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Biomedical subjects

P Hawe

Publications and source records attributed to P Hawe.

At least 19 recordsLinked to original sources
PubMed2002

Criteria for evaluating evidence on public health interventions.

Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.

Evidence-Based Medicine↗
PubMed2001

Focus group composition: a comparison between natural and constructed groups.

OBJECTIVE: To provide insight into the effects of focus group composition. METHOD: In an early phase of an ongoing study of parental reception to messages about childhood immunisation, we conducted four focus groups; two with participants who had never met before (constructed groups) and two with participants who were part of a pre-established first-time mothers' group (natural groups). RESULTS: Marked differences were noted in the group dynamics, depth of interaction and diversity between groups. Discussions with constructed groups were animated, enthusiastic, expressed more divergent views and articulated greater complexities of the topic. Discussions with natural groups were generally flatter and less enthusiastic, displaying a higher level of apparent conformity to conventional wisdom. The need to protect other participants from potentially disturbing information about vaccination was expressed across groups but acted to censor natural groups, where participants knew more of each others' sensitivities. IMPLICATIONS: Insight into the factors contributing to such differences may enhance understanding of the contexts in which constructed groups are more appropriate. The processes of social censorship may be of primary interest to the researcher. However, where it is paramount to elicit a range of opinions about a potentially controversial topic, we suggest that natural groups in the delicate stage of norming be avoided. The peculiarities of each individual research circumstance are best explored in pilot studies.

Adolescent↗
PubMed2001

Collaborative intersectoral approaches to nutrition in a community on the urban fringe.

A case study is presented that describes the 10-year evolution of a local intersectoral project aimed at improving components of a community's food system as an approach to improving nutrition. Aspects of innovation and good contemporary practice in collaborating for health promotion are illustrated. Key initiators of the project were a university public health department, a community health service, and a local government authority. Players brought into the process included the agricultural sector and food retailers. Several strategies have contributed to the success and institutionalization of the project. These include a specific focus on organizational development and capacity building among the key intersectoral partners and the use of formative evaluation methods to hasten the natural phases of collaborative problem solving. The project achieved many policy- and system-level changes. The impact on food consumption patterns is still to be evaluated.

Community Participation↗
PubMed2000

Are preferences over health states complete?

Most applied work in health economics accepts, if only implicitly, the axiom of completeness. Preferences over health states or health services are assumed to be well formed. They are effectively 'data' waiting to be collected. An alternative perspective suggests that values are initially incomplete and are constructed rather than just revealed in the process of answering choice-related questions such as willingness to pay or standard gambles. What might appear as measurement error may, therefore, be a more deliberate process of reflection and deliberation. This paper reports on a study that assessed the completeness of health preferences. The results show a mixed pattern. For most of the sample, values were stable over repeat administration, suggesting completeness. However, one-third of participants deliberately changed their answers and suggested that the interview process had forced them to think about their values more deeply. While it is premature to draw conclusions from this small sample, the suggestion is that completeness cannot be taken for granted.

Adult↗
PubMed2000

Social capital and health promotion: a review.

Interest in social capital and health has emerged at an exciting time. In public health, there is a renewed interest in mechanisms that link social inequalities and health. In epidemiology, there has been a critical interrogation of methods and a call for a more explicit use of theory. In health promotion over the last 20-30 years, social health interventions have been somewhat marginalised in an era dominated by interest in traditional cardiovascular disease risk factors. Now that social hypotheses are being reborn in health, there is a risk that the sophistication that has developed in social health promotion and the literatures that have informed it could be overlooked. In this paper, we present a brief history of social capital and how it has come into recent prominence through the debate linking income inequality and health. We present the background to this, the earlier literatures on social environmental influences on health and the possible processes thought to underlie this relationship. Social capital has relational, material and political aspects. We suggest that, although the relational properties of social capital are important (eg, trust, networks), the political aspects of social capital are perhaps under recognised. The paper also reviews how complex social processes at the community level have come to be operationalised by social theorists and intervention agents in other fields. We suggest that social capital research so far has inadequately captured the underlying constructs, in particular the qualitative difference between the macro/context level and the micro/individual level. While being cautious about the science, we conclude that social capital's power as rhetoric and as a metaphor may be of value. We conclude by suggesting that the coalescence of interests in context-level influences on health now invites a revitalisation of theories and interventions inspired by diverse fields, such as geography and ecological community psychology.

Canada↗
PubMed1998

Use of systematic reviews of randomised trials by Australian neonatologists and obstetricians.

OBJECTIVE: To determine what proportion of Australian neonatologists and obstetricians report using systematic reviews of randomised trials. DESIGN: Cross-sectional survey using structured telephone interviews. SETTING: Australian clinical practice in 1995. PARTICIPANTS: 103 of the 104 neonatologists in Australia (defined as clinicians holding a position in a neonatal intensive care unit); a random sample of 145 members of the Royal Australian College of Obstetricians and Gynaecologists currently practising in Australia. MAIN OUTCOME MEASURES: Information sources used in clinical practice; reported awareness of, access to and use of systematic reviews, and consequent practice changes. RESULTS: Response rates were 95% (neonatologists) and 87% (obstetricians); 71 neonatologists (72%) and 55 obstetricians (44%) reported using systematic reviews, primarily for individual patient care. Databases of systematic reviews were used with a median frequency of once per month. Among neonatologists, systematic reviews were used more commonly by those who were familiar with computers, attended professional meetings, and had authored research papers. Among obstetricians, they were used more commonly by those who were familiar with computers, had less than 10 years' clinical experience, attended more deliveries, and were full-time staff specialists in public hospitals. Of neonatologists who reported using systematic reviews, 58% attributed some practice change to this use. For obstetricians, the corresponding figure was 80%. CONCLUSIONS: There is evidence that Australian neonatologists and obstetricians use systematic reviews and modify their practice accordingly. Dissemination efforts can benefit from knowledge of factors that predict use of systematic reviews.

Adult↗
PubMed1998

Randomised controlled trial of the use of a modified postal reminder card on the uptake of measles vaccination.

OBJECTIVE: To determine whether rewording postal reminder cards according to the "health belief model", a theory about preventive health behaviour, would help to improve measles vaccination rates. DESIGN: A randomised controlled trial, with blind assessment of outcome status. Parents of children due for their first measles vaccination were randomised to one of two groups, one receiving the health belief model reminder card, the other receiving the usual, neutrally worded card. The proportion of children subsequently vaccinated in each group over a five week period was ascertained from clinical (provider based) records. SETTING: A local government operated public vaccination clinic. PARTICIPANTS: Parents of 259 children due for measles vaccination. MAIN RESULTS: The proportion of children vaccinated in the health belief model card group was 79% compared with 67% of those sent the usual card (95% CI, 2% to 23%), a modest but important improvement. CONCLUSION: This study illustrates how the effectiveness of a minimal and widely practised intervention to promote vaccination compliance can be improved with negligible additional effort.

Adult↗
PubMed1997

Multiplying health gains: the critical role of capacity-building within health promotion programs.

Health outcomes in populations are the product of three factors: (1) the size of effect of the intervention; (2) the reach or penetration of an intervention into a population and (3) the sustainability of the effect. The last factor is crucial. In recent years, many health promotion workers have moved the focus of their efforts away from the immediate population group or environment of interest towards making other health workers and other organisations responsible for, and more capable of, conducting health promotion programs, maintaining those programs and initiating others. 'Capacity-building' by health promotion workers to enhance the capacity of the system to prolong and multiply health effects thus represents a 'value added' dimension to the health outcomes offered by any particular health promotion program. The value of this activity will become apparent in the long term, with methods to detect multiple types of health outcomes. But in the short term its value will be difficult to assess unless we devise specific measures to detect it. At present the term 'capacity-building' is conceptualised and assessed in different ways in the health promotion literature. Development of reliable indicators of capacity-building which could be used both in program planning and in program evaluation will need to take this into account. Such work will provide health-decision makers with information about program potential at the conclusion of the funding period, which could be factored into resource allocation decisions, in addition to the usual information about a program's impact on health outcomes. By program potential, we mean ability to reap greater and wider health gains.

Australia↗
PubMed1997

Developing the effectiveness of an intersectoral food policy coalition through formative evaluation.

There is a difference between bringing parties together and making them work effectively. We present a case study of an intersectoral food policy Committee, part of a three-tiered coalition nested within local municipal government, which sought to promote and nutrition in a rapidly growing metropolitan region by tackling food supply issues in the first instance. This was new territory for all players. After 12 months, the group felt it was floundering and requested an evaluation. In-depth qualitative interviews with committee members (n = 21) and quantitative assessment of Committee processes revealed insufficient mechanisms for engaging new members, conflict between perceived roles for the group and a notable lack of confidence in the group's capacity to achieve its goals, or outcome efficacy. Feedback of the data and subsequent discussion led to a reform of project structure, stronger mechanisms to realize its goals and better incentive management, or ways to maximize the benefits and limit the costs for the diverse parties involved. The impact was reflected in a 4 year time series analysis of media releases, decision making and related municipal government actions. The study illustrates how theory-informed formative evaluation can help to improve health promotion practice.

Australia↗
PubMed1997

Lessons from a review of publications in three health promotion journals from 1989 to 1994.

A thematic analysis was undertaken of 72 editorials in three leading health promotion journals, Health Education Research: Theory & Practice, Health Education Quarterly and Health Promotion International, from 1989 to 1994. The three main themes which emerged were (1) the need to broaden health promotion interventions, (2) the need to promote rigour and professionalism in the discipline of health promotion, and (3) the need to respond to the information requirements of practitioners. Against this context, we conducted a content analysis of the journals, examining the nature of the 649 peer-reviewed publications in the same time period. Categories from the traditional bio-medical 'stages of research' models had to be adapted before full classification of articles published was feasible. The largest number of articles published could be termed descriptive research, followed by studies developing and validating health promotion measurement tools and health promotion theory. The proportion of program evaluations was small and the proportion of randomized controlled trials ('highest quality evidence' of effectiveness) decreased over time. Dissemination studies were also poorly represented in spite of this being identified in editorials as an important professional need. Ways to redress some of the imbalances observed are discussed.

Bibliometrics↗
PubMed1996

Needs assessment must become more change-focused.

Area-based needs-assessment methods tend to reinforce the status quo in service or program delivery rather than challenge it. Data collection easily becomes routine and self-justifying. To rid ourselves of ritualistic methods of data collection, we must turn attention to the process of change that should result from it. That is, we must think in advance of the types of decisions that must made about service delivery and the nature of the change process itself. There are two routes to this end, depending on how change is conceptualised. If one adopts a conflict model of change, then felt need or, more crudely, what consumers or groups and communities want becomes the primary focus. This would place consumers in the chief role within an action-oriented advocacy process. Alternatively, if a more functionalist model of change is adopted, then the focus of activity is on the information needs of managers and the type of data they require to justify a resource shift. Typically these data are not about "needs' but marginal health gains and costs. In either event, the data collection procedures should be far more specific and directed than the existing broad-brush procedures that presently serve only a limited purpose and effectively dilute or detract from both agendas for change. There are several possible pathways to resolve some of these issues, in particular, using hypothetical results to foresee if or how change could result from any proposed data collection activity.

Australia↗