Opportunities and challenges of unplanned follow-up interviews: Experiences with Polish migrants in London

Although there is growing interest in qualitative longitudinal research as a way of taking time seriously (ADAM, 2000), this approach still holds many challenges for the social researcher. In this article we use a reflexive approach, drawing on a Goffmanian analysis of self-presentation, to consider our separate but related experience of re-interviewing Polish migrants over intervals of several years. In each case, the repeat interviews were not part of the original research design and were undertaken years later for a range of different reasons. After briefly presenting case studies from our individual interviews, we critically reflect upon some opportunities and challenges of researching change through time. We first consider the ways in which repeat interviews may challenge earlier analyses and findings. We then explore some of the ethical considerations involved in unplanned repeat interviews. Next, we reflect upon dilemmas about self-revelation, particularly in contexts of social media and on-line technologies. Finally, we discuss what we have learned from our different experiences and what implications there are for this kind of ad hoc longitudinal research in migration studies

Incorporating evidence and politics in health policy: Can institutionalising evidence review make a difference?

Much of the evidence translation literature focuses narrowly on the use of evidence in the initial policy formulation stages, and downplays the crucial role of institutions and the inherently political nature of policy making. More recent approaches acknowledge the importance of institutional and political factors, but make no attempt to incorporate their influence into new models of evidence translation. To address this issue, this article uses data from a comparative case study of bowel cancer screening policy in Australia, the United Kingdom and New Zealand, to propose alternative models of evidence incorporation which apply to all stages of the policy process.Stacy Carter is supported by a NHMRC Career Development Fellowship (2012-2015) APP103296

'When good evidence is not enough: the role of context in bowel cancer screening policy in New Zealand'.

Bowel cancer is a serious health problem in developed countries. Australia, the United Kingdom (UK) and New Zealand (NZ) reviewed the same randomised controlled trial evidence on the benefits and harms of population-based bowel cancer screening. Yet only NZ, with the highest age standardised rate of bowel cancer mortality, decided against introducing a bowel cancer screening programme. This case study of policy making explores the unique resource, ethical, institutional and political environments in which the evidence was considered. It highlights the centrality of context in assessing the relative worth of evidence in policy making and raises questions about the suitability of knowledge utilisation strategies.NHMRC Program Grant (402764

Getting evidence into policy: The need for deliberative strategies?

Getting evidence into policy is notoriously difficult. In this empirical case study we used document analysis and key informant interviews to explore the Australian federal government’s policy to implement a national bowel cancer screening programme, and the role of evidence in this policy. Our analysis revealed a range of institutional limitations at three levels of national government: within the health department, between government departments, and across the whole of government. These limitations were amplified by the pressures of the 2004 Australian federal election campaign. Traditional knowledge utilisation approaches, which rely principally on voluntarist strategies and focus on the individual, rather than the institutional level, are often insufficient to ensure evidence-based implementation. We propose three alternative models, based on deliberative strategies which have been shown to work in other settings: review of the evidence by a select group of experts whose independence is enshrined in legislation and whose imprimatur is required before policy can proceed; use of an advisory group of experts who consult widely with stakeholders and publish their review findings; or public discussion of the evidence by the media and community groups who act as more direct conduits to the decision-makers than researchers. Such deliberative models could help overcome the limitations on the use of evidence by embedding public review of evidence as the first step in the institutional decision-making processes. Highlights Achieving evidence-based policy implementation is much harder than the rhetoric suggests. Our case study showed traditional voluntarist approaches are not enough to overcome institutional filtering of the evidence. Deliberative strategies open up the decision-making processes to greater expert and public scrutiny. Our framework illustrates the potential for deliberative strategies to increase the relative weight of evidence in policy. This article challenges researchers and policy-makers to acknowledge and address the institutional context of decision-making. Keywords: Australia; Health policy; Decision-making; Evidence; Knowledge utilisation; Bowel cancer; Screening; DeliberativeNHMR

Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) Patient–Clinician Communication Model® intervention in a primary health-care setting

Funded by Informed Medical Decisions Foundation. Grant Number: #0175-1 National Health and Medical Research Council Public Health Training Fellowship. Grant Number: 568962Peer reviewedPublisher PD

Variation in hospital rates of induction of labour: a population-based record linkage study

BACKGROUND: Understanding the extent of hospital heterogeneity in induction of labour (IOL) practices to identify areas of practice improvement may result in improved maternity outcomes. We examined inter-hospital variation in rates of IOL to identify potential targets to reduce high rates of practice variation. METHODS: Population-based record linkage study of all births of ≥24 weeks gestation in 72 hospitals in New South Wales, Australia, 2010-2011. Births were categorized into 10 mutually exclusive groups, derived from the Robson caesarean section (CS) classification. These groups were categorised by parity, plurality, fetal presentation, prior CS and gestational age. Multilevel logistic regression was used to examine variation in hospital IOL rates by the groups, adjusted for differences in casemix. RESULTS: The overall IOL rate was 26.7% (46,922 of 175,444 maternities were induced), ranging from 9.7%- 41.2% (interquartile range 21.8%- 29.8%) between hospitals. Nulliparous and multiparous women at 39-40 weeks gestation with a singleton cephalic birth were the greatest contributors to the overall IOL rate (23.5% and 20.2% of all IOL respectively), and had persisting high unexplained variation after adjustment for casemix (adjusted hospital IOL rates ranging from 11.8%- 44.9% and 7.1%- 40.5% respectively). In contrast, there was little variation in inter-hospital IOL rates among multiparous women with a singleton cephalic birth at ≥41 weeks gestation, women with singleton non-cephalic pregnancies, and women with multifetal pregnancies. CONCLUSION: Seven of the 10 groups showed high or moderate unexplained variation in inter-hospital IOL rates, most pronounced for women at 39-40 weeks gestation with a singleton cephalic birth. Outcomes associated with divergent practice require determination, which may guide strategies to reduce practice variation.NHMRC, AR

Methods of classification for women undergoing induction of labour: a systematic review and novel classification system

OBJECTIVE To develop and demonstrate the applicability of a classification system for induction of labour (IOL) that fulfils recognised classification system attributes for clinical, surveillance and research purposes. DESIGN Proof of concept. SETTING, POPULATION Applicability demonstrated in a population cohort of 909,702 maternities in New South Wales, Australia, 2002-2011. METHODS A multidisciplinary collaboration developed a classification system through a systematic literature review, development of a clinically logical model, and presentation to stakeholders for feedback and refinement. Classification factors included parity (nulliparous, parous), previous caesarean section (CS), gestational age (≤36, 37-38, 39-40, ≥41 weeks gestation), number (singleton, multiple) and presentation of the fetus (cephalic, non-cephalic). We determined: the size of each classification group, the contribution each group made to overall IOL rates, and within-group IOL rates (calculated as proportions of all maternities, all maternities excluding prelabour CS and of all continuing maternities). MAIN OUTCOME MEASURES Applicability of IOL classification using routinely collected obstetric data. RESULTS A 10 group classification system was developed. Of all maternities, 25.4% were induced. Nulliparous and parous women without a prior CS at 39-40 weeks gestation with a singleton cephalic-presenting fetus were the largest groups (21.2% and 24.5% respectively) and accounted for the highest proportion of all IOL (20.7% and 21.5% respectively). The highest within group IOL rates were for nullipara (53.8%) and multipara (45.5%) ≥41 weeks gestation. CONCLUSION We propose a classification system for IOL that has the attributes of simplicity and clarity, utilises information that is readily and reliably collected and reported, and enables standard characterisation of populations of women having an IOL.NHMRC 1021025, ARC FT12010006

Theoretical Modeling of Starburst Galaxies

We have modeled a large sample of infrared starburst galaxies using both the PEGASE v2.0 and STARBURST99 codes to generate the spectral energy distribution of the young star clusters. PEGASE utilizes the Padova group tracks while STARBURST99 uses the Geneva group tracks, allowing comparison between the two. We used our MAPPINGS III code to compute photoionization models which include a self-consistent treatment of dust physics and chemical depletion. We use the standard optical diagnostic diagrams as indicators of the hardness of the EUV radiation field in these galaxies. These diagnostic diagrams are most sensitive to the spectral index of the ionizing radiation field in the 1-4 Rydberg region. We find that warm infrared starburst galaxies contain a relatively hard EUV field in this region. The PEGASE ionizing stellar continuum is harder in the 1-4 Rydberg range than that of STARBURST99. As the spectrum in this regime is dominated by emission from Wolf-Rayet (W-R) stars, this difference is most likely due to the differences in stellar atmosphere models used for the W-R stars. We believe that the stellar atmospheres in STARBURST99 are more applicable to the starburst galaxies in our sample, however they do not produce the hard EUV field in the 1-4 Rydberg region required by our observations. The inclusion of continuum metal blanketing in the models may be one solution. Supernova remnant (SNR) shock modeling shows that the contribution by mechanical energy from SNRs to the photoionization models is << 20%. The models presented here are used to derive a new theoretical classification scheme for starbursts and AGN galaxies based on the optical diagnostic diagrams.Comment: 36 pages, 16 figures, to be published in ApJ, July 20, 200