum level of performance, with regular meetings, availability of information for council members, and functioning of thematic commissions. Representativeness was the dimension with the worst performance, displayed by the weak relationship between the representatives and the organizations. The community involvement dimension displayed an advanced level with high participation by council and non-council members in the meetings and action with numerous proposals. The political influence dimension showed intermediate performance. We observed greater influence by the social representatives on the decision-making process and low capacity for follow-up on policies. The matrix proved adequate and feasible for performance assessment of health councils.

O artigo tem por objetivo apresentar e analisar os resultados de um modelo de avaliação de desempenho de conselhos de saúde. O referencial teórico metodológico está fundamentado no método spidergram, adaptado à realidade dos conselhos de saúde. A matriz avaliativa considerou cinco dimensões de maior influência sobre a participação: autonomia, organização, representatividade, envolvimento comunitário e influência política. Com base na avaliação dos indicadores, foi estimado o valor de desempenho de cada dimensão e localizado no gráfico de cinco eixos. A aplicação da matriz foi realizada no Conselho de Saúde de Vitória da Conquista, Bahia, Brasil. Utilizou-se análise de documentos, observação das reuniões e entrevistas com 18 conselheiros como técnicas de coleta de dados. Os resultados demonstram nível avançado de autonomia do conselho com condições estruturais adequadas, porém, com limitações na independência financeira. A dimensão organização atingiu nível máximo de desempenho com a realização regular de reuniões, disponibilidade de informações para os conselheiros e funcionamento das comissões temáticas. A representatividade foi a dimensão de pior desempenho, demostrado pela frágil relação dos representantes com as entidades. A dimensão envolvimento comunitário apresentou nível avançado, com elevada participação de conselheiros e não conselheiros às reuniões e perfil de atuação propositivo. A dimensão influência política obteve nível intermediário. Constatou-se elevada influência dos representantes sociais no processo deliberativo e diminuta capacidade de acompanhamento das políticas. A matriz utilizada mostrou-se adequada e viável para a avaliação de desempenho dos conselhos de saúde.

El objetivo de este artículo es presentar y analizar los resultados de un modelo de evaluación de desempeño en consejos de salud. El marco referencial teórico metodológico se fundamentó en el método spidergram, adaptado a la realidad de los consejos de salud. La matriz evaluativa consideró las cinco dimensiones de mayor influencia sobre la participación: autonomía, organización, representatividad, implicación comunitaria e influencia política. A partir de la evaluación de los indicadores, se estimó el valor del desempeño de cada dimensión y se localizó en el gráfico con cinco ejes. La aplicación de la matriz se realizó en el Consejo de Salud de Vitória da Conquista, Bahia, Brasil. Se realizó un análisis de documentación, observación de reuniones y entrevistas con 18 consejeros, así como técnicas de recogida de datos. Los resultados demuestran un nivel avanzado de autonomía del consejo con condiciones estructurales adecuadas, aunque con limitaciones en la independencia financiera. La dimensión organización alcanzó el nivel máximo de desempeño con la realización regular de reuniones, disponibilidad de información para los consejeros y funcionamiento de las comisiones temáticas. La representatividad fue la dimensión de peor desempeño, demostrada por la frágil relación de los representantes con las entidades. La dimensión implicación comunitaria presentó un nivel avanzado con una elevada participación de consejeros y no consejeros en las reuniones y perfil de actuación propositivo. La dimensión influencia política obtuvo un nivel intermedio. Se constató una elevada influencia de los representantes sociales en el proceso deliberativo y una diminuta capacidad de seguimiento de las políticas. La matriz utilizada se mostró adecuada y útil para la evaluación de desempeño en los consejos de salud.

An exploratory analysis of the nature of informal knowledge underlying theories of planned action used for public health oriented knowledge translation.

BACKGROUND: Informal knowledge is used in public health practice to make sense of research findings. Although knowledge translation theories highlight the importance of informal knowledge, it is not clear to what extent the same literature provides guidance in terms of how to use it in practice. The objective of this study was to address this gap by exploring what planned action theories suggest in terms of using three types of informal knowledge: local, experiential and expert. We carried out an exploratory secondary analysis of the planned action theories that informed the development of a popular knowledge translation theory. Our sample included twenty-nine (n = 29) papers. We extracted information from these papers about sources of and guidance for using informal knowledge, and then carried out a thematic analysis. RESULTS: We found that theories of planned action provide guidance (including sources of, methods for identifying, and suggestions for use) for using local, experiential and expert knowledge. CONCLUSION: This study builds on previous knowledge translation related work to provide insight into the practical use of informal knowledge. Public health practitioners can refer to the guidance summarized in this paper to inform their decision-making. Further research about how to use informal knowledge in public health practice is needed given the value being accorded to using informal knowledge in public health decision-making processes.

Modifying the Medical Research Council grading system through Rasch analyses.

The Medical Research Council grading system has served through decades for the evaluation of muscle strength and has been recognized as a cardinal feature of daily neurological, rehabilitation and general medicine examination of patients, despite being respectfully criticized due to the unequal width of its response options. No study has systematically examined, through modern psychometric approach, whether physicians are able to properly use the Medical Research Council grades. The objectives of this study were: (i) to investigate physicians' ability to discriminate among the Medical Research Council categories in patients with different neuromuscular disorders and with various degrees of weakness through thresholds examination using Rasch analysis as a modern psychometric method; (ii) to examine possible factors influencing physicians' ability to apply the Medical Research Council categories through differential item function analyses; and (iii) to examine whether the widely used Medical Research Council 12 muscles sum score in patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy would meet Rasch model's expectations. A total of 1065 patients were included from nine cohorts with the following diseases: Guillain-Barré syndrome (n = 480); myotonic dystrophy type-1 (n = 169); chronic inflammatory demyelinating polyradiculoneuropathy (n = 139); limb-girdle muscular dystrophy (n = 105); multifocal motor neuropathy (n = 102); Pompe's disease (n = 62) and monoclonal gammopathy of undetermined related polyneuropathy (n = 8). Medical Research Council data of 72 muscles were collected. Rasch analyses were performed on Medical Research Council data for each cohort separately and after pooling data at the muscle level to increase category frequencies, and on the Medical Research Council sum score in patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Disordered thresholds were demonstrated in 74-79% of the muscles examined, indicating physicians' inability to discriminate between most Medical Research Council categories. Factors such as physicians' experience or illness type did not influence these findings. Thresholds were restored after rescoring the Medical Research Council grades from six to four options (0, paralysis; 1, severe weakness; 2, slight weakness; 3, normal strength). The Medical Research Council sum score acceptably fulfilled Rasch model expectations after rescoring the response options and creating subsets to resolve local dependency and item bias on diagnosis. In conclusion, a modified, Rasch-built four response category Medical Research Council grading system is proposed, resolving clinicians' inability to differentiate among its original response categories and improving clinical applicability. A modified Medical Research Council sum score at the interval level is presented and is recommended for future studies in Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy.

Mapping progress: the evaluation and monitoring work of the Cancer Control Council of New Zealand 2005-2007.

The Cancer Control Council of New Zealand was established in 2005 to provide an independent, sustainable focus for cancer control. One of its key roles is to monitor and review implementation of the Cancer Control Strategy.

Reliability evaluation of the adapted national coordinating council medication error reporting and prevention (NCC MERP) index.

PURPOSE: Adapted National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index criteria were used in a study undertaken to evaluate commercial computerized provider order entry (CPOE) system impact on community hospital medication errors. This article describes: (1) adaptation of the Index, (2) classification criteria and processes used to assess the adapted Index, and (3) inter-rater reliability results. METHODS: A random sample of 130 (17%) of 2251 medication safety events (MSEs) were classified based on event type, that is, adverse drug event (ADE) or potential ADE (PADE); preventability, that is, 'yes' or 'no,' and outcome severity. Event outcome severity was categorized using adapted Index categories E-I (ADEs) and B-D (PADEs). Decision rules were used for rule-based classification, while an MSE Case Review Panel used judgment-based classification when decision rules did not apply. Inter-rater reliability for both classification approaches was assessed with kappa coefficients, percentage agreement, and confidence intervals (CI). RESULTS: Level of agreement was substantial for both rule-based and judgment-based MSE classification for event type (6 = 0.70-0.90), preventability (6 = 0.67-0.82), and decision rule application (6 = 0.79). Rule-based agreement for ADE and PADE severity was almost perfect for discrete (6 = 0.83-0.84) and combined (6 = 0.87-0.90) Index categories. Judgment-based agreement was substantial for discrete (6 = 0.63-0.67) and combined (6 = 0.66-0.84) Index categories. CONCLUSIONS: The adapted Index yielded substantial agreement for event type, preventability, and severity. Adaptation of the Index to support classification of non-preventable ADEs was an important improvement.

[Oral health on the public agenda: an analysis of Municipal Health Council records in cities from the 17th Regional Health Division in the State of Paraná, Brazil]. / A saúde bucal em pauta: análise de registros dos Conselhos Municipais de Saúde de municípios pertencentes à 17a Regional de Saúde do Estado do Paraná, Brasil.

The present study analyzes interventions pertaining to oral health recorded in the minutes of meetings held by 15 Municipal Health Councils in cities from the 17th Regional Health Division of the State of Paraná, Brazil. Document analysis was performed by identifying health themes, emphasizing categorization of issues related to interventions in oral health. The most frequently analyzed themes were records concerning the programming and organization of oral health services, followed by health budget issues. In 90 of the 591 minutes studied, 134 records pertaining to oral health interventions were identified. An analysis of the latter showed that oral health interventions involve reports of actions already implemented and lack the characteristics of proposals when analyzed from the health planning perspective. This study highlights the need for dentists to expand their representation in such forums in order to play a broader role in the planning process and support oral health as a basic citizen's right.

Facilitating interorganizational collaboration: the contributions of interorganizational alliances.

In an attempt to promote service delivery integration and improve interorganizational collaboration, many recent human service delivery initiatives have included the development of interorganizational alliances such as coalitions and coordinating councils. Despite their popularity, little is known about how these alliances influence interorganizational collaboration, specifically the extent to which they alter the interactions among human service delivery organizations. The present study examined the interorganizational interactions, specifically the exchange relationships, within one county that was implementing two interorganizational alliances--a countywide coordinating council and interagency service delivery teams. Membership on both alliances was associated with broader interorganizational exchange networks. Organizations involved in a coordinating council were more likely to be included in client, information, and resource exchanges, and participate in joint ventures with a broader range of organizations. Providers involved in interagency teams also exchanged clients and information with a broader sector of service delivery organizations than nonparticipating providers. Observational data suggested that both alliances created structures and processes intended to facilitate interorganizational exchanges. Together, these results suggest that the development of opportunities for and encouragement of staff and leader involvement in these types of alliances may be an important part of our attempt to create a more integrated social service delivery system. The implications of these findings for researchers and practitioners are discussed.

Health authorities. Raising the stakes.

A survey of 25 health authorities found user groups, professional forums, newsletters, complaint scheme, roadshows and focus groups the most extensive means of consultations. The majority of health authorities had identified the parties to be consulted over strategic planning. The results suggested that consultation is being used more for service planning than strategic purposes. Many health authorities plan to include police and fire services, the media, unions and the private sector and schools in consultations.