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Article ; Online: Lessons from complex interventions to improve health.

Hawe, Penelope

2015 Volume 36, Page(s) 307–323

Abstract: Complexity-resulting from interactions among many component parts-is a property of both the intervention and the context (or system) into which it is placed. Complexity increases the unpredictability of effects. Complexity invites new approaches to logic ...

Abstract	Complexity-resulting from interactions among many component parts-is a property of both the intervention and the context (or system) into which it is placed. Complexity increases the unpredictability of effects. Complexity invites new approaches to logic modeling, definitions of integrity and means of standardization, and evaluation. New metaphors and terminology are needed to capture the recognition that knowledge generation comes from the hands of practitioners/implementers as much as it comes from those usually playing the role of intervention researcher. Failure to acknowledge this may blind us to the very mechanisms we seek to understand. Researchers in clinical settings are documenting health improvement gains made as a consequence of complex systems thinking. Improvement science in clinical settings has much to offer researchers in population health.
MeSH term(s)	Cost-Benefit Analysis ; Health Promotion/methods ; Health Promotion/organization & administration ; Humans ; Preventive Medicine/methods ; Preventive Medicine/organization & administration ; Program Evaluation/methods ; Program Evaluation/standards ; Risk Reduction Behavior
Language	English
Publishing date	2015-03-18
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	760917-6
ISSN	1545-2093 ; 0163-7525
ISSN (online)	1545-2093
ISSN	0163-7525
DOI	10.1146/annurev-publhealth-031912-114421
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Article ; Online: Minimal, negligible and negligent interventions.

Hawe, Penelope

Social science & medicine (1982)

2015 Volume 138, Page(s) 265–268

Abstract: Many interventions are not disruptive enough of the patterns that entrench poor health and health inequities. Ways forward may require a break with tradition to embrace system-focussed theory, complex logic modelling, and ways of funding and responding ... ...

Abstract	Many interventions are not disruptive enough of the patterns that entrench poor health and health inequities. Ways forward may require a break with tradition to embrace system-focussed theory, complex logic modelling, and ways of funding and responding to problems that address the competition of ideas and needs.
MeSH term(s)	Anemia/drug therapy ; Antimalarials/therapeutic use ; Developing Countries ; Female ; Health Services Accessibility/organization & administration ; Humans ; Malaria/drug therapy ; Male ; Parasitemia/drug therapy ; Quality Improvement/organization & administration ; Quality of Health Care/organization & administration ; Rural Health Services/organization & administration
Chemical Substances	Antimalarials
Language	English
Publishing date	2015-08
Publishing country	England
Document type	Comment ; Journal Article
ZDB-ID	4766-1
ISSN	1873-5347 ; 0037-7856 ; 0277-9536
ISSN (online)	1873-5347
ISSN	0037-7856 ; 0277-9536
DOI	10.1016/j.socscimed.2015.05.025
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Article ; Online: Icing or cake? Grant competitions as a model for funding chronic disease prevention in Tasmania, Australia.

Loblay, Victoria / Garvey, Kate / Shiell, Alan / Kavanagh, Shane / Hawe, Penelope

Health promotion international

2022 Volume 37, Issue 5

Abstract: Competitive grant funding is a well-established mechanism for generating activity and interventions in the field of chronic disease prevention. Yet grant competitions may be burdensome for organizations, and money may not be enough to bring about lasting ...

Abstract	Competitive grant funding is a well-established mechanism for generating activity and interventions in the field of chronic disease prevention. Yet grant competitions may be burdensome for organizations, and money may not be enough to bring about lasting change in communities. In this study, we explore the dynamics of awarding and receiving money in the context of a state-level government grant competition to support community organizations and promote community-driven action for health and well-being in Tasmania, Australia. Drawing on reflections of successful grant recipients and real-time observation of grant decision-making, we consider the role and value of grant competitions both for individual organizations and for generating broader change processes. We found that grant competitions operated according to an 'icing-on-the-cake' approach to funding, whereby money was provided for extra activities and new initiatives. In this way, the grant competition was valuable not only for stimulating new programme activities but also to effect broader organizational change, such as developing planning capacity, igniting new directions and pushing organizations towards 'health'-focused activities. But for smaller organizations, grant funding was often stretched to support core work (i.e. cake rather than icing). Grants targeting specific focus areas could be a drain on resources if they diverted staff time away from core activities. We suggest an alternative approach to funding in which grants are able to be more responsive to the needs of community organizations and the support they require, as well as to desired outcomes. We describe the policy response to the results to date.
MeSH term(s)	Australia ; Chronic Disease ; Delivery of Health Care ; Financing, Organized ; Humans ; Tasmania
Language	English
Publishing date	2022-09-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1027448-0
ISSN	1460-2245 ; 0957-4824
ISSN (online)	1460-2245
ISSN	0957-4824
DOI	10.1093/heapro/daac115
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Article ; Online: The truth, but not the whole truth? Call for an amnesty on unreported results of public health interventions.

Hawe, Penelope

Journal of epidemiology and community health

2012 Volume 66, Issue 4, Page(s) 285

MeSH term(s)	Bias ; Humans ; Outcome Assessment (Health Care)/standards ; Public Health/methods ; Randomized Controlled Trials as Topic/standards ; Registries
Language	English
Publishing date	2012-04
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	391868-3
ISSN	1470-2738 ; 0142-467X ; 0141-7681 ; 0143-005X
ISSN (online)	1470-2738
ISSN	0142-467X ; 0141-7681 ; 0143-005X
DOI	10.1136/jech.2011.140350
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Zs.A 186: Show issues

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Article: Will E-Monitoring of Policy and Program Implementation Stifle or Enhance Practice? How Would We Know?

Conte, Kathleen P / Hawe, Penelope

Frontiers in public health

2018 Volume 6, Page(s) 243

Abstract: Electronic or digital monitoring systems could promote the visibility of health promotion and disease prevention programs by providing new tools to support the collection, analysis, and reporting of data. In clinical settings however, the benefits of e- ... ...

Abstract	Electronic or digital monitoring systems could promote the visibility of health promotion and disease prevention programs by providing new tools to support the collection, analysis, and reporting of data. In clinical settings however, the benefits of e-monitoring of service delivery remain contested. While there are some examples of e-monitoring systems improving patient outcomes, the smooth introduction into clinical practice has not occurred. Expected efficiencies have not been realized. The restructuring of team work has been problematic. Most particularly, knowledge from research has not advanced sufficiently because the meaning of e-monitoring has not been well theorized in the first place. As enthusiasm for e-monitoring in health promotion grows, it behooves us to ensure that health promotion practice learns from these insights. We outline the history of program monitoring in health promotion and the development of large-scale e-monitoring systems to track policy and program delivery. We interrogate how these technologies can be understood, noticing how they inevitably elevate some parts of practice over others. We suggest that progress in e-monitoring research and development could benefit from the insights and methods of improvement science (the science that underpins how practitioners attempt to solve problems and promote quality) as conceptually distinct from implementation science (the science of getting particular evidence-based programs into practice). To fully appreciate whether e-monitoring of program implementation will act as an aid or barrier to health promotion practice we canvass a wide range of theoretical perspectives. We illustrate how different theories draw attention to different aspects of the role of e-monitoring, and its impact on practice.
Language	English
Publishing date	2018-09-11
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711781-9
ISSN	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2018.00243
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Article ; Online: We should publish the cost of each piece of research.

Hawe, Penelope

BMJ (Clinical research ed.)

2011 Volume 342, Page(s) d4026

MeSH term(s)	Biomedical Research/economics ; Budgets ; Documentation ; United Kingdom
Language	English
Publishing date	2011-06-29
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.d4026
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Article ; Online: Soft infrastructure: the critical community-level resources reportedly needed for program success.

Kavanagh, Shane A / Hawe, Penelope / Shiell, Alan / Mallman, Mark / Garvey, Kate

BMC public health

2022 Volume 22, Issue 1, Page(s) 420

Abstract: Background: The mechanisms typically used to fund health promotion in communities, either as part of an effort to scale-up programs or to support the design of local activities, often pay insufficient attention to the foundational means of enhancing ... ...

Abstract	Background: The mechanisms typically used to fund health promotion in communities, either as part of an effort to scale-up programs or to support the design of local activities, often pay insufficient attention to the foundational means of enhancing well-being. Only recently have researchers begun to critically 'unpack' how funding processes connect with and activate local community capacities. Methods: We conducted a thematic analysis of 33 interviews with policy and program administrators in public health and local community workers and volunteers. We invited them to expound on their understandings of resources - specifically, what needs to be in place to make funded programs successful and/or what do communities draw on to make funded programs effective. Results: Policy and program administrators reflected mostly on the importance of traditional resources, such as adequate funding and staffing. Community-based participants often went further to describe psychological and sociological resources - the "soft infrastructure" which included trust and hope. Both groups emphasised the importance of building networks and relationships at multiple levels. Community workers also provided examples of how resources grow and improve in value in combination with other processes or through pathways of resource use or resource distribution. So, resources like information/knowledge are made more valuable when relayed locally. Physical amenities (e.g., meeting spaces, kitchens) have an instrumental role, but also act powerfully as a symbolic resource for identity. Participants reported that funding processes can damage the resources required for community health improvement. Funding instability undermines capacity. The ongoing threat of funding removal was described by one administrator as community "bullying". Conclusions: Processes of health promotion funding, and even standard processes of program scale-up and readiness assessment, risk underestimating the range of resources that are fundamental for community health improvement, particularly among disadvantaged communities. Funders should design ways to resource communities so that there is constant attention to and coaching of critically important diverse processes of resource growth, independent of program-specific funds.
MeSH term(s)	Data Collection ; Health Promotion ; Humans ; Program Evaluation ; Public Health ; Research Personnel
Language	English
Publishing date	2022-03-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-022-12788-8
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Variation in the operationalisation of dose in implementation of health promotion interventions: insights and recommendations from a scoping review.

Rowbotham, Samantha / Conte, Kathleen / Hawe, Penelope

Implementation science : IS

2019 Volume 14, Issue 1, Page(s) 56

Abstract: Background: While 'dose' is broadly understood as the 'amount' of an intervention, there is considerable variation in how this concept is defined. How we conceptualise, and subsequently measure, the dose of interventions has important implications for ... ...

Abstract	Background: While 'dose' is broadly understood as the 'amount' of an intervention, there is considerable variation in how this concept is defined. How we conceptualise, and subsequently measure, the dose of interventions has important implications for understanding how interventions produce their effects and are subsequently resourced and scaled up. This paper aims to explore the degree to which dose is currently understood as a distinct and well-defined implementation concept outside of clinical settings. Methods: We searched four databases (MEDLINE, PsycINFO, EBM Reviews and Global Health) to identify original research articles published between 2000 and 2015 on health promotion interventions that contained the word 'dose' or 'dosage' in the title, abstract or keywords. We identified 130 articles meeting inclusion criteria and extracted data on how dose/dosage was defined and operationalised, which we then synthesised to reveal key themes in the use of this concept across health promotion interventions. Results: Dose was defined in a variety of ways, including in relation to the amount of intervention delivered and/or received, the level of participation in the intervention and, in some instances, the quality of intervention delivery. We also observed some conflation of concepts that are traditionally kept separate (such as fidelity) either as slippage or as part of composite measures (such as 'intervention dose'). Discussion: Dose is not a well-defined or consistently applied concept in evaluations of health promotion interventions. While current approaches to conceptualisation and measurement of dose are suitable for interventions in organisational settings, they are less well suited to policies delivered at a population level. Dose often accompanies a traditional monotonic linear view of causality (e.g. dose response) which may or may not fully represent the intervention's theory of how change is brought about. Finally, we found dose and dosage to be used interchangeably. We recommend a distinction between these terms, with 'dosage' having the advantage of capturing change to amount 'dispensed' over time (in response to effects achieved). Dosage therefore acknowledges the inevitable dynamic and complexity of implementation.
MeSH term(s)	Health Promotion/methods ; Humans ; Implementation Science
Language	English
Publishing date	2019-06-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
ISSN	1748-5908
ISSN (online)	1748-5908
DOI	10.1186/s13012-019-0899-x
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The social determinants of health: how can a radical agenda be mainstreamed?

Hawe, Penelope

Canadian journal of public health = Revue canadienne de sante publique

2009 Volume 100, Issue 4, Page(s) 291–293

Abstract: The social justice framing within the WHO Commission's Report on the Social Determinants of Health is vital. Yet it can too easily be dismissed as ideology and an unfit justification for major change. Although the general public acknowledges that ... ...

Abstract	The social justice framing within the WHO Commission's Report on the Social Determinants of Health is vital. Yet it can too easily be dismissed as ideology and an unfit justification for major change. Although the general public acknowledges that structural factors, such as poverty, can affect health, they tend to see personal health behaviours as the strongest determinants of health, mirroring the main focus of health providers in recent decades. Thus a social reform agenda, while being an integral part of public health history, is nowadays too often seen as remote from the essential core of work in health. Translating the Commission's agenda into action therefore requires a recalibration of our entire health system, starting with an understanding of how complex issues can be framed in ways that inspire action, endorse mutuality of interests and enhance the perceived efficacy of the solutions, among the myriad of actors in position to make the reduction of health inequities succeed or fail. A sophisticated discourse analysis and/or communications research agenda could help to move us forward. It involves understanding and reframing the way politicians, policy-makers, practitioners and the public see "the problem" and reframing the potential of many roles in "the solution".
MeSH term(s)	Canada ; Communication ; Epidemiologic Factors ; Health Behavior ; Health Status ; Health Status Disparities ; Humans ; Mass Media ; Poverty ; Social Justice ; Social Values ; Socioeconomic Factors
Language	English
Publishing date	2009-09-01
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	417262-0
ISSN	0008-4263
ISSN	0008-4263
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Article ; Online: 30+ years of media analysis of relevance to chronic disease: a scoping review.

Rowbotham, Samantha / Astell-Burt, Thomas / Barakat, Tala / Hawe, Penelope

BMC public health

2020 Volume 20, Issue 1, Page(s) 364

Abstract: Background: Chronic, non-communicable diseases are a significant public health priority, requiring action at individual, community and population levels, and public and political will for such action. Exposure to media, including news, entertainment, ... ...

Abstract	Background: Chronic, non-communicable diseases are a significant public health priority, requiring action at individual, community and population levels, and public and political will for such action. Exposure to media, including news, entertainment, and advertising media, is likely to influence both individual behaviours, and attitudes towards preventive actions at the population level. In recent years there has been a proliferation of research exploring how chronic diseases and their risk factors are portrayed across various forms of media. This scoping review aims to map the literature in this area to identify key themes, gaps, and opportunities for future research in this area. Methods: We searched three databases (Medline, PsycINFO and Global Health) in July 2016 and identified 499 original research articles meeting inclusion criteria: original research article, published in English, focusing on media representations of chronic disease (including how issues are framed in media, impact or effect of media representations, and factors that influence media representations). We extracted key data from included articles and examined the health topics, media channels and methods of included studies, and synthesised key themes across studies. Results: Our findings show that research on media portrayals of chronic disease increased substantially between 1985 and 2016. Smoking and nutrition were the most frequent health topics, and television and print were the most common forms of media examined, although, as expected, research on online and social media channels has increased in recent years. The majority of studies focused on the amount and type of media coverage, including how issues are framed, typically using content analysis approaches. In comparison, there was much less research on the influences on and consequences of media coverage related to chronic disease, suggesting an important direction for future work. Conclusions: The results highlight key themes across media research of relevance to chronic disease. More in-depth syntheses of studies within the identified themes will allow us to draw out the key patterns and learnings across the literature.
MeSH term(s)	Chronic Disease ; Health Communication ; Humans ; Mass Media/statistics & numerical data
Language	English
Publishing date	2020-03-20
Publishing country	England
Document type	Journal Article ; Review
ISSN	1471-2458
ISSN (online)	1471-2458
DOI	10.1186/s12889-020-8365-x
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