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Introduction: Interventions to support behaviour change in people living with chronic health conditions increasingly use patient groups as the mode of delivery, but these are often designed without consideration of the group processes that can shape intervention outcomes. This article outlines a new approach to designing group‐based behaviour change interventions that prioritizes recipients' shared social identity as group members in facilitating the adoption of established behaviour change techniques (BCTs). The approach is illustrated through an example drawn from research focused on people living with severe obesity. Methods: A prioritization process was undertaken in collaboration with stakeholders, including behaviour change experts, clinicians, and a former patient to develop an evidence‐based, group intervention informed by the social identity approach to health. Three phases of development are reported: (1) identification of the health problem; (2) delineation of intervention mechanisms and operationalization of BCTs for group delivery and (3) intervention manualization. The fourth phase, intervention testing and optimization, is reported elsewhere. Results: A group‐based behaviour change intervention was developed, consisting of 12 group sessions and 3 one‐to‐one consultations. The intervention aimed to support the development of shared social identity among recipients, alongside the delivery of evidence‐based BCTs, to improve the likelihood of successful intervention and health outcomes among people living with severe obesity. Conclusions: A manualized intervention, informed by the social identity approach to health, was systematically designed with input from stakeholders. The development approach employed can inform the design of behavioural interventions in other health contexts where group‐based delivery is planned. [ABSTRACT FROM AUTHOR]

Background: eHealth technologies are widely believed to contribute to improving health and patients' experience of care and reducing health system costs. While many studies explore barriers to and facilitators of eHealth innovation, we lack understanding of how this knowledge can be translated into workable, practicable and properly resourced knowledge mobilisation (KM) strategies. Aims and objectives: This paper describes the aims, methods and outputs of a large European Union funded project (eHealth Productivity and Innovation in Cornwall and the Isles of Scilly (EPIC)) to support the development of a sustainable innovation ecosystem in Cornwall and the Isles of Scilly, in order to explore how knowledge mobilisation activities can help bridge the know-do gap in eHealth. Conclusions: Preparatory knowledge sharing, linkage making and capacity building are necessary preliminaries to co-production, with an emphasis on capturing the uses to which patients, carers and health workers want to put new technologies rather than promoting new technology for its own sake. Financial support can play a key role in supply-side dynamics, although the contextual and organisational barriers to eHealth innovation in England should not be underestimated.

This article suggests why a different approach may be required for commissioning services from third sector providers than from, say, corporate or public providers. English systems for commissioning third sector providers contain both commodified elements (for example formal procurement, provider competition, commissioner–provider separation) and collaborative, relational elements (for example long-term collaboration, reliance on inter-organizational networks). When the two elements conflicted, commissioners and third sector organizations tended to try to work around the commodified elements in order to preserve and develop the collaborative aspects, which suggests that, in practice, they find de-commodified, collaborative methods better adapted to the commissioning of third sector organizations. When publicly-funded services are outsourced, governments still use multiple governance structures to retain some control over the services provided. Using realist methods the authors systematically compared this aspect of community health activities provided by third sector organizations in six English localities during 2020–2022. Two modes of commissioning coexisted. Commodified commissioning largely embodied Washington consensus models of formal, competitive procurement. A contrasting, collaborative mode of commissioning relied more upon relational, long-term co-operation and networking among organizations. When the two modes conflicted, commissioners often favoured the collaborative mode and sought to adjust their commissioning to make it less commodified. [ABSTRACT FROM AUTHOR]

The English NHS has been repeatedly restructured since 1991. Drawing on multiple case studies in English primary health care from 1998 to 2005 and on (other) published studies, this article uses Therborn's theory of power to make a framework analysis of how these reforms redistributed power between medicine and management in NHS primary care. Legal changes ended the GP monopoly of primary medical care provision and, with greater managerial discretion in NHS spending, allowed more diverse organisational forms of primary care provision to appear, although general practice remained predominant. Changes in managerial and professional ideologies relaxed the restrictions on managerial decisions about general practice. Re-negotiations between the medical profession and the state mostly tended to increase managerial power. Evidence-based medicine has tended to weaken the impersonal sources of medical power. On balance, these events have tended to increase managerial power over medical practice. They also suggest adjustments to Therborn's conceptualisation of power.

Hirschman contrasts exit and voice as 'recuperation' mechanisms for making organisations responsive to users. However, the emergence of health-care quasi-markets and of network governance structures since Hirschman necessitate revising his theory, for they complicate the relationships between governance structures and recuperation mechanisms. Using a case study of nine primary care trusts (PCTs), this paper analyses the recuperation mechanisms, governance structures and relations between them in primary care in England. User voice can be exercised through dedicated networks besides hierarchies. As well as the 'user exit' described by Hirschman, two new 'exit' mechanisms now exist in quasimarkets. Commissioner exit occurs when a third-party payer stops using a given provider. Professional proxy exit occurs when a general practitioner (GP) fund-holder (or analogous budget-holder) behaves similarly. Neither exit mechanism requires the existence of mechanisms for user exit from healthcare purchasers, provided strong voice mechanisms exist instead to make commissioners responsive to users' demands. Establishing such voice mechanisms is not straightforward, however, as the experience of English PCTs illustrates. Keywords: Exit; Voice; Governance; Primary care; England; Quasi-market; UK

Epidemiological, demographic and environmental crises, transition to a new political regime and exceptionally severe economic crises were powerful stimuli to health sector reform in Russia. The Russian Federation responded by introducing medical insurance whilst decentralising public administration. Yet despite intense contextual pressures to do so and a new policy climate, Russian hospitals found it difficult to reprofile services and reallocate their resources. A case study analysing governance structures in Sverdlovsk oblast reveals that medical insurance created incentives to reduce costs by reducing bed-days, but if hospitals did so they would lose money under the formulae through which decentralised local government still allocated around three-quarters of hospital income. If instead hospitals tried to increase budgetary income by increasing numbers of bed-days, the insurance system would penalise them. This specific form of policy mess can be called 'governance in gridlock'. The juxtaposition of two overlapping but incompatible sets of governance structures practically immobilised official hospital management systems. It is as one-sided to blame residues of the Soviet system for this gridlock as it is to blame the medical insurance system. Gridlock resulted from the interaction of the two, a problem to which all health system reform is potentially vulnerable. Keywords: Decentralisation; Governance; Gridlock; Health insurance; Hospital management; Russia; Soviet Union

Analyses and policy statements about publicly funded services frequently distinguish `demands' from `needs'. The distinction has been challenged, calling into question the coherence of formulating welfare policy and evaluating public services in terms of needs. This paper explicates the conceptual distinction between demands and needs in terms of derived demand and information asymmetry. `Needs' can be defined as `rational demands', where `rational' means `consistent and evidence-based', and `demands' as `desires' rather than `effective (i.e. economic) demand'. On that basis, practical demand management in needs-based public services would require: 1. Knowledge of users' demands for services; 2. Content analyses of users' demands to identify any misinformed demands; 3. Conversion of any misinformed demands into evidence-based specifications of needs; 4. Formulating coherent, evidence-based demands on behalf of users who cannot to do so themselves. A study of English NHS Primary Care Groups explores the problems which authorities responsible for publicly funded services face in undertaking these activities. Demand management receives low priority in terms of the incentives and intellectual resources applied to it. Needs assessment has higher priority but is regarded as a branch of evidence-based professional practice, controlled by professionals rather than responsive to users. This separation tends to defeat the purposes of needs-based public services.