The impacts of injury at the individual, community and societal levels: a systematic meta-review.

OBJECTIVES: Injury is a major public health problem. While the impacts of injury on the injured person are well documented, there is relatively little knowledge about the impacts of injury on those individuals and groups in the community connected to the injured person. This study seeks to describe this breadth of research using a meta-review methodology. STUDY DESIGN: Systematic meta-review. METHODS: To gain a better understanding of the known impacts of injury on family, community and society, a systematic meta-review of injury outcomes research literature was conducted. Seventy-eight peer-reviewed published literature reviews were included in the meta-review. RESULTS: Of these, 70 reported outcomes at the level of the injured person including mortality, body functions, activity and participation limitations. Nine reviews reported impacts at the level of the community including impacts on family members, work colleagues and carers. Six studies reported impacts at the societal level including economic, health system and injury compensation system impacts. CONCLUSIONS: In summary, the meta-review identified a substantial body of knowledge at the individual level outcomes of injury, and a relative lack of information regarding the community and societal impacts of injury. An injury outcome framework is proposed on the basis of the findings of the meta-review to guide future research activity, particularly with regard to injury outcome domains where there is currently limited evidence. A comprehensive framework that takes account of all levels of impact is necessary for effective policies, systems and strategies to support recovery following injury.

Changing gendered norms about women and girls at the level of household and community: a review of the evidence.

Gendered norms are embedded in social structures, operating to restrict the rights, opportunities, and capabilities, of women and girls, causing significant burdens, discrimination, subordination, and exploitation. This review, developed for the Women and Gender Equity Knowledge Network of the WHO Commission on the Social Determinants of Health, sought to identify the best available research evidence about programmatic interventions, at the level of household and community, that have been effective for changing gender norms to increase the status of women. The focus was on developing countries. A wide range of single and multiple databases were searched, utilizing database specific keywords such as: women and girls; men and boys; household and community; intervention; and gender norms. Key themes were identified: education of women and girls; economic empowerment of women; violence against women, including female genital mutilation/cutting; and men and boys. Types of interventions, levels of action, populations of interest, and key outcomes from evaluations are identified. Evaluations are limited, with little evidence or measurement of changes in gender equity and women's empowerment. A key finding is, that targeting women and girls is a sound investment, but outcomes are dependent on integrated approaches and the protective umbrella of policy and legislative actions.

Organizational change-key to capacity building and effective health promotion

Contemporary health promotion is now a well-defined discipline with a strong (albeit diverse) theoretical base, proven technologies (based on program planning) for addressing complex social problems, processes to guide practice and a body of evidence of efficacy and increasingly, effectiveness. Health promotion has evolved principally within the health sector where it is frequently considered optional rather than core business. To maximize effectiveness, quality health promotion technologies and practices need to be adopted as core business by the health sector and by organizations in other sectors. It has proven difficult to develop the infrastructure, workforce and resource base needed to ensure the routine introduction of high-quality health promotion into organizations. Recognizing these problems, this paper explores the use of organizational theory and practice in building the capacity of organizations to design, deliver and evaluate health promotion effectively and efficiently. The paper argues that organizational change is an essential but under-recognized function for the sustainability of health promotion practice and a necessary component of capacity-building frameworks. The interdependence of quality health promotion with organizational change is discussed in this paper through three case studies. While each focused on different aspects of health promotion development, the centrality of organizational change in each of them was striking. This paper draws out elements of organizational change to demonstrate that health promotion specialists and practitioners, wherever they are located, should be building organizational change into both their practice and capacity-building frameworks because without it, effectiveness and sustainability are at risk. (AU)

Rural people utilising city hospitals: issues for service provision.

The geographic distribution of health services in Australia means that rural people may need to travel long distances from their homes to obtain specialist services. Because sophisticated and expensive medical technologies are centralised, it is not uncommon for rural people to need to access metropolitan health services for many forms of treatment. This study sought to investigate the experiences of central Victorian people for whom illness or injury necessitated their admission to metropolitan hospitals. Because of distance from both metropolitan hospitals and social support structures, these people were likely to have differing experiences from city people admitted to hospital. However, it was found that not only were variables of rurality and social support significant, but socio-economic status and family structure were also found to be important. Even though respondents identified distress and other problems associated with the metropolitan admission, they rationalised the whole experience in terms of the specialised treatment they received; treatment that was not available in country hospitals.