Research on media framing of public policies to prevent chronic disease: A narrative synthesis

Media coverage plays a key role in shaping public and political attitudes towards policy interventions to improve health. We reviewed studies of news media to identify the arguments used to frame policies that address risk factors for chronic disease, and the impact of different arguments on attitudes to policy. Drawing on a previous scoping review, we identified a subsample of 49 studies of media framing of policies to address risk factors for lifestyle-related chronic disease for further analysis. We extracted and synthesised data to explore key themes. Of the limited research that has been undertaken, most studies have focused on tobacco policy, followed by alcohol, with a small number of studies of food and beverage policies. Studies have primarily used content analysis. Our synthesis demonstrated that advocates and opponents draw on five frames: health, social, economic, practical and ideological. Only a small number of studies have examined the impact of framing on public attitudes towards policy interventions, although such studies have tended to focus on the impact of how problems, rather than solutions (i.e. policies) are framed. Media research is crucial to understanding the complex ways in which attitudes towards policy interventions shape, and are shaped by, public discourses and can provide public health advocates with insights into strategies to successfully position policy arguments. This review highlights key insights and gaps in the hope that this will stimulate further research that will enhance public health advocates' abilities to promote effective public health policy.The work was funded by the National Health and Medical Research Council of Australia (NHMRC) through its Partnership Centre grant scheme (grant GNT9100001). NSW Health, ACT Health, the Australian Government Department of Health, the Hospitals Contribution Fund of Australia and the HCF Research Foundation have contributed funds to support this work as part of the NHMRC Partnership Centre grant schem

Scaling-up Complex Interventions : Adaptation is not a Threat to Fidelity

Practitioners delivering evidence-based interventions get pulled in different directions. It is intuitive to adapt interventions to context, but usually against ‘standard’ recommendations to do so. The nexus of the problem lies with different understandings of “complex.” This seminar puts forward the argument that with complex-system thinking, program scale-up should be less about precise replication and more about (re)generation according to the principal mechanisms of action. This means that fidelity and adaptation may co-exist, rather than the conventional logic, where adaptation is routinely seen as a threat to fidelity. With the complex way of thinking, intervention and context are intertwined. This means adaptation is not an add on consideration – it is integral to design and hence integral to transfer to every context. Practice has long been recognised as messy. Yet there remains a dominant orthodoxy which makes program implementation and scale-up sound simpler than it is. New ways forward will require innovative forms of quality assurance and accountability. This seminar investigates these issues, drawing on the burgeoning literature in complex systems and current examples from research with population-level interventions. It shows how insights from applied implementation practice could be harvested and harnessed to improve the reach and effect of interventions

Communicating the benefits of population health interventions: The health effects can be on par with those of medication

How can we communicate to the public that population level health interventions are effective at improving health? Perhaps the most familiar currency of effect is that which can be brought about via medication. Comparisons of effect sizes may be effective ways of communicating the benefits of population health interventions if they are seen and understood in the same way that medications are. We developed a series of comparisons to communicate benefits of population health interventions in terms of similar gains to be obtained from statins, metformin and antihypertensive medications for prevention of cardiovascular events, type 2 diabetes, obesity and hypertension. A purposive search identified evidence of population health intervention-related benefits. This evidence ranged from meta-analyses of RCTs to that from observational cohort studies. Population health interventions included implementation of national smoke free legislation, enhanced neighbourhood walkability, increased opportunities for active travel and protection of urban green space. In some cases, the benefits of population health interventions were found to be equivalent to, or even outweighed those of the medications to which they were compared. For example, RCT-based evidence suggested that exercise taken with a view of a green space was associated with 12 mmHg and 6 mmHg reductions in systolic and diastolic blood pressure, respectively, which was at least on par with the reductions associated with antihypertensive medications. Future work will test the effectiveness of these comparisons for increasing the familiarity, credibility and acceptability of population health interventions and, in particular, examine the importance of communicating putative mechanisms and potential co-benefits

Does citizen science have the capacity to transform population health science?

Citizen science engages members of the public in research design, data collection, and analysis – in asking and answering questions about the world around them. The United States, European Union, and Australia have placed citizen science at the forefront of national science policy. Journals such as Science, Nature and Bioscience regularly feature projects conducted by citizens. Citizen science engages millions of people worldwide. However, to date, population health science has not relied heavily on citizen contributions. Although community-based participatory action research remains a strong foundational method to engage those affected by public health problems, there is additional potential to mainstream population health through wider, less intensive opportunities to be involved in our science. If we are to tackle the complex challenges that face population health then new avenues are needed to capture the energy and attention of citizens who may not feel affected by public health problems, i.e. to engage the ‘by-standers’ in population health science. Particular types of citizen science methods have the potential to do this. But simply increasing the breadth and volume of scientific evidence will not be enough. Complex, intractable, macro-level problems in population health require change in how our journals and funding bodies respond to data generated by the public. Of course, democratisation of science and the potential decentralisation of scientific authority will bring deep challenges. But potentially it brings a future where population health science is better known, understood and respected, with benefits for the types of public policies that derive from this science.The work was funded by the National Health and Medical Research Council of Australia (NHMRC) through its Partnership Centre grant scheme [grant number GNT9100001]. NSW Health, ACT Health, the Australian Government Department of Health, the Hospitals Contribution Fund of Australia and the HCF Research Foundation have contributed funds to support this work as part of the NHMRC Partnership Centre grant scheme

The costs of a community-based intervention to promote maternal health

The costs of community-level interventions are rarely reported, although such insights are needed if intervention research is to be useful to practitioners seeking to understand what might be involved in replicating interventions in different contexts. We report the costs of a 2-year community-based intervention to promote the health of recent mothers in Victoria, Australia. Program of Resources, Information and Support for Mothers was an integrated programme of primary care and community-based strategies. It had health care professional training, health education and community development components as well as an emphasis on creating &lsquo;mother-friendly&rsquo; environments. Costs included the programme costs [primarily the salaries of the community development officers (CDO) in the field] and also &lsquo;induced&rsquo; costs that relate to the CDOs\u27 successes in attracting additional resources to the intervention from the local community. The total cost averaged A$272 490 per rural community and A$313 900 per urban community, equivalent to A$172.40 and A$128.70 per mother, respectively. For every A$10 of public funds initially invested in the project, the CDOs were able to attract a further A$1&ndash;2 worth of local resources, predominantly in the form of volunteer time or donated services.<br /