ObjectivesThe nature of public health evidence presents challenges for conventional systematic review processes, with increasing recognition of the need to include a broader range of work including observational studies and qualitative research, yet with methods to combine diverse sources remaining underdeveloped. The objective of this paper is to report the application of a new approach for review of evidence in the public health sphere. The method enables a diverse range of evidence types to be synthesised in order to examine potential relationships between a public health environment and outcomes. Study designThe study draws on previous work by the National Institute for Health and Clinical Excellence on conceptual frameworks. It applied and further extended this work to the synthesis of evidence relating to one particular public health area, the enhancing of employee mental wellbeing in the workplace. MethodsThe approach utilised thematic analysis techniques from primary research together with conceptual modelling to explore potential relationships between factors and outcomes.

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AB S T R A C T UK government health policy now strongly supports local partnership working as a key mechanism for tackling health inequalities. There is, however, still a lack of evidence based operational guidance for the development of local partnerships in tackling inequalities in health, as well as continuing evidence of the deep-rooted political, organizational and cultural barriers to partnership working. This paper reports on the evaluation of a two year Health Education Authority programme of demonstration projects designed to test ve different models of partnership working in tackling health inequalities. The evaluation drew on Pettigrew et al.'s (1992) concepts of receptive and non-receptive contexts for change as well as the 'realistic evaluation' of Pawson & Tilley (1997). Data were collected using a range of qualitative methods including semi-structured interviews with key stakeholders and non-participant observation. Six key themes were identi ed from the case studies: shared strategic vision, leadership and management, relations and local ownership, accountability, organizational readiness and responsiveness to a changing environment. The importance of understanding how project mechanisms worked in the context of national and local policy change is emphasized, and lessons are identified for UK Health Improvement Programmes, Health Action Zones and Primary Care Groups.

This paper outlines the National Institute for Health and Clinical Excellence's (NICE) emerging conceptual framework for public health. This is based on the experience of the first 3 years of producing public health guidance at NICE (2005-2008). The framework has been used to shape the revisions to NICE's public health process and methods manuals for use post 2009, and will inform the public health guidance which NICE will produce from April 2009. The framework is based on the precept that both individual and population patterns of disease have causal mechanisms. These are analytically separate. Explanations of individual diseases involve the interaction between biological, social and related phenomena. Explanations of population patterns involve the same interactions, but also additional interactions between a range of other phenomena working in tandem. These are described. The causal pathways therefore involve the social, economic and political determinants of health, as well as psychological and biological factors. Four vectors of causation are identified: population, environmental, organizational and social. The interaction between the vectors and human behaviour are outlined. The bridge between the wider determinants and individual health outcomes is integration of the life course and the lifeworld.

BACKGROUNDThe Chronic Care Model is an effective framework for improving chronic disease management. There is scarce literature describing this model for people living with HIV. Decision Support (DS) and Clinical Information Systems (CIS) are two components of this model that aim to improve care by changing health care provider behavior.OBJECTIVEOur aim was to assess the effectiveness of DS and CIS interventions for individuals with HIV, through a systematic literature review.DESIGNWe performed systematic electronic searches from 1996 to February 2011 of the medical (E.g. Medline, EMBASE, CINAHL) and grey literature. Effectiveness was measured by the frequency of statistically significant outcome improvement. Data and key equity indicator extraction and synthesis was completed.PARTICIPANTS AND INTERVENTIONSWe included comparative studies of people living with HIV that examined the impact of DS or CIS interventions on outcomes.MAIN MEASURESThe following measures were assessed: outcome (immunological/virological, medical, psychosocial, economic measures) and health care process/performance measures.KEY RESULTSRecords were screened for relevance (n = 10,169), full-text copies of relevant studies were obtained (n = 123), and 16 studies were included in the review. Overall, 5/9 (55.6%) and 17/41 (41.5%) process measures and 5/12 (41.7%) and 3/9 (33.3%) outcome measures for DS and CIS interventions, respectively, were statistically significantly improved. DS–explicit mention of implementation of guidelines and CIS-reminders showed the most frequent improvement in outcomes. DS-only interventions were more effective than CIS-only interventions in improving both process and outcome measures. Clinical, statistical and methodological heterogeneity among studies precluded meta-analysis. Primary studies were methodologically weak and often included multifaceted interventions that made assessment of effectiveness challenging.CONCLUSIONSOverall, DS and CIS interventions may modestly improve care for people living with HIV, having a greater impact on process measures compared to outcome measures. These interventions should be considered as part of strategies to improve HIV care through changing provider performance.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-012-2145-y) contains supplementary material, which is available to authorized users.

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