IntroductionMultiple regression analysis (MRA) is a technique which seeks to link the value of a number of independent variables to a further variable whose value is supposedly dependent on them (i.e. the "dependent" variable). The intention is to produce a model, or equation, which will explain this relationship and hence enable prediction of the dependent variable in cases when this is unknown. Judgements about which model best achieves this aim are based on statistical tests. No attempt is made here to describe the technique fully, since its basis and the problems which may accompany it are well documented elsewhere (e.g.

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Use of clinical reminders, provider feedback, education and social marketing significantly increased the frequency at which HIV testing is offered and performed in VHA facilities. These findings support a multimodal approach toward achieving the goal of having every American know their HIV status as a matter of routine clinical practice.

BackgroundIncreasing the use of routine preventive care such as HIV testing is important, yet implementation of such evidence-based clinical care is complex. The Promoting Action on Research Implementation in Health Services (PARiHS) model for implementation posits that implementation will be most successful when the evidence, context, and facilitation strategies are strong for the clinical practice. We evaluated the relative importance of perceived evidence, context, and facilitation of HIV testing during the implementation of a multimodal intervention in US Department of Veterans Affairs primary care clinics.MethodsA multimodal intervention including clinical reminders (CRs), academic detailing—providing education sessions for providers—and social marketing to improve HIV testing was implemented in 15 VA primary care clinics in three regions. We conducted qualitative formative and process evaluations using semi-structured interviews with HIV lead clinicians, primary care lead clinicians, nurse managers, and social workers. Interviews were analyzed thematically to identify barriers and facilitators to implementation of HIV testing and how these were addressed by the intervention. Sites were then rated high, medium, or low on the dimensions of perceived evidence and the context for testing. We then assessed the relationship of these ratings to improvements in HIV testing rates found in earlier quantitative analyses.ResultsSites that showed greatest improvements in HIV testing rates also rated high on evidence and context. Conversely, sites that demonstrated the poorest improvements in testing rates rated low on both dimensions. Perceptions of evidence and several contextual aspects resulted in both barriers and facilitators to implementing testing. Evidence barriers included provider perceptions of evidence for routine testing as irrelevant to their population. Contextual barriers included clinical reminder overload, insufficient resources, onerous consent processes, stigma, provider discomfort, and concerns about linking individuals who test positive to HIV treatment. While most barriers were ameliorated by the intervention, HIV stigma in particular regions and concerns about linkage to care persisted.ConclusionsInterventions to implement evidence-based practices such as HIV testing can be successful when utilizing proven quality improvement techniques. However, it is critical to address providers’ perceptions of evidence and consider aspects of the local context in order to fully implement new routine clinical practices such as HIV testing.

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In most developed countries, children in lone parent families face a high risk of poverty. A partial solution commonly sought in English-speaking nations is to increase the amounts of private child maintenance paid by the other parent. However, where lone parent families are in receipt of social assistance benefits, some countries hold back a portion of the child maintenance to reduce public expenditures. This partial ‘pass-through’ treats child maintenance as a substitute for cash benefits which conceivably neutralises its poverty reduction potential. Such neutralising effects are not well understood and can be obscured further when more subtle interactions between child maintenance systems and social security systems operate. This research makes a unique contribution to knowledge by exposing the hidden interaction effects operating in similar child maintenance systems across four countries: the United Kingdom, United States (Wisconsin), Australia and New Zealand. We found that when child maintenance is counted as income in calculating benefit entitlements, it can reduce the value of cash benefits. Using model lone parent families with ten different employment and income scenarios, we show how the poverty reduction potential of child maintenance is affected by whether it is treated as a substitute for, or a complement to, cash benefits.

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As part of its 2012 Youth Service package, the Government has introduced compulsory income management for recipients of the new Youth Payment and Young Parent Payment benefits. The scheme involves dividing beneficiaries’ payments between automatic redirections for rent and other bills, an electronic payment card that can only be used for food and groceries and a cash payment of no more than $50 per week The only other country to operate comparable programmes is Australia which introduced income management in 2007 as part of the Northern Territory Emergency Response. This paper presents a preliminary assessment of the income management scheme introduced in the Youth Service package. We examine the design of, and apparent rationale for, the policy and consider some of its implications. We also compare the New Zealand policy with the way income management operates in Australia. We conclude that there is no evidence of widespread poor expenditure patterns amongst the two target groups that might justify the blanket application of the policy; that the design of the scheme inhibits people’s ability to budget optimally; and risks a number of negative and perverse outcomes. It appears that the rationale underlying the use of income management is to deter benefit receipt rather than to assist with financial management. In our view, this is not an appropriate use of the policy, especially if in doing so the scheme also risks negative outcomes.