Pub Date : 2024-05-01DOI: 10.12688/hrbopenres.13884.1
K. Matvienko-Sikar, Reindolf Anokye, Dimity Dutch, Moira Duffy, Eibhlin Looney, Vicki Brown, John Browne, Darren Dahly, Declane Devane, Janas Harrington, Catherine Hayes, Brittany Johnson, Patricia M Kearney, Jamie J Kirkham, Patricia Leahy-Warren, Andrew W Murphy, Sarah Redsell, A. Seidler, Helen Skouteris
Background Two core outcome sets for childhood obesity prevention have been developed; standardised sets of outcome measurement instruments for these core outcome sets are currently being developed. Core outcome sets and standardised measurement sets can reduce heterogeneity and improve evidence syntheses for trials of interventions to prevent childhood obesity and/or interventions to improve child health behaviours related to childhood obesity. Such benefits are only realised if core outcome sets and standardised measurement sets are used in trials. The aims of this study are 1) to examine trialists’ awareness and attitudes towards the two existing core outcome sets and factors influencing their use; 2) to explore the characteristics of outcome measurement instruments that trialists currently use; and 3) to better understand how trialists choose outcome measurement instruments and the factors that influence those choices. Methods A cross-sectional online survey will be conducted with researchers involved in the design and/or conduct of trials of interventions to prevent childhood obesity and/or to improve child health behaviours related to childhood obesity, in children aged 0 to 5 years (trialists). Trialists will be recruited using purposive sampling, and will complete a 22-item survey examining trialist characteristics, awareness of the existing core outcome sets, factors influencing use of the existing core outcome sets, characteristics of measurement instruments, how trialists choose measurement instruments, and factors influencing choice of measurement instrument. Quantitative data will be analysed descriptively; responses to open-ended questions will be analysed using qualitative content analysis. Conclusions Findings from this study will inform approaches to maximising use of core outcome sets and standardised measurement sets for childhood obesity prevention. Use of standardised approaches to what and how outcomes are measured in this area will reduce heterogeneity and research waste and enhance evidence syntheses to better determine intervention effects.
{"title":"Factors influencing use and choice of Core Outcome Sets and outcome measurement instruments in trials of interventions to prevent childhood obesity: A survey protocol","authors":"K. Matvienko-Sikar, Reindolf Anokye, Dimity Dutch, Moira Duffy, Eibhlin Looney, Vicki Brown, John Browne, Darren Dahly, Declane Devane, Janas Harrington, Catherine Hayes, Brittany Johnson, Patricia M Kearney, Jamie J Kirkham, Patricia Leahy-Warren, Andrew W Murphy, Sarah Redsell, A. Seidler, Helen Skouteris","doi":"10.12688/hrbopenres.13884.1","DOIUrl":"https://doi.org/10.12688/hrbopenres.13884.1","url":null,"abstract":"Background Two core outcome sets for childhood obesity prevention have been developed; standardised sets of outcome measurement instruments for these core outcome sets are currently being developed. Core outcome sets and standardised measurement sets can reduce heterogeneity and improve evidence syntheses for trials of interventions to prevent childhood obesity and/or interventions to improve child health behaviours related to childhood obesity. Such benefits are only realised if core outcome sets and standardised measurement sets are used in trials. The aims of this study are 1) to examine trialists’ awareness and attitudes towards the two existing core outcome sets and factors influencing their use; 2) to explore the characteristics of outcome measurement instruments that trialists currently use; and 3) to better understand how trialists choose outcome measurement instruments and the factors that influence those choices. Methods A cross-sectional online survey will be conducted with researchers involved in the design and/or conduct of trials of interventions to prevent childhood obesity and/or to improve child health behaviours related to childhood obesity, in children aged 0 to 5 years (trialists). Trialists will be recruited using purposive sampling, and will complete a 22-item survey examining trialist characteristics, awareness of the existing core outcome sets, factors influencing use of the existing core outcome sets, characteristics of measurement instruments, how trialists choose measurement instruments, and factors influencing choice of measurement instrument. Quantitative data will be analysed descriptively; responses to open-ended questions will be analysed using qualitative content analysis. Conclusions Findings from this study will inform approaches to maximising use of core outcome sets and standardised measurement sets for childhood obesity prevention. Use of standardised approaches to what and how outcomes are measured in this area will reduce heterogeneity and research waste and enhance evidence syntheses to better determine intervention effects.","PeriodicalId":508744,"journal":{"name":"HRB Open Research","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-16DOI: 10.12688/hrbopenres.13850.1
Pawel Hursztyn, Almas Khan, K. Matvienko-Sikar, K. Kõlves, Marguerite M. Nyhan, John Browne
Background Unforeseeable public health emergencies (PHEs) profoundly impact psychological well-being and disrupt mental health care provision in affected regions. To enhance preparedness for future emergencies, it is crucial to understand the effectiveness of mental health services, their underlying mechanisms, the populations they are tailored to, and their appropriateness across distinct emergencies. The aim of this scoping review will be to explore how mental health services have responded to PHEs, focusing on their effectiveness as well as barriers and facilitators to implementation. Methods Following the five-stage Arksey-O'Malley guidance, as updated further by Westphaln and colleagues, this mixed-methods scoping review will search academic and grey literature. Publications related to mental health interventions and supports delivered during PHEs will be considered for inclusion. The interventions and supports are operationally defined as any adaptations to mental health service provision at the international, national, regional or community level as a consequence of PHEs. The “Four Ss” framework will be utilised to provide structure for the evidence synthesis and inform categorisation of interventions and supports delivered during PHEs. Any research methodology will be considered for inclusion. Two reviewers will independently screen titles, abstracts, and full texts of publications against eligibility criteria. The gathered data will be depicted in accordance with the Four Ss” framework through the utilisation of descriptive/analytical statistics and supplemented by narrative exploration of findings. Conclusions Considering the diverse research methodologies and the varied applicability of services in different contexts of PHEs, this review will offer insights into the type, effectiveness, and implementation barriers and facilitators of mental health interventions and supports delivered during PHEs. By employing the “Four Ss” framework, the review will guide decision-making bodies in identifying effective and practical aspects of mental health system operations during emergencies.
背景不可预见的公共卫生突发事件（PHEs）对受影响地区的心理健康造成了深远的影响，并扰乱了心理保健服务的提供。为了加强对未来突发事件的准备，了解心理健康服务的有效性、其基本机制、服务对象以及在不同突发事件中的适宜性至关重要。本次范围界定审查的目的是探讨心理健康服务如何应对紧急状况，重点关注其有效性以及实施过程中的障碍和促进因素。方法 按照由 Westphaln 及其同事进一步更新的 Arksey-O'Malley 五阶段指南，本范围界定综述将采用混合方法搜索学术文献和灰色文献。与公共健康教育期间提供的心理健康干预和支持相关的出版物将被考虑纳入其中。干预和支持在操作上被定义为因公共健康教育而在国际、国家、地区或社区层面对心理健康服务提供的任何调整。将利用 "四个S "框架为证据综述提供结构，并为在公共健康教育期间提供的干预和支持的分类提供信息。任何研究方法都将被考虑纳入。两名审稿人将根据资格标准独立筛选出版物的标题、摘要和全文。收集到的数据将按照 "四个 S "框架进行描述，即利用描述性/分析性统计，并辅以对研究结果的叙述性探讨。结论 考虑到研究方法的多样性以及公共卫生教育服务在不同情况下的不同适用性，本综述将对公共卫生教育期间所提供的心理健康干预和支持的类型、有效性、实施障碍和促进因素进行深入分析。通过采用 "四个 S "框架，本综述将指导决策机构确定紧急情况下心理健康系统运作的有效和实用方面。
{"title":"Factors influencing mental health service delivery during public health emergencies: a scoping review protocol","authors":"Pawel Hursztyn, Almas Khan, K. Matvienko-Sikar, K. Kõlves, Marguerite M. Nyhan, John Browne","doi":"10.12688/hrbopenres.13850.1","DOIUrl":"https://doi.org/10.12688/hrbopenres.13850.1","url":null,"abstract":"Background Unforeseeable public health emergencies (PHEs) profoundly impact psychological well-being and disrupt mental health care provision in affected regions. To enhance preparedness for future emergencies, it is crucial to understand the effectiveness of mental health services, their underlying mechanisms, the populations they are tailored to, and their appropriateness across distinct emergencies. The aim of this scoping review will be to explore how mental health services have responded to PHEs, focusing on their effectiveness as well as barriers and facilitators to implementation. Methods Following the five-stage Arksey-O'Malley guidance, as updated further by Westphaln and colleagues, this mixed-methods scoping review will search academic and grey literature. Publications related to mental health interventions and supports delivered during PHEs will be considered for inclusion. The interventions and supports are operationally defined as any adaptations to mental health service provision at the international, national, regional or community level as a consequence of PHEs. The “Four Ss” framework will be utilised to provide structure for the evidence synthesis and inform categorisation of interventions and supports delivered during PHEs. Any research methodology will be considered for inclusion. Two reviewers will independently screen titles, abstracts, and full texts of publications against eligibility criteria. The gathered data will be depicted in accordance with the Four Ss” framework through the utilisation of descriptive/analytical statistics and supplemented by narrative exploration of findings. Conclusions Considering the diverse research methodologies and the varied applicability of services in different contexts of PHEs, this review will offer insights into the type, effectiveness, and implementation barriers and facilitators of mental health interventions and supports delivered during PHEs. By employing the “Four Ss” framework, the review will guide decision-making bodies in identifying effective and practical aspects of mental health system operations during emergencies.","PeriodicalId":508744,"journal":{"name":"HRB Open Research","volume":"55 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139961133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-16DOI: 10.12688/hrbopenres.13834.1
Tanya O'Brien, Catherine D Darker, D. Mockler, E. Barrett
Background Physical activity is essential for youth physical and mental health, yet just 15% of adolescent girls versus 22% of adolescent boys worldwide meet the World Health Organization guideline of 60 minutes of moderate-to-vigorous physical activity per day. As activity patterns established in adolescence often persist into adulthood, there is a looming risk of adverse health outcomes due to insufficient physical activity. A persistent challenge faced by physical activity providers, however, is recruiting adolescent girls into their programmes. This systematic review will quantitatively synthesise existing knowledge surrounding the recruitment of adolescent girls into physical activity interventions and aims to provide evidence-based recommendations for optimal recruitment practices. Methods Five electronic databases will be searched to identify randomised controlled trials of physical activity interventions for adolescent girls worldwide. Hand-searches of reference lists of included randomised controlled trials, relevant systematic reviews, and author publications will also be conducted. Data will be extracted regarding study, participant, and intervention characteristics, pre-determined recruitment goals, recruitment strategies employed, and the number of participants screened, eligible, approached, randomised, and retained. Outcomes will include whether pre-determined recruitment goals were met, recruitment rate, and any adapted or extended recruitment measures required mid-study. Descriptive statistics, including the median recruitment rate for all included studies, will be calculated and stratified by subgroups such as the type or setting of physical activity. Recruitment strategies will be categorised, and the percentage of studies using each category, along with their associated recruitment rates, will be documented. If sufficient studies are found, multi-variable regression will be employed to determine if the use of a specific recruitment strategy increases enrolment. Discussion Application of the findings of this review by physical activity programme providers may enhance their recruitment processes, potentially increasing teenage girls’ physical activity enrolment worldwide. Systematic review registration PROSPERO CRD#42023475858
{"title":"Strategies for recruitment of adolescent girls into physical activity programmes: a systematic review protocol","authors":"Tanya O'Brien, Catherine D Darker, D. Mockler, E. Barrett","doi":"10.12688/hrbopenres.13834.1","DOIUrl":"https://doi.org/10.12688/hrbopenres.13834.1","url":null,"abstract":"Background Physical activity is essential for youth physical and mental health, yet just 15% of adolescent girls versus 22% of adolescent boys worldwide meet the World Health Organization guideline of 60 minutes of moderate-to-vigorous physical activity per day. As activity patterns established in adolescence often persist into adulthood, there is a looming risk of adverse health outcomes due to insufficient physical activity. A persistent challenge faced by physical activity providers, however, is recruiting adolescent girls into their programmes. This systematic review will quantitatively synthesise existing knowledge surrounding the recruitment of adolescent girls into physical activity interventions and aims to provide evidence-based recommendations for optimal recruitment practices. Methods Five electronic databases will be searched to identify randomised controlled trials of physical activity interventions for adolescent girls worldwide. Hand-searches of reference lists of included randomised controlled trials, relevant systematic reviews, and author publications will also be conducted. Data will be extracted regarding study, participant, and intervention characteristics, pre-determined recruitment goals, recruitment strategies employed, and the number of participants screened, eligible, approached, randomised, and retained. Outcomes will include whether pre-determined recruitment goals were met, recruitment rate, and any adapted or extended recruitment measures required mid-study. Descriptive statistics, including the median recruitment rate for all included studies, will be calculated and stratified by subgroups such as the type or setting of physical activity. Recruitment strategies will be categorised, and the percentage of studies using each category, along with their associated recruitment rates, will be documented. If sufficient studies are found, multi-variable regression will be employed to determine if the use of a specific recruitment strategy increases enrolment. Discussion Application of the findings of this review by physical activity programme providers may enhance their recruitment processes, potentially increasing teenage girls’ physical activity enrolment worldwide. Systematic review registration PROSPERO CRD#42023475858","PeriodicalId":508744,"journal":{"name":"HRB Open Research","volume":"32 39","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139962210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-16DOI: 10.12688/hrbopenres.13843.1
L. Ahern, Suzanne Timmons, Sarah E. Lamb, R. McCullagh
Background Parkinson’s is a common progressive neurological condition characterized by motor and non-motor deficits. Physical activity and exercise can improve health, but many people with Parkinson’s (PwP) have trouble reaching the recommended dosage. Our recent literature review found improvements in exercise adherence with behavioural change interventions, but it remains unclear which are most effective. Further qualitative research and patient and public involvement has informed a novel behavioural change intervention to be tested alongside an existing exercise program. Objective To examine the feasibility of behavioural change techniques delivered alongside an exercise programme to improve physical activity, function, and self-efficacy in PwP (and study procedures) to inform a future pilot RCT trial. Methods A parallel-arm single blinded randomised feasibility study. Twenty participants with Parkinson’s (Hoehn and Yahr stage 1-3) will be recruited from a physiotherapy primary-care waiting list. Following written consent, and baseline assessment, the participants will be randomly allocated to the intervention (n=10) or the control group (n=10). Both groups will receive usual care, which includes a weekly program of a multidisciplinary education, a supervised exercise class and a prescribed home exercise program. The intervention group will receive additional behavioural change techniques, targeting behaviour regulation, belief about capabilities and social influences. Class and home exercise adherence, behavioural component uptake and adherence, and negative events will be recorded. Outcomes will include enrolment and maintenance rates, physical function, falls, physical activity, and exercise self-efficacy measured pre- and post- the 12-week program (in-person). Surveys will be used to compare experiences and satisfaction between groups. Exit interviews will be completed with the intervention group only, exploring their experience of the behavioural change techniques. Discussion The results will help inform a future pilot RCT, based on the intervention acceptability, consent rate, maintenance, and protocol integrity. Trial Registration ClincialTrials.gov NCT06192628
{"title":"Behavioural change for Parkinson’s Disease: A randomised controlled feasibility study to promote physical activity and exercise adherence among people with Parkinson’s: study protocol","authors":"L. Ahern, Suzanne Timmons, Sarah E. Lamb, R. McCullagh","doi":"10.12688/hrbopenres.13843.1","DOIUrl":"https://doi.org/10.12688/hrbopenres.13843.1","url":null,"abstract":"Background Parkinson’s is a common progressive neurological condition characterized by motor and non-motor deficits. Physical activity and exercise can improve health, but many people with Parkinson’s (PwP) have trouble reaching the recommended dosage. Our recent literature review found improvements in exercise adherence with behavioural change interventions, but it remains unclear which are most effective. Further qualitative research and patient and public involvement has informed a novel behavioural change intervention to be tested alongside an existing exercise program. Objective To examine the feasibility of behavioural change techniques delivered alongside an exercise programme to improve physical activity, function, and self-efficacy in PwP (and study procedures) to inform a future pilot RCT trial. Methods A parallel-arm single blinded randomised feasibility study. Twenty participants with Parkinson’s (Hoehn and Yahr stage 1-3) will be recruited from a physiotherapy primary-care waiting list. Following written consent, and baseline assessment, the participants will be randomly allocated to the intervention (n=10) or the control group (n=10). Both groups will receive usual care, which includes a weekly program of a multidisciplinary education, a supervised exercise class and a prescribed home exercise program. The intervention group will receive additional behavioural change techniques, targeting behaviour regulation, belief about capabilities and social influences. Class and home exercise adherence, behavioural component uptake and adherence, and negative events will be recorded. Outcomes will include enrolment and maintenance rates, physical function, falls, physical activity, and exercise self-efficacy measured pre- and post- the 12-week program (in-person). Surveys will be used to compare experiences and satisfaction between groups. Exit interviews will be completed with the intervention group only, exploring their experience of the behavioural change techniques. Discussion The results will help inform a future pilot RCT, based on the intervention acceptability, consent rate, maintenance, and protocol integrity. Trial Registration ClincialTrials.gov NCT06192628","PeriodicalId":508744,"journal":{"name":"HRB Open Research","volume":"22 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139960721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.12688/hrbopenres.13848.1
Luisne Mac Conghail, Sarah Parker, S. Burke
Background The onset of the COVID-19 pandemic prompted the Irish state to address unprecedented challenges by prioritising public health and equitable access to care. Confronted with the threat of overwhelmed capacity in acute public hospitals, Ireland, initiated a historic Safety Net Agreement (SNA) with 19 private hospitals in March 2020, marking the inaugural establishment of universal single-tier access to hospital care in Ireland. This research aimed to comprehensively examine the policy process underlying the agreement, deriving insights for the implementation of Universal Healthcare. Methods Employing a retrospective qualitative case study approach, the research examined the policy process, including the content, context, actors, and mechanisms involved in the SNA’s implementation. The study used a dataset of 68 policy documents and conducted seven key informant interviews. Results Responding to the pandemic, Ireland classified COVID-19 as a notifiable infectious disease under the 1947 Health Act, exempting affected patients from public hospital charges. The government swiftly implemented health policy measures for universal access through the SNA, recognising challenges in public healthcare capacity and ethical dilemmas within the two-tier hospital system. The agreement's discontinuation was heavily influenced by private hospital consultants, revealing strained relationships and misunderstandings of the private sector. The ongoing policy drift since the pandemic highlights the need for a reassessment of private-sector strategies to alleviate capacity pressures in Ireland's public health system. The SNA also sparked the consideration of a Universal Health Insurance model for Ireland's hospital care. Conclusions Exploring the policy dynamics at the intersection of public and private healthcare, the study imparts lessons for health system reform. The insights have the potential to contribute to long-term goal alignment, robust governance practices, and trust-building mechanisms for effective public-private collaborations in a two-tier health system, offering valuable guidance for future healthcare policy and implementation.
{"title":"Examining universal access to acute hospital care in Ireland during the first three months of COVID-19: Lessons from the policy process","authors":"Luisne Mac Conghail, Sarah Parker, S. Burke","doi":"10.12688/hrbopenres.13848.1","DOIUrl":"https://doi.org/10.12688/hrbopenres.13848.1","url":null,"abstract":"Background The onset of the COVID-19 pandemic prompted the Irish state to address unprecedented challenges by prioritising public health and equitable access to care. Confronted with the threat of overwhelmed capacity in acute public hospitals, Ireland, initiated a historic Safety Net Agreement (SNA) with 19 private hospitals in March 2020, marking the inaugural establishment of universal single-tier access to hospital care in Ireland. This research aimed to comprehensively examine the policy process underlying the agreement, deriving insights for the implementation of Universal Healthcare. Methods Employing a retrospective qualitative case study approach, the research examined the policy process, including the content, context, actors, and mechanisms involved in the SNA’s implementation. The study used a dataset of 68 policy documents and conducted seven key informant interviews. Results Responding to the pandemic, Ireland classified COVID-19 as a notifiable infectious disease under the 1947 Health Act, exempting affected patients from public hospital charges. The government swiftly implemented health policy measures for universal access through the SNA, recognising challenges in public healthcare capacity and ethical dilemmas within the two-tier hospital system. The agreement's discontinuation was heavily influenced by private hospital consultants, revealing strained relationships and misunderstandings of the private sector. The ongoing policy drift since the pandemic highlights the need for a reassessment of private-sector strategies to alleviate capacity pressures in Ireland's public health system. The SNA also sparked the consideration of a Universal Health Insurance model for Ireland's hospital care. Conclusions Exploring the policy dynamics at the intersection of public and private healthcare, the study imparts lessons for health system reform. The insights have the potential to contribute to long-term goal alignment, robust governance practices, and trust-building mechanisms for effective public-private collaborations in a two-tier health system, offering valuable guidance for future healthcare policy and implementation.","PeriodicalId":508744,"journal":{"name":"HRB Open Research","volume":"33 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139775957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.12688/hrbopenres.13848.1
Luisne Mac Conghail, Sarah Parker, S. Burke
Background The onset of the COVID-19 pandemic prompted the Irish state to address unprecedented challenges by prioritising public health and equitable access to care. Confronted with the threat of overwhelmed capacity in acute public hospitals, Ireland, initiated a historic Safety Net Agreement (SNA) with 19 private hospitals in March 2020, marking the inaugural establishment of universal single-tier access to hospital care in Ireland. This research aimed to comprehensively examine the policy process underlying the agreement, deriving insights for the implementation of Universal Healthcare. Methods Employing a retrospective qualitative case study approach, the research examined the policy process, including the content, context, actors, and mechanisms involved in the SNA’s implementation. The study used a dataset of 68 policy documents and conducted seven key informant interviews. Results Responding to the pandemic, Ireland classified COVID-19 as a notifiable infectious disease under the 1947 Health Act, exempting affected patients from public hospital charges. The government swiftly implemented health policy measures for universal access through the SNA, recognising challenges in public healthcare capacity and ethical dilemmas within the two-tier hospital system. The agreement's discontinuation was heavily influenced by private hospital consultants, revealing strained relationships and misunderstandings of the private sector. The ongoing policy drift since the pandemic highlights the need for a reassessment of private-sector strategies to alleviate capacity pressures in Ireland's public health system. The SNA also sparked the consideration of a Universal Health Insurance model for Ireland's hospital care. Conclusions Exploring the policy dynamics at the intersection of public and private healthcare, the study imparts lessons for health system reform. The insights have the potential to contribute to long-term goal alignment, robust governance practices, and trust-building mechanisms for effective public-private collaborations in a two-tier health system, offering valuable guidance for future healthcare policy and implementation.
{"title":"Examining universal access to acute hospital care in Ireland during the first three months of COVID-19: Lessons from the policy process","authors":"Luisne Mac Conghail, Sarah Parker, S. Burke","doi":"10.12688/hrbopenres.13848.1","DOIUrl":"https://doi.org/10.12688/hrbopenres.13848.1","url":null,"abstract":"Background The onset of the COVID-19 pandemic prompted the Irish state to address unprecedented challenges by prioritising public health and equitable access to care. Confronted with the threat of overwhelmed capacity in acute public hospitals, Ireland, initiated a historic Safety Net Agreement (SNA) with 19 private hospitals in March 2020, marking the inaugural establishment of universal single-tier access to hospital care in Ireland. This research aimed to comprehensively examine the policy process underlying the agreement, deriving insights for the implementation of Universal Healthcare. Methods Employing a retrospective qualitative case study approach, the research examined the policy process, including the content, context, actors, and mechanisms involved in the SNA’s implementation. The study used a dataset of 68 policy documents and conducted seven key informant interviews. Results Responding to the pandemic, Ireland classified COVID-19 as a notifiable infectious disease under the 1947 Health Act, exempting affected patients from public hospital charges. The government swiftly implemented health policy measures for universal access through the SNA, recognising challenges in public healthcare capacity and ethical dilemmas within the two-tier hospital system. The agreement's discontinuation was heavily influenced by private hospital consultants, revealing strained relationships and misunderstandings of the private sector. The ongoing policy drift since the pandemic highlights the need for a reassessment of private-sector strategies to alleviate capacity pressures in Ireland's public health system. The SNA also sparked the consideration of a Universal Health Insurance model for Ireland's hospital care. Conclusions Exploring the policy dynamics at the intersection of public and private healthcare, the study imparts lessons for health system reform. The insights have the potential to contribute to long-term goal alignment, robust governance practices, and trust-building mechanisms for effective public-private collaborations in a two-tier health system, offering valuable guidance for future healthcare policy and implementation.","PeriodicalId":508744,"journal":{"name":"HRB Open Research","volume":"491 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139835719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-12DOI: 10.12688/hrbopenres.13854.1
D. McCausland, Margaret Haigh, P. McCallion, M. McCarron
A shift from single to multi-site health studies enabled a range of research benefits including faster recruitment of larger and more diverse samples; increased statistical power, greater rigour, generalisability, and external reliability; and increased likelihood of impacting policy and clinical practice. However, ethical review of multi-site studies by Institutional Review Boards (IRBs) raises specific challenges compared with single site studies, with requirements to apply to multiple local IRBs increasing the burden on research, possibly endangering the integrity of the research process or inhibiting development of multi-site studies. The option of a single centralised IRB may offer a clearer, more consistent and efficient review process. This study presents a case report and commentary from 15 years engaging with IRBs in multiple sites in Ireland by the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). It examines the ethics review process for IDS-TILDA through its first four waves. While the majority of 48 IRBs granted ethical approval within 13 weeks, six IRBs took 21–47 weeks to approve, leading to delays in data collection of up to 11 months. Despite additional review time, no changes were required to the study protocol. Therefore, a critical impact of the process was the delay in starting data collection within a small number of organisations, and reduced involvement in the study for one organisation. The ethical review process with multiple IRBs increased the degree of complexity of the process, with added bureaucracy and far greater communication required across 48 IRBs, substantially adding to the resource commitment for the review process. The relatively quick approval from the majority of IRBs was partially a result of the longitudinal study building relationships with organisations throughout multiple waves. That other health studies may not accrue this benefit supports calls for a single IRB system for multi-site health studies.
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Pub Date : 2024-02-12DOI: 10.12688/hrbopenres.13854.1
D. McCausland, Margaret Haigh, P. McCallion, M. McCarron
A shift from single to multi-site health studies enabled a range of research benefits including faster recruitment of larger and more diverse samples; increased statistical power, greater rigour, generalisability, and external reliability; and increased likelihood of impacting policy and clinical practice. However, ethical review of multi-site studies by Institutional Review Boards (IRBs) raises specific challenges compared with single site studies, with requirements to apply to multiple local IRBs increasing the burden on research, possibly endangering the integrity of the research process or inhibiting development of multi-site studies. The option of a single centralised IRB may offer a clearer, more consistent and efficient review process. This study presents a case report and commentary from 15 years engaging with IRBs in multiple sites in Ireland by the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). It examines the ethics review process for IDS-TILDA through its first four waves. While the majority of 48 IRBs granted ethical approval within 13 weeks, six IRBs took 21–47 weeks to approve, leading to delays in data collection of up to 11 months. Despite additional review time, no changes were required to the study protocol. Therefore, a critical impact of the process was the delay in starting data collection within a small number of organisations, and reduced involvement in the study for one organisation. The ethical review process with multiple IRBs increased the degree of complexity of the process, with added bureaucracy and far greater communication required across 48 IRBs, substantially adding to the resource commitment for the review process. The relatively quick approval from the majority of IRBs was partially a result of the longitudinal study building relationships with organisations throughout multiple waves. That other health studies may not accrue this benefit supports calls for a single IRB system for multi-site health studies.
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