Health Research Policy and Systems最新文献

{"title":"Do not attempt cardiopulmonary resuscitation practice and policy in Ireland: a mixed-methods study of service user and advocacy group perspectives.","authors":"John Lombard, Hope Davidson, Owen Doody","doi":"10.1186/s12961-025-01315-x","DOIUrl":"https://doi.org/10.1186/s12961-025-01315-x","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary resuscitation offers the potential to save a person's life. However, this highly invasive medical treatment is not always appropriate, and the likelihood of success is relatively low. In Ireland, the Health Service Executive (HSE) National Consent Policy establishes the national guidance in respect of DNACPR decisions, and this was supplemented by HSE Guidance Regarding Cardiopulmonary Resuscitation and DNAR Decision-Making during the COVID-19 Pandemic. Previous research on DNACPR practice in Ireland concentrated on the perspective of the medical and nursing professions and was completed prior to publication of the supplementary guidance. In contrast, this article reports on research which investigates service user and advocacy group perspectives on DNACPR practice and policy in Ireland.</p><p><strong>Methods: </strong>The research utilized mixed methods design to collect quantitative and qualitative data. A questionnaire with close-ended and open-ended questions was distributed via Qualtrics, targeting the public while explicitly excluding healthcare workers to focus on patient and caregiver experiences. Recruitment involved identifying relevant advocacy and state organizations and leveraging professional networks and social media to maximize participation and minimize selection bias. Recruitment was conducted through collaboration with organizations that advocate for individuals affected by DNACPR decisions. Survey data were analysed in SPSS for closed questions and thematic analysis for open responses. Four semi-structured interviews with representatives of advocacy groups were completed, transcribed and analysed using thematic analysis. The qualitative and quantitative data's reporting rigour was guided by the CROSS and SRQR guidelines.</p><p><strong>Results: </strong>A total of 148 participants completed the survey, and 4 interviews were completed with representatives of advocacy groups; 70.5% (n = 98) selected the correct definition of a DNACPR decision. Many survey participants overestimated the rate of survival for both in-hospital and out-of-hospital cardiac arrest. There was a strong desire for involvement and support in the decision-making process. Interviewees drew attention to poor awareness of national policy, uncertainty as to the decision-making authority of family members and difficulties in communication. Interviewees also highlighted the need for additional information concerning the nature of DNACPR and CPR.</p><p><strong>Conclusions: </strong>The research study highlights points of weakness in the DNACPR decision-making framework for service users. While there is a desire to be involved in the DNACPR decision-making process, this is challenged by deficiencies in the understanding of CPR and uncertainty surrounding decisional authority. The decision-making framework may be strengthened by the development of accessible information and educational resources.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"43"},"PeriodicalIF":3.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of national policies for dementia prevention and control in mainland China.","authors":"Jingbin Zhang, Xiaowan Wang, Shasha Yuan","doi":"10.1186/s12961-025-01314-y","DOIUrl":"10.1186/s12961-025-01314-y","url":null,"abstract":"<p><strong>Introduction: </strong>Limited knowledge has been found on the policies of dementia prevention and control from low- and middle-income (LMIC) countries. This study aims to provide comprehensive evidence of policy progress regarding dementia prevention and control in mainland China by scoping review on the basis of seven priority areas proposed in The Global Action Plan on the Public Health Response to Dementia 2017-2025.</p><p><strong>Methods: </strong>We searched the websites of China State Council, National Health Commission, Ministry of Civil Affairs, National Development and Reform Commission, National Healthcare Security Administration and National Administration of Traditional Chinese Medicine for all policies regarding dementia. The keywords included Chi Dai (dementia), A Er Ci Hai Mo (Alzheimer's), Ren Zhi Zhang Ai (cognitive impairment) and Shi Zhi (dementia), and the search covered materials published by 15 April 2023. Policy diffusion analysis, policy reference network analysis and thematic framework analysis were used to analyse the policy contents.</p><p><strong>Results: </strong>The number of national policies for dementia prevention and control in mainland China increased significantly during 2015-2022. The National Health Commission was responsible for the most policies, while the State Council was responsible for the most important ones. A total of 50 departments were involved in the development of policies for dementia prevention and control, but the stable collaborative relationship among them needs further strengthened. In terms of WHO dementia global action plan, the topic of \"dementia as a public health priority\" was strongly emphasized, while the areas of \"dementia research and innovation\" and \"information systems for dementia\" were less focussed on.</p><p><strong>Conclusions: </strong>Some policy gaps, including priority arrangement, multisectoral cooperation and policy implementation, must still be addressed in the future to support the interests of people with dementia and their caregivers more effectively.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"42"},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An integrated knowledge mobilization approach to substance use health.","authors":"Sheena Taha, Shea Wood, Chandni Sondagar, Eftyhia Helis, Doris Payer, Miguel Hernandez-Basurto","doi":"10.1186/s12961-025-01313-z","DOIUrl":"10.1186/s12961-025-01313-z","url":null,"abstract":"<p><p>The Canadian Centre on Substance Use and Addiction (CCSA) has a mandate to provide national leadership in evidence-informed analysis and knowledge mobilization to advance solutions that reduce substance-related harms. Doing this work effectively requires an understanding of the needs, priorities, perspectives and ideologies of multiple groups. Partnerships across various sectors support a full understanding and acknowledgement of the systems that create differential health outcomes for individuals and communities. CCSA has developed an integrated knowledge mobilization model to guide our work in supporting better substance use health outcomes. Our model begins by understanding the context a particular need (for example, research question and practice improvement) is occurring within. This involves engaging key partners with multiple viewpoints to understand the current situation, constraints and opportunities, including barriers to care, social and structural determinates of health and community strengths and assets. Based on this, the steps that follow involve determining the appropriate action and CCSA's unique role to respond in alignment with partner and community priorities to advance solutions within the given context. This leads to an iterative process of generating and mobilizing knowledge. This integrated and collaborative approach ensures that responses are relevant to the identified knowledge gap, that recommendations reflect partners' realities and that our efforts will achieve impact while minimizing the risk of harm. Through an iterative process of generating and mobilizing knowledge (for example, supporting the scale and spread of innovations, developing new tools and generating or tailoring evidence for a specific audience/context/substance/setting, among others), outputs such as increased awareness, knowledge, use of information and strengthened capacity occur. Together, these efforts contribute to the outcome of a healthier society for people living in Canada, where multiple forms of evidence advance substance use health. Meaningful engagement of partners and evaluation of our efforts are ingrained throughout the model to ensure our work has the intended effects. We share our approach for the consideration of other organizations (in the space of substance use health and otherwise) to engage partners in the development of evidence and other resources that can drive impactful programs, practice and policy.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"41"},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fitting a square peg in a round hole? A mixed-methods study on research ethics and collaborative health and social care research involving 'vulnerable' groups.","authors":"Chiara De Poli, Jan Oyebode, Mara Airoldi, Martin Stevens, Andrea Capstick, Nicholas Mays, Michael Clark, Annelieke Driessen, Carol Rivas, Bridget Penhale, James R Fletcher, Amy M Russell","doi":"10.1186/s12961-025-01290-3","DOIUrl":"10.1186/s12961-025-01290-3","url":null,"abstract":"<p><strong>Background: </strong>Current research ethics frameworks that oversee health and social care research, in the United Kingdom and internationally, originated in biomedical research, having positivist underpinnings and an orientation towards experimental research. Limitations of these frameworks have been extensively documented including with regard to health and social care research that adopts collaborative approaches. This article contributes to debates about how the research ethics system deals with collaborative research with groups labelled or potentially perceived as vulnerable, and identifies practical recommendations to ensure a better fit between principles and practices of research ethics and those of collaborative research.</p><p><strong>Methods: </strong>We conducted a two-round online Delphi study with 35 academic researchers with experience of collaborative research involving vulnerable groups and of seeking research ethics approval in England (United Kingdom), followed by a focus group with eight members of the Delphi panel. The Delphi questionnaire, organised in 12 themes, comprised 66 statements about how researchers experience research ethics review and how the research ethics system could be improved. The focus group discussed the results of the Delphi study to generate practical recommendations.</p><p><strong>Results: </strong>By the end of the second Delphi round, only one statement relating to the experience of the current research ethics system reached consensus, signalling heterogeneous experiences among researchers working in this field. A total of 32 statements on potential improvements reached consensus. The focus group discussed the 14 Delphi statements with the highest levels of consensus and generated 12 practical recommendations that we grouped into three clusters (1. Endorsing the 'collaborative' dimension of collaborative research; 2. Allowing flexibility; and 3. Strengthening the relational and ongoing nature of ethical research practice).</p><p><strong>Conclusions: </strong>This work provides further empirical evidence of how the research ethics system deals with collaborative research involving 'vulnerable' groups. It also offers practical recommendations to ensure that the collaborative dimension of such research receives proper ethical scrutiny, to introduce a degree of flexibility in research ethics processes and supporting documents, and to replace formal, one-off research ethics approvals with ongoing, situated, relational ethical processes and practices.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"40"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic impacts of community-based health insurance: evidence from Gondar Zuria District, Amhara Regional State, Ethiopia.","authors":"Melkamu Workie Tadesse, Ayenew Hailu Gebremichael, Fentahun Baylie Sendekie","doi":"10.1186/s12961-025-01294-z","DOIUrl":"10.1186/s12961-025-01294-z","url":null,"abstract":"<p><strong>Background: </strong>Healthcare insurance is one of the strategies to achieving universal health coverage and reduce health care inequality among rich and poor households. In line with this goal, the Ethiopian government launched a community-based health insurance program in 2011 to protect rural households and informal workers from catastrophic out-of-pocket medical expenditure that would increase health service quality. However, there is a dearth of evidence on the effect of this program on socio-economic spheres of the community in the study area. This study aims to assess the socio-economic impacts of community-based health insurance through a case study in Gondar Zuria district of Central Gondar Zone, north-west Ethiopia.</p><p><strong>Methods: </strong>A concurrent mixed-methods approach was applied, combining a comparative cross-sectional study design for the quantitative section and descriptive analysis for the qualitative part. The quantitative analysis included responses from 407 households, while the qualitative analysis was based on ten in-depth interviews and three key informant interviews (KIIs). Systematic and maximum variation sampling techniques are used to determine the sample sizes of the datasets, respectively. The quantitative data is generated from the responses of households to structured closed-ended questionnaire by trained data collectors. In-depth interviews and key informant interviews are conducted by the authors with tape-recorder to gather the qualitative data. The quantitative data is analysed by propensity score matching method using STATA-14 software. Findings from the qualitative data are generated through descriptive analysis.</p><p><strong>Results: </strong>A quantifiable positive association was found between community-based health insurance (CBHI) and welfare on the basis of quantitative data analysis. The results show that insured households have 17% and 20% lower probabilities of experiencing catastrophic health expenditure and labour absenteeism in the workplace, respectively, compared with non-insured households. Insured households are also more likely to have better vertical social capital compared with non-insured households.</p><p><strong>Conclusions: </strong>Thus, the study concludes that community-based health insurance improves both economic and social status of insured households in the study area, and hence, the program should be scaled-up to include more non-beneficiaries to improve welfare in Ethiopia.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"39"},"PeriodicalIF":3.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building Resilient and Responsive Health Research Systems:Responses and the Lessons Learned from the COVID-19 Pandemic.","authors":"Mark Embrett, Andrea Carson, Meaghan Sim, Aislinn Conway, Emily Moore, Kristy Hancock, Iwona Bielska","doi":"10.1186/s12961-024-01229-0","DOIUrl":"10.1186/s12961-024-01229-0","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic highlighted the crucial role of robust health research systems (HRSs) in supporting effective public health responses. Understanding the responses and lessons learned from HRS during the pandemic is vital for future preparedness.</p><p><strong>Methods: </strong>This environmental scan examined high income Countries with a HRS that responded to the COVID-19 pandemic using both academic and grey literature sources to gather comprehensive insights into these areas. The analysis was structured using an organizing framework to facilitate systematic extraction and synthesis of relevant information. A total of 5336 sources were identified of which 3609 were screened following duplicate removal. A total of 117 full-text sources were reviewed leading to 65 being included.</p><p><strong>Findings: </strong>Effective interdisciplinary and cross-sector collaborations significantly enhanced the capacity to respond to the pandemic. Clear and streamlined governance structures were essential for coordinated efforts across various entities, facilitating swift decision-making and resource allocation. The robustness of pre-existing research infrastructures played a crucial role in the rapid mobilization of resources and execution of large-scale research projects. Knowledge mobilization efforts were vital in disseminating research findings promptly to inform public health responses. Continuous tracking and evaluation of health research activities enabled real-time adjustments and informed decision-making. Rapid identification and funding of research priorities, including vaccine and therapeutic development, were critical in addressing urgent public health needs. Effective resource allocation and capacity-building efforts ensured focused and accelerated research responses. Comprehensive strategic planning, involving stakeholder engagement and robust monitoring tools, was essential for aligning research efforts with health system needs.</p><p><strong>Conclusion: </strong>The findings underscore the necessity of flexible funding mechanisms, enhanced data-sharing practices and robust strategic planning to prepare for future health emergencies. Policy implications emphasize the need for sustained investments in health policy and systems research (HPSR) and the development of comprehensive governance frameworks. Research implications highlight the importance of community engagement and interdisciplinary partnerships. For decision-makers, the study stresses the importance of rapid response mechanisms and evidence-based policy making. Health research systems must prioritize maintaining adaptable infrastructures and strategic planning to ensure effective crisis response. Despite potential biases and the rapidly evolving context, this comprehensive analysis provides valuable lessons for strengthening HRSs to address future public health challenges.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"38"},"PeriodicalIF":3.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An international comparison of longitudinal health data collected on long COVID in nine high income countries: a qualitative data analysis.","authors":"Josephine Exley, Edmund Stubbs, Raphael Wittenberg, Nicholas Mays","doi":"10.1186/s12961-025-01298-9","DOIUrl":"10.1186/s12961-025-01298-9","url":null,"abstract":"<p><strong>Background: </strong>Long coronavirus disease (COVID) presents a significant health challenge. Long-term monitoring is critical to support understanding of the condition, service planning and evaluation. We sought to identify and examine longitudinal health data collected on long COVID to inform potential decisions in England regarding the rationale for data collection, the data collected, the sources from which data were collected and the methods used for collection.</p><p><strong>Methods: </strong>We included datasets in high-income countries that experienced similar coronavirus disease 2019 (COVID-19) waves to England pre-vaccine rollout. Relevant datasets were identified through literature searches, the authors' networks and participants' recommendations. We undertook semi-structured interviews with individuals involved in the development and running of the datasets. We held a focus group discussion with representatives of three long COVID patient organisations to capture the perspective of those with long COVID. Emergent findings were tested in a workshop with country interviewees.</p><p><strong>Results: </strong>We analysed 17 datasets from nine countries (Belgium, Canada, Germany, Italy, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom). Datasets sampled different populations, used different data collection tools and measured different outcomes, reflecting different priorities. Most data collection was research (rather than health care system)-funded and time-limited. For datasets linked to specialist services, there was uncertainty surrounding how long these would continue. Definitions of long COVID varied. Patient representatives' favoured self-identification, given challenges in accessing care and receiving a diagnosis; New Zealand's long COVID registry was the only example identified using this approach. Post-exertion malaise, identified by patients as a critical outcome, was absent from all datasets. The lack of patient-reported outcome measures (PROMs) was highlighted as a limitation of datasets reliant on routine health data, although some had developed mechanisms to extend data collection using patient surveys.</p><p><strong>Conclusions: </strong>Addressing research questions related to the management of long COVID requires diverse data sources that capture different populations with long COVID over the long-term. No country examined has developed a comprehensive long-term data system for long COVID, and, in many settings, data collection is ending leaving a gap. There is no obvious model for England or other countries to follow, assuming there remains sufficient policy interest in establishing a long-term long COVID patient registry.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"37"},"PeriodicalIF":3.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A bespoke rapid evidence review process engaging stakeholders for supporting evolving and time-sensitive policy and clinical decision-making: reflection and lessons learned from the Wales COVID-19 Evidence Centre 2021-2023.","authors":"Ruth Lewis, Alison Cooper, David Jarrom, Mala Mann, Rebecca-Jane Law, Deborah Edwards, Judith Carrier, Hannah Shaw, Tom Winfield, Llinos Haf Spencer, Jane Noyes, Helen Morgan, Jennifer Washington, Elise Hasler, Micaela Gal, Elizabeth Doe, Natalie Joseph-Williams, Adrian Edwards","doi":"10.1186/s12961-025-01297-w","DOIUrl":"10.1186/s12961-025-01297-w","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic presented policymakers with time-sensitive decision problems and a rapidly increasing volume of research, not all of which was robust, or relevant to local contexts. A bespoke evidence review process supporting stakeholder engagement was developed as part of the Wales COVID-19 Evidence Centre (WCEC), which could flexibly react to the needs of decision-makers, to address urgent requests within days or months as required.</p><p><strong>Aims: </strong>To describe and appraise the WCEC review process and methods and identify key learning points.</p><p><strong>Methods: </strong>Three types of rapid review products were used, which could accommodate the breadth of decision problems and topics covered. Stakeholder (including public) engagement was integrated from the onset and supported throughout. The methods used were tailored depending on the needs of the decision-maker, type of research question, timeframe, and volume and type of evidence. We appraised the overall process and compared the methods used with the most recent and relevant best practice guidance.</p><p><strong>Results: </strong>The remote collaboration between research teams, establishing a clear pathway to impact upfront, and the strong stakeholder involvement embedded in the review process were considered particular strengths. Several key learning points were identified, which focused on: enhancing stakeholders' abilities to identify focused policy-relevant research questions; the collection and storage of review protocols at a central location; tightening quality assurance process regarding study selection, data extraction and quality assessment; adequate reporting of methodological shortcuts and understanding by stakeholders; piloting of an algorithm for assigning study design descriptors, and a single quality assessment tool covering multiple study designs; and incorporate, where appropriate an assessment of the confidence in the overall body of evidence using GRADE or similar framework.</p><p><strong>Conclusions: </strong>The review process enabled a high volume of questions that were directly relevant to policy and clinical decision making to be addressed in a timely manner using a transparent and tailored approach.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"36"},"PeriodicalIF":3.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collaborative networks in community-based health and social care services: insights from Blackpool and the Fylde Coast (United Kingdom).","authors":"Kristof Santa, Zsofia Boda, Buket Kara, Jörg Huber, Heather Catt, Barbara Mezes","doi":"10.1186/s12961-025-01303-1","DOIUrl":"10.1186/s12961-025-01303-1","url":null,"abstract":"<p><strong>Background: </strong>Globally, health and social care systems have been responding to the demand for better integrated service delivery to tackle complex public health and socioeconomic challenges. Similarly, services in the United Kingdom strive for comprehensive, person-centred care to support health equity and improved quality of life. This study took place in Blackpool and the Fylde Coast, United Kingdom, where socioeconomic deprivation and health inequalities persist and effective collaboration among health and social care providers offers an opportunity to tackle such complex challenges. The study used social network analysis (SNA) to investigate collaboration patterns between organizations to identify key characteristics and areas for improved integration.</p><p><strong>Methods: </strong>Data were collected from March to June 2023. First, a comprehensive mapping exercise identified a total of 453 community-based providers who were invited to participate via email. Data on service provision were collected using an adapted version of the Template for Intervention Description and Replication (TIDieR) form from organizations' websites. Service descriptions were thematically categorized into 11 domains. A total of 44 organizations provided information on their collaborations through an online survey, reporting on collaborations across 321 organizations. SNA examined collaboration patterns via visualization and multivariate network regressions (MRQAP).</p><p><strong>Results: </strong>The mapping identified a great range of community-based support. The network density indicated relatively low overall collaboration (2.2%) among 321 organizations. Within the subset of 44 organizations who completed the questionnaire, collaborations were more frequent (15%). Collaboration ties were unevenly distributed, where some organizations had more connections. MRQAP showed that organizations within the same domain were more likely to collaborate. Some combinations, such as collaborations between housing, shelter and nutritional support with child and family support and mental health were significantly overrepresented.</p><p><strong>Discussion: </strong>The network had low density, highlighting the potential for more collaborations. The network appears fragmented, probably owing to a tendency for organizations to collaborate with others operating in the same service domain. The frequent collaborations between certain domains highlight the complex needs of local communities. Effective integrated care initiatives, data sharing and place-based partnership/voluntary, community, faith, social enterprise sector capacity-building programmes could build more resilient and interconnected networks that meet community needs.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"35"},"PeriodicalIF":3.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis for health system resilience against the economic crisis: a best-fit framework synthesis.","authors":"Zeynab Foroughi, Parvin Ebrahimi, Shahram Yazdani, Aidin Aryankhesal, Majid Heydari, Mohammadreza Maleki","doi":"10.1186/s12961-025-01285-0","DOIUrl":"10.1186/s12961-025-01285-0","url":null,"abstract":"<p><strong>Introduction: </strong>Countries, especially developing countries, are prone to economic crises, which are the consequences of various crises, including pandemics, climate crises, armed conflicts and migration. Therefore, policy-makers need a guiding framework for policy-making against the economic crisis that contributes to health system resilience. This study aimed to provide a holistic framework that guides health system policies before or during an economic crisis.</p><p><strong>Method: </strong>The study utilized the best-fit framework synthesis to enhance and adapt the Resilience Analysis Meta-Framework (RAMF) in the context of an economic crisis. The study analysed and compared the experiences of three high-income countries and three low-middle-income countries with the greatest diversity in terms of their context, shocks that caused the economic crises and their responses to them. The framework was expanded and adjusted on the basis of the adopted policies in the context of the economic crisis.</p><p><strong>Results: </strong>The adapted RAMF provides a holistic framework which shows the priority and relationships of various policy alternatives in each health system building block. This framework can be used as a guide to analyse any policy solution against the economic crisis by considering its necessary antecedent policies and consequence policies in other health system building blocks.</p><p><strong>Conclusions: </strong>Awareness in a health system via adapting appropriate cost control policies and governance structure can contribute to evidence-based cost control in all health system building blocks and need-based financing, drug and medical equipment procurement, human resource planning and service provision.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"33"},"PeriodicalIF":3.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}