Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa
481
484
EN
Jakub
Gajewski
0000-0003-0440-6051
Royal College of Surgeons in Ireland, Dublin 2, Ireland
jakubgajewski@rcsi.ie
Leon
Bijlmakers
0000-0003-2252-0579
Radboud University
Medical Centre, Nijmegen, The Netherlands
leon.bijlmakers@radboudumc.nl
Ruairí
Brugha
0000-0003-0729-0197
Royal College of Surgeons in Ireland, Dublin 2, Ireland
rbrugha@rcsi.ie
10.15171/ijhpm.2018.27
<span class="fontstyle0">Surgery has the potential to address one of the largest, neglected burdens of disease in low- and middle-income countries (LMICs), especially in sub-Saharan Africa (SSA). The Lancet Commission on Global Surgery (LCoGS) has provided a blueprint for a systems approach to making safe emergency and elective surgery accessible and affordable and has started to enable African governments to develop national surgical plans. This editorial outlines an important gap, which is the need for surgical systems research, especially at district hospitals which are the first point of surgical care for rural communities, to inform the implementation of country plans. Using the Lancet Commission as a starting point and illustrated by two European Union (EU) funded research projects, we point to the need for implementation research to develop and evaluate contextualised strategies. As illustrated by the case study of Zambia, coordination by global and external stakeholders can enable governments to lead national scale-up of essential surgery, supported by national partners including surgical specialist associations.</span>
Global Surgery,Africa,Systems Approach,National Surgical Plans
https://www.ijhpm.com/article_3485.html
https://www.ijhpm.com/article_3485_b0d03a63699c77df49098703f33ab11c.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Fostering the Catalyst Role of Government in Advancing Healthy Food Environments
485
490
EN
Raphael
Lencucha
0000-0002-9273-2027
School of Physical & Occupational Therapy, McGill University, Montréal, QC,
Canada
raphael.lencucha@mcgill.ca
Laurette
Dubé
McGill Centre for the Convergence for Health and Economics, McGill
University, Montréal, QC, Canada
laurette.dube@mcgill.ca
Chantal
Blouin
Institut national de sante publique, Québec,
QC, Canada
chantalblouin22@gmail.com
Anselm
Hennis
Department of Noncommunicable Diseases and Mental Health,
Pan American Health Organization, Washington, DC, USA
hennisa@paho.org
Mauricio
Pardon
Pan American
Health Organisation, Washington, DC, USA
pardonm@paho.org
Nick
Drager
McGill University, Montréal, QC,
Canada
dragern@gmail.com
10.15171/ijhpm.2018.10
<span class="fontstyle0">Effective approaches to non-communicable disease (NCD) prevention require intersectoral action targeting health and engaging government, industry, and society. There is an ongoing vigorous exploration of the most effective and appropriate role of government in intersectoral partnerships. This debate is particularly pronounced with regards to the role of government in controlling unhealthy foods and promoting healthy food environments. Given that food environments are a key determinant of health, and the commercial sector is a key player in shaping such environments (eg, restaurants, grocery stores), the relationship between government and the commercial sector is of primary relevance. The principal controversy at the heart of this relationship pertains to the potential influence of commercial enterprises on public institutions. We propose that a clear distinction between the regulatory and catalyst roles of government is necessary when considering the nature of the relationship between government and the commercial food sector. We introduce a typology of three catalyst roles for government to foster healthy food environments with the commercial sector and suggest that a richer understanding of the contrasting roles of government is needed when considering approaches NCD prevention via healthy food environments.</span>
Non-communicable Disease,Food Industry,Government,Multi-stakeholder Partnership,Governance
https://www.ijhpm.com/article_3462.html
https://www.ijhpm.com/article_3462_4bc2b3647d3b10eaa6f9c057587a5b1f.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
What Is Resilience and How Can It Be Nurtured? A Systematic Review of Empirical Literature on Organizational Resilience
491
503
EN
Edwine
Barasa
0000-0001-5793-7177
Health Economics Research Unit, KEMRI Wellcome Trust Research
Programme, Nairobi, Kenya
ebarasa@kemri-wellcome.org
Rahab
Mbau
0000-0001-6705-049X
Health Economics Research Unit, KEMRI Wellcome Trust Research
Programme, Nairobi, Kenya
rmbau@kemri-wellcome.org
Lucy
Gilson
0000-0002-2775-7703
School of Public Health and Family Medicine, University
of Cape Town, Cape Town, South Africa
lucy.gilson@uct.ac.za
10.15171/ijhpm.2018.06
<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Recent health system shocks such as the Ebola outbreak of 2014–2016 and the global financial crisis of 2008 have generated global health interest in the concept of resilience. The concept is however not new, and has been applied to other sectors for a longer period of time. We conducted a review of empirical literature from both the health and other sectors to synthesize evidence on organizational resilience.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">We systematically searched for literature in PubMed, Econlit, EBSCOHOST databases, google, and Google Scholar and manually searched the reference lists of selected papers. We identified 34 papers that met our inclusion criteria. We analysed data from the selected papers by thematic review.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Resilience was generally taken to mean a system’s ability to continue to meet its objectives in the face of challenges. The concepts of resilience that were used in the selected papers emphasized not just a system’s capacity to withstand shocks, but also to adapt and transform. The resilience of organizations was influenced by the following factors: Material resources, preparedness and planning, information management, collateral pathways and redundancy, governance processes, leadership practices, organizational culture, human capital, social networks and collaboration.<br /></span><br /> <br /> <span class="fontstyle0">Conclusions</span><br /> <span class="fontstyle0">A common theme across the selected papers is the recognition of resilience as an emergent property of complex adaptive systems. Resilience is both a function of planning for and preparing for future crisis (planned resilience), and adapting to chronic stresses and acute shocks (adaptive resilience). Beyond resilience to acute shocks, the resilience of health systems to routine and chronic stress (everyday resilience) is also key. Health system software is as, if not more important, as its hardware in nurturing health system resilience</span>
Health System Resilience,Complex Adaptive Systems,Everyday Resilience,Health System Shocks
https://www.ijhpm.com/article_3460.html
https://www.ijhpm.com/article_3460_c345c9e12775645b1d1f07d2d4dacdd8.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Sunshine Policies and Murky Shadows in Europe: Disclosure of Pharmaceutical Industry Payments to Health Professionals in Nine European Countries
504
509
EN
Alice
Fabbri
0000-0001-8413-0440
Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney,
Camperdown, NSW, Australia
alealifab@gmail.com
Ancel.la
Santos
Health Action International, Amsterdam, The
Netherlands
ancel.la@haiweb.org
Signe
Mezinska
Faculty of Medicine and Institute of Clinical and Preventive
Medicine, University of Latvia, Riga, Latvia
signe.mezinska@gmail.com
Shai
Mulinari
0000-0001-8773-9796
Department of Sociology, Faculty
of Social Sciences, Lund University, Lund, Sweden
shai.mulinari@soc.lu.se
Barbara
Mintzes
Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney,
Camperdown, NSW, Australia
barbara.mintzes@sydney.edu.au
10.15171/ijhpm.2018.20
<span class="fontstyle0">Relationships between health professionals and pharmaceutical manufacturers can unduly influence clinical practice. These relationships are the focus of global transparency efforts, including in Europe. We conducted a descriptive content analysis of the transparency provisions implemented by February 2017 in nine European Union (EU) countries concerning payments to health professionals, with duplicate independent coding of all data. Using an author-generated, semi-structured questionnaire, we collected information from each disclosure policy/code on: target industries, categories of healthcare professionals covered, scope of payments included, location and searchability of the disclosed data. Our analysis shows that although important improvements have been put in place in the past few years, significant gaps remain in disclosure requirements and their implementation. The situation differs substantially from country to country and the most striking differences are between governmental and self-regulatory approaches, especially with regard to the comprehensiveness of the disclosed data. In many cases, individuals can still opt out and reporting is incomplete, with common influential gifts such as food and drink excluded. Finally, in several countries data are only available as separate PDFs from companies, thus making the payment reports difficult to access and analyse. In order to overcome these gaps, minimum standards for disclosures should be implemented across Europe. All payments to healthcare professionals and organizations should be included, all health-related industries should be required to submit reports, and usability of disclosed data should be guaranteed.</span>
Transparency,Pharmaceutical Industry,Conflict of Interest,Industry Relationships,Disclosure
https://www.ijhpm.com/article_3478.html
https://www.ijhpm.com/article_3478_01506afd7a87a4afdd601c98746920d5.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia
510
521
EN
Angela
Lawless
0000-0003-0718-8088
College of Nursing and Health Sciences, Flinders University, Adelaide, SA,
Australia
angela.lawless@flinders.edu.au
Fran
Baum
0000-0002-2294-1368
Southgate Institute for Health Society and Equity, Flinders University,
Adelaide, SA, Australia
fran.baum@adelaide.edu.au
Toni
Delany-Crowe
Southgate Institute for Health Society and Equity, Flinders University,
Adelaide, SA, Australia
toni.delany@flinders.edu.au
Colin
MacDougall
College of Medicine and Public Health, Flinders
University, Adelaide, SA, Australia
colin.macdougall@flinders.edu.au
Carmel
Williams
0000-0003-2765-3020
Department of Health and Ageing, Adelaide,
SA, Australia
carmel.williams@adelaide.edu.au
Dennis
McDermott
The Poche Centre for Indigenous Health and Well-being, Flinders
University, Adelaide, SA, Australia
dennis.mcdermott@flinders.edu.au
Helen
van Eyk
Southgate Institute for Health Society and Equity, Flinders University,
Adelaide, SA, Australia
helen.vaneyk@flinders.edu.au
10.15171/ijhpm.2017.121
<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">The importance of evaluating policy processes to achieve health equity is well recognised but such evaluation encounters methodological, theoretical and political challenges. This paper describes how a program theorybased evaluation framework can be developed and tested, using the example of an evaluation of the South Australian Health in All Policies (HiAP) initiative.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">A framework of the theorised components and relationships of the HiAP initiative was produced to guide evaluation. The framework was the product of a collaborative, iterative process underpinned by a policy-research partnership and drew on social and political science theory and relevant policy literature.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">The process engaged key stakeholders to capture both HiAP specific and broader bureaucratic knowledge and was informed by a number of social and political science theories. The framework provides a basis for exploring the interactions between framework components and how they shape policy-making and public policy. It also enables an assessment of HiAP’s success in integrating health and equity considerations in policies, thereby laying a foundation for predicting the impacts of resulting policies.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">The use of a program theory-based evaluation framework developed through a consultative process and informed by social and political science theory has accommodated the complexity of public policy-making. The framework allows for examination of HiAP processes and impacts, and for the tracking of contribution towards distal outcomes through the explicit articulation of the underpinning program theory.</span>
Healthy Public Policy,Evaluation,Inter-Sectoral Action,Health Equity,Social Determinants
https://www.ijhpm.com/article_3429.html
https://www.ijhpm.com/article_3429_08e3e1d940657729be4c8cbc2a98110b.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Promoting Researchers and Policy-Makers Collaboration in Evidence-Informed Policy-Making in Nigeria: Outcome of a Two-Way Secondment Model between University and Health Ministry
522
531
EN
Chigozie
Jesse Uneke
0000-0003-4718-2182
African Institute for Health Policy & Health Systems, Ebonyi State University,
Abakaliki, Nigeria
unekecj@yahoo.com
Abel
Ebeh Ezeoha
African Institute for Health Policy & Health Systems, Ebonyi State University,
Abakaliki, Nigeria
aezeoha@yahoo.co.uk
Henry
Chukwuemeka Uro-Chukwu
National Obstetrics Fistula Centre,
Abakaliki, Nigeria
hurochu@gmail.com
Chinonyelum
Thecla Ezeonu
Department of Paediatrics, Faculty of Medicine, Ebonyi
State University, Abakaliki, Nigeria
ctezeonu@gmail.com
Jonathan
Igboji
Ebonyi State Ministry of Health, Abakaliki,
Nigeria
igboyam@yahoo.com
10.15171/ijhpm.2017.123
<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">There is need to strengthen institutions and mechanisms that can more systematically promote interactions between researchers, policy-makers and other stakeholders who can influence the uptake of research findings. In this article, we report the outcome of a two-way secondment model between Ebonyi State University (EBSU) and Ebonyi State Ministry of Health (ESMoH) in Nigeria as an innovative collaborative strategy to promote capacity enhancement for evidence-to-policy-to-action.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">This study was an exploratory design with a quantitative cross-sectional survey technique. A secondment memorandum of understanding (MOU) was signed between heads of EBSU and ESMoH. The secondment program lasted six months with ten researchers and ten policy-makers spending up to two days per week in each other’s organization. The secondee researchers got engaged in policy-making and implementation activities in ESMoH, while the policy-maker secondees got involved in research activities in EBSU. Secondees evidence-to-policy capacity enhancement meetings were held and questionnaires designed in 5-point Likert scale were used to assess their impact.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">The secondee policy-makers and researchers admitted having considerable knowledge of secondment with mean ratings (MNRs) of 3.40 and 3.74 respectively on the 5 points scale. Secondment appeared to be more common in the policy-makers’ organization (MNRs: 2.80-3.07) than in the researchers’ institution (MNRs: 2.58-2.84). The secondee policy-makers participated in some academic and research activities including serving in research ethics committee in EBSU and provided policy-making perspective to the activities. The secondee researchers supported the policymaking process in ESMoH through policy advisory roles, and provided capacity enhancement for staff of the ministry on the use of research evidence in policy-making. There was a noteworthy increase on knowledge of policy analysis and contextualization among the secondees ranging from 20.7% to 50.4% and 31.3% to 42.8% respectively following a training session. A Society for Health Policy Research and Knowledge Translation was established by mutual agreement of secondees as a platform to permanently institutionalize the collaboration.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">The outcome of this study clearly suggests that secondment has great potential in promoting evidence informed policy-making and merits further consideration.</span>
Researchers,Policy-makers,Collaboration,Evidence-Informed,Secondment,Nigeria
https://www.ijhpm.com/article_3430.html
https://www.ijhpm.com/article_3430_58ba939f63d71b0971180addf715114d.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Prioritising, Ranking and Resource Implementation - A Normative Analysis
532
541
EN
Lars
Sandman
0000-0003-0987-7653
National Center for Priority Setting in Health-Care, Department of Medicine and Health, Linköping University, Linköping, Sweden
lars.sandman@liu.se
10.15171/ijhpm.2017.125
<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Priority setting in publicly financed healthcare systems should be guided by ethical norms and other considerations viewed as socially valuable, and we find several different approaches for how such norms and considerations guide priorities in healthcare decision-making. Common to many of these approaches is that interventions are ranked in relation to each other, following the application of these norms and considerations, and that this ranking list is then translated into a coverage scheme. In the literature we find at least two different views on how a ranking list should be translated into coverage schemes: (1) rationing from the bottom where everything below a certain ranking order is rationed; or (2) a relative degree of coverage, where higher ranked interventions are given a relatively larger share of resources than lower ranked interventions according to some “curve of coverage.”<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">The aim of this article is to provide a normative analysis of how the background set of ethical norms and other considerations support these two views.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">The result of the analysis shows that rationing from the bottom generally gets stronger support if taking background ethical norms seriously, and with regard to the extent the ranking succeeds in realising these norms. However, in non-ideal rankings and to handle variations at individual patient level, there is support for relative coverage at the borderline of what could be covered. A more general relative coverage curve could also be supported if there is a need to generate resources for the healthcare system, by getting patients back into production and getting acceptance for priority setting decisions.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Hence, different types of reasons support different deviations from rationing from the bottom. And it should be noted that the two latter reasons will imply a cost in terms of not living up to the background set of ethical norms.</span>
Priority Setting,Ethics,Ranking,Reimbursement
https://www.ijhpm.com/article_3432.html
https://www.ijhpm.com/article_3432_62c71755a6ba0ec18b70f6b6c2ac9744.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Misuse of Artemisinin Combination Therapies by Clients of Medicine Retailers Suspected to Have Malaria Without Prior Parasitological Confirmation in Nigeria
542
548
EN
Earnest
Nwokolo
Society for Family Health, Abuja, Nigeria
enwokolo@sfhnigeria.org
Chinazo
Ujuju
Society for Family Health, Abuja, Nigeria
cnnamani@sfhnigeria.org
Jennifer
Anyanti
Society for Family Health, Abuja, Nigeria
janyanti@sfhnigeria.org
Chinwoke
Isiguzo
Society for Family Health, Abuja, Nigeria
cisiguzo@sfhnigeria.org
Ifeanyi
Udoye
Society for Family Health, Abuja, Nigeria
iudoye@sfhnigeria.org
Elamei
Bongos-Ikwue
Society for Family Health, Abuja, Nigeria
ebongos-ikwue@sfhnigeria.org
Onoriode
Ezire
Society for Family Health, Abuja, Nigeria
oezire@enrnigeria.org
Mopelola
Raji
Society for Family Health, Abuja, Nigeria
mraji@sfhnigeria.org
Wellington A.
Oyibo
ANDI Centre of Excellence for
Malaria Diagnosis, College of Medicine, University of Lagos, Lagos, Nigeria
woyibo@unilag.edu.ng
10.15171/ijhpm.2017.122
<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Prompt and effective case detection and treatment are vital components of the malaria case management strategy as malaria-endemic countries implement the testing, treating and tracking policy. The implementation of this policy in public and formal private sectors continue to receive great attention while the informal private retail sector (mostly the patent and propriety medicine vendors [PPMVs]) where about 60% of patients with fever in Nigeria seek treatment is yet to be fully integrated. The PPMVs sell artemisinin combination therapies (ACTs) without prior testing and are highly patronized. Without prior testing, malaria is likely to be over-treated. The need to expand access to diagnosis in the huge informal private health sector among PPMVs is currently being explored to ensure that clients that patronize retail drug stores are tested before sales of ACTs.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">A cross-sectional multistage study was conducted among 1279 adult clients, 20 years and above, who purchased malaria medicines from 119 selected PPMVs in five administrative areas (States) of Nigeria, namely: Adamawa, Cross River, Enugu, Lagos and Kaduna, as well as the Federal Capital Territory, Abuja. Exit interviews using a standard case report questionnaire was conducted after the purchase of the antimalarial medicine and thick/thin blood smears from the clients’ finger-prick were prepared to confirm malaria by expert microscopy.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Of the 1279 clients who purchased malaria medicines from the PPMV outlets, 107 (8.4%) were confirmed to have malaria parasites. The malaria prevalence in the various study areas ranged from 3.5% to 16%. A high proportion of clients in the various study sites who had no need for malaria medicines (84%-96.5%) purchased and used antimalarial medicines from the PPMVs. This indicated a high level of over-treatment and misuse of antimalarials. Common symptoms that are widely used as indicators for malaria such as, fever, headache, and tiredness were not significantly associated with malaria. Nausea/vomiting, poor appetite, chills, bitter taste in the mouth and dark urine were symptoms that were significantly associated with malaria among the adult clients (</span><span class="fontstyle0">P </span><span class="fontstyle0">< .05) but not fever (</span><span class="fontstyle0">P </span><span class="fontstyle0">= .06).<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Misuse of ACTs following overtreatment of malaria based on clinical diagnosis occurs when suspected cases of malaria are not prior confirmed with a test. Non-testing before sales of malaria medicines by PPMVs will perpetuate ACT misuse with the patients not benefiting due to poor treatment outcomes, waste of medicines and financial loss from out-of-pocket payment for unneeded medicines.</span>
ACT Misuse,Malaria Case Management in Africa,Test Before Treatment,Private Medicine Vendors,Presumptive Malaria Treatment
https://www.ijhpm.com/article_3434.html
https://www.ijhpm.com/article_3434_327540839a42482eefba872bd3a42365.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Knowledge, Attitude, and Practices Regarding HIV and TB Among Homeless People in Tehran, Iran
549
555
EN
Fahimeh
Bagheri Amiri
Urology and Nephrology Research Center, Shahid Beheshti University of
Medical Sciences, Tehran, Iran
drop.dr.bagheri@gmail.com
Amin
Doosti-Irani
Department of Epidemiology, School of
Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
doostiiraniamin@gmail.com
Abbas
Sedaghat
Blood Transfusion Research Center, High Institute for Research and Education
in Transfusion Medicine, Tehran, Iran
abased@gmail.com
Noushin
Fahimfar
0000-0001-6205-9794
Department
of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
nfahimfar@gmail.com
Ehsan
Mostafavi
0000-0002-1997-517X
Department of Epidemiology and Biostatistics, Research Centre for Emerging
and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
mostafavi@pasteur.ac.ir
10.15171/ijhpm.2017.129
<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Homeless people are at high risk of HIV and tuberculosis (TB) infection due to living in poor sanitary conditions and practicing high-risk behavior. The aim of this study is to assess the knowledge, attitude, and practice (KAP) of homeless people in Tehran regarding TB and HIV.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Using a convenience sampling, we performed a cross-sectional study on homeless people in Tehran from June to August 2012. Participants aged 18-60 years having at least 10 days of homelessness in the preceding month to the study period were included. All required data were collected through face-to-face interviews conducted using a researcherdesigned questionnaire. Each score in KAP of TB and HIV was separately divided by the maximum score and multiplied by 100 to attain percentage scores. The mean scores were compared using analysis of variance (ANOVA) and student’s </span><span class="fontstyle0"><em>t</em> </span><span class="fontstyle0">test. A Tukey test was used for post hoc analysis and two-by-two comparisons.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">In this study, 593 participants consisting of 513 men and 80 women were included. The mean age of the participants was 41.74 ± 0.45 years. Moreover, the total mean score of KAP toward HIV was 79.24 (95% CI: 77.36, 81.12), 57.13 (95% CI: 55.12, 59.14), and 21.14 (95% CI: 18.35, 23.93), respectively. The total mean score of knowledge and practice regarding TB was 62.04 (95% CI: 59.94, 64.14) and 42.57 (95% CI: 40.36, 44.78), respectively. </span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Although a relatively acceptable knowledge was detected in this high-risk population, practices regarding TB and HIV showed some weaknesses. Developing special programs to improve the healthy behavior of this population is highly recommended.</span>
Homeless,Tehran,KAP Study,HIV,Tuberculosis
https://www.ijhpm.com/article_3435.html
https://www.ijhpm.com/article_3435_fa993d2da014f0618fc43b17f5df90c2.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Connections, Communication and Collaboration in Healthcare’s Complex Adaptive Systems; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”
556
559
EN
Tracey
Bucknall
0000-0001-9089-3583
School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong,
VIC, Australia
tracey.bucknall@deakin.edu.au
Danielle
Hitch
Occupational Therapy,
School of Health and Social Development, Deakin University, Geelong, VIC,
Australia
dani.hitch@gmail.com
10.15171/ijhpm.2017.138
<span class="fontstyle0">A more sophisticated understanding of the unpredictable, disorderly and unstable aspects of healthcare organisations is developing in the knowledge translation (KT) literature. In an article published in this journal, Kitson et al introduced a new model for KT in healthcare based on complexity theory. The Knowledge Translation Complexity Network Model (KTCNM) provides a fresh perspective by making the complexity inherent in complex systems overt. The model encourages a whole system view and focuses on the interdependent relationships between actions, interactions and actors. Taking a systems approach assists our understanding of the connections, communication and collaboration necessary to promote knowledge mobilisation and facilitate the adoption of change. With further development, this could enable the targeting of more effective strategies across the various stakeholders and levels of service, fostering redesign and innovation.</span>
Complexity Theory,Complex Adaptive Systems,Clinical Decision Making,Systems Network Analysis,Integrated Knowledge Translation
https://www.ijhpm.com/article_3443.html
https://www.ijhpm.com/article_3443_4666c4396e2c7e955e4c34364c4c77b5.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Applying KT Network Complexity to a Highly-Partnered Knowledge Transfer Effort; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”
560
562
EN
JoAnn E.
Kirchner
QUERI for Team-Based Behavioral Healthcare, Central Arkansas Veterans
Healthcare System, Little Rock, AR, USA
joann.kirchner@va.gov
Sara J.
Landes
VISN 16 South Central Mental
Illness Research Education and Clinical Center (MIRECC), Central Arkansas
VA Health Care System, Little Rock, AR, USA
sara.landes@va.gov
Aaron E.
Eagan
Office of Mental Health and
Suicide Prevention, Department of Veterans Affairs, Gainesville, FL, USA
aaron.eagan@va.gov
10.15171/ijhpm.2017.141
<span class="fontstyle0">The re-conceptualization of knowledge translation (KT) in Kitson and colleagues’ manuscript “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation” is an advancement in how one can incorporate implementation into the KT process. Kitson notes that “the challenge is to explain how it might help in the healthcare policy, practice, and research communities.” We propose that these concepts are well presented when considering highly-partnered research that includes all sectors. In this manuscript we provide an example of highly-partnered KT effort framed within the KT Complexity Network Theory. This effort is described by identifying the activities and sectors involved.</span>
Knowledge Translation,Complexity Theory,Implementation Science,Healthcare,Partnered Research
https://www.ijhpm.com/article_3444.html
https://www.ijhpm.com/article_3444_d68e0b54c935cbb9061cdad1483fd3df.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Using Complexity to Simplify Knowledge Translation; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”
563
565
EN
Anita
Kothari
0000-0003-1533-6976
School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
akothari@uwo.ca
Shannon
Sibbald
0000-0002-4328-6489
School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
ssibbald@uwo.ca
10.15171/ijhpm.2017.139
<span class="fontstyle0">Putting health theories, research and knowledge into practice is a challenge referred to as the knowledge-toaction gap. Knowledge translation (KT), and its related concepts of knowledge mobilization, implementation science and research impact, emerged to mitigate this gap. While the social interaction view of KT has gained currency, scholars have not easily made a link between KT and the concept of complexity. Kitson and colleagues suggest we ought to examine the role of complexity in KT processes using defined theories and concepts borrowed from network and complex adaptive systems theory. They further argue that better KT outcomes might be achieved using this new lens. There remain, however, several critical considerations for this sort of theory application to work in the real-world. Complexity and network theory offer explanatory power about the KT problem, but these theories are less helpful for understanding solutions.</span>
Knowledge Translation (KT),Evidence-Based Practice,Implementation Science,Complex Adaptive Systems,Networks,Complexity
https://www.ijhpm.com/article_3447.html
https://www.ijhpm.com/article_3447_fcf7743f3f86fcf05b46b614e9ec044b.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
From Linear to Complicated to Complex; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”
566
568
EN
Jo
Rycroft-Malone
0000-0003-3858-5625
School of Healthcare Sciences, Bangor University, Bangor, UK
j.rycroft-malone1@lancaster.ac.uk
10.15171/ijhpm.2018.02
<span class="fontstyle0">Attention to collaborative approaches to encouraging evidence use in healthcare practice are gaining traction. The inherent complexities in collaborative and networked approaches to knowledge translation (KT) have been embraced by Kitson and colleagues in their complexity network model. In this commentary, the potential of complexity as presented by Kitson et al within their model is considered. The utility of such a model will be contingent upon how easy users find it to understand and apply to their challenge, and doing so in a way that is useful to not only help with explanation, but also with prediction.</span>
Knowledge Translation,Complexity,Model,Framework,Collaboration
https://www.ijhpm.com/article_3453.html
https://www.ijhpm.com/article_3453_2b4fe539db485d73a1786d3f8cc8283b.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
The Paradox of Intervening in Complex Adaptive Systems; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”
569
571
EN
Jacqueline
Chandler
Cochrane, London, UK
jchandler@cochrane.org
10.15171/ijhpm.2018.05
<span class="fontstyle0">This commentary addresses two points raised by Kitson and colleagues’ article. First, increasing interest in applying the Complexity Theory lens in healthcare needs further systematic work to create some commonality between concepts used. Second, our need to adopt a better understanding of how these systems organise so we can change the systems overall behaviour, creates a paradox. We seek to manipulate systems that self-organise and follow their own internal rules. Although, our actions may impact and indeed meet some of our objectives, system behaviour will always emerge with unpredictable consequences. Likewise, outcomes at the aggregated level of the system never reaches an optimal point as defined by the ‘external controller.’ Kitson and colleagues’ theoretical model may struggle to resolve the paradox of gaining control over the multiple knowledge translation (KT) systems covered by the model, because theoretically these systems retain control under the principle of self-organisation. That is not to suggest that individual agents cannot influence system dynamics just that the desired outcome cannot be guaranteed. Indeed, for systems to change they will need strong incentives.</span>
Complex Adaptive Systems,Complexity Theory,Knowledge Translation
https://www.ijhpm.com/article_3456.html
https://www.ijhpm.com/article_3456_5ca311b0b5a9175d0dbfeed2e8022ede.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
7
6
2018
06
01
Researching the Co-Existence and Continuity of Standardization and Customization in Healthcare: A Response to Recent Commentaries
572
573
EN
Russell
Mannion
0000-0002-0680-8049
Health Services Management Centre, University of Birmingham, Birmingham, UK
r.mannion@bham.ac.uk
Mark
Exworthy
Health Services Management Centre, University of Birmingham, Birmingham, UK
m.exworthy@bham.ac.uk
10.15171/ijhpm.2018.07
Standardization,Customization,Personalization,Competing Logics
https://www.ijhpm.com/article_3457.html
https://www.ijhpm.com/article_3457_76deb3a5f1d3278aab4c62eeeff21f1e.pdf