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This is a protocol for a Cochrane Review (Qualitative). The objectives are as follows: \ud • To identify factors that influence referral to pulmonary rehabilitation for COPD from the perspective of service users, their family/carers, and healthcare providers. \ud • To identify factors that influence uptake of pulmonary rehabilitation for COPD (i.e. at least one attendance of an assessment or first programme session) from the perspective of service users, their family/carers, and healthcare providers. \ud • To identify factors that influence attendance at pulmonary rehabilitation programmes for COPD from the perspective of service users, their family/carers, and healthcare providers. \ud • To develop an inductive explanatory framework for how these factors may interact to contribute to better or poorer uptake or completion of pulmonary rehabilitation in order to guide actions of healthcare decision-makers to improve opportunities for people with COPD to benefit from pulmonary rehabilitation.

Policy implementation reflects a complex change process where government decisions are transformed into programs, procedures, regulations, or practices aimed at social betterment. Three factors affecting contemporary implementation processes are explored: networked governance, sociopolitical context and the democratic turn, and new public management. This frame of reference invites evaluators to consider challenges present when evaluating macrolevel change processes, such as the inherent complexity of health and social problems, multiple actors with variable degrees of power and influence, and a political environment that emphasizes accountability. The evaluator requires a deep and cogent understanding of the health or social issues involved; strong analysis and facilitation skills to deal with a multiplicity of values, interests, and agendas; and a comprehensive toolbox of evaluation approaches and methods, including network analysis to assess and track the interconnectedness of key champions (and saboteurs) who might affect intervention effects and sustainability. © Wiley Periodicals, Inc., and the American Evaluation Association.

Aims Aboriginal peoples have a high prevalence of smoking and are at major risk for diabetes. The role of insulin resistance vs. compromised β-cell function in the link between smoking and glycaemic disease is not clear. This study tested whether relations between insulin resistance and β-cell function differ between current smokers, former smokers and non-smokers, and if having diabetes modifies smoking-related effects. Methods A community-based diabetes screening initiative was mounted for a North-western First Nation (Interior Salishan) in rural British Columbia, Canada. Respondents were on-reserve Aboriginal people (n = 156), all adults 18 + years. Glycaemic status was determined by oral glucose tolerance test. Fasting values for glucose and insulin were used to estimate β-cell function and insulin resistance by homeostasis model assessment (HOMA). Analyses adjusted for age, sex, alcohol intake, education, body mass index and physical activity. Results For normoglycaemic persons (n = 119) current smokers relative to non-smokers had high β-cell values [difference (95% confidence interval) 19.5 (17.1, 21.9)], while former smokers had low β-cell values [difference −22.8 (−20.3, −25.3)] (P