"The Terminology Might Be Ahead of Practice": Embedding Shared Decision Making in Practice-Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care.

Background. It is a patient's right to be included in decisions about their health care. Implementing shared decision making (SDM) is important to enable active communication between clinicians and patients. Although health policy makers are increasingly mandating SDM implementation, SDM adoption has been slow. This study explored stakeholders' organizational- and system-level barriers and facilitators to implementing policy mandated SDM in maternity care in Victoria, Australia. Method. Twenty-four semi-structured interviews were conducted with participants including clinicians, health service administrators and decision makers, and government policy makers. Data were mapped to the Theoretical Domains Framework to identify barriers and facilitators to SDM implementation. Results. Factors identified as facilitating SDM implementation included using a whole-of-system approach, providing additional implementation resources, correct documentation facilitated by electronic medical records, and including patient outcomes in measurement. Barriers included health service lack of capacity, unclear policy definitions of SDM, and policy makers' lack of resources to track implementation. Conclusion. This is the first study to our knowledge to explore barriers and facilitators to SDM implementation from the perspective of multiple actors following policy mandating SDM in tertiary health services in Australia. The primary finding was that there are concerns that SDM implementation policy is outpacing practice. Nonclinical staff play a crucial role translating policy to practice. Addressing organizational- and system-level barriers and facilitators to SDM implementation should be a key concern of health policy makers, health services, and staff. Highlights: New government policies require shared decision making (SDM) implementation in hospitals.There is limited evidence for how to implement SDM in hospital settings.There are concerns SDM implementation policy is outpacing practice.Understanding and capacity for SDM varies considerably among stakeholders.Whole of system approaches and electronic medical records are seen to facilitate SDM.

A united approach to promoting healthy living behaviours and associated health outcomes: a global call for policymakers and decisionmakers.

Chronic disease pandemics have challenged societies and public health throughout history and remain ever-present. Despite increased knowledge, awareness and advancements in medicine, technology, and global initiatives the state of global health is declining. The coronavirus disease 2019 (COVID-19) pandemic has compounded the current perilous state of global health, and the long-term impact is yet to be realised. A coordinated global infrastructure could add substantial benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical must be supported by unified approaches that maximise public health. We present a call to action for established public health organisations and governments globally to consider the lessons from the COVID-19 pandemic and unite with true collaborative efforts to address current, longstanding, and growing challenges to public health.

Co-designing a theory-informed intervention to increase shared decision-making in maternity care.

BACKGROUND: Shared decision-making (SDM) has been shown to improve healthcare outcomes and is a recognized right of patients. Policy requires health services to implement SDM. However, there is limited research into what interventions work and for what reasons. The aim of the study was to develop a series of interventions to increase the use of SDM in maternity care with stakeholders. METHODS: Interventions to increase the use of SDM in the setting of pregnancy care were developed using Behaviour Change Wheel and Theoretical Domains Framework and building on findings of an in-depth qualitative study which were inductively analysed. Intervention development workshops involved co-design, with patients, clinicians, health service administrators and decision-makers, and government policy makers. Workshops focused on identifying viable SDM opportunities and tailoring interventions to the local context (the Royal Women's Hospital) and salient qualitative themes. RESULTS: Pain management options during labour were identified by participants as a high priority for application of SDM, and three interventions were developed including patient and clinician access to the Victorian Government's maternity record via the patient portal and electronic medical records (EMR); a multi-layered persuasive communications campaign designed; and clinical champions and SDM simulation training. Factors identified by participants for successful implementation included having alignment with strategic direction of the service, support of leaders, using pre-standing resources and workflows, using clinical champions, and ensuring equity. CONCLUSION: Three interventions co-designed to increase the use of SDM for pain management during labour address key barriers and facilitators to SDM in maternity care. This study exemplifies how health services can use behavioural science and co-design principles to increase the use of SDM. Insights into the co-design of interventions to implement SDM in routine practice provide a framework for other health services, policy makers and researchers.

Gender composition and wage gaps in the Canadian health policy research workforce in comparative perspective.

BACKGROUND: Gendered challenges have been shown to persist among health practitioners in countries at all levels of development. Less is known about non-clinical professionals, that is, those who do not deliver services directly but are essential to health systems performance, such as health policy researchers. This national observational study examined gender occupational segregation and wage gaps in the Canadian health policy research workforce using a cross-domain comparative labour market analysis approach. METHODS: Sourcing data from the 2016 population census, we applied linear regression and Oaxaca-Blinder decomposition techniques to assess wage differentials by sex, traditional human capital measures (e.g., age, education, place of work), and social identity variables intersecting with gender (household head, childcare, migrant status) among health policy researchers aged 25-54. We compared the gender composition and wage gap with seven non-health policy and programme domains, as mapped under the national occupational classification by similarity in the types of work performed. RESULTS: The health policy research workforce (N = 19 955) was characterized by gender segregation: 74% women, compared with 58% women among non-health policy research occupations (N = 102 555). Women health policy researchers earned on average 4.8% (95% CI 1.5‒8.0%) less than men after adjusting for other professional and personal variables. This gap was wider than among education policy researchers with similar gender composition (75% women; adjusted wage gap of 2.6%). Wages among health policy researchers were 21.1% (95% CI 19.4‒22.8%) lower than their counterparts in the male-dominated economics policy domain, all else being equal. Overall, women's earnings averaged 3.2% lower than men's due to factors that remained unexplained by policy domain or other measured predictors. CONCLUSIONS: This investigation found that the gender inequalities already widely seen among clinical practitioners are replicated among health policy researchers, potentially hindering the competitiveness of the health sector for attracting and retaining talent. Our findings suggest intersectoral actions are necessary to tackle wage gaps and devaluation of female-dominated health professions. Accountability for gender equity in health must extend to the professionals tasked with conducting equity-informative health policy research.

Implementing cancer patient pathways in Scandinavia how structuring might affect the acceptance of a politically imposed reform.

Through political decisions all three Scandinavian countries implemented national reforms in cancer care introducing cancer patient pathways. Though resistance from the professional community is common to top-down initiatives, we recognized positive receptions of this reform in all three countries and professionals immediately contributed in implementing the core measures. The implementation of a similar reform in three countries with a similar health care system created a unique opportunity to look for shared characteristics. Combining analytical framework of institutional theory and research on policy implementation, we identified common patterns of structuring of the initial implementation: The hierarchical processes were combined with supplementary structures located both within and outside the formal management hierarchy. Some had a permanent character while others were more project-like or even resembled social movements. These hybrid structures made it possible for actors from high up in the hierarchy to communicate directly to actors at the operational hospital level. Across the cases, we also identified structural components acting together with the traditional command-control; negotiation, consensus and counseling. However, variations in the presence of these did not seem to have significant impact on processes causing decisions and acceptance. These variations may, however, influence the long-term practice and outcome of cancer-care pathway-reform. Knowledge from our study should be considered when orchestrating future health care reforms and especially top-down politically initiated reforms.

Impact of the 1115 behavioral health Medicaid waiver on adult Medicaid beneficiaries in New York State.

OBJECTIVE: To evaluate the impact of the Health and Recovery Plan (HARP), a capitated special needs Medicaid managed care product that fully integrates physical and behavioral health delivery systems in New York State. DATA SOURCES: 2013-2019 claims and encounters data on continuously enrolled individuals from the New York State Medicaid data system. STUDY DESIGN: We used a difference-in-difference approach with inverse probability of exposure weights to compare service use outcomes in individuals enrolled in the HARP versus HARP eligible comparison group in two regions, New York City (NYC) pre- (2013-2015) versus post- (2016-2018) intervention periods, and rest of the state (ROS) pre- (2014-2016) versus post- (2017-2019) intervention periods. DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: HARPs were associated with a relative decrease in all-cause (RR = 0.78, 95% CI 0.68-0.90), behavioral health-related (RR = 0.76, 95% CI 0.60-0.96), and nonbehavioral-related (RR = 0.87, 95% CI 0.78-0.97) stays in the NYC region. In the ROS region, HARPs were associated with a relative decrease in all-cause (RR = 0.87, 95% CI 0.80-0.94) and behavioral health-related (RR = 0.80, 95% CI 0.70-0.91) stays. Regarding outpatient visits, the HARPs benefit package were associated with a relative increase in behavioral health (RR = 1.21, 95% CI 1.13-1.28) and nonbehavioral health (RR = 1.08, 95% CI 1.01-1.15) clinic visits in the NYC region. In the ROS region, the HARPs were associated with relative increases in behavioral health (RR = 1.47, 95% CI 1.32-1.64) and nonbehavioral health (RR = 1.17, 95% CI 1.11-1.25) clinic visits. CONCLUSIONS: Compared to patients with similar clinical needs, HARPs were associated with a relative increase in services used and led to a better engagement in the HARPs group regardless of the overall decline in services used pre- to postperiod.

What place does nurse-led research have in the COVID-19 pandemic?

AIM: Reflect upon the visibility of nursing-led research during the COVID-19 pandemic. BACKGROUND: The emerging SARS-CoV-2 infection has galvanized collaborative and multidisciplinary efforts in clinical and research practice worldwide. The scarce evidence-base to manage patients with COVID-19 has included limited nurse-led research. INTRODUCTION: Clinical research nurses have greatly contributed to the delivery of COVID-19 research, yet the number of COVID-19 nursing-led research papers appears to be limited, with even fewer nurse-led research projects funded. METHODS: Authors' views and PubMed search on 'COVID-19 and nursing'. FINDINGS: There is a dearth of nursing-led research. Most papers describe the nursing contribution to COVID-19 care, changes in nursing working arrangements and emotional burden. There are opportunities to explore the consequences to vulnerable population groups of public health measures implemented to stop the progress of the COVID-19 pandemic. DISCUSSION: Workforce gaps, limited integration in research structures and clinical redeployment may have hampered nurse-led research. COVID-19 may exacerbate staffing deficits by disrupting the education pipeline, obstructing the transition from clinical to academic practice, particularly in areas where clinical academic roles are yet to emerge. CONCLUSION: The absence of nurse-led research in COVID-19 can be explained by chronic, underlying factors and the features of the pandemic response. Emerging models of care, effective staffing and inequalities related to COVID-19 appear obvious research areas. Nursing leadership needs to strengthen its political voice and lobbying skills to secure nurse-led research funding. IMPLICATIONS FOR NURSING POLICY: Embracing international nursing research, strengthening collaborations and lobbying policymakers for investment in nurse-sensitive research would enhance the response to COVID-19.

The Firearm Suicide Crisis: Physicians Can Make a Difference.

Firearm suicide receives relatively little public attention in the United States, however, the United States is in the midst of a firearm suicide crisis. Most suicides are completed using a firearm. The age-adjusted firearm suicide rate increased 22.6% from 2005 to 2017, and globally the US firearm suicide rate is 8 times higher than the average firearm suicide rate of 22 other developed countries. The debate over how to solve the firearm suicide epidemic tends to focus on reducing the firearm supply or increasing access to behavioral health treatment. Ineffectual federal firearm control policies and inadequate behavioral health treatment access has heightened the need for primary care physicians to play a more meaningful role in firearm suicide prevention. We offer suggestions for how individual physicians and the collective medical community can take action to reduce mortality arising from firearm suicide and firearm deaths.

Identifying diabetes management opportunity areas in the USA.

Using adherence to diabetes management guidelines as a case study, this paper applied a novel geospatial hot-spot and cold-spot methodology to identify priority counties to target interventions. Data for this study were obtained from the Dartmouth Atlas of Healthcare, the United States Census Bureau's American Community Survey and the University of Wisconsin County Health Rankings. A geospatial approach was used to identify four tiers of priority counties for diabetes preventive and management services: diabetes management cold-spots, clusters of counties with low rates of adherence to diabetes preventive and management services (Tier D); Medicare spending hot-spots, clusters of counties with high rates of spending and were diabetes management cold-spots (Tier C); preventable hospitalisation hot-spots, clusters of counties with high rates of spending and are diabetes management cold-spots (Tier B); and counties that were located in a diabetes management cold-spot cluster, preventable hospitalisation hot-spot cluster and Medicare spending hot-spot cluster (Tier A). The four tiers of priority counties were geographically concentrated in Texas and Oklahoma, the Southeast and central Appalachia. Of these tiers, there were 62 Tier A counties. Rates of preventable hospitalisations and Medicare spending were higher in Tier A counties compared with national averages. These same counties had much lower rates of adherence to diabetes preventive and management services. The novel geospatial mapping approach used in this study may allow practitioners and policy makers to target interventions in areas that have the highest need. Further refinement of this approach is necessary before making policy recommendations.

Patient perceptions of tobacco control after smoke-free hospital grounds legislation: Multi-center cross-sectional study.

OBJECTIVE: To examine patient perceptions of the role of health care providers in tobacco control and tobacco-related services they should provide after the introduction of national smoke-free hospital grounds legislation in Spain. DESIGN: Multi-center cross-sectional study. SETTING: Thirteen hospitals in Barcelona province in 2014-2015. PARTICIPANTS: A total of 1,047 adult hospital patients, with a stay ≥ 24 h were randomly selected. METHOD: We explored participants' perceptions of the role of health professionals and hospitals in tobacco control by asking about their agreement with several statements after the introduction of national legislation on smoke-free hospital grounds: (i) health professionals "should set an example and not smoke" and "should provide smoking cessation support"; (ii) hospitals "should provide smoking cessation treatments" and are "role model organizations in compliance with the smoke-free legislation", and (iii) "hospitalization is a perfect moment to quit smoking". Responses were described overall and according to participant and hospital characteristics: patient sex and age, type of hospital unit, number of beds, and smoking prevalence among hospital staff. RESULTS: The majority of participants considered that health professionals should be role models in tobacco cessation (75.3%), should provide smoking cessation support to patients (83.0%), and that hospitalization is a good opportunity for initiating an attempt to quit (71.5%). Inpatients admitted to general hospitals where smoking cessation was not given as part of their portfolio, with a low level of implementation in tobacco control, and who stayed in surgical units had higher expectations of receiving smoking cessation interventions. CONCLUSIONS: Inpatients strongly support the role of hospitals and health professionals in tobacco control and expect to receive smoking cessation interventions during their hospital stay. Systematically providing smoking cessation services in hospitals may have a relevant impact on health outcomes among smokers and on health care system expenditures.

A National Scoping Study on Barriers to Conducting and Using Research Among Nurses in the United Arab Emirates.

It is important that nurses fully engage with the development and use of evidence-based practice so they can influence policy and improve patient care. There are significant challenges in developing nursing research and evidence-based practice in the United Arab Emirates (UAE). Therefore, the UAE Nursing and Midwifery Council formed a Scientific Research Subcommittee to lead the development of nursing research. Following a literature review to assess the status of nursing research in the UAE, the Subcommittee initiated a study to clarify UAE nurses' perceptions of barriers to implementing research. The results were expected to enable comparisons with other countries and establish a baseline on which to build and prioritize initiatives to address identified barriers. A cross-sectional design with convenience sampling was used to survey 606 nurses from across the UAE. The survey included the BARRIERS questionnaire and was administered online and in paper-based formats. The top three nurse-perceived barriers that affected nurses' use of research in the UAE (in descending order) were as follows: lack of authority to change patient care procedures, insufficient time to read research, and insufficient time on the job to implement new ideas. The highest ranked barriers to nurses conducting research in the UAE were lack of time and competing demands for time. The findings of this survey and a published literature review informed development of a strategy to address identified barriers to nurses in the UAE using and conducting research. This multifaceted strategy includes initiatives to reform policy and practice at local and national levels.

Optimal timing for heart transplantation in patients bridged with left ventricular assist devices: Is timing of the essence?

OBJECTIVES: Due to the scarcity of donor hearts to meet recipient demands, more than 40% of heart transplants are performed in patients bridged to transplant (BTT) with a left ventricular assist device (LVAD). The objective of this study was to determine the effect of BTT duration with an LVAD on posttransplant outcomes. METHODS: From 2009 to 2014, we identified 2639 fee-for-service Medicare patients who underwent a primary heart transplants with 1186 (45%) patients BTT with an LVAD. The LVAD patients were stratified as BTT ≤31 days (n = 28 [2.4%]), BTT 31-365 days (n = 748 [63.1%]), and BTT >365 days (n = 409 [34.5%]). Patients went directly to heart transplantation and were not bridged in 1453 cases (55%). LVAD duration was analyzed dichotomously and as a continuous variable with adjusted overall survival as the primary end point. RESULTS: All-cause mortality was significantly worse in patients who were BTT <31 days. Survival at 30 days was 81.5% for BTT <31 days, 94% for BTT 31 to 365 days, 95% for BTT >365 days, and 94% for no BTT. At 1 year, survival was 74% for BTT <31 days, 85% for BTT 31 to 365 days, 88% for BTT >365 days, and 89% for no BTT (P = .018). When LVAD duration was analyzed as a continuous variable, patients BTT with an LVAD <34 days had significantly increased mortality. CONCLUSIONS: Patients who underwent heart transplantation within the first month of BTT with an LVAD had significantly increased mortality. However, there was no survival difference among patients who were BTT with an LVAD longer than 31 days.

Conducting health policy analysis in primary care research: turning clinical ideas into action.

Healthcare guidelines play a prominent role in the day-to-day practice of primary care providers, and health policy research leads to the formation of these guidelines. Health policy research is the multidisciplinary approach to public policy explaining the interaction between health institutions, special interests and theoretical constructs. In this article, we demonstrate how primary care providers can conduct high-impact health policy research using Eugene Bardach's eightfold policy analysis framework in a primary care context. In a medical case, a woman with a history of total hysterectomy had scheduled a visit for a Papanicolaou (Pap) smear screening test as part of a well-woman health check-up with a family medicine resident. Conflicting recommendations on Pap smear screening after total hysterectomy sparked an investigation using the US Preventive Services Task Force criteria for conducting a health policy analysis. We illustrate broadly how clinical care dilemmas can be examined by using Bardach's broadly applicable health policy framework in order to inform meaningful policy change. Bardach's framework includes (1) defining the problem, (2) assembling evidence, (3) constructing alternatives, (4) selecting criteria, (5) projecting outcomes, (6) confronting trade-offs, (7) decision-making and (8) sharing the results of the process. The policy analysis demonstrated insufficient evidence to recommend Pap test screening after hysterectomy and the findings contributed to national recommendations. By following Bardach's steps, primary care researchers have a feasible and powerful tool for conducting meaningful health policy research and analysis that can influence clinical practice.

Day of Week, Site of Service, and Patient Complexity Disparities in Musculoskeletal MRI Interpretations by Radiologists Versus Nonradiologists.

OBJECTIVE: Although most musculoskeletal MRI examinations are interpreted by radiologists, some nonradiologists provide interpretations as well. We aimed to study day of week (weekday vs weekend), site of service, and patient complexity differences between radiologists and nonradiologists interpreting lower extremity MRI examinations on Medicare beneficiaries. MATERIALS AND METHODS: Using fee-for-service carrier claims for a 5% sample of Medicare beneficiaries nationally from 2012 through 2014, we identified all lower extremity joint MRI examinations. Services were classified by physician specialty, day of week, and site of service. Charlson comorbidity index (CCI) values were calculated for all patients. Chi-square statistical testing was performed. RESULTS: Of all 125,800 billed lower extremity joint MRI examinations, 118,295 (94.0%) were performed on weekdays and 7505 (6.0%) on weekends. Of the weekday examinations, radiologists interpreted 85,991 (83.3%) and nonradiologists 17,260 (16.7%). Of the weekend examinations, radiologists interpreted 6212 (92.8%) and nonradiologists 485 (7.2%). Of examinations performed in inpatient hospital and emergency department settings, radiologists interpreted 6499 (99.2%) and nonradiologists 51 (0.8%). Of the examinations on the most clinically complex patients (CCI ≥ 3), radiologists interpreted 4228 (90.2%) and nonradiologists 461 (9.8%). All interspecialty differences were statistically significant (p < 0.001). CONCLUSION: In the Medicare population, radiologists interpret most lower extremity joint MRI examinations. Compared with nonradiologists, radiologists disproportionately provide services on weekends, in the highest acuity settings, and on the most clinically complex patients. To promote patient access and minimize disparities, future pay-for-performance metrics should consider temporal, acuity, and complexity parameters.

Midwifery policy in contemporary and modern China: From the past to the future.

OBJECTIVE: This study aims to outline the progress of midwifery-related policies in contemporary and modern China as well as the obstacles in this process, and to provide recommendations for policy makers in the establishment of Chinese midwifery policies, ultimately promoting the development of midwifery in China. BACKGROUND AND INTRODUCTION: Policy plays an increasingly important role in midwifery development, particularly needed in modern China. A review of policies of midwifery could help policy makers develop effective strategies to address current problems in China, including the insufficient numbers of midwives, the shrinking of responsibility and the degradation of midwives' competency. METHODS: The Policy Triangle was used to examine through literature the laws and regulations regarding midwifery from 1928 in China and was conducted from April to September in 2013. This was followed by insider interviews with two senior policy makers from the National Health Commission to explain nursing policy progress, thereby identifying the reasons why midwifery has developed more slowly than nursing. RESULTS: The development of midwifery in China could be classified into four stages: (1) the beginning period (1928-1949), beginning with the first midwifery rules; (2) the development period (1949-1979), in which the quality and quantity of midwives were significant; (3) the unclear positioning period (1979-2008), without clear midwifery policy; and (4) the subordination to nursing period (2008-present), with the Nurse Byelaw 2008 stating that midwives must apply for nursing licenses. DISCUSSION: The main factors influencing midwifery policies are: (1) social background, such as the changes of different governments and health care reform, and (2) the powers of the actors. Currently, it is an appropriate time to develop strategies for policy makers to facilitate midwifery development in China. CONCLUSIONS AND IMPLICATIONS FOR HEALTH POLICY: Midwifery policy should be independently included in the frame of national medical industry reform because midwives are an indispensable part of the health care workforce. In-depth research should be conducted to confirm the position of midwifery in China to ensure its sustainable development.

The Affordable Care Act Attenuates Financial Strain According to Poverty Level.

We use data from the 2011-2016 National Health Interview Survey to examine how the Patient Protection and Affordable Care Act (ACA) has influenced disparities in health care-related financial strain, access to care, and utilization of services by categories of the Federal Poverty Level (FPL). We use multivariable regression analyses to determine the ACA's effects on these outcome measures, as well as to determine how changes in these measures varied across different FPL levels. We find that the national implementation of the ACA's insurance expansion provisions in 2014 was associated with improvements in health care-related financial strain, access, and utilization. Relative to adults earning more than 400% of the FPL, the largest effects were observed among those earning between 0% to 124% and 125% to 199% of the FPL after the implementation of the ACA. Both groups experienced reductions in disparities in financial strain and uninsurance relative to the highest FPL group. Overall, the ACA has attenuated health care-related financial strain and improved access to and the utilization of health services for low- and middle-income adults who have traditionally not met income eligibility requirements for public insurance programs. Policy changes that would replace the ACA with less generous age-based tax subsidies and reductions in Medicaid funding could reverse these gains.

Strengthening the policy environment for health research in the Philippines: Insights from a preliminary analysis of existing policies

@#<p><strong>BACKGROUND AND OBJECTIVE:</strong> Research plays an important role in generating new knowledge that could improve health outcomes when translated into action. As such, there must exist a supportive research policy environment that facilitates the provision of necessary resources and sustainably ensures an appropriate number of skilled researchers buttressed by institutions. These, in turn, are envisioned to provide facilities, information systems, financial grants, and avenues for career development and collaboration. This study aims to analyze factors in the current policy environment that makes health research possible in the Philippines.</p><p><strong>METHODS:</strong> Qualitative exploratory design was used to characterize the Philippine health research environment. Guided by Adamchak's framework on policy environment, a content review of 39 policy documents (1991 to 2018) by the four core agencies of the Philippine National Health Research System was conducted. Seven elements of the policy environment were described.</p><p><strong>RESULTS:</strong> The policies analyzed in this study mainly addressed the legal, political, cultural, economic, and ecological elements of the policy environment. Policies that support the demographic and technological elements are lacking, in that these leave out details that are essential for capacity building and use of research output. A cross-cutting effort to resolve gaps may be necessary.</p><p><strong>CONCLUSION:</strong> Several factors continuously affect the environment in which policy is developed. There is room for improvement in terms of showcasing the government's regulatory quality and independence from political pressure. Equal attention must also be paid to human capital development, innovation partnerships, and mechanisms to improve knowledge impact, absorption, and utilization.</p>

Factors influencing sexually transmitted infections among adolescents in South Korea.

BACKGROUND: No data exist regarding the sexually transmitted infection (STI) rate in adolescents aged 12-15 in South Korea. Only a Korean few studies have attempted to investigate the factors influencing sexually transmitted infections among adolescents. AIM: The purpose of this study was to investigate the self-reported sexually transmitted infection contraction rate and analyse individual and family factors that influence this rate among middle school students aged 12-15 in South Korea. METHODS: Using statistics from the 8th Korea Youth Risk Behavior Web-based Survey, secondary data analysis was conducted. The study sample consisted of 714 individuals who had reported initiating sexual intercourse. RESULTS: The rate of self-reported sexually transmitted contraction was 13.5%. The following factors predicted STI contraction: second year of middle school, excellent academic achievement, habitual or purposeful drug use, first intercourse before middle school, intercourse after drinking alcohol, weekly allowance, and living without family predicted sexually transmitted infection contraction. LIMITATIONS: The parental data were collected by the self-reported surveys in a cross-sectional manner and questions of STI contraction and intercourse after drinking may have confused the subjects. CONCLUSION: We need to utilize these predictors in providing adolescents with sexual health interventions and establishing adolescent sexual health policies. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Increased sex education and employment of a school nurse in each middle school are needed. High-risk students need to be monitored given the predictors of sexually transmitted infection contraction, and the school health personnel need to inform female students and their parents the importance of seeing a gynaecologist for regular check-ups.

Primary health care research in Bolivia: systematic review and analysis.

Bolivia is currently undergoing a series of healthcare reforms centred around the Unified Family, Community and Intercultural Health System (SAFCI), established in 2008 and Law 475 for Provision of Comprehensive Health Services enacted in 2014 as a first step towards universal health coverage. The SAFCI model aims to establish an intercultural, intersectoral and integrated primary health care (PHC) system, but there has not been a comprehensive analysis of effective strategies towards such an end. In this systematic review, we analyse research into developing PHC in Bolivia utilizing MEDLINE, the Virtual Health Library and grey literature from Pan American Health Organization/World Health Organization's internal database. We find that although progress has been made towards implementation of a healthcare system incorporating principles of PHC, further refining the system and targeting improvements effectively will require increased research and evaluation. Particularly in the 7 years since establishment of SAFCI, there has been a dearth of PHC research that makes evaluation of such key national policies impossible. The quantity and quality of PHC research must be improved, especially quasi-experimental studies with adequate control groups. The infrastructure for such studies must be strengthened through improved financing mechanisms, expanded institutional capacity and setting national research priorities. Important for future progress are improved tracking of health indicators, which in Bolivia are often out-of-date or incomplete, and prioritization of focused national research priorities on relevant policy issues. This study aims to serve as an aid towards PHC development efforts at the national level, as well as provide lessons for countries globally attempting to build effective health systems accommodating of a multi-national population in the midst of development.

Conceptualizing the use of public involvement in health policy decision-making.

The concept of public involvement use is not well-defined in the literature. Previous research studies have provided brief accounts of how public involvement may influence health policy, but have not detailed the internal dynamics and process through which it is actually used in the policy process. The study objective is to examine and clarify the concept and process of public involvement use in health policy decision-making. Using qualitative concept analysis methods, we reviewed the literature on the use of public involvement and conducted semi-structured interviews with key informants who have theoretical and/or practical insights on public involvement and its use in policy decision-making. Our findings are organized around interrelated questions that animate how the concept of use is understood, interpreted, and operationalized. In asking, "How is 'use' perceived in relation to health policy decision-making?" meanings are constructed for the concept by identifying differences and drawing connections between "use" and related terms. In asking "How would one know if public involvement was used in health policy decision-making?" our findings weigh in on the act of listening as a precursor to use, the ways in which use is mediated, and responses to the input obtained from public involvement processes as signals of use. These findings are a first step toward improving conceptual clarity about what public involvement use means, how it is understood and interpreted by relevant actors in the public involvement and public policy fields, and how it might be operationalized. We expect our findings to be particularly useful for public involvement practitioners who are often confronted with questions from public involvement participants regarding how their input will be used in health policy decision-making.