Power relations and contrasting conceptions of evidence in patient-involvement processes used to inform health funding decisions in Australia

Lopes, Edilene; Carter, Drew; Street, Jackie

doi:10.1016/j.socscimed.2015.04.021

Cited by 25 publications

(17 citation statements)

References 45 publications

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“…One study suggested that those proposing innovations should ensure these were aligned with other activities already familiar to decision-making stakeholders [ 57 ]. Another study found that involvement processes for enabling patient organisations to participate in funding decisions were inadequate for including patients’ experiences [ 62 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, taking into account a range of external stakeholders’ views could hinder implementing innovations based on formal evidence alone; the politics of decision-making could be more important than evidence, including the assessment of likely public perceptions of decisions taken [ 53 ]. Decision-making could be enhanced through the use of deliberative involvement processes enabling multiple stakeholders to participate [ 62 ].…”

Section: Resultsmentioning

confidence: 99%

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Evidence use in decision-making on introducing innovations: a systematic scoping review with stakeholder feedback

et al. 2017

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BackgroundA range of evidence informs decision-making on innovation in health care, including formal research findings, local data and professional opinion. However, cultural and organisational factors often prevent the translation of evidence for innovations into practice. In addition to the characteristics of evidence, it is known that processes at the individual level influence its impact on decision-making. Less is known about the ways in which processes at the professional, organisational and local system level shape evidence use and its role in decisions to adopt innovations.MethodsA systematic scoping review was used to review the health literature on innovations within acute and primary care and map processes at the professional, organisational and local system levels which influence how evidence informs decision-making on innovation. Stakeholder feedback on the themes identified was collected via focus groups to test and develop the findings.ResultsFollowing database and manual searches, 31 studies reporting primary qualitative data met the inclusion criteria: 24 were of sufficient methodological quality to be included in the thematic analysis. Evidence use in decision-making on innovation is influenced by multi-level processes (professional, organisational, local system) and interactions across these levels. Preferences for evidence vary by professional group and health service setting. Organisations can shape professional behaviour by requiring particular forms of evidence to inform decision-making. Pan-regional organisations shape innovation decision-making at lower levels. Political processes at all levels shape the selection and use of evidence in decision-making.ConclusionsThe synthesis of results from primary qualitative studies found that evidence use in decision-making on innovation is influenced by processes at multiple levels. Interactions between different levels shape evidence use in decision-making (e.g. professional groups and organisations can use local systems to validate evidence and legitimise innovations, while local systems can tailor or frame evidence to influence activity at lower levels). Organisational leaders need to consider whether the environment in which decisions are made values diverse evidence and stakeholder perspectives. Further qualitative research on decision-making practices that highlights how and why different types of evidence come to count during decisions, and tracks the political aspects of decisions about innovation, is needed.Electronic supplementary materialThe online version of this article (10.1186/s13012-017-0669-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Evidence use in decision-making on introducing innovations: a systematic scoping review with stakeholder feedback

et al. 2017

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“…The findings interpreted using a Foucauldian lens are reported elsewhere. 65 (see Appendix S1 -Theoretical frameworks, recruitment, data collection, and coding for further details on research design and methodology. )…”

Section: Theoretical Framework and Critical Perspectivementioning

confidence: 99%

Involving patients in health technology funding decisions: stakeholder perspectives on processes used in Australia

Lopes

Street

Carter

et al. 2015

Health Expectations

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Background Governments use a variety of processes to incorporate public perspectives into policymaking, but few studies have evaluated these processes from participants' point of view.Objective The objective of this study was twofold: to understand the perspectives of selected stakeholders with regard to involvement processes used by Australian Advisory Committees to engage the public and patients; and to identify barriers and facilitators to participation.Design Twelve semi-structured interviews were conducted with representatives of different stakeholder groups involved in health technology funding decisions in Australia. Data were collected and analysed using a theoretical framework created by Rowe and Frewer, but adapted to more fully acknowledge issues of power and influence.

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“…Empowering technologies [13, 66] can also be disempowering [67, 68] depending on whose values and conceptions of evidence inform decisions about uses of new technologies on individual, professional, and societal levels [69]. While it may be easy to dismiss on moral grounds innovations like ‘chip in a pill’ (e.g., wireless surveillance of medication consumption via biological markers) that warns clinicians of a patient’s poor compliance [70], vigilance is also necessary for less obvious pitfalls.…”

Section: Discussionmentioning

confidence: 99%

Transitions from biomedical to recovery-oriented practices in mental health: a scoping review to explore the role of Internet-based interventions

Strand

Gammon

Ruland

2017

BMC Health Serv Res

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BackgroundThe Internet is transforming mental health care services by increasing access to, and potentially improving the quality of, care. Internet-based interventions in mental health can potentially play a role in transitions from biomedical to recovery-oriented research and practices, but an overview of what this may entail, current work, and issues that need addressing, is lacking. The objective of this study is to describe Internet-based recovery-oriented interventions (referred to as e-recovery) and current research, and to identify gaps and issues relevant to advancing recovery research and practices through opportunities provided by the Internet.MethodsFive iterative stages of a scoping review framework were followed in searching and analyzing the literature. A recovery framework with four domains and 16 themes was used to deductively code intervention characteristics according to their support for recovery-oriented practices. Only Internet-based interventions used in conjunction with ongoing care were included.ResultsTwenty studies describing six e-recovery interventions were identified and originated in Australia, Finland, the Netherlands, Norway and USA. The domain supporting personal recovery was most clearly reflected in interventions, whereas the last three domains, i.e., promoting citizenship, organizational commitment and working relationship were less evident. Support for the formulation and follow-up of personal goals and preferences, and in accessing peer-support, were the characteristics shared by most interventions. Three of the six studies that employed a comparison group used randomization, and none presented definitive findings. None used recovery-oriented frameworks or specific recovery outcome measures. Four of the interventions were specific to a diagnosis.ConclusionResearch about how technologies might aid in illuminating and shaping recovery processes is in its formative stages. We recommend that future e-recovery research and innovation attend to four dimensions: evidence-supported interventions, new knowledge about personal recovery, values-based approaches and Internet as a facilitator for organizational transformation. The incremental changes facilitated by e-recovery may help propel a shift in mental health care toward recovery-oriented practices.

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Power relations and contrasting conceptions of evidence in patient-involvement processes used to inform health funding decisions in Australia

Cited by 25 publications

References 45 publications

Evidence use in decision-making on introducing innovations: a systematic scoping review with stakeholder feedback

Evidence use in decision-making on introducing innovations: a systematic scoping review with stakeholder feedback

Involving patients in health technology funding decisions: stakeholder perspectives on processes used in Australia

Transitions from biomedical to recovery-oriented practices in mental health: a scoping review to explore the role of Internet-based interventions

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