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Although researchers argue for the importance of involving the public in developing health policy, there has been little focus on central research questions - such as what techniques of public participation work, in what circumstances, and why. This paper presents a realist synthesis which identifies and explains the underlying mechanisms and specific contextual factors that lead to effective public participation in health policy and planning. Peer-reviewed, English language literature was searched, which resulted in 77 articles for review and synthesis. This synthesis uncovered the underlying mechanism of 'political commitment' that generates public participation effectiveness. The other three possible underlying mechanisms, namely: 'partnership synergy', 'inclusiveness' and 'deliberativeness', were found to potentially provide further explanation on public participation effectiveness for health policy and planning. The findings of this review provide evidence that can be useful to health practitioners and decision-makers to actively involve the public when drafting public health policies and programs and, more importantly, guide them in deciding which strategies to best employ for which contexts. [ABSTRACT FROM AUTHOR]

The National Bowel Cancer Screening Program (NBCSP) offers population-based screening for colorectal cancer (CRC) across Australia. The aims of this paper were to highlight the inequities in CRC screening in South Australia (SA) and the system-related barriers and enablers to CRC screening from the perspective of participants identified as having inequitable participation. First, de-identified data for the SA population of the NBCSP were statistically analysed and then mapped. Second, 117 in-depth interviews were conducted with culturally and linguistically diverse (CALD) groups, Indigenous and Anglo-Saxon Australians. Participation rates in the NBCSP were geographically and statistically significantly different (P<0.0001) on the basis of gender (higher for women), age (higher for older people) and socioeconomic status (higher for more affluent people). The main system-related barriers were the lack of awareness of CRC or CRC screening within these groups, the problems with language due to most of the information being in English and the lack of recommendation by a doctor. This study revealed that inequity exists in the NBCSP participation in SA, and we identified both barriers and facilitators to CRC screening that require action at the level of both policy and practice. There is a large role in primary health care of both recommending CRC screening and facilitating equitable participation. [ABSTRACT FROM AUTHOR]

This paper presents the findings from a qualitative study, which sought to investigate the barriers and enablers to implementation of a continuous quality improvement (CQI) program by health-care professionals in Aboriginal primary health-care services in South Australia. Eighteen semi-structured interviews across 11 participating services were conducted alongside CQI implementation activities. Multiple barriers exist, from staff perspectives, which can be categorised according to different levels of the primary health-care system. At the macro level, barriers related to resource constraints (workforce issues) and access to project support (CQI coordinator). At the meso level, barriers related to senior level management and leadership for quality improvement and the level of organisational readiness. At the micro level, knowledge and attitudes of staff (such as resistance to change; lack of awareness of CQI) and lack of team tenure were cited as the main barriers to implementation. Staff identified that successful and sustained implementation of CQI requires both organisational systems and individual behaviour change. Improvements through continuing regional level collaborations and using a systems approach to develop an integrated regional level CQI framework, which includes building organisational and clinic team CQI capacity at the health centre level, are recommended. Ideally, this should be supported at the broader national level with dedicated funding. [ABSTRACT FROM AUTHOR]

Objectives. The aims of the present study were to: (1) identify trends in bariatric surgery in South Australia (SA) from 2001 to 2013; and (2) compare public and private hospitals, and so discuss the implications of these trends as they relate to equity in access to bariatric procedures and public system healthcare expenditure. Methods. An analysis of retrospective data of all bariatric procedures in public and private hospitals in SA was conducted using all SA public and private hospital administrative records between 2001 and 2013. Results. Of all procedures conducted in SA, 22.6% were revisions or reversals. The number of revisions or reversals conducted in SA has increased at a rate higher than weight loss procedures (6.4- vs 3.8-fold increase). An increasing proportion of public surgeries are revisions or reversals of weight loss procedures that occurred outside of the SA public system (interstate or in the private system). Conclusion. Further investigation is necessary to identify the pathways patients navigate to access bariatric surgery, the utilisation of public services following private procedures and why rates of revisions or reversals of bariatric procedures are increasing in SA. What is known about the topic? Rates of bariatric surgery are increasing internationally as a treatment for obesity. What does this paper add? Trends in bariatric procedures in SA have not been published. We have identified that: (1) rates of bariatric revisions or reversals in SA far surpass the rate at which bariatric weight loss procedures are increasing; (2) rates of revisions or reversals are increasing in public hospitals; and (3) an increasing number of the revision or reversal procedures in public hospitals are for weight loss procedures that have occurred outside the public system. What are the implications for practitioners? The data have implications for practitioners caring for patients interested in undergoing bariatric surgery for the treatment of obesity. The data suggest that rates of revisions or reversals are increasing in public hospitals, which suggests that further information is needed regarding the effectiveness of weight loss procedures and the implications of revision or reversal increases on waiting times for patients seeking weight loss treatment in a system with limited resources. [ABSTRACT FROM AUTHOR]

Objective. To provide baseline findings regarding Australians' trust in federal, state and local government. Methods. A computer-assisted telephone interviewing (CATI) survey was administrated during October to December 2009 to a random sample (n = 1109) across Australia (response rate 41.2%). Binary logistic regression analyses were carried out by means of SPSS. Results. Age, household size, household income, IRSD and ARIA were found to be significant indicators for trust in federal, state and local government. Trust in state government is lower for older respondents and respondents living in inner and outer regional areas. Trust in local council is lower in respondents living in inner regional areas, respondents living in disadvantaged areas, and respondents in the income bracket of $60 001 to $100 000. Trust in federal government is lower for older respondents and respondents living in disadvantaged areas. Of note is diminished trust in government among older, regional and lower income ($30 001-$60 000) respondents. Conclusions. Trust in all levels of government was found to be the lowest in population groups that are identified by empirical research and media to have the poorest access to government services. As a consequence, improved access to services for these populations may increase trust in health policy. Increased trust in health governance may in turn, ensure effective dissemination and implementation of health policies and that existing inequities are not perpetuated through distrust of health information and policy initiatives. [ABSTRACT FROM AUTHOR]