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Background: The World Health Organization Astana Declaration of 2018 sees primary healthcare as key to universal health coverage and gives further support to the goal of building sustainable models of community palliative care. Yet evaluating the benefits of such models continues to pose methodological and conceptual challenges. Objective: To explore evaluation issues associated with a community-based palliative care approach in Kerala, India. Design: An illuminative case study using a rapid evaluation methodology. Methodology: Qualitative interviews, documentary analysis and observations of home care and community organising. Results: We appraise a community palliative care programme in Kerala, India, using three linked 'canvases' of enquiry: (1) 'complex' multi-factorial community-based interventions and implications for evaluation; (2) 'axiological' orientations that foreground values in any evaluation process and (3) the status of evaluative evidence in postcolonial contexts. Three values underpinning the care process were significant: heterogeneity, voice and decentralisation. We identify 'objects of interest' related to first-, second- and third-order outcomes: (1) individuals and organisations; (2) unintended targets outside the core domain and (3) indirect, distal effects within and outside the domain. Conclusion: We show how evaluation of palliative care in complex community circumstances can be successfully accomplished when attending to the significance of community care values. Plain language summary: Where are the values in evaluating palliative care? Learning from community-based palliative care provision The evaluation of any intervention or service will inevitably involve a series of decisions on what we measure, what criteria we use to judge whether the intervention has been successful (or not), what type of data we actually collect and what methods we use to do this. When evaluating a range of palliative care interventions, we suggest that these decisions have often been taken in a concealed way and tend to favour relatively narrow quantitative measures linked to end outcomes. Our paper reports on the evaluation of a community-based palliative care intervention on Kerala, India. In it, we suggest that such complex work requires a broader approach to evaluation that: makes the values being used to assess success explicit; draws on a range of data types; is interested in delivery processes; and places the voices of participants at the heart of the assessment. The paper concludes with some broader observations on how these principles might be applied more widely within palliative care. [ABSTRACT FROM AUTHOR]

The need to foster resilience amongst young people with intellectual disabilities is increasingly recognised within policy. Critically, understanding of the actual means by which this aspiration might be most sensitively and effectively met is considered weak. This paper reports on an exploratory case-study of a social enterprise community café – The Usual Place - that through the promotion of employability, seeks to promote resilience amongst its young 'trainees' with intellectual disabilities. Two research questions were set: " how is 'resilience' conceptualized within the organisation " and " what features within the organisation are significant in fostering resilience"? We identify a range of significant features associated with being able to successfully foster resilience – the need for a foundational 'whole organisation'(settings) approach based on high levels of participation and choice; the negotiation of a constructive dynamic tension between 'support' and 'exposure'; and the embedding of these actions in embodied actions and day-to-day organisational activities. [ABSTRACT FROM AUTHOR]

Objective: The objective of this research was to explore how accessible the concept of food and physical literacy is for health and well-being professionals, and assess its potential effect on service delivery. Design: Formative research and 'concept testing' with potential deliverers of food and physical literacy. Setting: Dumfries and Galloway, a rural region in South West Scotland, UK. Method: The research was undertaken after four workshops hosted by National Health Service (NHS) public health specialists, aiming to introduce and discuss the concept. An immediate post-event focus group and a short qualitative questionnaire were used to assess professionals' initial perspectives on the concept, whether they thought the concept was applicable to their work, and what they might require by way of support if the concept was to be taken forward. Results: The findings illustrated the extent to which professionals feel that food and physical literacy is necessary, barriers to its implementation and ideal components for advancing work within this field. Conclusion: The concept of food and physical literacy has a sufficiently high level of resonance (proof of the concept) among informants to provide a foundation on which further work on its operationalisation can be based. The use of formative research and concept testing with potential service deliverers was able to identify areas to be considered during developmental stages, increasing the likelihood that the end result will be accepted by the professionals expected to utilise it. Thus, the benefits of an inclusive approach to service development were also highlighted. [ABSTRACT FROM AUTHOR]

The claim is made by many that we have reached a point where we are exposed to too much information. This potential phenomenon is particularly prominent in the health field where there is a suggestion that the volume of available information has increased significantly and more importantly that such volume has had detrimental effects on both the overall quality of such information and the ability of people to process and use it. This paper explores the nature and validity of these claims.Within the context of the notion of an `information society', it outlines a range of concerns that have been expressed in relation to this increase, including the simple problem of overload, the potential for less robust information to enter the system and thus the overall quality of available information to decline. This excess of information is seen to act against the benefits that are sought — information can be invalid and people may not have time to reflect and act on excessive information loads. This can result in irrationality or disinformation.The suggestion is made, however, that these concerns are largely unsupported by empirical evidence and are potentially the basis of a panic over the entry of alternative perspectives on health. The pessimistic perspectives are thus balanced by more constructive and optimistic views on this growth and opening up of information production and potential consumption. Seeing information creation as organic and pluralistic, it is suggested that increased information volume can actually be a constructive phenomenon.The paper concludes with the contention that it is unrealistic to expect a return to former circumstances of controlled and limited information flows. Rather, a series of more pragmatic suggestions is offered within existing circumstances, including differentiating between information rich and poor health areas, addressing structural issues like information access and health literacy, and working towards organizing health information so that it is of a high quality, is physically accessible, relevant to the needs and literacy of groups, and in a usable form. [ABSTRACT FROM PUBLISHER]

Interest in the potential for public health and palliative care to work together is now widely established. Based on a mapping review of existing literature, we describe for the first time the ways in which public health has entered palliative care policy and practice and how this has been specifically articulated. We then go on to pursue analytical and critical lines of enquiry that are largely absent from the existing literature. We do this in three ways: (i) by considering why the link between public health and palliative care has become so ubiquitous within palliative care policy; (ii) by establishing how this has been constructed; and (iii) by exploring public health as a 'reference discipline' from which its 'secondary deployment' can become embedded inside another disciplinary field. From this, we develop a range of critical perspectives on the relationship between public health and palliative care by scrutinising its claims of utility and effectiveness and questioning the strength of the interdisciplinary interaction between the two disciplines. We see their relationship in a 'cross disciplinary' context which is still largely symbolic and tactical in nature. We conclude by considering the significance of these insights for policy and practice, with two possible scenarios. If the use of public health is essentially figurative and its resources are not unique, the particular and exclusive use of the term becomes insignificant. Progressive and effective policy and practice is possible, independent of any explicit public health label. If however public health is considered to have intrinsic and definable worth, we suggest that this currently asymmetrical association needs to be significantly developed with much higher levels of theoretical, practical and critical engagement between the two disciplines. Such work would result in more reflective and robust policy and practice. [ABSTRACT FROM AUTHOR]