Translating policy into practice: A case study in the secondary prevention of coronary heart disease

Background: This paper focuses on the relationships between health ‘policy’ as it is embodied in official documentation, and health ‘practice’ as reported and reflected on in the talk of policy makers, health professionals and patients. The specific context for the study involves a comparison of policies relating to the secondary prevention of coronary heart disease (CHD) in the two jurisdictions of Ireland – involving as they do a predominantly state funded (National Health Service) system in the north and a mixed healthcare economy in the south. The key question is to determine how the rhetoric of health policy as contained in policy documents connects to, and gets translated into practice and action.

Methods: The data sources for the study include relevant healthcare policy documents (N=5) and progress reports (N=6) in the two Irish jurisdictions, and semi-structured interviews with a range of policy-makers (N=28), practice nurses (14), general practitioners (12) and patients (13) to explore their awareness of the documents’ contents and how they saw the impact of ‘policy’ on primary care practice.

Results: The findings suggest that although strategic policy documents can be useful for highlighting and channelling attention to health issues that require concerted action, they have little impact on what either professionals or lay people do.

Conclusion: To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements – specifying tasks to be undertaken and methods for monitoring and reporting on activity - are required.

The Role of Subjectivity and Knowledge Power Struggles in the Formation of Public Policy

There is a growing incentive for sociologists to demonstrate the use value of their research. Research ‘impact’ is a driver of research funding and a measure of academic standing. Academic debate on this issue has intensified since Burawoy’s (2004) call for a ‘public’ sociology. However the academy is no longer the sole or primary producer of knowledge and empirical sociologists need to contend with the ‘huge swathes’ of social data that now exist (Savage and Burrows, 2007). This article furthers these debates by considering power struggles between competing forms of knowledge. Using a case study, it specifically considers the power struggle between normative and empirical knowledge, and how providers of knowledge assert legitimacy for their truth claims. The article concludes that the idea of ‘impact’ and ‘use-value’ are extremely complex and depends in the policy context on knowledge power struggles, and on how policy makers want to view the world. © The Author(s) 2012

Exploring lay views on physical activity and their implications for public health policy. A case study from East Belfast

It is now recognised that inactive lifestyles underpin much of the disease burden evident in the richer nations of the world. Indeed, the WHO has identified physical inactivity as a 'global public health problem' and has established minimum physical activity (PA) targets for people at different stages of the life-course. Yet, according to WHO, just under 1/3 of working age adults across the globe meet those targets and it is not at all clear how the disjunction between the recommendations of policy makers and the behaviour of ordinary people might be surmounted. Using an opportunity to examine the impact of an urban regeneration project on community residents in East Belfast (Northern Ireland) this paper examines the views of some 113 people on how to increase rates of PA in an area of multiple deprivation. The results of the analysis suggest that lay people rarely consider PA as a discrete issue, or one that centres on individuals and their motivation, but rather as one component in a complex web of concerns, processes and events that include such things as the actions of neighbours and relatives, material and political environments, vandalism, violence, and the weather. We explore and unravel the nature of those concerns using novel methods of content analysis that generate 'issue webs'. Particular attention is paid to the ways in which lay people conceptualize 'activity' and to the manner in which they point to ways of encouraging activity that are rooted in everyday life rather than in the corpocentric, agent-centred and often sport dominated strategies favoured by local policy makers. Our results support those who argue that interventions to increase rates of PA need to move beyond behavioural approaches that focus on individuals and consider the social, political and material contexts in which 'activity' occurs.

Is Northern Ireland abnormal? An extension of the sociological debate on religion in modern Britain

This article places Northern Ireland within the unfolding sociological debate on religion in modern Britain. It measures secularization along Casanova’s three dimensions (1994): religious differentiation, decline and privatization. It finds that Northern Ireland has, in common with Britain, high levels of religious differentiation, grey areas of religious belief and little convinced secularism. However, Northern Ireland differs in that it has higher levels of religious affiliation and practice, and religion plays more roles in civil society than it does in other parts of Britain. The article explores the role of conflict in forming these religious trends, asking if they represent a persistence of the sacred, or simply mask deeper ethnic divisions. It concludes that the social dimensions of religion are just as important as the supernatural, and that they often inform each other. Finally, it suggests that the dynamics of religious change are comparable across regions and, as such, Northern Ireland might be a useful case study for British policy makers, particularly as it becomes increasingly multicultural and religiously plural.

One thing leads to another: science in the news as a basis for curriculum and professional development

Science based news is widely reported in the media. The ability to interact critically with such news reports is increasingly seen as a legitimate part of the science education agenda. This paper reports the findings of two studies looking at the early response and subsequent usage of a resource promoting the integration of science-based news in secondary science curriculum in Northern Ireland. This paper charts the introduction of the resource into schools. The subsequent impact on the science curriculum and the implications for teacher professional development are considered. Many science teachers demonstrate willingness and aptitude to use primary media sources within their teaching. Some who adopted the resource demonstrate the capacity to sustain the development using the resource as a catalyst in ongoing curricular change. Insights gained in this study are relevant to policy makers and curriculum developers as well as teachers seeking to promote this aspect of science education

Perceived and reported access to the general practitioner: an international comparison of universal access and mixed private/public systems.

Timely and convenient access to primary healthcare is essential for the health of the population as delays can incur additional health and financial costs. Access to health care is under increasing scrutiny as part of the drive to contain escalating costs, while attempting to maintain equity in service provision. The objective was to compare primary care services in Republic of Ireland and Northern Ireland, and to report on perceived and reported access to GP services in universal access and mixed private/public systems. A questionnaire study was performed in Northern Ireland (NI) and the Republic of Ireland (ROI). Patients of 20 practices in the ROI and NI were contacted (n = 22,796). Main outcome measures were overall satisfaction and the access to GP services. Individual responses and scale scores were derived using the General Practice Assessment Questionnaire (G-PAQ). The response rate was 52% (n = 11,870). Overall satisfaction with GP practices was higher in ROI than in NI (84.2% and 80.9% respectively). Access scores were higher in ROI than in NI (69.2% and 57.0% respectively) Less than 1 in 10 patients in ROI waited two or more working days to see a doctor of choice (8.1%) compared to almost half (45.0%) in NI. In NI overall satisfaction decreased as practice size increased; 82.8%, 80.4%, and 75.8%. In both systems, in large practices, accessibility is reduced when compared to smaller practices. The faster access to GP services in ROI may be due to the deterrent effect of the consultation charge freeing up services although, as it is the poorest and sickest who are deterred by the charge this improved accessibility may come at a significant cost in terms of equity. The underlying concern for policy makers centres around provision of equitable services.

Substance Use among Young People Living in Residential State Care

Existing empirical evidence on substance use among young people living in residential state care during adolescence is comparatively limited. This paper reports on substance use trends of young people living in residential state care during three annual data-sweeps when aged 14, 15 and 16 years. A repeated cross-sectional research design was utilised in the research. The findings suggest some similarities for lifetime prevalence rates for tobacco and alcohol use for those living in residential state care with a group of same-age young people not living in residential state care who participated in the research. However, solvent abuse and cannabis use was higher among those living in care. More frequent substance use was reported by the residential care sample for all substances at each stage of the study. These findings suggest that young people living in state care continue to merit higher levels of vigilance from researchers and policy-makers in order to fully understand this behaviour and develop appropriate prevention initiatives to meet their needs regarding potential drug problems.

A contingent valuation of the 2012 London Olympic games - A regional perspective

Major sporting events such as the Olympics are usually assessed in terms of economic impacts. Recently, policy makers have begun to place greater emphasis on possible intangible effects (such as civic pride, legacy of sporting facilities) associated with such events. To date, little work has been carried out on quantifying these effects in a meaningful way. This study uses contingent valuation methodology to assess the value of the proposed 2012 London Olympic Games. The survey is carried out on the provincial city of Bath, approximately 2 hours west of London. Conducting the survey outside of London is justified on the basis that the organizers of London 2012 have emphasized the value of the event to the United Kingdom as a whole. The results suggest that positive intangible effects are associated with the event and residents outside of London are willing to pay toward funding.

The importance of stakeholder engagement in invasive species management: A cross-jurisdictional perspective in Ireland

The management of invasive non-native species is a frequent cause of conflict in the field of biodiversity conservation because perceptions of their costs and benefits differ among stakeholder groups. A lack of cohesion between scientific researchers, the commercial sector and policy makers lies at the root of a widespread failure to develop and implement sustainable management practices for invasive species. The crisis of this situation is intensified by drivers stemming from international conventions and directives to address invasive species issues. There are further direct conflicts between legislative instruments promoting biodiversity conservation on the one hand while liberalizing trade at the national, European and global level on the other. The island of Ireland provides graphic illustration of the importance of cross-jurisdictional approaches to biological invasions. Using primarily Irish examples in this review, we emphasize the importance of approaching risk assessment, risk reduction and control or eradication policies from a cost-efficient, highly flexible perspective, incorporating linkages between environmental, economic and social objectives. The need for consolidated policies between Northern Ireland and the Republic of Ireland is particularly acute, though few model cross-border mechanisms for such consolidation are available. The importance of engaging affected stakeholders through positive interactions is discussed with regard to reducing the currently fragmented nature of invasive species management between the two jurisdictions.

Teachers’ understandings of reconciliation and inclusion in four troubled societies.

In this article, the authors examine how teachers in four troubled societies – Israel, Cyprus, Northern Ireland and South Africa – understand and implement reconciliation in light of the increasing diversity of these societies. The authors particularly pay attention to a dialogical encounter between reconciliation and inclusion, as they look for ways to contemplate how each might be of mutual benefit in educational theory and practice. In the first part of the article, the authors give an overview of current thinking on reconciliation and its role in education, and suggest that the notion of inclusiveness can enrich it. The context of the research is then provided by looking briefly at the socio-political and educational settings in which the study was conducted, followed by a discussion of the research methodology. The findings from the study are then presented with the main themes identified as arising across the four research locations. These themes concern understandings of reconciliation and inclusion, student diversity, teachers’ challenges, helping students deal with conflict, and teachers’ development. Finally, whilst acknowledging the exploratory nature of these findings, the authors discuss what policy makers, school leaders and teachers might change about policies and practices for reconciliation education in the four settings studied and, by implication, other comparable settings.

Living with children diagnosed with Autism Spectrum Disorder: Parental and professional views

The number of children diagnosed with an autistic spectrum disorder (ASD) is rising and is now thought to be as high as 1:100. While the debate about best treatment continues, the effects of having a child diagnosed with ASD on family life remain relatively unexplored. This article, by Karola Dillenburger of Queens University Belfast, Mickey Keenan of the University of Ulster, Alvin Doherty from the Health Service Executive Western Region, Tony Byrne of Parents’ Education as Autism Therapists (PEAT) and Stephen Gallagher of the University of Ulster, sets out to adjust that balance. Drawing upon data from a comprehensive study of parental needs, these authors argue that parental and professional views do not always concur; that families make extraordinary sacrifices; that siblings are affected; and that parents are under tremendous stress. Parents argue that educational and social service supports are not efficient and that they are forced to rely largely on support from within the family or from friends. In particular, some important differences between parental and professional perceptions became apparent in relation to interventions based on Applied Behaviour Analysis (ABA). The authors of this article propose that these differences need to be taken seriously by teachers and other professionals as well as by policy-makers.

Translating evidence into practice: A shared priority in public health?

Translational and transdisciplinary research is needed to tackle complex public health problems. This article has three aims. Firstly, to determine how academics and non-academics (practitioners, policy makers and community workers) identified with the goals of the UKCRC Centre of Excellence for Public Health in Northern Ireland and how their attitudes varied in terms of knowledge brokerage and translation. Secondly, to map and analyse the network structure of the public health sector and the placement of the Centre within this. Thirdly, to aggregate responses from members of the network by work setting to construct the trans-sectoral network and devise the Root Mean Sum of Squares to determine the quality and potential value of connections across this network.The analysis was based on data collected from 98 individuals who attended the launch of the Centre in June 2008. Analysis of participant expectations and personal goals suggests that the academic members of the network were more likely to expect the work of the Centre to produce new knowledge than non-academics, but less likely to expect the Centre to generate health interventions and influence health policy. Academics were also less strongly oriented than non-academics to knowledge transfer as a personal goal, though more confident that research findings would be diffused beyond the immediate network. A central core of five nodes is crucial to the overall configuration of the regional public health network in Northern Ireland, with the Centre being well placed to exert influence within this. Though the overall network structure is fairly robust, the connections between some component parts of the network - such as academics and the third sector - are unidirectional.Identifying these differences and core network structure is key to translational and transdisciplinary research. Though exemplified in a regional study, these techniques are generalisable and applicable to many networks of interest: public health, interdisciplinary research or organisational involvement and stakeholder linkage.

Upholding the convention on the rights of the child: a quandary in cyberspace

Put in place to protect the rights of the child, the Convention on the Rights of the Child is a set of non-negotiable standards. A core principle underpinning the Convention is the child's right to participate fully in social arenas and to access sources of social support without excessive interference. Juxtaposing this is the right of the child to be shielded from harm, abuse and exploitation. Over the past several decades the Internet has emerged as a fast and easily accessible medium for people to connect and communicate. While the Internet provides children with a source of support through chat rooms, online communities and social networking sites, just as equally it can expose vulnerable children to predatory and deviant individuals exacerbating the potential for harm. Upholding the Convention in cyberspace is a challenge. The Internet is not owned or regulated by any governing body and accountability is difficult to enforce. This article discusses some of the difficulties of upholding the Convention online and provides recommendations for policy-makers to protect children as they participate in cyberspace.

Dublin docklands. The urban fabric as cultural heritage

Introduction

Since the 1980s there have been major policies and projects for the redevelopment of Dublin Docklands. These projects were mainly aimed at profitable development of office, commercial and residential space, without a sound plan that would preserve the identity or community of the area. The recent shift in policies and urban design principles in the Dublin Docklands Area Master Plan 2008 shows that policy makers have acknowledged that mistakes were made in the last decades of the 20th century. The current map of the Dublin Docklands Area Master Plan 2008 gives us useful information about these changes. The Ringsend/ Irishtown area, which has kept a great part of its urban form and community identity throughout centuries, is described as an ‘area of protection of residential and services amenities’ (DDDA, 2008, map A). Meanwhile, the area of the Grand Canal Docks, recently developed, is described with the objective ‘to seek the social, economic and physical development or rejuvenation
within an area of mixed use of which residential and enterprise facilities would be the predominant uses’ (DDDA, 2008, map A). This classification shows that recent development has been unable to achieve the cohesion and complexity of existing neighbourhoods, revealing flaws not only in policy, but also in the built environment and approaches to urban design.

The shift towards the consideration of more community participation reveals a need to understand the tradition and past of these communities, while the urban fabric of small plots in the existing neighbourhoods, therefore, seems to have a very important role in the conservation of identity of place and providing the opportunity for difference within regularity. On the other hand, the new fabric of residential block developments in the docklands denies the possibility of developing a sense of community, and by providing only regularity, does not leave space for difference.

This paper will address questions related to urban morphology and town analysis in the case of Ringsend and Irishtown. This will provide a tool to learn from the past and perhaps find new models of development that might be less detrimental for the heritage of cities and urban communities. One of the ideas of this paper is to adhere to the new tendency in conservation policies to provide a broader analysis of urban areas, not only considering individual monuments in cities, but also analysing the significance of urban morphology and intangible heritage. It forms part of an OPW Post- Doctoral Fellowship in Conservation Studies and Environmental History.1 Research has been carried out in different areas of urban history of Dublin’s southern waterfront, including infrastructure history and a thorough analysis of the letters of the Pembroke Estate of the 19th century, which included the areas of Ringsend and Irishtown. However, this paper focuses on the study of urban form of the area and its significance to Dublin’s heritage.