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Decision Making in Public Health
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Decision Making in Public Health

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 43373

Special Issue Editors

Dr. Aoife DeBrun

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Guest Editor
University College Dublin Centre for Interdisciplinary Research, Teaching and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin 4, Ireland
Interests: applied health; organisational psychology; medical decision-making; nursing
Special Issues, Collections and Topics in MDPI journals
Dr. Edel Doherty

E-Mail Website
Guest Editor
J.E. Cairnes School of Business and Economics, National University of Ireland, H91 Galway, Ireland
Interests: health economics; environmental economics; microeconometrics; discrete choice experiment; health inequalities; social exclusion
Dr. Emma Nicholson

E-Mail Website
Guest Editor
Centre for Interdisciplinary Research Education and Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, University College Dublin, D04 C7X2 Dublin, Ireland
Interests: emergency care; paediatrics; nursing; health systems; intellectual disability services
Dr. Deirdre O'Donnell

E-Mail Website
Guest Editor
School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield 4 Dublin, Ireland
Interests: health systems and policy; integrated health care; healthy ageing; assisted decision-making; nursing

Special Issue Information

Dear Colleagues,

The role of public health is to protect population health and generate evidence to inform health interventions, supports, and policies. Public health decision-making applies evidence from a broad range of disciplines and relies on research evidence, expertise, and information about the local context to inform decision-making at various system levels.

Public health decision-making can occur at the policy level (e.g., actions taken by a government or health system) or at more local levels (e.g., actions taken by health care professionals to support specific population groups), depending on the situation at hand. We welcome papers which focus on decision-making in public health at both the systems level and at more localised levels. This may include articles which consider contextual, social, and psychological influences upon individual decision-making regarding public health and social care such as the uptake of services or adherence to public health recommendations. They may also include the decision-making that occurs at a team level among health and social care professionals (HSCPs) who are in charge of translating public health policy to practice. The decisions of these teams may be influenced by various contextual factors including team dynamics, leadership styles, and environmental, resourcing, or structural influences. Multidisciplinary research and varying types of research methodologies are welcome. 

Public health decision-making is most challenging during public health emergencies, for instance, the COVID-19 pandemic, when the science and evidence is uncertain, lacking, and emerging on an iterative basis. We welcome articles that specially address public health decision-making in contexts of uncertainty and intend to feature articles that address a range of topics in public health decision-making, including but not limited to:

  • Promoting patient/public engagement;
  • Building the decision-making capacity of key actors in public health (public, patients, HSCPs, policy makers);
  • Barriers and facilitators to knowledge transfer and the uptake of evidence to inform decision-making;
  • Challenges to decision-making during public health emergencies and/or contextual influences on public health decision-making (e.g., in contexts characterised by geopolitical uncertainty, resource scarcity, etc.);
  • Informational needs for effective public health decision-making;
  • Public health communication strategies;
  • Social representations of public health decision-making.

Dr. Aoife DeBrun
Dr. Emma Nicholson
Dr. Deirdre O'Donnell
Dr. Edel Doherty
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • public health
  • decision-making
  • evidence
  • knowledge
  • translation
  • health communication

Published Papers (16 papers)

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23 pages, 556 KiB  
Article
Price Decision-Making in Dual-Channel Healthcare Services Supply Chain Considering the Channel Acceptance, Price Ceiling, and Public Welfare
by Yanbo Ma, Zheng Li, Kaiyue Liu and Zhengmin Liu
Int. J. Environ. Res. Public Health 2022, 19(20), 13028; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192013028 - 11 Oct 2022
Viewed by 1104
Abstract
Given that an increasing number of online healthcare channels play an essential role as a supply method in the healthcare service supply chain (HSSC), this paper studies the price decision-making problem for a dual-channel HSSC considering the channel acceptance, price ceiling, and public [...] Read more.
Given that an increasing number of online healthcare channels play an essential role as a supply method in the healthcare service supply chain (HSSC), this paper studies the price decision-making problem for a dual-channel HSSC considering the channel acceptance, price ceiling, and public welfare. In this HSSC, a healthcare institution establishes both a traditional offline channel and an online channel to provide healthcare services for some health conditions. Considering the public welfare of healthcare institutions, we employ a sum formula of economic revenue and patient surplus to describe the total revenue of both healthcare service channels. Based on the Stackelberg game, we develop a decentralized supply chain model to maximize supply chain members’ revenue. By employing the Karush–Kuhn–Tucker optimality condition, we derive an analytical expression for the optimal service price, which includes the functions of the public welfare coefficient and channel acceptance. Finally, we conduct extensive numerical analyses under various system parameters to verify the optimal price decision-making strategies. Our analytical results indicate that: (1) the healthcare service price is closely related to the patients’ channel acceptance, the public welfare coefficient, and the government price ceiling policy; (2) the public welfare coefficient strongly influences the service price and total revenue, and its increase can decrease the economic revenue of the HSSC; (3) the acceptance of online channels is an essential factor that should be carefully considered in the construction of a dual-channel HSSC. Improving patient acceptance of online channels is conducive to developing and improving a sustainable dual-channel HSSC. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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18 pages, 702 KiB  
Article
Managing the Wellbeing of Elite Rugby Union Players from an Occupational Safety and Health Perspective
by Yanbing Chen, Conor Buggy and Seamus Kelly
Int. J. Environ. Res. Public Health 2022, 19(19), 12229; https://doi.org/10.3390/ijerph191912229 - 27 Sep 2022
Viewed by 1677
Abstract
The intense, physical contact nature of rugby union often encourages the normalization of risk-taking behaviour resulting in a relatively high acceptance of risk. This study aims to explore safety culture in rugby union from an OSH perspective, with the purpose of assisting coaches [...] Read more.
The intense, physical contact nature of rugby union often encourages the normalization of risk-taking behaviour resulting in a relatively high acceptance of risk. This study aims to explore safety culture in rugby union from an OSH perspective, with the purpose of assisting coaches and management in their decision-making processes to improve players’ health, welfare, and long-term well-being. In terms of data collection, this study involved semi-structured interviews with senior support staff (n = 15) in elite rugby union. Interview transcripts underwent inductive analysis prior to an abductive analysis that was guided by an established occupational-safety-and-health (OSH) framework. Rugby union players’ safety can be considered from two dimensions: management’s commitment to safety (i.e., safety prioritization, safety empowerment, and safety justice), players’ involvement in safety (i.e., safety prioritization, and trust in other players’ safety competence, and players’ safety concern for the opposition players). Within the themes identified, players’ attitude towards their opponents’ safety which has been rarely considered as a factor for injury prevention is also discussed in this study. If sport support staff (i.e., managers/coaches/medical) can become more involved in players’ performance-orientated training using OSH management processes to aid in their decision-making, their exists the capacity to benefit players’ safe return to play after injury rehabilitation. Meanwhile, directing the development of appropriate behavioural educational interventions to raise safety-awareness amongst players can improve their long-term health and well-being and provide them with the necessary safety and health information to support their own decision-making processes. As a multidisciplinary design, this study contributes new multidisciplinary insights that have the potential to advance managerial practices utilizing an OSH perspective, including decision-making supporting risk alleviation for safety and long-term health and wellbeing initiatives in competitive team sports. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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18 pages, 1929 KiB  
Article
An Improved Genetic Algorithm for Location Allocation Problem with Grey Theory in Public Health Emergencies
by Shaoren Wang, Yenchun Jim Wu and Ruiting Li
Int. J. Environ. Res. Public Health 2022, 19(15), 9752; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159752 - 08 Aug 2022
Cited by 4 | Viewed by 1942
Abstract
The demand for emergency medical facilities (EMFs) has witnessed an explosive growth recently due to the COVID-19 pandemic and the rapid spread of the virus. To expedite the location of EMFs and the allocation of patients to these facilities at times of disaster, [...] Read more.
The demand for emergency medical facilities (EMFs) has witnessed an explosive growth recently due to the COVID-19 pandemic and the rapid spread of the virus. To expedite the location of EMFs and the allocation of patients to these facilities at times of disaster, a location-allocation problem (LAP) model that can help EMFs cope with major public health emergencies was proposed in this study. Given the influence of the number of COVID-19-infected persons on the demand for EMFs, a grey forecasting model was also utilized to predict the accumulative COVID-19 cases during the pandemic and to calculate the demand for EMFs. A serial-number-coded genetic algorithm (SNCGA) was proposed, and dynamic variation was used to accelerate the convergence. This algorithm was programmed using MATLAB, and the emergency medical facility LAP (EMFLAP) model was solved using the simple (standard) genetic algorithm (SGA) and SNCGA. Results show that the EMFLAP plan based on SNCGA consumes 8.34% less time than that based on SGA, and the calculation time of SNCGA is 20.25% shorter than that of SGA. Therefore, SNCGA is proven convenient for processing the model constraint conditions, for naturally describing the available solutions to a problem, for improving the complexity of algorithms, and for reducing the total time consumed by EMFLAP plans. The proposed method can guide emergency management personnel in designing an EMFLAP decision scheme. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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22 pages, 1596 KiB  
Article
Factors Associated with the Quality and Transparency of National Guidelines: A Mixed-Methods Study
by Tanja Kovačević, Davorka Vrdoljak, Slavica Jurić Petričević, Ivan Buljan, Dario Sambunjak, Željko Krznarić, Ana Marušić and Ana Jerončić
Int. J. Environ. Res. Public Health 2022, 19(15), 9515; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159515 - 03 Aug 2022
Cited by 1 | Viewed by 1665
Abstract
We assessed the methodological quality and transparency of all the national clinical practice guidelines that were published in Croatia up until 2017 and explored the factors associated with their quality rating. An in-depth quantitative and qualitative analysis was performed using rigorous methodology. We [...] Read more.
We assessed the methodological quality and transparency of all the national clinical practice guidelines that were published in Croatia up until 2017 and explored the factors associated with their quality rating. An in-depth quantitative and qualitative analysis was performed using rigorous methodology. We evaluated the guidelines using a validated AGREE II instrument with four raters; we used multiple linear regressions to identify the predictors of quality; and two focus groups, including guideline developers, to further explore the guideline development process. The majority of the guidelines (N = 74) were developed by medical societies. The guidelines’ quality was rated low: the median standardized AGREE II score was low, 36% (IQR 28–42), and so were the overall-assessments. The aspects of the guidelines that were rated best were the “clarity of presentation” and the “scope and purpose” (median ≥ 59%); however, the other four domains received very low scores (15–33%). Overall, the guideline quality did not improve over time. The guidelines that were developed by medical societies scored significantly worse than those developed by governmental, or unofficial working groups (12–43% per domain). In focus group discussions, inadequate methodology, a lack of implementation systems in place, a lack of awareness about editorial independence, and broader expertise/perspectives in working groups were identified as factors behind the low scores. The factors identified as affecting the quality of the national guidelines may help stakeholders who are developing interventions and education programs aimed at improving guideline quality worldwide. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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12 pages, 824 KiB  
Article
Donating Health Data to Research: Influential Characteristics of Individuals Engaging in Self-Tracking
by Katharina Pilgrim and Sabine Bohnet-Joschko
Int. J. Environ. Res. Public Health 2022, 19(15), 9454; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159454 - 02 Aug 2022
Cited by 2 | Viewed by 1987
Abstract
Health self-tracking is an ongoing trend as software and hardware evolve, making the collection of personal data not only fun for users but also increasingly interesting for public health research. In a quantitative approach we studied German health self-trackers (N = 919) for [...] Read more.
Health self-tracking is an ongoing trend as software and hardware evolve, making the collection of personal data not only fun for users but also increasingly interesting for public health research. In a quantitative approach we studied German health self-trackers (N = 919) for differences in their data disclosure behavior by comparing data showing and sharing behavior among peers and their willingness to donate data to research. In addition, we examined user characteristics that may positively influence willingness to make the self-tracked data available to research and propose a framework for structuring research related to self-measurement. Results show that users’ willingness to disclose data as a “donation” more than doubled compared to their “sharing” behavior (willingness to donate = 4.5/10; sharing frequency = 2.09/10). Younger men (up to 34 years), who record their vital signs daily, are less concerned about privacy, regularly donate money, and share their data with third parties because they want to receive feedback, are most likely to donate data to research and are thus a promising target audience for health data donation appeals. The paper adds to qualitative accounts of self-tracking but also engages with discussions around data sharing and privacy. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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24 pages, 1826 KiB  
Article
Designing the Well-Being of Romanians by Achieving Mental Health with Digital Methods and Public Health Promotion
by Gabriel Brătucu, Andra Ioana Maria Tudor, Adriana Veronica Litră, Eliza Nichifor, Ioana Bianca Chițu and Tamara-Oana Brătucu
Int. J. Environ. Res. Public Health 2022, 19(13), 7868; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19137868 - 27 Jun 2022
Cited by 2 | Viewed by 2005
Abstract
Taking care of mental health is a state of mind. Amid the challenges of the current context, mental health has become one of the problems with the greatest impact on citizens and the evolution of any economy. Due to the COVID-19 pandemic, people [...] Read more.
Taking care of mental health is a state of mind. Amid the challenges of the current context, mental health has become one of the problems with the greatest impact on citizens and the evolution of any economy. Due to the COVID-19 pandemic, people have become more anxious, solitary, preoccupied with themselves, and depressed because their entire universe has changed, by restricting their social and professional life; the increase in concern caused by a possible illness of them or those close to them made to isolate themselves. Two qualitative (group and in-depth interviews) and one survey-based quantitative research were carried out, which allowed the quantification of the opinions, perceptions, and attitudes of Romanians regarding the effectiveness of policies for the prevention and treatment of depression. Quantitative research revealed that most of the subjects had never participated in a mental health assessment, and a quarter of them had visited a mental health specialist more than two years ago. Based on the results, proposals were elaborated, which have been addressed both to the specialists from the Ministry of Health and to those from the academic environment, that may have an impact on the elaboration of some public mental health programs. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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17 pages, 821 KiB  
Article
Israeli Medical Experts’ Knowledge, Attitudes, and Preferences in Allocating Donor Organs for Transplantation
by Amir Elalouf
Int. J. Environ. Res. Public Health 2022, 19(11), 6945; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116945 - 06 Jun 2022
Viewed by 1769
Abstract
Medical advancement has increased the confidence in successful organ transplants in end-stage patients. As the waitlist of organ demand is multiplying, the organ allocation process is becoming more crucial. In this situation, a transparent and efficient organ allocation policy is required. This study [...] Read more.
Medical advancement has increased the confidence in successful organ transplants in end-stage patients. As the waitlist of organ demand is multiplying, the organ allocation process is becoming more crucial. In this situation, a transparent and efficient organ allocation policy is required. This study evaluates the preferences of medical experts to substantial factors for allocating organs in different hypothetical scenarios. Twenty-five medical professionals with a significant role in organ allocation were interviewed individually. The interview questionnaire comprised demographic information, organ donation status, important organ allocation factors, public preference knowledge, and experts’ preferences in different hypothetical scenarios. Most medical experts rated the waiting time and prognosis as the most important, while the next of kin donor status and care and contribution to the well-being of others were the least important factors for organ allocation. In expert opinion, medical experts significantly considered public preferences for organ allocation in making their decisions. Altogether, experts prioritized waiting time over successful transplant, age, and donor status in the hypothetical scenarios. In parallel, less chance of finding another organ, donor status, and successful transplant were prioritized over age. Medical experts are the key stakeholders; therefore, their opinions are substantial in formulating an organ allocation policy. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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13 pages, 359 KiB  
Article
Drug Consumption Rooms and Public Health Policy: Perspectives of Scottish Strategic Decision-Makers
by James Nicholls, Wulf Livingston, Andy Perkins, Beth Cairns, Rebecca Foster, Kirsten M. A. Trayner, Harry R. Sumnall, Tracey Price, Paul Cairney, Josh Dumbrell and Tessa Parkes
Int. J. Environ. Res. Public Health 2022, 19(11), 6575; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116575 - 27 May 2022
Cited by 5 | Viewed by 6107
Abstract
There is widespread support for the introduction of Drug Consumption Rooms (DCRs) in Scotland as part of a policy response to record levels of drug-related harm. However, existing legal barriers are made more complex by the division of relevant powers between the UK [...] Read more.
There is widespread support for the introduction of Drug Consumption Rooms (DCRs) in Scotland as part of a policy response to record levels of drug-related harm. However, existing legal barriers are made more complex by the division of relevant powers between the UK and Scottish Governments. This paper reports on a national, qualitative study of key decision-makers in both local and national roles across Scotland. It explores views on the political barriers and enablers to the adoption of Drug Consumption Rooms and the potential role of these facilities in the wider treatment system. It also considers approaches to evidence, especially the types of evidence that are considered valuable in supporting decision-making in this area. The study found that Scottish decision-makers are strongly supportive of DCR adoption; however, they remain unclear as to the legal and political mechanisms that would make this possible. They view DCRs as part of a complex treatment and support system rather than a uniquely transformative intervention. They see the case for introduction as sufficient, on the basis of need and available evidence, thus adopting a pragmatic and iterative approach to evidence, in contrast to an appeal to traditional evidence hierarchies more commonly adopted by the UK Government. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
18 pages, 485 KiB  
Article
The Impact of Two-Invoice System on Pharmaceutical Manufacturers’ Selling Expenses in China: A Difference-in-Differences Approach
by Yi Ran, Yuanyuan Hu, Shouming Chen, Fangjun Qiu and Ahmed Rabeeu
Int. J. Environ. Res. Public Health 2022, 19(7), 4400; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19074400 - 06 Apr 2022
Cited by 1 | Viewed by 2390
Abstract
A perennial question for the pharmaceutical industry has been excessive drug prices. To alleviate patients’ burden of expensive medical bills and increase the affordability of medicines, China adopted the Two-Invoice System (TIS) in drug procurement for public medical institutions in 2017. In this [...] Read more.
A perennial question for the pharmaceutical industry has been excessive drug prices. To alleviate patients’ burden of expensive medical bills and increase the affordability of medicines, China adopted the Two-Invoice System (TIS) in drug procurement for public medical institutions in 2017. In this paper, we study the impact of the TIS on pharmaceutical manufacturers’ selling expenses. Using a Difference-in-Differences (DID) methodology and a sample of the A-share pharmaceutical manufacturing firms listed on the Shanghai Stock Exchange and Shenzhen Stock Exchange from the years 2014 to 2020, we find that the TIS leads to a significant increase in pharmaceutical manufacturers’ selling expenses but gradually weakens over time. In addition, we further explore whether the impact of the TIS on pharmaceutical manufacturers’ selling expenses is affected by the pharmaceutical manufacturers’ previous drug circulation mode. The results indicate that the TIS could significantly increase the pharmaceutical manufacturers’ selling expenses in the agency mode group. However, there is no evidence to support the TIS having the same effect in the direct sales office model group. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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31 pages, 3356 KiB  
Article
A Novel Integration of IF-DEMATEL and TOPSIS for the Classifier Selection Problem in Assistive Technology Adoption for People with Dementia
by Miguel Angel Ortíz-Barrios, Matias Garcia-Constantino, Chris Nugent and Isaac Alfaro-Sarmiento
Int. J. Environ. Res. Public Health 2022, 19(3), 1133; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031133 - 20 Jan 2022
Cited by 6 | Viewed by 2662
Abstract
The classifier selection problem in Assistive Technology Adoption refers to selecting the classification algorithms that have the best performance in predicting the adoption of technology, and is often addressed through measuring different single performance indicators. Satisfactory classifier selection can help in reducing time [...] Read more.
The classifier selection problem in Assistive Technology Adoption refers to selecting the classification algorithms that have the best performance in predicting the adoption of technology, and is often addressed through measuring different single performance indicators. Satisfactory classifier selection can help in reducing time and costs involved in the technology adoption process. As there are multiple criteria from different domains and several candidate classification algorithms, the classifier selection process is now a problem that can be addressed using Multiple-Criteria Decision-Making (MCDM) methods. This paper proposes a novel approach to address the classifier selection problem by integrating Intuitionistic Fuzzy Sets (IFS), Decision Making Trial and Evaluation Laboratory (DEMATEL), and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). The step-by-step procedure behind this application is as follows. First, IF-DEMATEL was used for estimating the criteria and sub-criteria weights considering uncertainty. This method was also employed to evaluate the interrelations among classifier selection criteria. Finally, a modified TOPSIS was applied to generate an overall suitability index per classifier so that the most effective ones can be selected. The proposed approach was validated using a real-world case study concerning the adoption of a mobile-based reminding solution by People with Dementia (PwD). The outputs allow public health managers to accurately identify whether PwD can adopt an assistive technology which results in (i) reduced cost overruns due to wrong classification, (ii) improved quality of life of adopters, and (iii) rapid deployment of intervention alternatives for non-adopters. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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19 pages, 496 KiB  
Article
Field Trial of an Automated Batch Chlorinator System at Two Shared Shallow Tubewells among Camps for Forcibly Displaced Myanmar Nationals (FDMN) in Cox’s Bazar, Bangladesh
by Nuhu Amin, Mahbubur Rahman, Mahbub-Ul Alam, Abul Kasham Shoab, Md. Kawsar Alome, Maksudul Amin, Tarique Md. Nurul Huda and Leanne Unicomb
Int. J. Environ. Res. Public Health 2021, 18(24), 12917; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182412917 - 08 Dec 2021
Viewed by 3165
Abstract
Chlorination of shallow tubewell water is challenging due to various iron concentrations. A mixed-method, small-scale before-and-after field trial assessed the accuracy and consistency of an automated chlorinator, Zimba, in Rohingya camp housing, Cox’s Bazar. From August–September 2018, two shallow tubewells (iron concentration = [...] Read more.
Chlorination of shallow tubewell water is challenging due to various iron concentrations. A mixed-method, small-scale before-and-after field trial assessed the accuracy and consistency of an automated chlorinator, Zimba, in Rohingya camp housing, Cox’s Bazar. From August–September 2018, two shallow tubewells (iron concentration = 6.5 mg/L and 1.5 mg/L) were selected and 20 households were randomly enrolled to participate in household surveys and water testing. The field-team tested pre-and post-treated tubewell and household stored water for iron, free and total chlorine, and E. coli. A sub-set of households (n = 10) also received safe storage containers (5 L jerry cans). Overall mean iron concentrations were 5.8 mg/L in Zimba water, 1.9 mg/L in household storage containers, and 2.8 mg/L in the project-provided safe storage containers. At baseline, 0% samples at source and 60% samples stored in household vessels were contaminated with E. coli (mean log10 = 0.62 MPN/100 mL). After treatment, all water samples collected from source and project-provided safe storage containers were free from E. coli, but 41% of post-treated water stored in the household was contaminated with E. coli. E. coli concentrations were significantly lower in the project-provided safe storage containers (log10 mean difference = 0.92 MPN, 95% CI = 0.59–1.14) compared with baseline and post-treated water stored in household vessels (difference = 0.57 MPN, 95% CI = 0.32–0.83). Zimba is a potential water treatment technology for groundwater extracted through tubewells with different iron concentrations in humanitarian settings. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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21 pages, 1727 KiB  
Article
Will the Volume-Based Procurement Policy Promote Pharmaceutical Firms’ R&D Investment in China? An Event Study Approach
by Yuanyuan Hu, Shouming Chen, Fangjun Qiu, Peien Chen and Shaoxiong Chen
Int. J. Environ. Res. Public Health 2021, 18(22), 12037; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182212037 - 16 Nov 2021
Cited by 3 | Viewed by 3340
Abstract
Innovation is the key to the development of the pharmaceutical industry. The pilot program of China’s “4 + 7” volume-based procurement policy (“4 + 7” procurement policy) brings the drug price back to a reasonable level through trading procurement quantities for lower drug [...] Read more.
Innovation is the key to the development of the pharmaceutical industry. The pilot program of China’s “4 + 7” volume-based procurement policy (“4 + 7” procurement policy) brings the drug price back to a reasonable level through trading procurement quantities for lower drug prices. The policy manages to reduce the burden of the health care system, improve efficiency, and push the pharmaceutical industry to transform and update from the era of high gross profit of generic drugs to innovative drugs. So far, few studies have investigated the influence of the volume-based procurement policy on the innovation of pharmaceutical firms. By combining the event study and Difference-in-Difference (DiD) methodology, this study finds that the abnormal return (AR) of firms with high R&D intensity is lower than that of firms with low R&D intensity during the event window period. Moreover, further analysis identifies the moderating effect of firm size and firm type. Specifically, the results show that the negative influence of high R&D intensity on abnormal return (AR) during the announcement of the “4 + 7” procurement policy is stronger in large firms and innovative pharmaceutical firms. Finally, we discuss the policy implications of our study. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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28 pages, 596 KiB  
Article
Measuring Quality of Public Hospitals in Croatia Using a Multi-Criteria Approach
by Nikola Kadoić, Diana Šimić, Jasna Mesarić and Nina Begičević Ređep
Int. J. Environ. Res. Public Health 2021, 18(19), 9984; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18199984 - 23 Sep 2021
Cited by 5 | Viewed by 2072
Abstract
Quality of public hospital services presents one of the most important aspects of public health in general. A significant number of health services are delivered due to public hospitals. Under the World Bank program “Improving Quality and Efficiency of Health Services: Program for [...] Read more.
Quality of public hospital services presents one of the most important aspects of public health in general. A significant number of health services are delivered due to public hospitals. Under the World Bank program “Improving Quality and Efficiency of Health Services: Program for Results”, the competent bodies in Croatia aimed to identify the top 40% best-performing public acute hospitals in Croatia, based on a clinical audit in the preceding 12 months. This paper presents how this goal was achieved, using a multi-criteria decision-making (MCDM) approach. A MCDM approach was selected due to the multidimensionality and complexity of healthcare performance and service quality. We aimed to develop a methodology for ranking top-performing hospitals at the national level. We chose the composite indicator methodology, combined with the analytic hierarchy process (AHP) as a tool for determining weights for aggregation of individual indicators. The study looked at three clinical entities: acute myocardial infarction, cerebrovascular insult, and antimicrobial prophylaxis in colorectal surgery. Indicators for each entity were evidence-based, following the national guidelines, but limited by availability of data. The clinical audit and databases of competent administrative bodies were used as sources of data. The problem investigated in this paper has a significant impact at the strategic (national) level. Even though the AHP has already been applied in the public health domain, to the best of our knowledge, this is the first application of the AHP in combination with composite indicators for hospital ranking at a national level. The AHP enabled participation of experts from the audited hospitals in the assessment of indicator weights. Results show that composite indicators can be successfully implemented for acute hospital evaluation using the AHP methodology: (1) the AHP supported a flexible structuring of the problem; (2) the resulting complexity of pairwise comparisons was appropriate for the experts (consistency ratios were under 0.1); (3) using the AHP approach enabled a successful aggregation of different opinions into group priorities; (4) the developed methodology was robust and enabled identifying the top 40% ranking best-performing public acute hospitals in Croatia combining 20 criteria within three entities, based on input from 36 clinical experts. The proposed methodology can be useful to other researchers for assessment of healthcare quality at the strategic level. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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6 pages, 275 KiB  
Article
Reasons for Pack Size Purchase among US Adults Who Purchase Cigars
by Jessica L. King, Anna Bilic and Julie W. Merten
Int. J. Environ. Res. Public Health 2021, 18(15), 7790; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18157790 - 22 Jul 2021
Cited by 4 | Viewed by 1896
Abstract
With municipalities across the US establishing minimum cigar pack size regulations, it is critical to understand what drives pack size preference. The purpose of this exploratory study was to identify reasons for cigar pack size purchase. We used Amazon’s Mechanical Turk to survey [...] Read more.
With municipalities across the US establishing minimum cigar pack size regulations, it is critical to understand what drives pack size preference. The purpose of this exploratory study was to identify reasons for cigar pack size purchase. We used Amazon’s Mechanical Turk to survey adults who had purchased cigars and reported past 30 day use. Participants responded to an open-ended item asking their reasons for purchasing their usual pack size. Responses were double-coded and categorized. Of 152 respondents, 61 used traditional cigars, 85 used cigarillos, and 36 used filtered cigars. Across all cigar types, most participants (73.7%) purchased boxes rather than singles; 5–9-packs were the most popular pack size category (19.7%), followed by 20+-packs (18.4%). We identified 16 reasons for pack size purchase across seven categories: price, consumption, social aspect, convenience, product characteristics, availability, and general preferences. Reasons varied according to whether the consumer purchased larger or smaller pack sizes. In this exploratory study to identify reasons for cigar pack size purchases, findings were consistent with those identified through tobacco industry documents and in the cigarette literature. Future research should examine the prevalence of these reasons, including as a function of demographic and use characteristics, to help inform the understanding of potential minimum cigar pack regulations. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
18 pages, 967 KiB  
Article
Surveillance of U.S. Corporate Filings Provides a Proactive Approach to Inform Tobacco Regulatory Research Strategy
by Samantha Emma Sarles, Edward C. Hensel and Risa J. Robinson
Int. J. Environ. Res. Public Health 2021, 18(6), 3067; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063067 - 16 Mar 2021
Cited by 6 | Viewed by 3295
Abstract
The popularity of electronic cigarettes in the United States and around the world has led to a startling rise in youth nicotine use. The Juul® e-cigarette was introduced in the U.S. market in 2015 and had captured approximately 13% of the U.S. [...] Read more.
The popularity of electronic cigarettes in the United States and around the world has led to a startling rise in youth nicotine use. The Juul® e-cigarette was introduced in the U.S. market in 2015 and had captured approximately 13% of the U.S. market by 2017. Unlike many other contemporary electronic cigarette companies, the founders behind the Juul® e-cigarette approached their product launch like a traditional high-tech start-up company, not like a tobacco company. This article presents a case study of Juul’s corporate and product development history in the context of US regulatory actions. The objective of this article is to demonstrate the value of government-curated archives as leading indicators which can (a) provide insight into emergent technologies and (b) inform emergent regulatory science research questions. A variety of sources were used to gather data about the Juul® e-cigarette and the corporations that surround it. Sources included government agencies, published academic literature, non-profit organizations, corporate and retail websites, and the popular press. Data were disambiguated, authenticated, and categorized prior to being placed on a timeline of events. A timeline of four significant milestones, nineteen corporate filings and events, twelve US regulatory actions, sixty-four patent applications, eighty-seven trademark applications, twenty-three design patents and thirty-two utility patents related to Juul Labs and its associates is presented, spanning the years 2004 through 2020. This work demonstrates the probative value of findings from patent, trademark, and SEC filing literature in establishing a premise for emergent regulatory science research questions which may not yet be supported by traditional archival research literature. The methods presented here can be used to identify key aspects of emerging technologies before products actually enter the market; this shifting policy formulation and problem identification from a paradigm of being reactive in favor of becoming proactive. Such a proactive approach may permit anticipatory regulatory science research and ultimately shorten the elapsed time between market technology innovation and regulatory response. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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14 pages, 405 KiB  
Case Report
Lessons Learnt during the Implementation of WISN for Comprehensive Primary Health Care in India, South Africa and Peru
by Sikhumbuzo A. Mabunda, Mona Gupta, Wezile W. Chitha, Ntombifikile G. Mtshali, Claudia Ugarte, Ciro Echegaray, María Cuzco, Javier Loayza, Felipe Peralta, Seimer Escobedo, Veronica Bustos, Onke R. Mnyaka, Buyiswa Swaartbooi, Natasha Williams and Rohina Joshi
Int. J. Environ. Res. Public Health 2021, 18(23), 12541; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312541 - 28 Nov 2021
Cited by 8 | Viewed by 3768
Abstract
Introduction: The World Health Organization introduced the workload indicators of staffing needs (WISN) in 1998 to improve country-level health workforce planning. This study presents the primary care health workforce planning experiences of India, South Africa and Peru. Methods: A case study approach was [...] Read more.
Introduction: The World Health Organization introduced the workload indicators of staffing needs (WISN) in 1998 to improve country-level health workforce planning. This study presents the primary care health workforce planning experiences of India, South Africa and Peru. Methods: A case study approach was used to explore the lessons learnt in the implementation of WISN in India and South Africa. It also describes the methods developed and implemented to estimate health workforce in Peru. We identify the barriers and facilitators faced by countries during the implementation phase through the triangulation of literature, government reports and accounts of involved health planners in the three countries. Results: India implemented WISN in a referral pathway of three district health facilities, including a primary health centre, community health centre and district hospital. Implementation was impeded by limited technical support, poor stakeholder consultation and information systems challenges. South Africa implemented WISN for health workforce planning in primary care and found the skills mix and staff determinations to be unaffordable. The Peruvian Ministry of Health considered using WISN but decided to develop a context-specific tool to estimate the health workforce needed using its available resources such as the National Register of Health Personnel. The main challenge in using WISN was the insufficient information on its inputs. Conclusion: While India and South Africa had unique experiences with the integration of WISN in their health system, none of the countries has yet benefited from the implementation of WISN due to financial, infrastructure and technical challenges. Since the methodology developed by the Peruvian Ministry of Health is context-specific, its implementation has been promising for health workforce planning. The learnings from these countries’ experiences will prove useful in bringing future changes for the health workforce. Full article
(This article belongs to the Special Issue Decision Making in Public Health)
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