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PubMed2003

Images of health technology in national and local strategies.

OBJECTIVES: This paper examines the potential of various models relating technology to society and institutional structures to inform health policy. Among the models discussed are various versions of technological determinism, social constructivism, actor network theory and critical theory. METHODS: The paper considers recent developments in policy and strategy that aim to shape the way the UK's National Health Service (NHS) integrates Information and Communication Technologies (ICTs) into health care and considers what these alternative models highlight or emphasise, and how they might influence the activities of setting local implementation strategies. RESULTS AND CONCLUSIONS: Contemporary ICTs are often presented as having a particular relevance and power in reforming or transforming the delivery of health care. Understanding how such technologies might be conceived of, implemented and become an integral part of some future health care system is an important and challenging task that requires innovative theoretical treatments.

Computer Communication Networks↗
PubMed1991

A "consumer-friendly" model of implementation.

Policy analysts and citizen groups have long struggled with the complexities of the implementation process. The model presented here empowers students, community organizers, and consumers with theoretically sound and practically useful procedures for assessing the extent to which social agencies are implementing any particular policy or piece of legislation. It also identifies key implementation processes for citizens to target in their agency change efforts. Specific research results are presented to illustrate the practical utility of the model.

Child↗
PubMed2005

Prevention for HIV-seropositive persons: successive approximation toward a new identity.

This article presents a three-module intervention based on social action theory that focuses on health promotion and social identity formation for seropositive youth. The modules are designed to reduce transmission of HIV by reducing sexual and substance abuse acts, increasing healthy acts and adherence to care, and maintaining positive behavioral routines. Components of the modules are described, including examples of how these components are implemented in the actual intervention sessions. The importance of using successive approximation to consolidate changes in behavior by defining social roles and personal identities that are consistent with positive behavioral routines is demonstrated. Outcomes of the intervention are presented as well as issues of cost-effectiveness, feasibility, and alternative implementation strategies.

Adolescent↗
PubMed2005

The rural community care gerontologic nurse entrepreneur: role development strategies.

Rural elderly individuals are an underserved population with limited access to health care. There is an increasing need for independent community care nurses to provide assistance to home-based elderly individuals with chronic illnesses to prevent unnecessary medical and placement decisions and, thus, allow them to maintain independence and quality of life. This article describes the rural setting and why community care nurses are needed, and explores strategies for implementing the role of the independent nurse entrepreneur in caring for community-based elderly individuals in rural settings.

Aged↗
PubMed1997

Improving cancer prevention at the worksite: how are Belgian companies dealing with smoking regulations?

Little is known about the impact of smoking policy on companies' policies related to smoking in Belgium. The study was designed in order to compare the companies' policies related to smoking (CPRS) in 1990 and in 1993. During this 3 year period, numerous information and regulation inputs (media, brochures) were aimed at companies to regulate smoking behavior in the workplace, so as to reduce the risks of passive smoking. A short questionnaire was mailed to 3543 Belgian companies in October 1990 and in June 1993 to assess: designation of smoke free areas (SFA); willingness to offer a worksite information program (WIP); willingness to offer a worksite smoking cessation program (WSCP); willingness to subsidize a WSCP; willingness to offer a WSCP during working hours; willingness to offer a meeting room for a WSCP and actual organization of a WSCP. In 1990, 773 companies (22%) and in 1993, 890 companies (25%) responded to the questionnaire. The results showed that small companies and companies with a high blue/white collar ratio were less able to implement health policy recommendations. A total of 325 (9%) companies responded to the 1990 and 1993 questionnaires. Comparison of 1990 and 1993 dataset showed that during this 3 year period, no major changes occurred for a majority of companies. Amongst the small positive changes, only the designation of smoke free areas and the organization of a small number of WSCP was observed. The conclusion is that despite inputs, little impact on smoking policies is noticeable. Strategies designed to intensify inputs and to promote implementation of regulation of WSCP should therefore further be studied.

Belgium↗
PubMed2002

Overview of cancer control programs in Japan.

Japan has a population of about 127 million, with an average life expectancy that is one of the highest in the world. Cancer has been the leading cause of death in Japan since 1981. The incidence of cancer for all sites in 1994 was estimated to be 440 000; crude incidence rates per 100 000 for males and females were 416.3 and 299.4, respectively. In 1997, the number of cancer deaths was 275 413; crude death rates for males and females per 100 000 were 273.0 and 169.9, respectively. Projections for 2015 indicate that 890 000 people will develop cancer and 450 000 will die as a result. It is not too much to say that Japan is now amid a 'Cancer Era'. Meanwhile, the progress in medical sciences is improving survival in cancer patients; in cancer patients diagnosed during 1987-89, relative 5-year survival was reported to be 41.2% for all sites and cancer survivorship research estimated the number of cancer survivors for all sites in 1998 who have lived for between 5 and 24 years after diagnosis to be 1.5 million. The Ministry of Health and Welfare is focusing on five different measures in the implementation of its cancer control programs: public health education, nationwide cancer screening programs, development and support of specialized medical institutions, training of specialists and promotion of basic and clinical cancer research. As a tool for public health education, the Ministry published in 2000 a 10-year health promotion program entitled 'Healthy Japanese in the 21st Century'. In the plan, seven particular goals are enumerated with regard to cancer. In practice, issues of concern include the development of new modalities, telling the truth to cancer patients, clinical trials and bioethical issues.

Female↗
PubMed1996

Status of health promotion program implementation and future tasks in Japanese companies.

This study was performed to elucidate the status of the implementation of health promotion programs (HPPs) and future tasks in occupational settings in Japan. A survey was conducted using a multiple type questionnaire mailed to 395 companies throughout Japan in 1993. The questionnaire was mailed back, after having been answered anonymously, with a response rate of 59%. Companies with more than 300 employees accounted for 76% of the sample. Approximately 70% of the companies implemented HPPs of which health guidance and fitness programs were the two most frequently adopted programs. Nutrition education and mental health programs seemed to be emphasized as future possibilities. Smoking cessation programs were not as common as segregation policies, such as zoning of smoking areas. Currently, 45% of the companies used only in-house health personnel for HPPs, but the prospective percentage in the future was 24%. Most of the companies shared the cost of HPPs with a Health Insurance Society. Lack of health personnel and budgetary restrictions on HPPs constituted the major barriers to the implementation of HPPs. Small-scale enterprises were noted to be particularly influenced by these barriers.

Attitude to Health↗
PubMed2000

Successful systems integration strategies: the access program for persons who are homeless and mentally ill.

In 1993, the Access to Community Care and Effective Services and Supports (ACCESS) federal demonstration program was initiated. Using a quasi-experimental design, the 5-year demonstration program sought to assess the impact of integrated systems of care on outcomes for homeless persons with mental illness. The authors report on which integration strategies were chosen and how their implementation is quantified. Data collected primarily through annual site visits revealed that only two strategies were used by all nine systems. The systems integration strategies employed remained relatively stable over the 5 years. Successful implementation appears to be related to the strategies selected.

Delivery of Health Care, Integrated↗
PubMed2007

[The implementation of decentralized health systems: a comparative study of five cases in Bahia, Brazil].

Understanding the effects of health decentralization policies in Brazil requires different methodological approaches to capture the issue's complexity from distinct angles. Five case studies were thus performed to evaluate the degree of implementation of components related to decentralization of the health system management in selected municipalities (counties) in Bahia State, Brazil. A logical model was elaborated with definitions related to policy goals. A comparative study of the five municipalities, considered "exemplary cases", showed that decentralization alone does not explain the organizational changes in the municipal health systems. Local government characteristics such as the municipal master plan, governing capacity, and governance proved important for heath care changes. The main problems and insufficiencies were found in the system's management and quality of healthcare delivered to the population. The authors discuss their findings and identify critical areas for future interventions with special emphasis on the institutionalization of planning and evaluation and the development of inter-sector projects.

Brazil↗
PubMed1996

Evaluation of preventive and health promotion activities in 166 primary care practices in Spain. The Coordinating Group For Prevention and Health Promotion in Primary Care in Spain.

BACKGROUND: Since January 1989 the Spanish Society of Family and Community Medicine has supported the Program of Prevention and Health Promotion (PAPPS) with the following objectives: to detect possible difficulties in the implementation of recommendations especially among asymptomatic low-risk adults and children in Spain, to disseminate those recommendations, and to encourage research in prevention and health promotion in primary care. OBJECTIVE: We wished to evaluate the implementation of PAPPS in primary care practices. METHODS: A retrospective audit of medical records in practices enrolled in the programme was carried out. From 166 primary care practices widely distributed in Spain 21,631 patients were selected using systematic sampling. RESULTS: Age was positively associated with correct performance in the adult population, while in the paediatric population it was negatively associated. Females had higher probability than males of having blood pressure measurement (OR 1.34, 95% CI 1.24-1.45) and smoking counselling (OR 1.38, 95% CI 1.33-1.43) correctly performed. Practices not using the preventive chart had a lower probability than user practices of correctly performing blood pressure measurement (OR 0.69, 95% CI 0.62-0.76), alcohol counselling (OR 0.66, 95% CI 0.60-0.73) and smoking counselling (OR 0.69, 95% CI 0.63-0.76). Non-teaching practices had a higher probability than teaching centres of correct performance of blood pressure measurement (OR 1.47, 95% CI 1.35 to 1.59), alcohol counselling (OR 1.67, 95% CI 1.54 to 1.79) and smoking counseling (OR 1.39, 95% CI 1.29 to 1.51). CONCLUSIONS: There is an unequal level of performance depending on the procedure and on the target population. A preventive chart might be useful in improving implementation of periodic health maintenance. Teaching centres with training physicians need to put more emphasis on prevention and health promotion activities.

Adolescent↗
PubMed2005

Dissemination of an effective inpatient tobacco use cessation program.

The present study aimed to determine whether tobacco use cessation rates observed in controlled trials of a hospital-based tobacco use cessation program could be replicated when the program was disseminated to a wide range of hospitals in a two-stage process including implementation and institutionalization phases. Using a nonrandomized, observational design, we recruited six hospitals to participate in the study. The research team helped implement the program during the first year of participation (implementation) and then withdrew from active involvement during the second year (institutionalization). The mean 6-month self-reported cessation rates were 26.3% (range = 17.6%-52.8%) for the implementation phase and 22.7% (range = 12.9%-48.2%) for the institutionalization phase. Hospitals with paid professionals providing the program had the best outcomes. Inpatient tobacco use cessation programs are feasible to implement and should target a 6-month self-reported cessation rate of at least 25%.

Adult↗
PubMedDate not supplied

[Is it possible to sustain health promotion programs in private companies? The case of four Quebec private companies of blue collar workers].

OBJECTIVE: Sustained health promotion programmes in the workplace (HPPW) continues to be a public health challenge. This article presents an evaluation of the implementation and sustainability of such programmes in private blue-collar companies in Quebec to shed light on issues specific to this type of setting. METHOD: A multiple case (4 sites), longitudinal (7 years) and interpretive study method was used. The interpretation framework considered that the implementation and sustainability of HPPW in companies are the result of organizational learning in health promotion, determined by the strategies of individuals in a position of control who shape the decisional processes related to these programmes. RESULTS: After seven years of observation, two of the four sites had continued their HPPW, although these programmes were no longer applied within these companies. The health promotion organizational learning processes in both sites were defined according to targeted organizational purposes set by the decision-makers who supported HPPW. However, these gains were largely lost when HPPW were no longer retained as a component of their organizational development strategy. DISCUSSION: The organizational conditions that are conducive to HPPW are difficult to put together and sustain in companies like those in our study. Businesses implement these programmes mainly for the organizational benefits they expect to reap in the short term, whereas improvement in the health of workers in the longer term is not a priority.

Feasibility Studies↗
PubMedDate not supplied

Overview of executive order 13148: requirements for environmental management systems at federal facilities.

In April 2000, the White House issued Executive Order 13148, Greening the Government Through Leadership in Environmental Management. This Order applies to all appropriate federal facilities that have operations which interact with the environment and includes a number of environmentally-related requirements. The most significant requirement is that all appropriate federal facilities must implement an Environmental Management System (EMS) by December 31, 2005. This Order affects federal laboratories, testing facilities, maintenance facilities, hospitals, and so forth across all federal departments and agencies.

Environmental Monitoring↗
PubMed2006

Feasibility and cost efficiency of a diagnostic guideline for chronic polyneuropathy: a prospective implementation study.

BACKGROUND: Extensive investigations are often performed to reveal the cause of chronic polyneuropathy. It is not known whether a restrictive diagnostic guideline improves cost efficiency without loss of diagnostic reliability. METHODS: In a prospective multicentre study, a comparison was made between the workup in patients with chronic polyneuropathy before and after guideline implementation. RESULTS: Three hundred and ten patients were included: 173 before and 137 after guideline implementation. In all patients, the diagnosis would remain the same if the workup was limited to the investigations in the guideline. After guideline implementation, the time to reach a diagnosis decreased by two weeks. There was a reduction of 33% in the number and costs of routine laboratory investigations/patient, and a reduction of 27% in the total number of laboratory tests/patient, despite low guideline adherence. CONCLUSION: The implementation of a diagnostic guideline for chronic polyneuropathy can reduce diagnostic delay and the number and costs of investigations for each patient without loss of diagnostic reliability. Continuous evaluation strategies after guideline implementation may improve guideline adherence and cost efficiency.

Chronic Disease↗
PubMed2006

Factors influencing implementation of the Coordinated Approach to Child Health (CATCH) Eat Smart School Nutrition Program in Texas.

The purpose of this research was to evaluate factors influencing the implementation of the Coordinated Approach to Child Health (CATCH) Eat Smart School Nutrition Program in Texas using data from the CATCH dissemination study. A mail survey was sent to school foodservice personnel (N = 213) who attended a CATCH training from August 2000 through January 2002. A response rate of 40% (n = 85) was achieved. The mean score for the percentage of CATCH Eat Smart guidelines implemented was 80.44. Multivariate linear regression analysis revealed that, after adjusting for age and number of years employed in school foodservice, the following factors were significantly associated with the percentage of CATCH Eat Smart guidelines implemented: utility of CATCH and CATCH Eat Smart in meeting requirements for Coordinated School Health Programs (P = 0.006), school foodservice personnel's satisfaction with food made using the CATCH Eat Smart guidelines (P = 0.008), utility of CATCH in facilitating interschool communication about children's health (P = 0.019), and perceived student satisfaction with food made using the CATCH Eat Smart guidelines (P = 0.046). These results suggest that dissemination approaches for Coordinated School Health Programs should focus on ways to enhance program satisfaction, be consistent with legislated mandates, and increase interschool staff communication to increase program implementation by school foodservice personnel.

Adolescent↗
PubMed1991

Health policies and Health For All strategies in the Nordic countries.

In the 1980s all five Nordic countries expressed, at the highest political level, their commitment to WHO's program Health for All (HFA) by the Year 2000. This program aims at improving the prerequisites for a healthier and longer life by changing lifestyles, decreasing environmental hazards and by shifting the emphasis in health care from specialized services towards primary health care. Following their policy statements all the Nordic countries formulated national HFA strategies during the latter half of the 1980s. This paper looks at the background and the formulation and implementation of these strategies, covering the period up until the end of the 1980s. The implementation of national strategies seems to be a slow and difficult process. The monitoring of progress toward accepted healthy policy goals is not easy, because measurable objectives or targets are mostly missing.

Demography↗
PubMed1997

The strategic approach to contraceptive introduction.

The introduction of new contraceptive technologies has great potential for expanding contraceptive choice, but in practice, benefits have not always materialized as new methods have been added to public-sector programs. In response to lessons from the past, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP) has taken major steps to develop a new approach and to support governments interested in its implementation. After reviewing previous experience with contraceptive introduction, the article outlines the strategic approach and discusses lessons from eight countries. This new approach shifts attention from promotion of a particular technology to an emphasis on the method mix, the capacity to provide services with quality of care, reproductive choice, and users' perspectives and needs. It also suggests that technology choice should be undertaken through a participatory process that begins with an assessment of the need for contraceptive introduction and is followed by research and policy and program development. Initial results from Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Vietnam, and Zambia confirm the value of the new approach.

Africa↗
PubMed2007

Lessons learned in the implementation of an innovative consultation and liaison service for children of cancer patients in various hospital settings.

OBJECTIVE: To evaluate the process of implementing a family-oriented consultation and liaison service in various hospital-based settings, with special regard to problems and obstacles encountered. METHOD: Qualitative content analysis using categorization and sequential, phenomenological analysis of descriptive progress notes during the implementation period. The team members of the liaison service were defined as participant observers. Interpretations of the material were derived in previously defined, sequential steps in team discussions. RESULTS: Despite a consistent concept behind the new service, the degree to which it was able to be integrated into different medical settings varied to a remarkable degree. Obstacles encountered were often linked to a lack of consideration being given to divergent concepts of care. It was necessary to give special attention to providing physicians with practical evidence of the value of the intervention. The new service was most readily utilized by families when physicians personally communicated the referrals as a standard procedure to their patients and when the referrals were not made too quickly after the parent's initial diagnosis. CONCLUSIONS: Hospital-based services for cancer patients with children under the age of 18 should carefully address patients' fears of psychiatric stigmatization. Furthermore, they should include modules for acute crisis intervention. Implications for future implementation activities in this field are discussed.

Adaptation, Psychological↗