Issue addressed: This paper considers the role of ethics and ethics review processes in the development of health promotion quality assurance and evaluation activities involving human participants.
...Content: The Australian National Health and Medical Research Council (NHMRC) National Statement on Ethical Conduct in Human Research and associated documents provide the framework for the ethical conduct and independent review of research (including quality assurance and evaluation) involving humans in Australia. Identifying the level of risk to which participants may be exposed by participation in quality assurance and evaluation activities is essential for health promotion workers undertaking such activities. Organisations can establish processes other than review by a Human Research Ethics Committee for negligible and low risk research activities. Health promotion quality assurance and evaluation activities often involve negligible and low risk to participants. Seven triggers that indicate the need for ethics review of quality assurance and evaluation activities and a procedural checklist for developing ethical quality assurance and evaluation activities are provided.
Conclusion: Health promotion workers should be familiar with the NHMRC's National Statement on Ethical Conduct in Human Research. When ethical considerations underpin the planning and conduct of all quality assurance and evaluation from the very beginning, the activity is the better for it, independent 'ethics approval' can mostly be secured without much trouble and workers' frustration levels are reduced.
This article details how health impacts came to be assessed in three mega, billion dollar, transport infrastructure projects, two road tunnels and one light rail, in Sydney Australia. The known ...health impacts of transport decisions include environmental, behavioural and social factors. EIA practice prioritises environmental risks, and there has been scant attention to understanding why this is persistently the case. Here we provide a critical theory lens, using critical realist methodology, to analyse empirical data collected through interviews and documents for the three cases. Our analysis focusses on EIA practice within its institutional context, building on ‘new institutional’ approaches to policy analysis that emphasise actors (the stakeholders involved in the EIA), structures (the ‘rules of the game’ that influence practice in systems), and power. We find that the various actors engaged in the EIAs principally to address particular goals that were pre-determined by the system in which they worked or belonged. Structurally, each EIA was undertaken as a compliance process relatively late in the planning process. Considering project options was not part of the EIA's purpose. Resources to undertake the EIAs were provided by those funding the projects (“the proponents”) and determined the types of issues to be considered. The full range of links between transport and health were not identified. Concerning power, health impacts were considered through inter-professional technical negotiation. The inability to engage in the fundamental options driving projects meant impacted communities questioned the validity of the EIA, and the health assessment within this. Our institutional analysis provides important knowledge about how the EIAs preferenced a focus on specific health risks to the detriment of the known broader determinants that shape the health impacts of transport.
Urban health is a field of research and practice that has attracted the interest of various disciplines. While it is encouraged for diverse disciplines to contribute to a multidisciplinary field of ...study such as urban health, this often results in tensions, conflicts or competition between the different traditions that stem from different epistemological backgrounds. This meta-narrative review aims to identify and describe the multiple paradigms and articulate the underlying epistemological, ontological, methodological, and aetiological differences in their approaches. Articulating the paradigms not only contributes to the advancement of research, but also provides a framework for understanding the different policy beliefs and ideas policy actors hold and apply in the policy process.
We apply the meta-narrative method to systematic literature review which includes the following six iterative phases. The planning phase includes the finalisation of the review protocol and assembly of review team. The search phase includes a comprehensive literature search in key databases and a double-sided systematic snowballing method. We will search multidisciplinary databases including Web of Science, Scopus and ProQuest, and topic-specific databases including Urban Studies Abstracts (EBSCO), MEDLINE, and EMBASE from their inception onwards. Bibliometric analyses of this literature will be used to triangulate the mapping of the paradigms. The mapping phase includes identifying the dominant paradigms and landmark publications through agreement with the review team. In the appraisal phase, the literature will be assessed by their respective quality standards, followed by data extraction to identify the individual narratives in the conceptual, theoretical, methodological, and instrumental dimensions of each paradigm. The synthesis phase will review the data to compare and contrast and identify the overarching meta-narratives. The recommendation phase will include dissemination of the findings from the review.
The meta-narrative review will reveal the how the different paradigms conceptualise, frame and prioritise urban health issues, their preferred methodologies to study the phenomenon, and the nature of the solutions to improve human health. This review will assist researchers and practitioners in understanding and interpreting evidence produced by other traditions that study urban health. Through this, urban health researchers and practitioners will be able to seek coherence in understanding, explaining, and exploring the urban health phenomenon.
Open Science Framework ( https://osf/io/tn8vk ).
Explicit incorporation of patients' values and preferences is important in health care decision making. However, there are few data about this topic for patients with chronic kidney disease (CKD). We ...conducted 9 focus groups (3 each for CKD stages 1 to 5, CKD stage 5D, and CKD stages 1 to 5T). Five major themes were identified: (1) personal meaning of CKD, (2) managing and monitoring health, (3) lifestyle consequences, (4) family impact, and (5) informal support structures. Patients had to adjust to the disruptive and permanent implications of the illness on their physical health, identity, emotions, family, lifestyle, relationships, and employment. The overwhelming fatigue, complex treatment regimens, side effects, and liquid and diet restrictions constrained patients' lives. Patients appreciated specialist care, but described the health care system as nonintegrated and believed they received insufficient information and psychosocial support. Choice of treatments was based on lifestyle, family impact, and physical comfort, seldom on clinical outcomes. Time was needed to comprehend the diagnosis, cope with uncertainty, integrate their treatment regimen into their daily routine, and reestablish a sense of normality in their lives. Rather than focusing on clinical targets, greater attention may need to be given to providing information and psychosocial and practical support at a patient-level not organ-specific level, to maximize patient quality of life.
Estate renewal programs can have positive and negative impacts on the health and wellbeing of public housing residents. We aimed to investigate the potential health impacts of relocating residents as ...part of the redevelopment of a public housing estate in South Western Sydney, New South Wales. In-depth interviews were undertaken with public housing residents as well as with informants from local health and housing authorities. We found that a range of current and potential health impacts were linked to individual residents' responses to the processes of estate redevelopment and relocation, housing and neighbourhood quality, residents' social networks and access to social and health care services. Improved housing quality and maintenance, a personalised approach to relocation and equitable access to services were identified to contribute to positive health outcomes.
The scientific evidence for global warming is overwhelming. Health organisations, as large carbon polluters, are at significant 'carbon risk' and must act to reduce their carbon emissions. Many ...environmental sustainability initiatives, if properly implemented, would not only reduce harm, waste and pollution but also deliver health, social and financial benefits.
We have been involved for more than a decade in efforts to reduce the greenhouse gas emissions of New South Wales (NSW) Health organisations in which we have worked. We draw on our collective experience to offer eight key lessons about implementing environmental sustainability initiatives in health organisations.
Sustainability plans have been developed in at least three Area Health Services/Local Health Districts in NSW, but in each case they have been imperfectly implemented.
Based on our experience, we offer eight key lessons relating to leadership, engagement and developing networks, data, complex adaptive systems, broadening the issue, and political factors.
This case report is a reflective narrative, documenting the methods used to develop a policy framework for a National Strategy on Climate, Health and Well-being for Australia. The report aims to ...guide advocates, communities of practice, and governments in developing a comprehensive policy response to climate change and its health impacts.
Transport policy and practice impacts health. Environmental Impact Assessments (EIAs) are regulated public policy mechanisms that can be used to consider the health impacts of major transport ...projects before they are approved. The way health is considered in these environmental assessments (EAs) is not well known. This research asked: How and to what extent was human health considered in EAs of four major transport projects in Australia.
We developed a comprehensive coding framework to analyse the Environmental Impact Statements (EISs) of four transport infrastructure projects: three road and one light rail. The coding framework was designed to capture how health was directly and indirectly included.
We found that health was partially considered in all four EISs. In the three New South Wales (NSW) projects, but not the one South Australian project, this was influenced by the requirements issued to proponents by the government which directed the content of the EIS. Health was assessed using human health risk assessment (HHRA). We found this to be narrow in focus and revealed a need for a broader social determinants of health approach, using multiple methods. The road assessments emphasised air quality and noise risks, concluding these were minimal or predicted to improve. The South Australian project was the only road project not to include health data explicitly. The light rail EIS considered the health benefits of the project whereas the others focused on risk. Only one project considered mental health, although in less detail than air quality or noise.
Our findings suggest EIAs lag behind the known evidence linking transport infrastructure to health. If health is to be comprehensively included, a more complete model of health is required, as well as a shift away from health risk assessment as the main method used. This needs to be mandatory for all significant developments. We also found that considering health only at the EIA stage may be a significant limitation, and there is a need for health issues to be considered when earlier, fundamental decisions about the project are being made.
AbstractBackground Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no ...consolidated reporting framework exists for any type of qualitative design. Objective To develop a checklist for explicit and comprehensive reporting of qualitative studies (indepth interviews and focus groups). Methods We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Results Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Conclusions The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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