Abstract:Objective: To evaluate the impact of implementing smoke-free policy in an Australian high security forensic psychiatry inpatient hospital.Methods: Focus groups (N=21) and surveys with patients (N=45) and surveys with staff (N=111, 53.2% nurses) elicited their experience and attitudes towards smoke-free policy. A follow-up survey elicited the impact of the policy on 15 patients' smoking practice post discharge.Results: Eighty-five percent of patients stated it was easier quitting when no-one else smoked. Over half of discharged patients surveyed (58%) continued to not smoke postdischarge, despite almost half of staff (41%) perceiving that patients were unlikely to quit long-term. Smoking staff were significantly more pessimistic than non-smoking staff. Many patients (69%) perceived that their health had improved as a result of not smoking. Most staff (80%) viewed nicotine dependence treatment as important, but fewer (66%) felt confident to support patients to stop smoking. Increased patient violence and management difficulties expected by staff were not realized.Conclusions: Smoke-free policy can be successfully implemented in forensic psychiatry inpatient units. Nursing staff are a large and important group who need particular support to implement smoke-free policy into practice effectively, particularly those who are smokers.Continuity of care as part of a coordinated policy and service response is needed.

Objective This study evaluated the changing trends in glaucoma management in Scotland between 1994 and 2004.Methods A retrospective analysis of national health statistics in Scotland from 1994 to 2004. The Scottish morbidity record was used to collect information on all episodes of trabeculectomy. Data on number of prescriptions were gathered for individual drugs and also for groups of active ingredient. The population likely to have glaucoma (PLG) was calculated from estimates of prevalence in individuals aged 40 years and older, based on published epidemiological studies. The outcome measures were trabeculectomy rates, corrected for population likely to be at risk of glaucoma (PLG), and prescribing volume and cost for glaucoma medications.

This Research and Evidence Paper presents the theory-based and participatory evaluation design of the Child Labour: Action-Research- Innovation in South and South-Eastern Asia (CLARISSA) programme. The evaluation is embedded in emergent Participatory Action Research with children and other stakeholders to address the drivers of the worst forms of child labour (WFCL). The report describes the use of contribution analysis as an overarching approach, with its emphasis on crafting, nesting and iteratively reflecting on causal theories of change. It illustrates how hierarchically-nested impact pathways lead to specific evaluation questions and mixing different evaluation methods in response to these questions, critical assumptions, and agreement on causal mechanisms to be examined in depth. It also illustrates how realist evaluation can be combined with contribution analysis to deeply investigate specific causal links in the theory of change. It reflects on learning from the use of causal hotspots as a vehicle for mixing methods. It offers considerations on how to navigate relationships and operational trade-offs in making methodological choices to build robust and credible evidence on how, for whom, and under what conditions participatory programming can work to address complex problems such as child labour.

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