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IntroductionHealth systems responsiveness is a key objective of any health system, yet it is the least studied of all objectives particularly in low-income and middle-income countries. Research on health systems responsiveness highlights its multiple elements, for example, dignity and confidentiality. Little is known, however, about underlying theories of health systems responsiveness, and the mechanisms through which responsiveness works. This realist synthesis contributes to bridging these two knowledge gaps.Methods and analysisIn this realist synthesis, we will use a four-step process, comprising: mapping of theoretical bases, formulation of programme theories, theory refinement and testing of programme theories using literature and empirical data from Ghana and Vietnam. We will include theoretical and conceptual pieces, reviews, empirical studies and grey literature, alongside the primary data. We will explore responsiveness as entailing external and internal interactions within health systems. The search strategy will be purposive and iterative, with continuous screening and refinement of theories. Data extraction will be combined with quality appraisal, using appropriate tools. Each fragment of evidence will be appraised as it is being extracted, for its relevance to the emerging programme theories and methodological rigour. The extracted data pertaining to contexts, mechanisms and outcomes will be synthesised to identify patterns and contradictions. Results will be reported using narrative explanations, following established guidance on realist syntheses.Ethics and disseminationEthics approvals for the wider RESPONSE (Improving health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam) study, of which this review is one part, were obtained from the ethics committees of the following institutions: London School of Hygiene and Tropical Medicine (ref: 22981), University of Leeds, School of Medicine (ref: MREC19-051), Ghana Health Service (ref: GHS-ERC 012/03/20) and Hanoi University of Public Health (ref: 020-149/DD-YTCC).We will disseminate results through academic papers, conference presentations and stakeholder workshops in Ghana and Vietnam.PROSPERO registration numberCRD42020200353. Full record: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200353.

The hemoglobin A1c (A1C) test is increasingly used as a diagnostic and screening test for type 2 diabetes. With an estimated 8.8% of adults globally having diabetes, effective screening, diagnosis, and monitoring is of major global importance (1). The biomarker of A1C refers to glycated hemoglobin A molecules and has gained prominence in the diagnosis of type 2 diabetes because it offers certain advantages over plasma glucose testing regimens (2). It is well established that some of the hundreds of hemoglobin (Hb) variants, including the clinically relevant HbS, HbE, HbC, and HbD (3,4), may interfere with the validity of A1C results. Thus, testing strategies and tools employing A1C should ideally identify variants when they are present. Incidental findings of Hb variants present several ethical challenges for laboratories, health care providers, patients, and their families. These challenges have, to date, received little attention. This article reviews some of the advantages of detecting sickle cell trait, identified by the routine A1C test, but also several related ethical dilemmas. We explore issues such as whether informed consent is necessary, how the results should be communicated, how patients may be affected by knowing their carrier status, the timing of communications, complications caused by partial results, and the circumstance of being a “healthy carrier” while potentially experiencing symptoms. A multidisciplinary team and a patient diagnosed as a sickle cell carrier through the A1C test worked together to explore these ethical challenges to produce this article. We hope it will instigate discussion around the issues presented and ultimately lead to the development of appropriate international guidelines. Sickle Hb (HbS) is one of the most common Hb variants. Worldwide, an estimated 300 million people have sickle cell trait (SCT) and ∼4.4 million people have sickle cell disease (SCD), the overall name for a group …

Sickle cell disorders are a complex multisystem inherited genetic blood disorders that affect millions of people worldwide and complications of the disorders can include anaemia, pain episodes and organ damage. Medical advances, early detection, intervention in infancy and specialised care across the life-course are transforming these genetic blood disorders into chronic conditions, with longer life expectancies and better quality of life, yet public health debates continue to view sickle cell disorders as purely biomedical problems that need to be prevented. We argue that adopting a social determinants of health approach to sickle cell disorders can help to move the policy focus from viewing sickle cell disorders as burdens to be prevented, to a more holistic perspective that would ensure better health and well-being across the life-course. The social determinants of health promotes a socially just and ethical framing of health and well-being in all policies, that are fundamental to achieving the United Nations Sustainable Development Goals (SDGs), including SDG 10—of reducing health inequalities within and between countries.

Cold homes contribute to twenty to forty thousand excess winter deaths each year in the UK and approximately 300,000 hospital admissions. Using fuel poverty as an identifier for those at risk does not always capture everyday exposure to cold homes due to variations in financial trade-offs and behavioural factors. Few fuel poverty studies have combined environmental measurements with qualitative data on lived experiences of fuel poverty and cold homes. This paper looks at the strengths and limitations of using a mixed method, environmental and qualitative interviewing approach. A series of six discreet studies were conducted between 2001 and 2015 using a similar methodology with a mixed methods design where in-depth interviews were conducted alongside temperature and humidity measurements. The research studies found that combining environmental monitoring with qualitative research methods allows both cross validation and triangulation of data in order to provide a richer and more insightful examination into the lives of people living in cold homes. The studies demonstrate how a combined methodological approach can help explain the choices, decisions and behaviour of households experiencing cold homes and fuel poverty. The paper concludes with recommendations for future development and implementation of the research method.

Purpose“Honour”-based violence (HBV), a form of gender-based violence (GBV), has received increasing interest from media, human rights organisations, academics and the public. A significant increase in the occurrence and reporting of HBV in many parts of the world and its detrimental impact on the health and well-being of women, girls, communities and wider society; marks it as a major public health concern. However, awareness and recognition of HBV in the field of public health is low in many countries and there is little known about its nature, roots and distribution. The paper aims to discuss these issues.Design/methodology/approachThe literature was searched using the Scopus database and a series of search terms related to HBV, GBV and health and well-being.FindingsDefinition of HBV and its forms is varied across cultures. There is a lack of consensus on how HBV can be identified over other forms of violence and no explicit theoretical perspectives have been sufficiently developed to deepen the understanding of HBV. Although the findings from the review suggest that HBV forms and patterns may be regionally distinct, causes emanate from gender-based and socio-economic inequalities.Research limitations/implicationsThis review has limitations in that it included only English and Spanish language papers and those accessed through Scopus; it therefore may have excluded papers from other languages, countries and databases. Another major weakness in this review was a lack of papers specifically dedicated to HBV. Despite these weaknesses the paper is an attempt to raise awareness and recognition of HBV in public health research, policy and practice domain.Originality/valueThe findings from the review highlight the complexity of tackling HBV in a globalised world. They also provide insights on how a public health model can be used to analyse both the causes and prevention of HBV. Further, a non-culturalised, unprejudiced and inclusive definition is required to flag-up and record HBV cases.

Objectives: This study aimed to understand the influences and decisions of households with children with asthma regarding keeping warm and well at home in winter. \ud \ud Setting: Community settings in Rotherham and Doncaster, South Yorkshire, UK. \ud \ud Participants: Individuals from 35 families and 25 health, education and social care staff underwent interview. 5 group interviews were held, 1 with parents (n=20) and 4 with staff (n=25). \ud \ud Outcome measures: This qualitative study incorporated in-depth, semistructured individual and group interviews, framework analysis and social marketing segmentation techniques. \ud \ud Results: The research identifies a range of psychological and contextual influences on parents that may inadvertently place a child with asthma at risk of cold, damp and worsening health in a home. Parents have to balance a range of factors to manage fluctuating temperatures, damp conditions and mould. Participants were constantly assessing their family’s needs against the resources available to them. Influences, barriers and needs interacted in ways that meant they made ‘trade-offs’ that drove their behaviour regarding the temperature and humidity of the home, including partial self-disconnection from their energy supply. Evidence was also seen of parents lacking knowledge and understanding while working their way through conflicting and confusing information or advice from a range of professionals including health, social care and housing. Pressure on parents was increased when they had to provide help and support for extended family and friends. \ud \ud Conclusions: The findings illustrate how and why a child with asthma may be at risk of a cold home. A ‘trade-off model’ has been developed as an output of the research to explain the competing demands on families. Messages emerge about the importance of tailored advice and information to families vulnerable to cold-related harm.

Objectives To report the findings of a literature review of the concept of wellbeing and consider its operational and heuristic potential within a range of disciplines. Design A literature review to examine the philosophical roots of wellbeing and the contributions of the main disciplines uncovered by the review; economics, psychology, health studies, sociology, anthropology and biomedicine. Setting 'Wellbeing' is a concept of increasing interest to those working in health promotion, social and public health medicine and medical sociology. Despite its popularity, wellbeing lacks a clear conceptual base and there is little consensus about how it may be identified, measured and achieved. Method Although conducted rigorously this was more of a scoping exercise than a systematic review. The reviewer was given a fairly broad exploratory brief including qualitative and quantitative dimensions. The search was restricted to articles in the English Language between the years 1980-2001. Results Most disciplines tended to be biased towards one or two aspects of the three major aspects of physical, social and psychological Wellbeing, with the main exception of child wellbeing studies. Those working in economics made a significant contribution to understanding conceptual elements of wellbeing. The fields of psychology and biomedicine were more concerned with negative than positive affect. There was a particular lack of consensus and research around social wellbeing. Conclusion Although wellbeing may indeed be extremely useful as a unifying concept for all those involved in health improvement or health research,at present it is being used unreflectively, thus potentially masking differences.

Although it is gratifying to see updates to the National Institute for Health and Care Excellence (NICE) clinical guideline on feverish illness in children,1 we would like to redress the balance for concern about altered thermoregulation in sick children. Fever is a cardinal sign of inflammation, infection, and trauma, but low body temperature is also a …