The experience of community first responders in co-producing rural health care : in the liminal gap between citizen and professional

Non peer reviewedPublisher PD

Media framing of childhood obesity: a content analysis of UK newspapers from 1996-2014

Background: Media can influence public and policy-makers’ perceptions of causes of, and solutions to, public health issues through selective presentation and framing. Childhood obesity is a health issue with both individual-level and societal-level drivers and solutions, but public opinion and mass media representations of obesity have typically focused on individual-level framings, at the cost of acknowledgement of a need for regulatory action. Objective and setting: To understand the salience and framing of childhood obesity across 19 years of UK national newspaper content. Design and outcome measures: Quantitative content analysis of 757 articles about childhood obesity obtained from six daily and five Sunday newspapers. Articles were coded manually for definitions, drivers and potential solutions. Data were analysed statistically, including analysis of time trends and variations by political alignment of source. Results: The frequency of articles grew from a low of two in 1996 to a peak of 82 in 2008, before declining to 40 in 2010. Individual-level drivers (59.8%) and solutions (36.5%) were mentioned more frequently than societal-level drivers (28.3%) and solutions (28.3%) across the sample, but societal solutions were mentioned more frequently during the final 8 years, coinciding with a marked decline in yearly frequency of articles. Conclusions: Increased focus on societal solutions aligns with public health goals, but coincided with a reduction in the issue’s salience in the media. Those advocating public policy solutions to childhood obesity may benefit from seeking to raise the issue’s media profile while continuing to promote structural conceptualisations of childhood obesity

Newspaper framing of food and beverage corporations’ sponsorship of sport: a content analysis

Background: Unhealthy diets are a leading contributor to obesity, disability and death worldwide. One factor cited as contributing to rises in obesity rates is the pervasive and ubiquitous marketing of unhealthy foods and beverages (F&Bs) across a variety of mediums, such as sport sponsorship at both professional and amateur levels. Despite increased academic attention on the detrimental impacts of sport sponsorship within the obesogenic environment, this has not been matched by legislative action. One explanation may be the way that F&B corporations’ sport sponsorship is framed within policy debates. Framing is the deliberate ways in which (often contested) issues are presented in communication. This paper examines how sport sponsorship by F&B corporations is framed through media reports. Methods: This study employed a mixed methods content and framing analysis. First, we conducted a quantitative newsprint content analysis (n = 234). This then informed and directed a thematic framing analysis of a sub-set of articles (n = 54) that specifically associated sport sponsorship by F&B corporations with obesity and childhood obesity. Results: The findings suggest that two competing frames are evident within newspaper coverage: 1) public health and 2) industry. The public health frame rejects the sponsorship of sport by High in Fat Sugar and Salt (HFSS) product corporations in particular, calling for such sponsorship to be restricted or banned. The industry frame characterises sponsorship of sport as a form of corporate social responsibility, positioning industry as good moral actors and part of the solution to childhood and adult obesity. These frames are evident across other Unhealthy Commodity Industries (UCIs) policy debates. However, the prominence of industry actors within the sample is potentially indicative of their discursive power within this space, particularly with their emphasis on the financial maintenance of sport as well as encouraging physical activity, contributing to the lack of regulatory development of sport sponsorship by F&B corporations. Conclusions: The findings of this study are particularly useful for public health organisations who seek regulatory change, as it may provide further insight into countering industry framing practices, raising the salience of regulation of sport sponsorship and thus increasing the likelihood of regulatory development that seeks to improve population health

Experiences of connectivity and severance in the wake of a new motorway: Implications for health and well-being.

The construction of new urban roads may cause severance, or the separation of residents from local amenities or social networks. Using qualitative data from a natural experimental study, we examined severance related to a new section of urban motorway constructed through largely deprived residential neighbourhoods in Glasgow, Scotland. Semi-structured and photo-elicitation interviews were used to better understand severance and connectivity related to the new motorway, and specifically implications for individual and community-level health and well-being through active travel and social connections. Rather than a clear severance impact attributable to the motorway, a complex system of connection and severance was spoken about by participants, with the motorway being described by turns as a force for both connection and severance. We conclude that new transport infrastructure is complex, embedded, and plausibly causally related to connectedness and health. Our findings suggest the potential for a novel mechanism through which severance is enacted: the disruptive impacts that a new road may have on third places of social connection locally, even when it does not physically sever them. This supports social theories that urge a move away from conceptualising social connectedness in terms of the local neighbourhood only, towards an understanding of how we live and engage dynamically with services and people in a much wider geographical area, and may have implications for local active travel and health through changes in social connectedness

Community hospitals and their services in the NHS: identifying transferable learning from international developments - scoping review, systematic review, country reports and case studies

Background: The notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential. Objectives This study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care. Methods A multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland. Results The evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented. Limitations The use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth. Conclusions At a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s). Funding: The National Institute for Health Research Health Services and Delivery Research programme

Community participation to design rural primary healthcare services

Background: This paper explores how community participation can be used in designing rural primary healthcare services by describing a study of Scottish communities. Community participation is extolled in healthcare policy as useful in planning services and is understood as particularly relevant in rural settings, partly due to high social capital. Literature describes many community participation methods, but lacks discussion of outcomes relevant to health system reconfiguration. There is a spectrum of ideas in the literature on how to design services, from top-down standard models to contextual plans arising from population health planning that incorporates community participation. This paper addresses an evidence gap about the outcomes of using community participation in (re)designing rural community health services. Methods: Community-based participatory action research was applied in four Scottish case study communities in 2008–10. Data were collected from four workshops held in each community (total 16) and attended by community members. Workshops were intended to produce hypothetical designs for future service provision. Themes, rankings and selections from workshops are presented. Results: Community members identified consistent health priorities, including local practitioners, emergency triage, anticipatory care, wellbeing improvement and health volunteering. Communities designed different service models to address health priorities. One community did not design a service model and another replicated the current model despite initial enthusiasm for innovation. Conclusions: Communities differ in their receptiveness to engaging in innovative service design, but some will create new models that fit in a given budget. Design diversity indicates that context influences local healthcare planning, suggesting community participation impacts on design outcomes, but standard service models maybe useful as part of the evidence in community participation discussions