Perceptions of representatives of public, private, and community sector institutions of the barriers and enablers for physically active transport

Active transport bridges many shared concerns in the public health and transport sectors. To positively affect opportunities for active transport, public health and transport professionals are engaging with other sectors, including urban planning, housing, recreation, retail, education, and employer groups. A first step in such inter-sectoral collaboration is to understand the perceptions of key players in all of these sectors. This paper describes the results of structured interviews with senior and middle-level administrators from public, private, and community groups in a rapidly developing region in Queensland, Australia, to assess the perceived barriers and enablers to active transport. Key themes emerged relating to infrastructure delivery, public transport services, walk- and cycle-friendly community attributes, political leadership and government coordination, and societal travel norms and culture. There were also themes relating to limits due to resources and limited relevant technical expertise, institutional and practitioner cultures, and agencies not identifying with their roles in active transport. Policies and cross-government initiatives were seen to hold promise, including economic incentives and built environment guidelines, campaigns targeting public attitudes and opinions, and community participation in policy-making. These elements are potential keys to positively promoting comprehensive active transport initiatives among gatekeepers and leaders across different sectors.

General practitioners’ decision to refer patients to dietitians : insight into the clinical reasoning process

The aim of this project was to describe general practitioners’ (GPs’) decision-making process for reducing nutrition risk in cardiac patients through referring a patient to a dietitian. The setting was primary care practices in Victoria. The method we employed was mixed methods research: in Study 1, 30 GPs were interviewed. Recorded interviews were transcribed and narratives analysed thematically. Study 2 involved a survey of statewide random sample of GPs. Frequencies and analyses of variance were used to explore the impact of demographic variables on decisions to refer. We found that the referral decision involved four elements: (i) synthesising management information; (ii) forecasting outcomes; (iii) planning management; and (iv) actioning referrals. GPs applied cognitive and collaborative strategies to develop a treatment plan. In Study 2, doctors (248 GPs, 30%) concurred with identified barriers/enabling factors for patients’ referral. There was no association between GPs’ sex, age or hours worked per week and referral factors. We conclude that a GP’s judgment to offer a dietetic referral to an adult patient is a four element reasoning process. Attention to how these elements interact may assist clinical decision making. Apart from the sole use of prescribed medications/surgical procedures for cardiac care, patients offered a dietetic referral were those who were considered able to commit to dietary change and who were willing to attend a dietetic consultation. Improvements in provision of patients’ nutrition intervention information to GPs are needed. Further investigation is justified to determine how to resolve this practice gap.

An exploratory cluster randomised controlled trial of knowledge translation strategies to support evidence-informed decision-making in local governments (The KT4LG study)

Background: Childhood overweight and obesity is the most prevalent and, arguably, politically complex child health problem internationally. Governments, communities and industry have important roles to play, and are increasingly expected to deliver an evidence-informed system-wide prevention program. However, efforts are impeded by a lack of organisational access to and use of research evidence. This study aims to identify feasible, acceptable and ideally, effective knowledge translation (KT) strategies to increase evidence-informed decision making in local governments, within the context of childhood obesity prevention as a national policy priority.
Methods/Design: This paper describes the methods for KT4LG, a cluster randomised controlled trial which is exploratory in nature, given the limited evidence base and methodological advances. KT4LG aims to examine a program of KT strategies to increase the use of research evidence in informing public health decisions in local governments. KT4LG will also assess the feasibility and acceptability of the intervention. The intervention program comprises a facilitated program of evidence awareness, access to tailored research evidence, critical appraisal skills development, networking and evidence summaries and will be compared to provision of evidence summaries alone in the control program. 28 local governments were randomised to intervention or control, using computer generated numbers, stratified by budget tertile (high, medium or low). Questionnaires will be used to measure impact, costs, and outcomes, and key informant interviews will be used to examine processes, feasibility, and experiences. Policy tracer studies will be included to examine impact of intervention on policies within relevant government policy documents.
Discussion: Knowledge translation intervention studies with a focus on public health and prevention are very few in number. Thus, this study will provide essential data on the experience of program implementation and evaluation of a system-integrated intervention program employed within the local government public health context. Standardised programs of system, organisational and individual KT strategies have not been described or rigorously evaluated. As such, the findings will make a significant contribution to understanding whether a facilitated program of KT strategies hold promise for facilitating evidence-informed public health decision making within complex multisectoral government organisations.

Public opinion and ethics

The article reports on the complicated relationship between public opinion and ethics and discusses how large a role, if any, public opinion should play in issues related to health care, such as euthanasia. In the article the author offers her opinions on democracy and on the role that public opinion plays in solving ethical issues related to health care.

Mental health-related risk factors for violence : using the evidence to guide mental health triage decision making

Mental health clinicians working in emergency crisis assessment teams or mental health triage roles are required to make rapid and accurate risk assessments. The assessment of violence risk at triage is particularly pertinent to the early identification and prevention of patient violence, and to enhancing the safety of clinical staff and the general public. To date, the evidence base for mental health triage violence risk assessment has been minimal. This study aimed to address this evidence gap by identifying best available evidence for mental health-related risk factors for patientinitiated violence.We conducted a systematic review based on the National Health and Medical Research Council of Australia’s methodology for systematic reviews. A total of 6847 studies were retrieved, of which 326 studies met the study inclusion criteria. Of these studies, 277 met inclusion criteria but failed the quality appraisal process, thus a total of 49 studies were included in the final review. The risk factors that achieved the highest evidence grading were predominantly related to dynamic clinical factors immediately observable in the patient’s general appearance, behaviour and speech. These factors included hostility/anger, agitation, thought disturbance, positive symptoms of schizophrenia, suspiciousness and irritability.

Critical uncertainty factors for efficient risk allocation in privately financed public infrastructure projects in Australia

Risk allocation in privately financed public infrastructure projects, commonly referred to as public-private partnership (PPP) projects, is a challenging job due to the nature of incomplete contracting. Choosing a risk allocation strategy could be viewed as the process of deciding the proportion of risk management attributable to the public and private partners based on a series of characteristics of the risk management service transaction in question. These characteristics can be related to the various uncertainty factors. In this study, uncertainty factors have been grouped into Institutional, Social and industrial, Economic, and Project-specific categories and examined in order to achieve efficient risk allocation and minimize risk management-related costs in a long-term view. Critical uncertainty factors for the allocation of three major risks have been identified through an industry-wide survey in Australia. These identified critical uncertainty factors are expected to help decision-makers from both public and private sectors choose efficient allocation strategies for major risks. Future research directions are also set out.

Factor analysis of partners' commitment to risk management in public-private partnership projects

Purpose – The purpose of this paper is to investigate and uncover key determinants that could explain partners' commitment to risk management in public-private partnership projects so that partners' risk management commitment is taken into the consideration of optimal risk allocation strategies.

Design/methodology/approach – Based on an extensive literature review and an examination of the purchasing power parity (PPP) market, an industry-wide questionnaire survey was conducted to collect the data for a confirmatory factor analysis. Necessary statistical tests are conducted to ensure the validity of the analysis results.

Findings – The factor analysis results show that the procedure of confirmatory factor analysis is statistically appropriate and satisfactory. As a result, partners' organizational commitment to risk management in public-private partnerships can now be determined by a set of components, namely general attitude to a risk, perceived one's own ability to manage a risk, and the perceived reward for bearing a risk.

Practical implications – It is recommended, based on the empirical results shown in this paper, that, in addition to partners' risk management capability, decision-makers, both from public and private sectors, should also seriously consider partners' risk management commitment. Both factors influence the formation of optimal risk allocation strategies, either by their individual or interacting effects. Future research may therefore explore how to form optimal risk allocation strategies by integrating organizational capability and commitment, the determinants and measurement of which have been established in this study.

Originality/value – This paper makes an original contribution to the general body of knowledge on risk allocation in large-scale infrastructure projects in Australia adopting the procurement method of public-private partnership. In particular, this paper has innovatively established a measurement model of organisational commitment to risk management, which is crucial to determining optimal risk allocation strategies and in turn achieving project success. The score coefficients of all obtained components can be used to construct components by linear combination so that commitment to risk management can be measured. Previous research has barely focused on this topic.

Communication as coping; how staff working in public housing use narrative to understand their complex and sometimes challenging work.

This paper describes how ethnographic research was used to explore the communication practices of staff working organisation charged with the provision of low cost housing to some of the very poorest and most marginalised members of society in Victoria, Australia. This paper is concerned with how the narratives of the participants (that is, their ‘stories’) provides a very useful and potent insight into the daily life of staff working with people experiencing ‘multiple and complex needs’. The paper uses vignettes and case studies to illuminate the daily work of staff, sharing with the reader the things they see and hear and describing the complexity of the ‘wicked’ problems they face. More importantly, the research uncovered a number of narrative structures staff employ to understand and respond to these problems.

Twitter free Iran: an evaluation of Twitter's role in public diplomacy and information operations in Iran's 2009 election crisis

Social media platforms such as Twitter pose new challenges for decision-makers in an international crisis. We examine Twitter’s role during Iran’s 2009 election crisis using a comparative analysis of Twitter investors, US State Department diplomats, citizen activists and Iranian protestors and paramilitary forces. We code for key events during the election’s aftermath from 12 June to 5 August 2009, and evaluate Twitter. Foreign policy, international political economy and historical sociology frameworks provide a deeper context of how Twitter was used by different users for defensive information operations and public diplomacy. Those who believe Twitter and other social network technologies will enable ordinary people to seize power from repressive regimes should consider the fate of Iran’s protestors, some of whom paid for their enthusiastic adoption of Twitter with their lives.

Book review : Citizen voices: performing public participation in science and environment communication

In Citizen Voices Phillips, Carvalho and Doyle present a collection of articles exploring the meaning of “citizens” and their role as initiators of communication on science and as actors in formal public engagement exercises involved in science governance. Focusing on the dialogic process, the articles provide empirical insight into the effect of citizen voices on participatory decision-making and a range of related theories and methodologies.

Medico-legal decision making for incapacitated neonates

This thesis finds there is a need for greater transparency and objectivity in end-of-life decision making for extremely premature and critically ill infants. To achieve this objectivity, the allocation of finite public healthcare resources, and corresponding quality of life, should be a principal consideration in treatment decisions.

Evidence and obesity prevention : developing evidence summaries to support decision making

Public health practitioners make decisions based on research evidence in combination with a variety of other influences. Evidence summaries are one of a range of knowledge translation options used to support evidence-informed decision making. The literature relevant to obesity prevention requires synthesis for it to be accessible and relevant to end-users. As part of a national collaboration on obesity prevention, we used a stakeholder-focused approach combined with transparent review methods to develop evidence summaries covering a selection of topics relevant to policy and practice in the context of childhood obesity prevention.

The study protocol of: 'initiating end of life care in stroke: clinical decision- making around prognosis'

 Background: The initiation of end of life care in an acute stroke context should be focused on those patients and families with greatest need. This requires clinicians to synthesise information on prognosis, patterns (trajectories) of dying and patient and family preferences. Within acute stroke, prognostic models are available to identify risks of dying, but variability in dying trajectories makes it difficult for clinicians to know when to commence palliative interventions. This study aims to investigate clinicians’ use of different types of evidence in decisions to initiate end of life care within trajectories typical of the acute stroke population.
Methods/design: This two-phase, mixed methods study comprises investigation of dying trajectories in acute stroke (Phase 1), and the use of clinical scenarios to investigate clinical decision-making in the initiation of palliative care (Phase 2). It will be conducted in four acute stroke services in North Wales and North West England. Patient and public involvement is integral to this research, with service users involved at each stage.
Discussion: This study will be the first to examine whether patterns of dying reported in other diagnostic groups are transferable to acute stroke care. The strengths and limitations of the study will be considered. This research will produce comprehensive understanding of the nature of clinical decision-making around end of life care in an acute stroke context, which in turn will inform the development of interventions to further build staff knowledge, skills and confidence in this challenging aspect of acute stroke care.