Search

The National Institute for Health Research (NIHR) aims to improve national 'health and wealth' by providing infrastructural support to enable clinical research in National Health Service settings in England and Wales. Cognisant of the consequences of studies' failure to achieve required numbers of participants, it also actively campaigns to promote patient awareness of research, and willingness to participate in trials. In this paper, we analyse recent NIHR campaigns and policies designed to encourage patients to participate in clinical research to interrogate how they are implicated in the national bioeconomy. In doing so we expand the notion of 'clinical labour' to include the work of patient recruitment and highlight an emergent obligation on patients to contribute to research processes. Whereas once patient knowledge and experience may have been devalued, here we draw on the concept of 'assetisation' (Birch 2012) to explore the emergent relationship between healthcare system and patient as research participant. We consider how patients' contribution goes beyond the provision of standardised objects of valuation so that patients themselves may be perceived as assets to, not only recipients of, the national healthcare system. [ABSTRACT FROM AUTHOR]

Background: Health impact assessment (HIA) involves assessing in advance how projects affect the health of particular populations. In many countries, HIA has become central to attempts to better integrate health and public participation into policy and decision making. In 2017, HIA gained statutory status in Wales. This study considers how the public and their evidence are presented within HIA reports and what insights this offers into how public participation is constructed within public health. Methods: Critical discourse analysis, as described by Fairclough (2003), to analyse seven HIA reports produced in Wales. Results: Discourses were grouped under four headings. "Consensus and polyphony" relates to the tendency to produce consensus. "Authors and authority" is concerned with how participants and their evidence are shaped by different authorial stances. "Discussions, decisions and planes of action" brings together material on how decision makers are (or are not) brought into contact with evidence in the reports. "Evidence: fragmentation and compression" analyses strategies of abstracting. Conclusions: This analysis suggests that participants and their evidence are presented in specific ways within HIA reports and that these are particularly shaped by genre, authorial stances and approaches to abstracting and re‐ordering texts. Acknowledging these issues may create opportunities to develop HIA in new directions. Further research to test these conclusions and contribute to a wider "sociology of public health documents" would be of value. [ABSTRACT FROM AUTHOR]

Although children's social care is an area rich in guidance, there is very little research looking at the implementation of new policies in the United Kingdom. In this article, we report on the first stage of a realist evaluation of the implementation of the new Safeguarding Children from Child Sexual Exploitation guidance in Wales. We discuss the development of an initial programme theory, for which we conducted semi‐structured interviews with practitioners and managers in three local authorities. We developed programme theories across three areas: policy nature and development, implementation plans and organizational context. Findings suggest that, for policies to produce a significant impact on practice, they need to be sufficiently different to social workers' current perceptions of practice. Second, we found that the coordination between national and local policies is critical for successful implementation as contradictions between them might lead to confusion in what local teams should prioritize. Finally, our findings highlight the importance of effective communication of policy changes, as well as a supportive organizational culture to strengthen implementation in local contexts. These findings illustrate the complexity of policy implementation and the need for policymakers to consider the meaningful involvement of local practitioners in national policy development. [ABSTRACT FROM AUTHOR]

Breastfeeding and the provision of human milk is established as protecting infant and maternal health. However, breastfeeding rates in many countries, including Wales, are low. Given the significant health, economic and environmental impacts of this, the need to strengthen breastfeeding promotion, protection and support is paramount. As part of this, the becoming breastfeeding friendly: a guide to global scale‐up (BBF) initiative sets out a methodology to enable countries to assess their readiness to scale up breastfeeding protection, promotion and support by gathering data and scoring progress under eight areas, termed 'gears', shown to be essential for large‐scale change. Recently, Wales took part in the BBF initiative. A cross‐sector committee, including stakeholders from Universities, Welsh Government, Public Health Wales and Health Boards alongside critical friends scored Wales' support for breastfeeding across the eight gears. The overall score for Wales was 1.1 out of a possible 0–3, representing a moderate scaling up the environment for breastfeeding. Six gears were rated in the moderate gear strength category and two ('Promotion' and 'Advocacy') in the weak gear strength category. Gaps in breastfeeding support were identified and 31 recommendations covering six themes for change were put forward. These included a strategic action plan, consistent and long‐term funding, a nuanced, cocreated engagement and promotion framework, strengthened education and training, robust monitoring and evaluation mechanisms and ensuring maternity rights and the International Code of Marketing of Breastmilk Substitute are upheld. Taken together, the analysis and recommendations present a clear vision for protecting and not merely promoting breastfeeding in Wales. Highlights: Wales is a small nation with devolved health legislation that should take advantage of its power to enact countrywide, universal breastfeeding policy and strategy.Policy, promotion and support should be nuanced and cocreated by communities to meet the needs of the diverse Welsh population.Policy must be supported by sustainable investment and political, positional and operational buy‐in across government, health and social services.Strategy must be evidence‐based with an emphasis on women's experiences and voices. Robust monitoring and evaluation mechanisms must be put in place so that data are up to date and meaningful. [ABSTRACT FROM AUTHOR]

Background and Aims: The Licensing Act 2003 deregulated trading hours in England and Wales. Previous evaluations have focused upon consumption and harm outcomes, finding mixed results. Several evaluations speculated on the reasons for their results, noting the role of changes in the characteristics of drinking occasions. This study aimed to test proposed mechanisms of effect for the Licensing Act 2003 by evaluating changes in characteristics of drinking occasions. Design, Setting and Participants Interrupted monthly time–series analysis of effects in England and Wales versus a Scottish control series, using 2001–08 data collected via 7‐day drinking occasions diaries by the market research company Kantar (n = 89 192 adults aged 18+). Measurements Outcomes were start‐ and end‐time of each reported occasion; variation in finish time; prevalence of pre‐loading, post‐loading and late‐night drinking; and alcohol consumption (in units). Findings After the introduction of the Act, occasions shifted later at night in England and Wales [finish time +11.4 minutes; 95% confidence interval (CI) = 3.6–19.2]. More occasions involved pre‐loading in England and Wales relative to Scotland (0.02% increase; 95% CI = 0.01–0.03). There was no evidence of changes in variation in finish time, post‐loading, late‐night drinking or alcohol consumption. Conclusions: The Licensing Act 2003 in England and Wales appears to have had only limited effects on the characteristics of drinking occasions. This may help to explain its lack of substantial impacts on alcohol harms [ABSTRACT FROM AUTHOR]

Background: For public health policies to be effective, it is critical that they are acceptable to the public as acceptance levels impact success rate. Objective: To explore public acceptance of public health statements and examine differences in acceptability across socio‐demographics, health behaviours (physical activity, diet, binge drinking and smoking), health status and well‐being. Method: A cross‐sectional survey was conducted with a nationally representative sample (N = 1001) using a random stratified sampling method. Face‐to‐face interviews were conducted at homes of residents in Wales aged 16+ years. Individuals reported whether they agreed, had no opinion, or disagreed with 12 public health statements. Results: More than half of the sample were supportive of 10 out of 12 statements. The three statements with the greatest support (>80% agreement) reflected the importance of: a safe and loving childhood to becoming a healthy adult, schools teaching about health, and healthier foods costing less. Individuals who engaged in unhealthy behaviours were less likely to agree with some of the statements (eg 39.8% of binge drinkers agreed alcohol adverts should be banned compared to 57.6% of those who never binge drink; P <.001). Conclusions: Findings show an appetite for public health policies among the majority of the public. The relationship between supporting policies and engaging in healthy behaviours suggests a feedback loop that is potentially capable of shifting both public opinion and the opportunities for policy intervention. If a nation becomes healthier, this could illicit greater support for stronger policies which could encourage more people to move in a healthier direction. [ABSTRACT FROM AUTHOR]