Consumer involvement in health research: a UK scoping and survey

Consumer involvement or patient and public involvement (PPI) in health research is a UK policy imperative and a prerequisite for many funders. PPI in research is defined as research carried out with or being carried out by the public (or service users), rather than research on patients and public as subjects or participants. Despite the clear policy driver, there is relatively little empirical evidence on the extent, processes and impact of user involvement in research. This paper aims to add to the international evidence base on PPI in research by providing a key overview of current trends and impacts. In order to understand the current extent and variation of PPI in research, a scoping exercise and survey were carried out on selected UK studies. Six research topic areas (cystic fibrosis, diabetes, arthritis, dementia, intellectual and developmental disabilities, and public health) were selected to ensure a range of designs, study populations and histories of PPI in research. A total of 838 studies (non‐commercial studies and not older than 2 years) were contacted. The response rate for the scoping was 38% and the survey 28%. In the scoping, 51% of studies had some evidence of PPI and in the survey 79%. The most common PPI activity was steering committee membership and reviewing patient information leaflets. There appeared to be some blurred roles with patients participating as research subjects as well as carrying out patient involvement roles. A major finding was the limited amount of available information about PPI in publicly accessible research documents. We suggest that the invisibility of this type of involvement and the lack of routinely collected information about PPI results in a lack of shared understanding of what optimal PPI in a study should look like, with important implications for practice. Furthermore, without a framework to review PPI it is difficult to know if different approaches to PPI have a different impact on key outcomes of the research.     

Rethinking the UK System of Doctoral Training in Marketing

There have been considerable changes in the system of doctoral education and training in the UK over the last decade. Despite the introduction of a range of ESRC initiatives, the UK marketing academy has been slow to actively debate this aspect of marketing education. This approach is different from that in the US where doctoral training practices in marketing have been widely debated by the AMA. The paper aims to fill this gap by critically assessing the UK system of doctoral training in marketing. The article begins with a brief overview of the historical development of postgraduate education and training in the UK in order to contextualise the subsequent discussion. Some of the most influential reports and policy documents over the last 40 years will be assessed, specifically in relation to how they have shaped, and continue to shape, ESRC policy and postgraduate education more generally in the UK. A critical evaluation of the existing research guidelines in marketing is undertaken and the need for more specific guidelines and a more wide-ranging and inclusive approach to the syllabus than is currently offered in many UK universities is proposed. The paper also explores the importance of staff expertise and critical mass in the context of delivering cost-effective, specialised provision. The article concludes by proposing new structures that marketing departments may wish to consider in delivering research training through the use of coalitions and the use of up-to-date developments in information technology.     

Exporting the Open Skies Concept:

The International Air Transport Act of 1979 promulgated policy guidelines for Americans to achieve the liberalizing goals of unlimited multiple carrier traffic rights without operating restrictions, freedom of pricing, and the elimination of discriminatory or unfair competitive practices in international aviation. This article documents the successes and failures of the United States in exporting the Open Skies concept overseas and examines the marketing impact on American air carriers.     

Local government demands more from purchasing

It is axiomatic that functional strategies cascade from corporate objectives. Local government has traditionally had priorities relating to public accountability, local democracy and policy creation. Those traditional goals are now being supplemented with new goals of local economic development and the environment. This paper examines local government goals as a definition of business success criteria. The conclusion arrived at is that local government Purchasing Managers are faced with new and differing demands from the private sector which traditional purchasing strategies fall short of addressing. New strategic options are discussed and tabled.     

Global aging and public finance

The world is getting older, and the rate of aging, as well as the composition of aging, has important global policy implications for public finance. We’re witnessing a speeding-up of the share of elderly in developing countries. It’s important to think about fiscal stress from aging in two ways. Aging from above results in changes in social expenditures. This is going to lead to increases in health expenditures, increases in pension expenditures, and decreases in education expenditures. Aging from below leads to changes in revenues as workers decline relative to the total population. I want to “right-size” spending on health care, pensions, and welfare. Let’s talk about our public policy values and goals and figure out what we can afford, and what that means, and who needs it.     

Building the case for financial education

The need for financial education among Americans is often demonstrated with alarming rates of bankruptcy, high consumer debt levels, low savings rates, and other negative outcomes that may be the result of poor family financial management and low financial literacy levels. The collective response by public and private organizations to the accepted and often demonstrated need for financial education has been impressive in size and scope. This article provides an overview of the wide range of programs aimed at improving Americans’ financial literacy as well as a short review of the current evidence of the effectiveness of financial education programs. We advocate for the adoption of a comprehensive framework or approach to evaluation to assist those currently delivering, and planning to deliver, financial education and highlight some of the key challenges. A five‐tiered approach to program evaluation is described and outlined to provide a general framework to guide financial education evaluation.     

The vulnerable healthcare consumer: an interpretive synthesis of the patient experience literature

The increased policy emphasis on the ‘patient experience’ places the health consumer in centre stage as the driver for healthcare delivery. This poses challenges for service providers to meet the needs of more vulnerable groups, notably those with disabilities, who are often more likely to be both in greater need of services and, at the same time, less able to access them. This paper reports an interpretive synthesis of qualitative research studies in the UK and US on the experience of vulnerable patient groups using a broad range of health services. An interpretive review method was adopted to capture the complexity of the data. Eighteen papers were identified as meeting the inclusion criteria for the review. Seven key themes were identified: life experience, service design, point of delivery, accessibility, availability, specialist education/training and consumer typology. Although policy makers and providers often refer to the need for greater consumerism in the development of health services, our review suggests that it may be appropriate to consider a model of ‘mediated consumerism’ for some groups of service users. While some concerns are common to both mainstream and vulnerable consumers, others such as accessibility of services, and the resulting experience of health care, are particular to specific vulnerable groups. Accessing the experiences of these more vulnerable groups therefore warrants close attention in the development of both policy and practice in health service delivery.     

Developing injury prevention policy through a multi-agency partnership approach: a case study of a state-wide sports safety policy in New South Wales, Australia

Sports injuries are an important public health issue. A multi-agency key stakeholder partnership was formed to develop a state-wide response to sports injury prevention in New South Wales, Australia. This study evaluated the partnership approach to injury prevention policy development. The partnership approach to policy development was evaluated pre- and post-partnership using semi-structured telephone interviews and questionnaire data gathered from participants. Participants were satisfied with the partnership operation and outcomes. Challenges included: maintaining focus and efficiency; time constraints; sector diversity limiting the likelihood of addressing needs and reaching consensus; and ensuring commitment from all relevant organisations. Potential benefits included: a sense of policy ownership; a broad-based approach across the sector and savings from resource sharing. Policy resulted from a shared understanding of the injury problem, and of an appropriate response. A credible industry leader, investment in partnership management and a consultative approach facilitated the success of the partnership.     

Consumer education in the UK: new developments in policy,strategy and implementation

Consumer education is an integral part of the European Community's consumer policy. It plays a key role in consumer empowerment, helping consumers gain the skills, attitudes and knowledge they need to be able to gear the choices they make as consumers to their economic interests and to protect their health and safety. In its policy statement, the Directorate General for Health and Consumer Protection states that the European Community is aware that joint measures at national and Community levels should be more structured, in order to achieve maximum effectiveness. This paper aims to set out the current policy and strategic context for consumer education and empowerment in the UK; review the role of UK government bodies and other agencies concerned with developments; review recent literature; present the results of interviews with an extensive range of key stakeholders and the results of a survey of service heads for trading standards throughout the UK. It will consider implementation, partnership, resources, ideas and opportunities. The research found that the agenda for consumer education in the UK is at an interesting stage of development. The Enterprise Act 2002 gives the Office of Fair Trading (OFT) a statutory power to carry out educational activities. Consumer education is also moving up the agenda in the trading standards service. In addition, the teaching of citizenship in English schools is already stimulating new developments in consumer education. The paper will consider the need for organizations like these to work together to build on these policy developments and ensure that consumer education gains the profile it needs to influence consumer attitudes and behaviour.     

Home injuries in Italy: patterns of injury and the most exposed people

Home injuries are a significant public health problem in developed and developing countries. To support future policies for reducing their occurrence and controlling their consequences, this study investigated the home injuries situation in Italy in 1999, using a nation-representative sample. The weighted correspondence analysis showed four different patterns of injury and seven profiles of the people most exposed to them. As results of this study falls were followed by bumps and cuts requiring specialist assistance then burns. Women were the most exposed to burn and fall risks and men to the risk of cuts and bumps. Among the elderly and children, falls and bumps leading to fractures, wounds or other consequences were frequent. The risks were highest for people with a lower level of education. Bumps and cuts were prevalent among unmarried and with the highest education level subjects. These injury risks were higher for young males. Cuts in adults doing do-it-yourself jobs had the worst consequences, while domestic work cuts generally did not need medical treatment. Burns occurred almost exclusively in the kitchen (90%) and did not need specialist assistance. Because home injuries are largely preventable, an efficient public health policy could promote and disseminate home safety culture.     

Reclaiming Marginalized Stakeholders

There is an increasing recognition of the need to provide ways for people to raise concerns about suspected wrongdoing by promoting internal policies and procedures which offer proper safeguards to actual and potential whistleblowers. Many organisations in both the public and private sectors now have such measures and these display a wide variety of operating modalities: in-house or outsourced, anonymous/confidential/identified, multi or single tiered, specified or open subject matter, etc. As a result of this development, a number of guidelines and policy documents have been produced by authoritative bodies. This article reviews the following five documents from a management perspective, the first two deal with the principles upon which legislation might be based and the others describing good management practice: the Council of Europe Resolution 1729 (COER); Transparency International ??Recommended Principles for Whistleblowing Legislation?? (TI); European Union Article 29 Data Protection Working Party Opinion (EUWP); International Chamber of Commerce ??Guidelines on Whistleblowing?? (ICC); and the British Standards Institute ??Whistleblowing arrangements Code of Practice 2008 (BSI).     

The Development and Implementation of the Concept of Consumer Education

With the recent upsurge of emphasis in consumer education at the State and Federal government levels, consumer educators need to review the historical roots of the current movement to develop a broader perspective for planning future directions in consumer education. It is also necessary to understand the two orientations (buymanship and life goals) towards consumer education course content. Finally, a review of previous research into factors that influence the level of consumer economic competency is required.     

教育支出规模与方式对生育水平的影响

本文构建了一个两期的世代交叠模型,通过理论演绎发现,如果公共财政教育支出让家庭感知到其作为生育补贴的方式进入家庭生育决策模型中,那么增加公共财政教育支出的确会促进社会生育。进一步采用2006-2017年省级面板数据,进行经验研究和异质性分析发现:增加公共财政教育支出会促进社会生育但不显著;教育早期阶段财政投入越大,越会显著地促进社会生育,尤其在幼儿园阶段,财政教育支出每增加1%,出生率上升0.495‰;相比补贴给教育供方,补贴给教育需方家庭的财政教育支出更可能会促进社会生育,等等。给我们的政策启示在于,让民众感知到财政教育支出对生育成本的降低作用,加大幼儿园以及学前的财政教育支出,增强对教育需求方家庭的补贴。     

Unlocking the potential to influence government skills policy: a case study of the UK construction industry

Despite a series of national policy initiatives aimed at addressing skills shortages in a number of sectors, little evidence of longer‐term change is apparent. This paper examines concerns expressed by small businesses that their local views are not sought or considered when national training policies and initiatives are either being developed or being implemented, and that the investment in skills development does not appear to adequately represent their skills needs. The research was carried out on the UK construction industry, which is characterized by a small number of large contractors who employ mainly managerial and professional staff, and a large number of small, micro‐ and self‐employed firms that provide, on a subcontract basis, the majority of the industry's demand for a skilled manual workforce. The identification and delivery of vocational education and training at an industry level rests firmly on addressing the skills needs of the small and micro‐type organizations and not those of the large construction firms, although it is the voice of the larger firms that appears to dominate the skills and training development agenda. The public policy model that articulates the requirements for training and skills development in the UK is based on sector‐specific skills councils. This model is examined in relation to the construction sector by drawing upon the experiences of the South Wales region as a case study. Findings indicate that the current construction skills framework, upon which public policy is formulated and delivered, fails to adequately reflect the structure, skills and training priorities of the industry. The tensions that exist in this system are highlighted and the implications for reform of public policy articulation with regard to sector skills councils are discussed.     

Road traffic accidents and policy interventions in Korea

The high rate of road traffic crashes, in conjunction with the absence of order on the road, has long been considered a critical social problem in Korea. The Korean public seems to agree that high priority ought to be placed on policies for improving road safety. Using data from government sources, this study describes what has happened in the area of road traffic crashes since 1970, the causes of traffic crashes, and the relative importance of traffic injuries as a cause of death in Korea. Road traffic crashes in Korea increased nearly eightfold, from 37,000 in 1970 to 290,481 in 2000. The fatalities increased three-fold and injuries ten-fold over the same period. Road traffic injuries were the leading cause of death for people under 29. However, through multiple policy interventions, partly in response to the 2002 FIFA World Cup, about two thousand road traffic deaths and nine thousand traffic-related disabilities were averted in 2001 alone. The policy interventions included enforcement of penalties for seven risky driving behaviours, including drunk driving and speeding, installation of traffic-monitoring cameras, financial rewards for citizens who reported traffic violations, introduction of a road safety evaluation system, correction of accident black spots in existing roads, and road safety education programs. Through multiple policy interventions, road traffic crashes in Korea were reduced in a relatively short time period, along with their associated injuries and fatalities. However, road traffic crashes still pose a major public health problem, threatening the quality of life of the Korean people.     

Low literacy,policy and consumer vulnerability: Are we really doing enough?

A perennial issue in transformative consumer research and public policy is the plight of low‐literate vulnerable consumers. Low‐literate consumers have been observed misinterpreting labels, misusing products and purchasing the wrong item, which leads to devastating outcomes as they continue to make poor decisions out of ignorance. Based on a thorough review of past studies on consumer literacy and vulnerability, we explore how stigma and attribution operate as underlying mechanisms for influencing how low‐literate consumers behave in the marketplace. This paper problematises blanket statements that all low‐literate consumers are vulnerable and addresses the possibility that universal policy actions may inadvertently create further marginalization for those it is meant to protect. Our paper contributes by introducing a new typology of low‐literate consumer vulnerability to challenge conventional understandings of who the vulnerable consumers are in relation to their literacy level and actual marketplace behaviour. From a policy standpoint, the insights gained from our review speak to the need for differentiating low‐literate consumers in terms of their status of vulnerability, which inform public policy initiatives and effective consumer education for their empowerment and protection.     

Policy Issues Raised by For-Profit Spinoffs from Professional Associations: An Evaluation of a Recent AICPA Initiative

This paper provides an evaluation of the spinoff of a for-profit company from the American Institute of Certified Public Accountants (AICPA), a nonprofit professional association. The evaluation is based on a review of the literature on public policy issues surrounding organizational conversions from nonprofit to for-profit legal status. Many criticisms of this for-profit spinoff were voiced by professional leaders and accounting regulators, and we demonstrate that these criticisms are grounded in widely recognized policy principles relating to nonprofit conversions. The public policy issues raised by this study have implications for the governance of professional associations in all disciplines.     

Embedding consumer culture in health and social care education – a university office's perspective

Health and social care services are changing – and this change is radical. Service user and carer involvement has been a key aspect of health and social care policy for a number of years. In terms of the National Health Service (NHS), this has been significantly strengthened by the report ‘High Quality Care for All’. The NHS will no longer be a monolith dictating what services it offers. It is beginning to take seriously the views of its consumers: the patients, service users and carers. The NHS is starting to put the patient experience at the centre of everything it does, and its regulators are asking for evidence of public and patient involvement. This process may yet prove to be one of the NHS' greatest challenges as it transforms to prioritize the consumer viewpoint. Social care, though further down the line in relation to involvement, is now responding to the relatively new personalization agenda. This paper will consider what the university sector can do to embed the consumer and service culture within the education of health and social care professionals. It looks at the challenges of involvement and required culture change, highlighting the key points to address in the early and middle stages of involvement from a university office's perspective. It includes examples of consumer involvement in teaching, assessment and the selection of students and how their input is starting to make a difference. Finally, the paper outlines what is needed in a development office to establish and support effective service user and carer involvement on health and social care courses in higher education. The article concludes by acknowledging that there is much more work that needs to be done in this field to embed the work of a development office, but that early steps have been promising.     

Does strategic involvement of mental health service users and carers in the planning,design and commissioning of mental health services lead to better outcomes?

There is an assumption, explicit in the current government policy, that involvement of mental health service users and carers in the planning, design and commissioning of mental health services will lead to better outcomes. The aim of this study was to examine evidence from board‐level participation of service users and carers that might support this assumption. A thematic analysis of documents generated by a strategic Lancashire Mental Health and Social Care Partnership during 2007 was undertaken. Themes for the analysis were generated from priorities identified from a postal survey of mental health services users from across Lancashire. The findings indicate that whilst service user and carer involvement is a high priority, the Lancashire Partnership spent most of its time discussing process and actions. Where service user involvement resulted in better outcomes, these improved outcomes were limited to the individual service users involved, rather than better outcomes for all service users. Whilst the membership of mental health service users and carers on the Lancashire Partnership Board presents a visible commitment from senior officers and may confer greater legitimacy to the decisions made by the Lancashire Partnership, service users and carers do not appear to play the desired instrumental role. Rather, their presence may be largely symbolic. This sends out the message across the health and social care system that partnership with service users and carers and their empowerment is important and has the potential to evolve further.     

Injuries,inequalities and health in Europe

Injuries account for a significant burden of mortality, morbidity, disability and health care costs. They differentially affect age and sex groups and reveal massive inequalities in occurrence within and between countries in Europe. Within countries, the poor suffer most and have least ability to change their exposures to risk. Addressing inequalities in injury occurrence would play a valuable role in reducing the differential burden of ill-health between rich and poor. Despite the evidence for many effective injury-related interventions, limited attention has been devoted to addressing injuries as a public health priority. This paper questions why attention has been limited to date and suggests policy action to support injuries being addressed as a mainstream concern by national and international health policy-makers. The paper briefly highlights the public health burden of injuries and violence; illustrates the range of inequalities that characterise their occurrence; highlights the scope for public health action and considers the extent to which policies that reduce the overall burden of injuries may also reduce inequalities in their occurrence; and finally examines why there has been a limited policy response to date and suggests ways of advancing the agenda.