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Policy researchers have used various categories of variables to explain why policies change, including those related to institutions, interests and ideas. Recent research has paid growing attention to the role of policy networks-the actors involved in policy-making, their relationships with each other, and the structure formed by those relationships-in policy reform across settings and issues; however, this literature has largely ignored the theoretical integration of networks with other policy theories, including the '3Is' of institutions, interests and ideas. This article proposes a conceptual framework integrating these variables and tests it on three cases of policy change in Burkina Faso, addressing the need for theoretical integration with networks as well as the broader aim of theory-driven health policy analysis research in low- and middle-income countries. We use historical process tracing, a type of comparative case study, to interpret and compare documents and in-depth interview data within and between cases. We found that while network changes were indeed associated with policy reform, this relationship was mediated by one or more of institutions, interests and ideas. In a context of high donor dependency, new donor rules affected the composition and structure of actors in the networks, which enabled the entry and dissemination of new ideas and shifts in the overall balance of interest power ultimately leading to policy change. The case of strategic networking occurred in only one case, by civil society actors, suggesting that network change is rarely the spark that initiates the process towards policy change. This analysis highlights the important role of changes in institutions and ideas to drive policymaking, but hints that network change is a necessary intermediate step in these processes.

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The study examined the utility of the Family Perception of Care Scale (FPCS), which consists of four subscales: resident care, family support, communication, and rooming. This instrument was developed for the purposes of this study. Overall, family members were satisfied with end-of-life care. Satisfaction did not have a statistically significant relationship to family and resident characteristics. Survey questions with the highest number of low satisfaction ratings included staffing levels, updating families and involving them in care planning, and decision making. Family members considered pain control an important priority, followed by comfort care that included caring for a family member with dignity and sensitivity. Family members also valued it when staff were able to inform them that the death of their family member was near. Place of death was significantly associated with satisfaction, family members being more satisfied with end-of-life care when their family member died in the LTC facility as opposed to in hospital. Resume I Cette etude avait pour objectif d'evaluer I'utilite de l'Echelle de perception des soins de la famille laquelle comprend quatre sous-echetles portant sur les soins en institution de longue duree, Ie soutien de la famille, les communications et Ie lieu ou Ie patient etalt soigne. Cette echelle a ete developpee uniquement aux fins de cette etude. Dans I'ensemble les families etalent satisfaites des solns de fin de vie qui avaient ete procures aux leurs. Ce degre de satisfaction n'avait aucun lien statistiquement significatif avec les caracteristlques propres ala famille et au resident. Dans cette etude, les questions ayant obtenu Ie plus grand nombre de reponses peu satisfaisantes avaient trait aux differents membres du personnel, a I'information transmise aux families, a la participation de la famille aux soins et a la prise de decisions. Les membres des families conslderaient Ie controls de la douleur comme etant la plus importante prlorite, suivi par la suita du confort du malade, et enfin de la dignite et de la senslblllte a apporter dans les relations avec les membres de la famille. Egalement d'importance l:1tait Ie fait que Ie personnel soignant puisse etre capable de prevonlr la famille lorsque la mort etait proche. L'endroit ou la personne est decedee etait un autre facteur de satisfaction, puisque les families etaient plus satisfaites lorsque leurs proches etalent morts dans une institution de soins prolonqes que dans un h6pital.

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