Health technology assessment and ill-structured problems: A case study concerning the drug mebeverine

Moret-Hartman, Margriet; Wilt, Gert Jan van der; Grin, John

doi:10.1017/s0266462307070481

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Community involvement is crucial in PRA and APA to adjust plans towards the specific needs of a community (7,13). In Llano Largo, the combination of PRA and APA techniques made it possible to sketch the overall situation and main health-related issues, along with their underlying causes.…”

Section: Discussionmentioning

confidence: 99%

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Development of a community-specific health promotion plan to improve children's health in rural Guatemala

Eelderink

Verster

2010

International Journal on Disability and Human Development

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The WHO Health Promoting School (HPS) approach embraces a comprehensive, integrated construct of a health promotion strategy aimed at the specific participation of the local school, health services and other stakeholders. The objective of this study was to initiate the development of a community-specific health promotion plan for the primary school in Llano Largo to reduce hygiene-and sanitationrelated health problems among children. Participatory Rural Appraisal (PRA) techniques and Argumentative Policy Analysis (APA) were applied to assess the underlying causes of health-related problems and to initiate the process of social learning among stakeholders, including parents, teachers, the village committee and representatives from the local hospital, local NGO, local government, and the village church. Stakeholders defined five core problems: 1) serious lack of hygiene; 2) no doctor and a lack of medicines; 3) hunger and malnutrition; 4) absence in school as a result of child labor; and 5) no discipline in school. Lack of communication, organization and education seem to be the underlying causes of these problems. In line with the HPS concept, a community-specific health promotion plan was constructed. A ''Social Communication Work Group'' was elected to execute the plan. In conclusion, PRA and APA techniques were successful to implement a HPS plan in Llano Largo. Followup studies should determine the long-term efficacy of the plan. rhea rates in children is abundant. A systematic review and meta-analysis summarizing data on water, sanitation and hygiene interventions by Fewtrell et al.(2) confirmed that hand-washing interventions are effective for reducing the frequency of diarrhea and disease. Water-supply interventions and water-quality interventions are also effective in reducing diarrhea rates. For example, flocculant-disinfectant can reduce the number of diarrheal episodes in children under 5 years of age by 50% (3).School health promotion on potential health risks can lead to positive changes in health-related behavior. However, the need for an intersectoral approach to establish collaboration on communication between different stakeholders, particularly the local population, is an important factor determining the success rate of an educational program (4-7). The World Health Organisation's ''Health Promoting School'' provides the tools for an organizational and structural systematic approach to improve school health, which, in turn, increases the learning capacity of students (8). The health promoting school (HPS)

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Section: Discussionmentioning

confidence: 99%

“…The basic assumption of APA is that successful implementation of policy requires the cooperation of the target populations (7). The purpose of APA is to collect available evidence to help policy makers, clinicians and patients understand the relative value of (health) technologies (14).…”

Section: Argumentative Policy Analysismentioning

confidence: 99%

Development of a community-specific health promotion plan to improve children's health in rural Guatemala

Eelderink

Verster

2010

International Journal on Disability and Human Development

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“…Interviews were transcribed verbatim, and then coded and summarized. We used the reconstructing interpretative frames method to analyse the stakeholders' reasoning (Grin et al, 1997;Moret-Hartman et al, 2007). An interpretative frame is the interviewer's reconstruction of a respondent's view, featuring four 'layers' of problem definitions, proposed solutions, empirical background theories ( = assumptions), and normative preferences (Grin and van de Graaf, 1996;Schön, 1983).…”

Section: Methods: Interactive Evaluationmentioning

confidence: 99%

Strengthening evaluation through interactive problem structuring: A case study of hospital care after attempted suicide

et al. 2011

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Thequalityofanevaluationlargelydependsonthequalityoftheunderlyingproblemdefinition andthequalityoftheproblemdefinitionoftenimprovesasstakeholderinvolvementincreases. Bymeansofastudyonthemanagementofattemptedsuicidesbydrugoverdose,weexplored whetheraninteractivemethodologycouldbeadequateforproblemstructuring.Despitethefact thatahighlevelofcareisoftenunnecessary,manypatientsareadmittedtotheinternalward orintensivecareunit.Tosolvetheefficiencyproblem,somephysiciansproposedtoevaluatethe effectivenessofasix-hourobservationunit.Althoughevaluatingsuchaunitwastechnicallyfeasible, wefeltuncertainabouttheappropriatenessofthisintervention.Theinteractivemethodologywas usefulinthatiteffectivelymadethedivergentproblemdefinitionsandunderlyingnormativevalues transparent.As a result, our research efforts will be better geared to information needs from personsinvolvedandthereforemoreuseful.

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“…In light of this value ladenness, it has been argued that “health technology assessment agencies (HTAs) presently employ value assessment frameworks that are ill fitted to capture the range and diversity of stakeholder values and thereby risk compromising the legitimacy of their recommendations.” Involved stakeholders, such as patients, providers, insurers, and citizens or taxpayers, hold a range of social, epistemic, and other values and may have very different conceptions of what makes specific health interventions valuable . Accordingly, stakeholders in pluralist societies may have warranted disagreements on what values that should guide implementation of health technology…”

Section: Evaluating Factsmentioning

confidence: 99%

Evaluating facts and facting evaluations: On the fact‐value relationship in HTA

Hofmann

Bond

Sandman

2018

Evaluation Clinical Practice

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Health technology assessment (HTA) is an evaluation of health technologies in terms of facts and evidence. However, the relationship between facts and values is still not clear in HTA. This is problematic in an era of “fake facts” and “truth production.” Accordingly, the objective of this study is to clarify the relationship between facts and values in HTA. We start with the perspectives of the traditional positivist account of “evaluating facts” and the social‐constructivist account of “facting values.” Our analysis reveals diverse relationships between facts and a spectrum of values, ranging from basic human values, to the values of health professionals, and values of and in HTA, as well as for decision making. We argue for sensitivity to the relationship between facts and values on all levels of HTA, for being open and transparent about the values guiding the production of facts, and for a primacy for the values close to the principal goals of health care, ie, relieving suffering. We maintain that philosophy (in particular ethics) may have an important role in addressing the relationship between facts and values in HTA. Philosophy may help us to avoid fallacies of inferring values from facts; to disentangle the normative assumptions in the production or presentation of facts and to tease out implicit value judgements in HTA; to analyse evaluative argumentation relating to facts about technologies; to address conceptual issues of normative importance; and to promote reflection on HTA's own value system. In this we argue for a(n Aristotelian) middle way between the traditional positivist account of “evaluating facts” and the social‐constructivist account of “facting values,” which we call “factuation.” We conclude that HTA is unique in bringing together facts and values and that being conscious and explicit about this “factuation” is key to making HTA valuable to both individual decision makers and society as a whole.

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Health technology assessment and ill-structured problems: A case study concerning the drug mebeverine

Abstract: To ensure that future studies on healthcare problems are useful, it is imperative that policy makers take the problem definitions of potential users into account.

Cited by 6 publications

References 24 publications

Development of a community-specific health promotion plan to improve children's health in rural Guatemala

Development of a community-specific health promotion plan to improve children's health in rural Guatemala

Strengthening evaluation through interactive problem structuring: A case study of hospital care after attempted suicide

Evaluating facts and facting evaluations: On the fact‐value relationship in HTA

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