Who's "in the room where it happens"? A taxonomy and five-step methodology for identifying and characterizing policy actors.

BACKGROUND: Engaging policy actors in research design and execution is critical to increasing the practical relevance and real-world impact of policy-focused dissemination and implementation science. Identifying and selecting which policy actors to engage, particularly actors involved in "Big P" public policies such as laws, is distinct from traditional engaged research methods. This current study aimed to develop a transparent, structured method for iteratively identifying policy actors involved in key policy decisions-such as adopting evidence-based interventions at systems-scale-and to guide implementation study sampling and engagement approaches. A flexible policy actor taxonomy was developed to supplement existing methods and help identify policy developers, disseminators, implementers, enforcers, and influencers. METHODS: A five-step methodology for identifying policy actors to potentially engage in policy dissemination and implementation research was developed. Leveraging a recent federal policy as a case study-The Family First Prevention Services Act (FFPSA)-publicly available documentation (e.g., websites, reports) were searched, retrieved, and coded using content analysis to characterize the organizations and individual policy actors in the "room" during policy decisions. RESULTS: The five steps are as follows: (1) clarify the policy implementation phase(s) of interest, (2) identify relevant proverbial or actual policymaking "rooms," (3) identify and characterize organizations in the room, (4) identify and characterize policy actors in the "room," and (5) quantify (e.g., count actors across groups), summarize, and compare "rooms" to develop or select engagement approaches aligned with the "room" and actors. The use and outcomes of each step are exemplified through the FFPSA case study. CONCLUSIONS: The pragmatic and transparent policy actor identification steps presented here can guide researchers' methods for continuous sampling and successful policy actor engagement. Future work should explore the utility of the proposed methods for guiding selection and tailoring of engagement and implementation strategies (e.g., research-policy actor partnerships) to improve both "Big P" and "little p" (administrative guidelines, procedures) policymaking and implementation in global contexts.

Policy actors' perceptions of public participation to tackle health inequalities in Scotland: a paradox?

BACKGROUND: Health inequalities are persistent and widening with transformative policy change needed. Radically shifting policy to tackle upstream causes of inequalities is likely to require public participation to provide a mandate, evidence and to address questions of co-design, implementation and acceptability. The aim of this paper is to explore perceptions among policy actors on why and how the public should be involved in policymaking for health inequalities. METHODS: In 2019-2020, we conducted exploratory, in-depth, semi-structured interviews with 21 Scottish policy actors from a range of public sector bodies and agencies and third sector organisations that work in, or across, health and non-health sectors. Data were analysed thematically and used to examine implications for the development of participatory policymaking. RESULTS: Policy actors viewed public participation in policymaking as intrinsically valuable for democratic reasons, but the main, and more challenging, concern was with how it could affect positive policy change. Participation was seen as instrumental in two overlapping ways: as evidence to improve policies to tackle health inequalities and to achieve public acceptance for implementing more transformative policies. However, our analysis suggests a paradox: whilst policy actors place importance on the instrumental value of public participation, they simultaneously believe the public hold views about health inequalities that would prevent transformative change. Finally, despite broad agreement on the need to improve public participation in policy development, policy actors were uncertain about how to make the necessary changes due to conceptual, methodological and practical challenges. CONCLUSIONS: Policy actors believe in the importance of public participation in policy to address health inequalities for intrinsic and instrumental reasons. Yet, there is an evident tension between seeing public participation as a route to upstream policies and a belief that public views might be misinformed, individualistic, short-term or self-interested and doubts about how to make public participation meaningful. We lack good insight into what the public think about policy solutions to health inequalities. We propose that research needs to shift from describing the problem to focusing more on potential solutions and outline a potential way forward to undertake effective public participation to tackle health inequalities.

Enacting Parental Engagement: Policy Work in a Primary School Setting.

Parental engagement is a common theme of education policy in most countries. In Aotearoa New Zealand, policies frame parental engagement in broad terms giving schools flexibility in enacting them. However, the generality assumes the complex and differentiated activities associated with parental engagement are well understood, leaving schools with little guidance for this work. This article examines the enactment of parental engagement in one New Zealand primary school to understand these activities better and provide a basis for improved policy. It partly draws on Ball et al. (Routledge 10.4324/9780203153185, 2012) policy enactment framework identifying several enactment roles associated with parental engagement, particularly in-school 'narrators' who are pivotal actors in articulating a rationale for engagement. Key findings were that teachers interpreted parental engagement differently, leading to differentiated practice, and parents are identified as important policy actors. The article concludes that there is a strong case for greater clarity in policy on parental engagement.

A review of the framework and strategy for disability and rehabilitation services in South Africa

Background: Rehabilitation is imperative for the successful integration of persons with disabilities into their social environments. The Framework and strategy for disability and rehabilitation services (FSDR) in South Africa, 2015-2020.was developed to strengthen access to rehabilitation services and ensure the inclusion of persons with disabilities in all aspects of community life. Despite the FSDR being commissioned, access to rehabilitation is a challenge for persons with disabilities and further compounded in rural communities. Objective: The study aimed to describe the barriers and facilitators that influenced the process of development, implementation and monitoring of the FSDR. Method: This qualitative study employed a single case study design. Data was collected through document analysis and in-depth interviews utilising the Walt & Gilson policy analysis framework that outlines the context, content, actors and process of policy development and implementation. In-depth interviews were conducted with twelve key informants (N=12) who were selected purposively for the study. Data obtained from the in-depth interviews were analysed using inductive thematic analysis. Results: We found many factors that influenced the implementation of the framework. Actor dynamics, insufficient resources, the rushed process, poor record-keeping, inappropriate leadership, negative attitudes of staff members and the insufficient monitoring impeded the successful implementation of the framework. While positive attitude, mentorship and support amongst the task team facilitated the implementation process, albeit with challenges. Conclusion: There is a need to address implementation gaps so that the FSDR is responsive to the current rehabilitation needs of persons with disabilities in South Africa. Contribution: This study may inform future disability policy, and can be used as a tool to advocate for the rights for persons with disabilities

What are we saving? Tracing governing knowledge and truth discourse in global COVID-19 policy responses.

As the world went suddenly into lockdown due to the COVID-19 pandemic, sending individuals to their homes and shutting businesses and institutions, the closing of schools posed big problems. The majority of the world's children were out of school, leading to the longest sustained period of school closures in history. We saw educators turning towards responses not aimed at collegial and community-engaged strategies for education in an emergency but at online learning cast as education/business as usual. This study explores the logic driving this global response through analyses of the documents released by three key global education actors: (1) the OECD and its paper A Framework to Guide Education Response to the COVID-19 Pandemic of 2020; (2) UNESCO's Global Education Coalition #LearningNeverStops; and (3) the World Bank's Guidance Note on Education Systems' Response to COVID-19; and Guidance Note: Remote Learning and COVID-19. The authors of this article draw on Carol Bacchi's approach to poststructural policy analysis to make visible the key concepts and binaries used within policy texts and to understand the "technologies of saving" that were invoked in each policy response, locating the education programmes, activities and actors within knowledge practices in educational reform. This article explores the World Bank, OECD and UNESCO responses using an analysis of knowledge harmonisation and difference among these institutions as well as their location as key norm-setters and governing actors in the field of education. The authors argue that all three responses privilege private-sector providers of digital technology. The consequence of these responses is that technologies of saving have centred on privatised, corporate edu-business and edu-tech aimed at online education delivery, bringing significant risks for the erasure of local knowledges. The authors' study suggests that local policymakers, including community-based and national actors, must be invited into the discussion to envision other possibilities and to name the potential destructiveness embedded in the international organisations' actions.

Que sauvons-nous ? Sur la piste du savoir dominant et du discours de vérité dans les réponses politiques mondiales à la COVID-19 ­ Quand le monde s'est brusquement confiné à cause de la COVID-19, renvoyant les gens chez eux et fermant entreprises et institutions, la fermeture des écoles a posé de gros problèmes. La majeure partie des enfants dans le monde se sont retrouvés hors des établissements scolaires, ce qui s'est traduit par la plus longue période de fermeture des écoles de toute l'histoire. Nous avons vu des pédagogues se tourner vers des réponses qui ne visaient pas à trouver des stratégies éducatives collégiale et axées sur la communauté dans une situation d'urgence mais à simplement adopter une forme d'apprentissage en ligne pour continuer d'enseigner comme d'habitude. Cette étude se penche sur la logique qui sous-tend cette réponse globale en analysant les documents publiés par trois acteurs clés de l'éducation : (1) Un cadre pour guider une réponse éducative à la Covid-19 en cas de pandémie de 2020 de l'OCDE; (2) la Coalition mondiale pour l'éducation #ContinuitePedagogique de l'UNESCO et (3) deux notes d'orientation de la Banque mondiale : Note d'orientation sur la riposte des systèmes éducatifs au COVID19 et Note d'orientation mise à jour:Apprentissage à distance et COVID-19. Les auteures de cet article s'inspirent de l'approche analytique de la politique poststructurelle de Carol Bacchi pour mettre en relief les concepts clés et les binaires utilisés dans les textes politiques, et pour comprendre les « technologies de l'économie ¼ invoquées dans toutes les réponses politiques, situant les programmes, les activités et les acteurs de l'éducation dans des pratiques du savoir en réforme éducative. Cet article examine les réponses de la Banque mondiale, de l'OCDE et de l'UNESCO en recourant à une analyse de l'harmonisation du savoir et des différences au sein de ces organismes ainsi que leur position en tant que décideurs clés qui imposent des normes et acteurs déterminants dans le secteur de l'éducation. Les auteures affirment que les trois réponses privilégient les fournisseurs de technologie numérique du secteur privé. En conséquence, les technologies de l'économie se sont focalisées sur un entrepreneuriat et une technologie privatisés en vue de proposer des services éducatifs en ligne, ce qui met considérablement en danger les savoirs locaux risquant ainsi d'être effacés. L'étude des auteures indique que les politiques locaux, y compris les acteurs communautaires et nationaux, doivent être invités à prendre part au débat afin d'envisager d'autres possibilités et dénoncer le pouvoir destructeur potentiel que recèlent les actions des organisations internationales.

Policy actors and human and animal health practitioners' perceptions of antimicrobial use and resistance in Tanzania: A qualitative study.

OBJECTIVE: To explore and describe the perceptions of policy actors and practitioners on antimicrobial use and resistance in human and animal health in Tanzania. METHODS: This was an exploratory qualitative study, which involved semi-structured interviews with nine policy makers and 102 practitioners. RESULTS: Improved multisectoral collaboration and coordination among experts from the animal and human sectors, government will, improved infrastructures, existence of public awareness campaigns on appropriate use of antimicrobials and existence of antimicrobial stewardship were identified as strengths for the implementation of National Action Plan on Antimicrobial Resistance (NAP-AMR) in Tanzania. Despite these strengths, insufficient public awareness of AMR, limited community engagement and inadequate human resources were among the reported weaknesses. A number of opportunities for the implementation of NAP-AMR were also reported including the presence of integrated disease surveillance and response strategy in health sector and development of a coordinated surveillance system. Furthermore, the inadequate laboratory capacity and poor resource mobilization were identified as challenges facing the implementation of NAP-AMR. CONCLUSION: The future policies of AMR need to capitalize on the identified strengths and opportunities as well as design interventions to improve public awareness of AMR and community engagement, deployment of adequate human resources and ensure adequate resource mobilization to meet AMR needs.

Demand-side broadband policy in the context of digital transformation: An examination of SME digital advisory policies in Wales.

Increasing attention has been paid to the potential for demand-side policies to stimulate use of broadband networks. Such policies form part of the increasing digitalisation of the economy and wider society. This is an area where governments are also facing challenges in their efforts to maximise the efficiency and effectiveness of their policies. The paper sheds light on the impact that the transition towards digital has had on demand-side policies supporting the adoption of broadband and digital technologies by SMEs, and draws out the implications for policy, using a case study of Wales in the UK over a ten-year period. It shows that digitalisation has seen policy mechanisms and messages evolving as policy makers have created a more integrated and multi-channel approach to the delivery of advisory support to SMEs, but that the emergence of multiple types of actors (large digital platform businesses) and ongoing digitalisation are adding complexity to policies and their interaction with other forms of public and private business support.

Localizando a criticidade na política: a contínua luta por justiça social na agenda da educação física escolar / Locating criticality in policy: the ongoing struggle for a social justice agenda in school physical education / Ubicando la criticidad en la política: la continua lucha por justícia social en la agenda de la educación física escolar

Há um sentimento de promessa não realizada quando se analisa o progresso do projeto crítico da Educação Física desde a virada da segunda década do século XXI. Estudos de qualidade continuam a emergir em torno da pedagogia crítica da Educação Física, evidenciando o prolongado comprometimento com sua promessa de fornecer aos aprendizes recursos pessoais e intelectuais que são necessários na orientação de produtivos futuros sadios num mundo cada mais complexo. Neste artigo nós discutimos destacados exemplos de investigações contemporâneas que demonstram as contínuas lutas em contextos práticos e revisita barreiras que continuam a restringir as aspirações dos estudos críticos. Focando na Educação Física como uma prática cultural e curricular nas escolas australianas, nós damos primazia aos modos pelos quais políticas diretivas podem ser melhor mobilizadas para capacitar a agenda crítica

There is a sense of unfulfilled promise as one reflects on the progress of the critical project in Physical Education (PE) at the turn of the second decade of the 21st century. Quality scholarship continues to emerge around critical pedagogy in PE, evidencing sustained commitment to its promise to provide learners with personal and intellectual resources needed in navigating productive healthy futures in an increasingly complex world. In this paper we discuss select examples of contemporary research to demonstrate ongoing struggles in practice-based contexts and revisit barriers that continue to restrict the translational aspirations of critical scholars. Focusing on PE as a cultural and curriculum practice in Australian schools, we give primacy to the ways in which policy directives might be better mobilised to enable the critical agenda

Hay un sentimiento de promesa no cumplida cuando se analiza el progreso del proyecto crítico de la Educación Física desde el giro de la segunda década del siglo XXI. Estudios de calidad continúan a emerger en torno a la pedagogía crítica de la Educación Física, evidenciando el prolongado compromiso con su promesa de ofrecer a los aprendices recursos personales e intelectuales que son necesarios en la orientación de productivos futuros saludables en un mundo cada vez más complejo. En ese artículo discutimos destacados ejemplos de investigaciones contemporáneas que demuestran las continuas luchas en contextos prácticos y revisita barreras que continúan restringiendo las aspiraciones de los discursos críticos. Con foco en la Educación Física como una práctica cultural y curricular en las escuelas australianas, priorizamos los modos por los cuales políticas directivas pueden ser mejor movilizadas para capacitar la agenda crítica

Towards an explanatory framework for national level maternal health policy agenda item evolution in Ghana: an embedded case study.

BACKGROUND: Understanding decision-making processes that influence the fate of items on the health policy agenda at national level in low- and middle-income countries is important because of the implications for programmes and outcomes. This paper seeks to advance our understanding of these processes by asking how and why maternal health policy agenda items have fared in Ghana between 1963 and 2014. METHODS: The study design was a single case study of maternal health agenda evolution once on a decision pathway in Ghana, with three different agenda items as sub-units of analysis (fee exemptions for maternal health, free family planning and primary maternal health as part of a per capita provider payment system). Data analysis involved chronologically reconstructing how maternal health policy items evolved over time. RESULTS: The fate of national level maternal health policy items was heavily influenced by how stakeholders (bureaucrats, professional bodies, general public and developmental partners) exercised power to put forward and advocate for specific ideas through processes of issues framing within a changing political and socioeconomic context. The evolution and fate of an agenda item once on a decision pathway involved an iterative process of interacting drivers shaping decisions through cycles of 'active' and 'static' pathways. Items could move from 'active' to 'static' pathways, depending on changing context and actor positions. Items that pursued the 'static' pathway in a particular cycle fell into obscurity by a process that could be described as a form of 'no decision made' in that an explicit decision was not taken to drop the item, but neither was any policy content agreed. Low political interest was exhibited and attempts to bring the item back into active decision-making were made by actors mainly in the bureaucratic arena seeking and struggling (unsuccessfully) to obtain financial and institutional support. Policy items that pursued 'active' pathways showed opposite characteristics and generally moved beyond agenda into formulation and implementation. CONCLUSION: Policy change requires sustaining policy agenda items into formulation and implementation. To do this, change agents need to understand and work within the relevant context, stakeholder interests, power, ideas and framing of issues.

Stakeholders' views on maternity care shortcomings in rural Ghana: An ethnographic study among women, providers, public, and quasiprivate policy sector actors.

Access to skilled provider and emergency obstetric care is not universal across all districts in Ghana. The lived experiences of 3 stakeholder groups on maternity care shortcomings in 3 rural Ghanaian districts are examined in this study. We applied an ethnographic study approach where field data were collected between March to May 2015 in 3 rural districts of northern Ghana. Data were collected among women with recent births experiences (n = 90), health care providers (n = 16), and policy actors (n = 6). Transcripts were read through to identify similar and divergent stakeholders' views. Significant expressions and experiences of stakeholders on maternity care shortcomings were extracted and evaluated to define key themes. Four themes emerged: social/community factors, payments for health care, facility level factors, and policy level factors. The results show that traditional women's roles divest time for maternity care. Poor transport arrangements, insufficient health workforce, health funding gaps, insurance reimbursements delays, and catastrophic health expenditures on travel and drugs are attested as major barriers across all stakeholder groups in all districts studied. The discussion of the study findings suggests it is important to ascertain the scale of informal payments and their impacts on health access. Investments in health workforce and reliable ambulatory service systems could help address poor referral difficulties in rural areas of the country. Social support for community initiatives that pool funds could provide extra resources and relieve cost access-related challenges for using maternity care in rural settings in Ghana.

Quick termination and implications of medical service price reform policy in Chongqing city:A case study of health policy with perspective of policy actors / 中国卫生政策研究

Local policy innovation is a distinct feature in the arena of public administration in China. Previous researches concerned with local policy innovation experience and policy introduction, but they pay little attention to the failure of policy innovations and their termination. This paper uses the theory and concept of public policy process to analyze the reasons for the quick termination process and its mechanism taking healthcare policy as a case study in Chongqing city. It concludes that relative policy strategy is closed in decision-making. The strategy of some special policy target groups as well as the mutual agitation between public and media agenda are the main reasons for the rap-id end of policy innovation. This study is helpful to understand the factors and logic mechanism of the quick termina-tion of local policy innovation as a special type of public policy change which is termed as short-lived and make more scientific healthcare policy decision making and reform in China.

Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda.

BACKGROUND: Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors' views regarding what evidence they deemed appropriate to guide health policy development. METHODS: Using exploratory qualitative methods, we conducted interviews with 51 key informants using an in-depth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. RESULTS: Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. CONCLUSION: What LICs like Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making.