Theories of the policy process in health promotion research: a review

The Ottawa Charter laid the ground work for a new research and practice agenda by urging health promoters to advocate for healthy public policies. After more than 20 years, it is now time to reflect on the state of policy research in health promotion and to examine how rigorously theories are applied. The review of the literature was
conducted on 11 peer-reviewed journals. The journals were selected for their solid track record in publishing health promotion articles and by using a set of predefined
inclusion and exclusion criteria. The articles, published between January 1986 and June 2006, were searched using Medline and CINAHL databases. The selected papers feature search terms related to ‘politics’, ‘policy’, ‘advocacy’ and ‘coalition’. We examined the theoretical grounding of each paper and whether it focuses on policy content (e.g. nature, impact, evolution of the policy), policy processes (e.g. advocacy capacity building and strategies) or theoretical/methodological issues in policy analysis. This review demonstrates that policy research in health promotion is still largely an a theoretical enterprise. Out of the 119 articles that were found eligible, 39 did apply to some degree a theoretical framework, of which 21 referred to a theoretical framework from political science. We conclude that the field has yet to acknowledge critical concepts that would help to shed light on the policy process, and that validated rigorous theoretical frameworks to inform research and practice are hardly applied. Recommendations are formulated to improve policy research in health promotion.

Why has the rising economic tide failed to float the disability employment boat? A call to action : business,community, government and people power

It is well established that people with disabilities are under-represented in the workforce. Disability labour market scholars agree that there is a significant gap between labour market participation of people with disabilities and people without disabilities, with on-going labour market disadvantage widely reported. All indicate that notwithstanding the recent economic growth of Western economies, the employment rate for people with disabilities has not improved. This paper draws on the findings of three recent research projects on disability employment in Australia and on data from contemporary literature on workplace discrimination and proposes that a combination of more robust social inclusion policies and legislation, revitalised supported employment models, intensive social marketing, and radical disability advocacy is required.

Contextualisation of international development principles to difficult contexts: a case study of Myanmar

Myanmar is a poor developing country with significant humanitarian needs, but international assistance is limited and restricted due to the political situation. Analysis of new primary data collected through interviews both within Myanmar and across the region sheds light on the implementation of principles of best-practice by International Non-Government Organisations (INGOs) operating within the country. This data highlights the adaptations INGOs make to widely-held development principles, ideas and approaches in order to become effective in this context. Forty-seven interviews were conducted with key individuals from INGOs, UN organisations and local NGOs. As there is no definitive list of best-practice principles for project-based INGO development interventions, a list is compiled from responses during the interviews. The adaptations made by INGOs to the context of Myanmar are discussed in terms of the way they work with civil society, NGOs, donors and officials (partnerships, capacity building, advocacy, rights-based approach and accountability), and the way they work in local communities (participation, equity, sustainability, active citizenry, and context sensitivity).

Mothers' AdvocateS In the Community (MOSAIC)- non-professional mentor support to reduce intimate partner violence and depression in mothers: a cluster randomised trial in primary care

Background : Effective interventions to increase safety and wellbeing of mothers experiencing intimate partner violence (IPV) are scarce. As much attention is focussed on professional intervention, this study aimed to determine the effectiveness of non-professional mentor support in reducing IPV and depression among pregnant and recent mothers experiencing, or at risk of IPV.

Methods : MOSAIC was a cluster randomised trial in 106 primary care (maternal and child health nurse and general practitioner) clinics in Melbourne, Australia. 63/106 clinics referred 215 eligible culturally and linguistically diverse women between January 2006 and December 2007. 167 in the intervention (I) arm, and 91 in the comparison (C) arm. 174 (80.9%) were recruited. 133 (76.4%) women (90 I and 43 C) completed follow-up at 12 months.

Intervention: 12 months of weekly home visiting from trained and supervised local mothers, (English & Vietnamese speaking) offering non-professional befriending, advocacy, parenting support and referrals.

Main outcome measures: Primary outcomes; IPV (Composite Abuse Scale CAS) and depression (Edinburgh Postnatal Depression Scale EPDS); secondary measures included wellbeing (SF-36), parenting stress (PSI-SF) and social support (MOS-SF) at baseline and follow-up.

Analysis: Intention-to-treat using multivariable logistic regression and propensity scoring.

Results : There was evidence of a true difference in mean abuse scores at follow-up in the intervention compared with the comparison arm (15.9 vs 21.8, AdjDiff -8.67, CI -16.2 to -1.15). There was weak evidence for other outcomes, but a trend was evident favouring the intervention: proportions of women with CAS scores ≥7, 51/88 (58.4%) vs 27/42 (64.3%) AdjOR 0.47, CI 0.21 to 1.05); depression (EPDS score ≥13) (19/85, 22% (I) vs 14/43, 33% (C); AdjOR 0.42, CI 0.17 to 1.06); physical wellbeing mean scores (PCS-SF36: AdjDiff 2.79; CI -0.40 to 5.99); mental wellbeing mean scores (MCS-SF36: AdjDiff 2.26; CI -1.48 to 6.00). There was no observed effect on parenting stress. 82% of women mentored would recommend mentors to friends in similar situations.

Conclusion : Non-professional mentor mother support appears promising for improving safety and enhancing physical and mental wellbeing among mothers experiencing intimate partner violence referred from primary care.

Democratizing health : consumer groups in the policy process

This timely book examines the role of consumer organisations in the health policy process. In an age of shifting boundaries between state and civil society, consumer groups are potentially drivers of democratisation in the health domain. Their activities bring new dynamics to relations between service providers, the medical profession, government agencies, and other policy actors. This book is unique in comprehensively exploring the opportunities and dilemmas of this type of activism, including sometimes ambiguous partnerships between consumer groups and stakeholders such as the pharmaceutical industry. These themes are explored within an internationally comparative frameThis book examines the important role of consumer activism within health policy in different national contexts. In an age of shifting boundaries between state and civil society, consumer groups are potentially drivers of democratization in the health domain. The expert contributors explore how their activities bring new dynamics to relations between service providers, the medical profession, government agencies, and other policy actors. This book is unique in comprehensively analysing the opportunities and dilemmas of this type of activism, including ambiguous partnerships between consumer groups and stakeholders such as the pharmaceutical industry. These themes are explored within an internationally comparative framework, with case studies from various countries. work, with case studies from many countries.

Introduction : consumer groups and the democratization of health policy

This book examines the important role of consumer activism within health policy in different national contexts. In an age of shifting boundaries between state and civil society, consumer groups are potentially drivers of democratization in the health domain. The expert contributors explore how their activities bring new dynamics to relations between service providers, the medical profession, government agencies, and other policy actors. This book is unique in comprehensively analysing the opportunities and dilemmas of this type of activism, including ambiguous partnerships between consumer groups and stakeholders such as the pharmaceutical industry. These themes are explored within an internationally comparative framework, with case studies from various countries. Students and researchers in the fields of health policy and sociology, public policy and social movements will find this relevant and path-breaking book enlightening. It will also prove invaluable for participants and activists in patient and health consumer organizations.

From activism to state inclusion : health consumer groups in Australia

This book examines the important role of consumer activism within health policy in different national contexts. In an age of shifting boundaries between state and civil society, consumer groups are potentially drivers of democratization in the health domain. The expert contributors explore how their activities bring new dynamics to relations between service providers, the medical profession, government agencies, and other policy actors. This book is unique in comprehensively analysing the opportunities and dilemmas of this type of activism, including ambiguous partnerships between consumer groups and stakeholders such as the pharmaceutical industry. These themes are explored within an internationally comparative framework, with case studies from various countries. Students and researchers in the fields of health policy and sociology, public policy and social movements will find this relevant and path-breaking book enlightening. It will also prove invaluable for participants and activists in patient and health consumer organizations.

Health consumer organizations and the pharmaceutical industry : is transparency the answer?

This book examines the important role of consumer activism within health policy in different national contexts. In an age of shifting boundaries between state and civil society, consumer groups are potentially drivers of democratization in the health domain. The expert contributors explore how their activities bring new dynamics to relations between service providers, the medical profession, government agencies, and other policy actors. This book is unique in comprehensively analysing the opportunities and dilemmas of this type of activism, including ambiguous partnerships between consumer groups and stakeholders such as the pharmaceutical industry. These themes are explored within an internationally comparative framework, with case studies from various countries. Students and researchers in the fields of health policy and sociology, public policy and social movements will find this relevant and path-breaking book enlightening. It will also prove invaluable for participants and activists in patient and health consumer organizations.

Characteristics of utility cyclists in Queensland, Australia : an examination of the associations between individual, social and environmental factors and utility cycling

Background: Initiatives to promote utility cycling in countries like Australia and the US, which have low rates of utility cycling, may be more effective if they first target recreational cyclists. This study aimed to describe patterns of utility cycling and examine its correlates, among cyclists in Queensland, Australia.

Methods: An online survey was administered to adult members of a state-based cycling community and advocacy group (n=1813). The survey asked about demographic characteristics and cycling behavior, motivators and constraints. Utility cycling patterns were described, and logistic regression modeling was used to examine associations between utility cycling and other variables.

Results: Forty-seven percent of respondents reported utility cycling: most did so to commute (86%). Most journeys (83%) were >5 km. Being male, younger, employed full-time, or university-educated increased the likelihood of utility cycling (p<0.05). Perceiving cycling to be a cheap or a convenient form of transport were associated with utility cycling (p<0.05).

Conclusions: The moderate rate of utility cycling among recreational cyclists highlights a potential to promote utility cycling among this group. To increase utility cycling, strategies should target female and older recreational cyclists and focus on making cycling a cheap and convenient mode of transport.

Multi-theoretic approaches to understanding the science classroom

Multi-camera on-site video technology and post-lesson video stimulated interviews were used in a purposefully inclusive research design to generate a complex data set amenable to parallel analyses from several complementary theoretical perspectives. The symposium reports the results of parallel analyses employing positioning theory, systemic functional linguistics, distributed cognition and representational analysis of the same nine-lesson sequence in a single science classroom during the teaching of a single topic: States of Matter. Without contesting the coherence and value of a well-constructed mono-theoretic research study, the argument is made that all such studies present an inevitably partial account of a setting as complex as the science classroom: privileging some aspects and ignoring others. In this symposium, the first presentation examined the rationale for multi-theoretic research designs, highlighting the dangers of the circular amplification of those constructs predetermined by the choice of theory and outlining the intended benefits of multi-theoretic designs that offer less partial accounts of classroom practice. The second and third presentations reported the results of analyses of the same lesson sequence on the topic “states of matter” using the analytical perspectives of positioning theory and systemic functional linguistics. The final presentation reported the comparative analysis of student learning of density over the same three lessons from distributed cognition and representational perspectives. The research design promoted a form of reciprocal interrogation, where the analyses provided insights into classroom practice and the comparison of the analyses facilitated the reflexive interrogation of the selected theories, while also optimally anticipating the subsequent synthesis of the interpretive accounts generated by each analysis of the same setting for the purpose of informing instructional advocacy.

Applying King et al.'s taxonomy to frame the IS discipline's engagement in green IS discourse

This paper considers how the IS discipline can engage with discourse on the institutions and their interventions which influence and regulate green IS innovation. To consider possible responses, we apply King et al.’s (1994) taxonomy, based on Institutional Theory, to frame a research agenda to guide future exploration and debate on the interventions to facilitate green IS innovation. Through the application of the taxonomy, we derive several pertinent questions for the discipline to consider as part of this debate. We conclude that the IS discipline can, and indeed should, play a more prominent role both through traditional responses (e.g., descriptive studies of green IS methodologies, organisational best practice, maturity models, etc.), but also through more active engagement in the form of participation and advocacy in shaping future green policy and regulation.

Context sensitivity by development INGOs in Myanmar

This chapter presents analysis of new primary research data collected on INGOs working inside Myanmar. In particular, it looks at the contextualisation they make to common international development approaches, in order to attain greatest effectiveness in this specific context. This research is based on in-depth interviews of forty-seven key informants from INGOs, UN organisations and local NGOs, working within Myanmar. The key finding is that INGO's believe that, with appropriate contextualisation, their effectiveness is not as heavily restricted in Myanmar as is commonly perceived, particularly in addressing the worst impact of extreme poverty in communities, but also in areas such as advocacy and capacity development of the emerging civil society.

An exploration of the impact of celebrity on the HIV/AIDS pandemic

The framework we present in this article separates into three generations the celebrity/personality involvement in the AIDS movement that has been steadily building momentum over the past 25 years. We analyze the celebrification of HIV/AIDS and the role of the media in the process. We contend the relationship between celebrity, the public and HIV/AIDS is multipurpose: celebrities maintain a positive public presence between projects while allowing themselves and their supporting fans to feel good about taking on and affecting a meaningful cause. Celebrities are vehicles and embodiments of concern that act as proxies for their various audiences. And this is their power–celebrities are embodiments of their audiences. The awareness that celebrities have brought to the HIV/AIDS epidemic has resulted in better treatment for victims and increased government support for medical research, and yet has also distracted the public’s attention from the scope of the epidemic. It is the third generation of celebrities who are refocusing efforts on worldwide prevention and a cure for HIV/AIDS.

Oral language competence, young speakers and the Law

Purpose: This paper highlights the forensic implications of language impairment in 2 key (and overlapping) groups of young people: identified victims of maltreatment (abuse and/or neglect) and young offenders.

Method: Two lines of research pertaining to oral language competence and young people's interface with the law are considered: 1 regarding investigative interviewing with children as victims or witnesses in the context of serious allegations of sexual abuse, and the other pertaining to adolescent offenders as suspects, witnesses, or victims. The linguistic demands that forensic interviewing places on these young people are also considered. Literature concerning the impact of early maltreatment on early language acquisition is briefly reviewed, as is the role of theory of mind in relation to the requirements of investigative interviewing of children and adolescents.

Implications: High-risk young people (i.e., those who are subject to child protection orders because of suspected or confirmed maltreatment, and those who are engaged with the youth justice system) face an elevated risk for suboptimal language development but may need to draw on their language skills in high-stakes forensic interviews. Implications for early intervention policy and practice are identified, and the need for greater speech-language pathology advocacy and engagement in forensic interviewing research is emphasized.