Changing the environment to improve population health: a framework for considering exposure in natural experimental studies

There is renewed optimism regarding the use of natural experimental studies to generate evidence as to the effectiveness of population health interventions. Natural experimental studies capitalise on environmental and policy events that alter exposure to certain social, economic or environmental factors that influence health. Natural experimental studies can be useful for examining the impact of changes to 'upstream' determinants, which may not be amenable to controlled experiments. However, while natural experiments provide opportunities to generate evidence, they often present certain conceptual and methodological obstacles. Population health interventions that alter the physical or social environment are usually administered broadly across populations and communities. The breadth of these interventions means that variation in exposure, uptake and impact may be complex. Yet many evaluations of natural experiments focus narrowly on identifying suitable 'exposed' and 'unexposed' populations for comparison. In this paper, we discuss conceptual and analytical issues relating to defining and measuring exposure to interventions in this context, including how recent advances in technology may enable researchers to better understand the nature of population exposure to changes in the built environment. We argue that when it is unclear whether populations are exposed to an intervention, it may be advantageous to supplement traditional impact assessments with observational approaches that investigate differing levels of exposure. We suggest that an improved understanding of changes in exposure will assist the investigation of the impact of complex natural experiments in population health.

Evaluation of construction contractor performance: a critical analysis of some recent research

International comparisons of construction industry performance are notoriously difficult. A recent comparative study, extensive in scope and using an innovative approach, is reviewed and questions raised regarding various aspects of the methodology adopted, the validity of the conclusions drawn and manner in which outcomes were reported. Particular areas of concern include the unequivocal statement of conclusions that are based on a small sample, and the use of data from that sample that are, in fact, no more than estimates of project performance. Attention is drawn to the limitations of the research reported and the reliability of the methods used, and the data gathered is examined.

Marketing research performance and strategy

Purpose - To investigate whether strategic orientation affects the evaluation of specific market research projects in for-profit firms.
Design/methodology/approach - A small-scale follow-up survey was conducted, building on qualitative and quantitative research among a sample of the top-1,000 marketing managers in Australia. The study used an existing market research evaluation tool, the USER scale and items generated from the qualitative research, to investigate the firm's most recent market research project.
Findings - Four market research performance factors were identified - market research as a knowledge enhancing (KE) function, the internal political use of market research, the misuse of market research and the generation of market understanding. The Miles and Snow strategy types were related to these factors, with Prospector types more likely to use market research rationally and less likely to use it for internal political purposes. Tactical projects were more likely to be misused than were those with a strategic orientation. Prospectors were far less likely and analysers far more likely to misuse tactical research projects. Prospectors were more often satisfied with the performance of their most recent market research. The Porter typology was less successful in predicting market research performance.
Research limitations/implications - The study was based on a small sample of market research projects in Australian for-profit firms. Future studies need to study these phenomena more intensively using ethnographic methods and more extensively using larger multi-country samples.
Practical implications - Market research suppliers should learn the nature of their client's strategic intent to improve their effectiveness. Defender firms should carefully monitor the use of market research, especially that of a tactical nature, which may be wasted or misused.
Originality/value - Contributes to an understanding of how strategic orientation relates to the ways market research information is used within the firm.

Challenges in health services and health systems research

The relationship between emerging trends in healthcare systems and the consequent research priorities will be explored.

Governments and policy makers in developed countries are increasingly focused on the management of chronic disease, reflecting demographic changes and shifts in the burden of disease. Systems of quality improvement and reward are increasingly based on performance in chronic disease management. There is some evidence that countries with well-developed systems of primary care, such as Australia, achieve better health outcomes at less cost. In the past 15 years, almost all developed countries have undergone some type of health care reform. There has been a major focus on reducing costs; often involving shifting services from secondary to primary care. While there are few international comparisons, most suggest a complex relationship between the strength of primary care within the overall health services system and good performance, particularly with regard to lower costs of care and particularly relevant measures of health.

Aims for 21st century health systems
What, then, are the issues which are shaping contemporary general practice in developed countries? There are several imperatives: Safety, effectiveness, patient-centredness, timeliness, efficiency and equity. A study by the Nuffield Trust (Dargie, 1999) projected the shape of healthcare for the first fifteen years of this century. The study identified six issues that need to be addressed in the process of formulating health systems policies:

• Peoples’ expectations and financial sustainability
• Demography and ageing
• Information and knowledge management
• Scientific advance and new technology
• Workforce education and training
• Systems performance and quality (efficiency, effectiveness, economy
and equity)

Each of these six issues requires innovative thinking and priority setting on the part of the health sector, such as the delivery of health services in new and creative ways. Furthermore, there is a clear need for a finely tuned research, development and evaluation strategies to match these goals.

Anticipating policy and logics of practice : Australian institutional and academic responses to the globalising "quality research" agenda

Research assessment is now an international trend. This article mobilises a critical policy sociology informed by Bourdieu to unpack the differential effects of research policy shifts in Australia on universities, academics and the field of educational research. It argues in anticipating policy moves - from surveying the logics of practice that have emerged elsewhere from research assessment - that institutional, individual and field responses, while specific to the Australian policy context and mix, have assumed a logic of practice counter productive to "quality" research, education as a field, and equity.

Rural primary health care workers and research : what is their present capacity?

Aims & rationale/Objectives : The main objectives of this project were to:
- conduct an audit of research skills and experience of primary health care staff in nine south western Victorian not-for-profit agencies
- identify capacity for research in five pre-identified areas
- investigate unpublished research endeavours/innovative projects taking place in the linked community organisations.
Methods : A 9-item survey was developed and will be distributed to all primary health care staff at the nine agencies via the internal email system of each organisation. The survey was developed after consultation with several agency directors, to obtain an organisational perspective on research capacity issues. Staff were also invited to take part in informal focus groups exploring key themes.
Principal findings : This study is in progress, and is expected to be completed at the end of March, 2007. Expected findings are the identification of primary health care staff's capacity for research, and discussion of relevant organisational assistance which would develop their research skills or enable continued participation in research.
Discussion : Phase 2 of the Australian PHC Research, Evaluation and Development Strategy aims to support the development and expansion of the primary health care research workforce. Findings from the current study will support this goal by assisting rural primary health care workers to identify the training and support they need to undertake quality research. The data could also be used to: a) assist the consortium to identify common research interests; b) to inform the consortium regarding the potential for collective research efforts; and c) to support funding submissions from the consortium or from individual agencies.
Implications : These findings will help to inform improved strategic planning in relation to building research capacity. The data could also be used by participating agencies to support applications for research grant funding.
Presentation type : Poster
Session theme : Building research capacity

Rape : psychopathology, theory and treatment

Whether treatment programs are effective at rehabilitating rapists is yet to be determined empirically. From a scientist–practitioner perspective, treatment should be based on an empirical understanding of rape and rapists, and evidence-based knowledge of treatment outcome with rapists. In this paper we comprehensively review the characteristics of rapists, etiological features implicated in the commission of rape, and relevant treatment outcome research. We pay particular attention to contemporary knowledge about the core vulnerabilities and features required to understand and treat rapists effectively, and, where possible, highlight similarities and differences between rapists, child molesters and non-sexual violent offenders. We use an epistemological framework to (a) critique the various etiological accounts of rape available and (b) help guide professionals' use of such knowledge in both treatment design and evaluation. Gaps in the understanding of rapists' characteristics and etiological features are highlighted, as are discrepancies between current knowledge and treatment approaches. We conclude by highlighting areas for future research and practice innovation.

Nonpharmacologic interventions need outcomes for evaluating complex interventions in rheumatic diseases

Introduction. Nonpharmacologic interventions are themselves complex and are often combined with drugs and other interventions in the treatment of rheumatic diseases. Therefore, overall strategies for treatment are complex interventions. These should be evaluated regarding their processes and outcomes.
Methods. The CARE network, an international organization of health professionals (physicians and nonphysicians) and patients conducted a survey in 2008 to identify core outcomes in the ICF perspective, completed with a second survey (2009–2010) with patients in routine practice. These surveys have provided new information about domains to investigate as a basis for evaluating complex interventions.
Results. Outcome Measures in Rheumatology Clinical Trials (OMERACT) participants in this Special Interest Group agreed that current outcomes used in pharmacological research are not sufficient if the nonpharmacologic independent or combined contributions are to be assessed; other domains need to be addressed. This is an area of interest for further development.
Conclusion. Recommendations are proposed to develop research in the area of outcome for evaluation of complex interventions in rheumatic diseases.

Chronic disease self-management in Aboriginal communities : towards a sustainable program of care in rural communities

The Chronic Disease Self-Management (CDSM) strategy for Aboriginal patients on Eyre Peninsula, South Australia, was designed to develop and trial new program tools and processes for goal setting, behaviour change and self-management for Aboriginal people with diabetes. The project was established as a one-year demonstration project to test and trial a range of CDSM processes and procedures within Aboriginal communities and not as a formal research project. Over a one-year period, 60 Aboriginal people with type-2 diabetes in two remote regional centres participated in the pilot program. This represents around 25% of the known Aboriginal diabetic population in these sites. The project included training for four Aboriginal Health Workers in goal setting and self-management strategies in preparation for them to run the program. Patients completed a Diabetes Assessment Tool, a Quality of Life Questionnaire (SF12), the Work and Social Adjustment Scale (WASAS) at 0, 6 and 12 months. The evaluation tools were assessed and revised by consumers and health professionals during the trial to determine the most functional and acceptable processes for Aboriginal patients. Some limited biomedical data were also recorded although this was not the principal purpose of the project. Initial results from the COAG coordinated care trial in Eyre suggest that goal setting and monitoring processes, when modified to be culturally inclusive of Aboriginal people, can be effective strategies for improving self-management skills and health-related behaviours of patients with chronic illness. The CDSM pilot study in Aboriginal communities has led to further refinement of the tools and processes used in chronic illness self-management programs for Aboriginal people and to greater acceptance of these processes in the communities involved. Participation in a diabetes self-management program run by Aboriginal Health Workers assists patients to identify and understand their health problems and develop condition management goals and patient-centred solutions that can lead to improved health and wellbeing for participants. While the development of self-management tools and strategies led to some early indications of improvements in patient participation and resultant health outcomes, the pilot program and the refinement of new assessment tools used to assist this process has been the significant outcome of the project. The CDSM process described here is a valuable strategy for educating and supporting people with chronic conditions and in gaining their participation in programs designed to improve the way they manage their illness. Such work, and the subsequent health outcome research planned for rural regions, will contribute to the development of more comprehensive CDSM programs for Aboriginal communities generally.

Social research: strength of evidence rating tool

This document provides guidelines for the Victorian Auditor-General's Office when it comes to propose or evaluate social research in the areas of sampling, questionnaires, interviews, focus groups, consulting with a group, descriptive and inferential statistics, document reviews and non-participatory observation.

Understanding the management of doctoral studies in Australia as risk management

This paper discusses and analyses theoretical explanations of risk and risk management in terms of the management of doctoral studies. It deals with the ways in which Government policy, together with contemporary approaches to the bureaucratisation of risk management and the development and imposition of rationalities of risk, are shaping the practices of universities concerning the selection, supervision, support and assessment of doctoral candidates. In particular, the impact of the Research Training Scheme on doctoral studies is discussed as a particular context in which the institutionalisation of risk management occurs.

RQF publication quality measures: methodoligical issues

The Research Quality Framework uses Thomson-ISI citation benchmarks as its main set of objective measures of research quality. The Thomson-ISI measures rely on identifying a core set of journals in which the major publications for a discipline are to be found. The core for a discipline is determined by applying a nontransparent process that is partly based on Bradford’s Law (1934). Yet Bradford was not seeking measures about quality of publications or journals. How valid then is it to base measures of publication quality on Bradford’s Law? We explore this by returning to Bradford’s Law and subsequent related research asking ‘what is Bradford’s Law really about?’ We go further, and ask ‘does Bradford’s Law apply in Information Systems?’ We use data from John Lamp’s internationally respected Index of Information Systems Journals to explore the latter question. We have found that Information Systems may have a core of journals only a subset of which is also in the list of Thomson-ISI journals. There remain many unanswered questions about the RQF metrics based on Thomson-ISI and their applicability to information systems.

Exploring contributions to scholarship in e-learning : weighing up the evidence

Recent views on the scholarship of teaching and learning have conceptualised the work of teachers as a form of inquiry, drawing on scholarly discourse about teaching and learning and communicating new understandings back to the scholarly community for peer review and evaluation. Knowledge about teaching may be based on a variety of forms of evidence, including research, evaluation, reflection, review, and the discussion or development of theoretical perspectives, ideas and concepts. This raises questions about the quality and forms of evidence about teaching which contribute to scholarship, whether these are the same in relation e-teaching and learning as they are for teaching in other contexts, and the implications of different forms of evidence for the relationship between research and teaching. In this paper we examine articles from three recent issues of three journals (two of them relating to e-learning and one to higher education in general), in order to draw some preliminary conclusions about the kind of contributions to discourse about e-learning which may be regarded as valuable in advancing the scholarship of teaching and learning.