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Despite decades of policies to widen participation in medical degrees, students selected for Medicine continue to reflect a socially elite group, rather than the diversity of the communities that graduates will serve. While research has documented experiences of students from disadvantaged backgrounds, this paper examines the "cultures of success" that enable advantaged students to gain entry to medical school. It documents how these students' school and home environments enable the development and realisation of "aspirational capacity". Aspirational capacity is not just about having a dream, but also the resources and knowledge to realise one's dream. The paper also examines a negative side of a narrow aspirational focus. "Aspirational constriction" describes the premature foreclosure of career ambitions, which can have negative implications for both the students and for society, and for less advantaged students, who are effectively excluded from degrees such as Medicine. [ABSTRACT FROM AUTHOR]

While historians have analyzed and discussed the fragmentation of life in transatlantic societies by focusing on economics, law, or politics, we propose that a focus on biomedicine in the period since 1970 adds important perspectives on the shifting public role of science and of medicine. Biomedicine (the convergence of biological research and of medicine within the life sciences) moved to the center of public debates after the end of the Cold War. The papers in this special issue highlight how it became a prism through which societies, governments, and states renegotiated the roles of the medical and scientific professions, the opportunities, risks, and limits associated with scientific research and medical technologies, the responsibilities of individuals and of the professions in making life-or-death decisions, and important norms shaping the lives of individuals, families, and communities. Historians have analyzed and discussed the impact of market-oriented governing rationalities and of shifting discourses about the societal roles of individuals by focusing on politics, economics, or law. The contributors to this special issue propose to expand the focus towards biomedicine in order to include developments that otherwise would remain distinct from evolving narratives in recent contemporary history. [ABSTRACT FROM AUTHOR]

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In Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession, Thomas Cavanaugh focuses on performative aspects of the taking of the oath which bear upon the formation of that community we identify as the medical profession. In this paper, I suggest that we can go further than Cavanaugh does in identifying what the Hippocratic oath makes possible. Given its particular content and what it communicates, the oath makes possible, to a degree few other oaths could, and in a way which might be significantly impaired by the absence of an oath, the form of community we have come to call the physician-patient relationship. In Section I, I will discuss Cavanaugh's treatment of the oath's relationship to the community of medical professionals. In Section II, I discuss at a relatively abstract level the relationship between communication and community. In Section III I show how the oath can additionally constitute the primordial moment in the existence of the physician-patient relationship. [ABSTRACT FROM AUTHOR]

This paper explores health care in one Lancashire working-class community during the golden age of biomedicine. Both the biomedical and alternative medical services available in the town are examined. The services provided by one community ‘wisewoman’; ranging from the respectable, such as midwifery, to the illegal, including abortion are a key focus. This case study is used as a way to engage with a larger theme in the history of medicine, namely, the tension between orthodox biomedical science and more traditional and alternative approaches to health care. The ways in which during the early twentieth century, traditional healing networks found ways to survive despite the increasing power and reach of biomedicine are demonstrated. This evidence points to the complexity of working-class attitudes to medical authority and practice during the period in question. In Rochdale, the working-class community remained slow to accept the orthodox challenge to traditional beliefs concerning health and healing. [ABSTRACT FROM PUBLISHER]

In the Anthropocene, primate conservation can only take place when considering human culture, perspectives, and needs. Such approaches are increasingly important under the growing impact of anthropogenic activities and increasing number of threatened primates. The Amazon rainforest, rich in cultural and biological diversity, where indigenous people play a crucial role in primate conservation, provides ample opportunity to study human–primate interactions and the sociocultural context in which they occur. Human activities threaten the Amazon's fragile ecosystems and its primates, which play a key role in its maintenance and regeneration. This study focuses on one of the largest indigenous groups in the Peruvian Amazon: the Shipibo. Interviews and participant observation were used to investigate local perceptions of animal presence and depletion, food preferences, and how primates are incorporated into daily life and culture. Since time immemorial and still today, primates remain important in Shipibo culture, mythology, and subsistence. Local Shipibo participants consistently identified the presence of 13 species of primate. Primates were among the preferred species for consumption, pet keeping, and held a fundamental role in mythology, traditional knowledge, and storytelling. Large-bodied primates were often mentioned as being locally extinct, with reports and observations suggesting increasing consumption of smaller-bodied primates. Commonly perceived reasons for primate depletion include noise disturbance, hunting, and population growth, often in parallel. This study sheds light on the cultural context of an area rich in biodiversity, where primates, essential for ecological balance and integral to Shipibo lives and identity, are being depleted. We highlight the need for an inclusive ethnoprimatological approach to conserving primates and preserving indigenous heritage while improving local livelihoods. [ABSTRACT FROM AUTHOR]

Ahsan T, Nerem RM The bioengineering of tissues and organs, sometimes called tissue engineering and at other times regenerative medicine, is emerging as a science, as a technology, and as an industry. The goal is the repair, replacement, and/or the regeneration of tissues and organs. The objective of this paper is to identify and discuss the major issues that have become apparent. One of the critical issues is that of cell source, i.e. what will be the source of the cells to be employed? Another critical issue is the development of approaches for the fabrication of substitute tissues/organs and/or vehicles for the delivery of biological active molecules for use in the repair/regeneration of tissues. A third critical issue, one very much related to cell source, is that of immune acceptance. In addition, there are technological hurdles; there are additional issues such as the scale-up of manufacturing processes and the preservation of living-cell products for off-the-shelf availability. Although the initial products have been superficially applied skin substitutes, as this fledgling industry continues to evolve, it is beginning to focus on a wider range of more invasive and complicated products. From a public health perspective, the real opportunity may be in addressing chronic diseases, as well as the transplantation crisis (i.e. the tremendous disparity between patient need for vital organs and donor availability) and, equally important is the challenge of neural repair. These are the grand challenges, and the scientific community, business/private sector, and federal government must mobilize itself together in this emerging area to translate the benchtop science to the patient bedside. [ABSTRACT FROM AUTHOR]

This paper is concerned with a little explored area of social theory—the structural strains and supports between a contained community and the larger society of which it is a part and on which it is dependent. Presumably, the body of theory used for analyzing a community must be translated, qualified, or changed when that community exists within a larger society. Examples of such communities are fraternal orders, secret or extreme political parties, ethic islands whether rural or urban, organized political or economic interest groups, or a specific profession such as medicine. From a broad inquiry into such structural relations between the contained community and the larger one, it may later be possible to derive important hypotheses about the forces that maintain both of them. The community studied is the professional community, which is different in important respects from the other examples. Only two sets of links have been chosen for exploration—socialization and social control, and client choice or evaluation of the professional.

The appropriation of spiritual and medical practices has become a significant topic among scholars and practitioners of Native American religions. Scholars often focus on New Age religion as the primary realm in which the commodification and appropriation of Indigenous religious beliefs, practices, and objects has occurred. Since the 1960s, practitioners of New Age religion have drawn on an eclectic array of spiritual practices, including those originating in Native American communities, for inspiration. Yet the commodification and appropriation of Native American practices began well before the dawning of the New Age. This article examines "Indian medicine companies," US-based patent medicine companies that developed and marketed Native American-themed medicinal products to the American public in the late nineteenth century. Examining facets of material culture produced by Indian medicine companies reveals the extent to which these business enterprises, in addition to peddling remedies, sold racialized narratives about Native American religion, culture, and history. Resumen: La apropiación de prácticas espirituales y médicas se ha convertido en un tema importante entre los estudiosos y practicantes de las religiones indígenas americanas. Los estudiosos suelen centrarse en la religión de la Nueva Era como el principal ámbito en el que se ha producido la mercantilización y apropiación de creencias, prácticas y objetos religiosos indígenas. Desde la década de 1960, los practicantes de la religión de la Nueva Era se han inspirado en una variedad ecléctica de prácticas espirituales, incluidas las originarias de las comunidades indígenas americanas. Sin embargo, la mercantilización y apropiación de las prácticas de los nativos americanos comenzó mucho antes de los albores de la Nueva Era. Este artículo examina las "Indian medicine companies", empresas de patentes médicas con sede en Estados Unidos que desarrollaron y comercializaron productos medicinales de temática indígena para el público estadounidense a finales del siglo XIX. El examen de las facetas de la cultura material producida por las compañías de medicina india revela hasta qué punto estas empresas comerciales, además de vender remedios, vendían narrativas racializadas sobre la religión, la cultura y la historia de los nativos americanos. [ABSTRACT FROM AUTHOR]

Aims: To provide knowledge and recommendations for researchers, health professionals and policymakers on navigating between science and mātauranga (knowledge) Māori when using co‐design methodologies. Context: It is well known that the health system in Aotearoa/New Zealand does not provide culturally responsive services, programmes or approaches. Indigenous, remote and vulnerable populations that are not well served by medical and scientific models would be better served by the underlying premise of co‐design methodology. However, co‐design is a Western methodology. Mahitahi is presented here as a culturally responsive method of co‐design that builds approaches by utilising the worldview of the people that the health system most needs to have impact upon. Co‐design and mahitahi have synergies, and working at the interface between Western and Māori knowledge systems can provide innovative solutions that draw on the strengths of both approaches. Approach: Authors will outline the benefit co‐design processes have for improving health outcomes for remote and vulnerable populations. Mahitahi will be described and the synergies with co‐design emphasised with important distinctions also highlighted. The use of Indigenous knowledge systems, using Māori as the case example, will be outlined. Conclusion: Recommendations will be provided to guide researchers, health professionals and policy makers when planning a co‐design approach with remote and vulnerable communities. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Recent studies have shown that groups sharing the same or very similar environments, but with diverse cultural backgrounds (e.g. different ethnos and/or religion) have considerably different knowledge of folk (medicinal) plant uses. Yet, it is not clear to what extent various factors (such as culture, economy, isolation, and especially social and political situations) contribute to such differences in the utilization of the same natural resources. Aim of the study This paper addresses the effect of border created in 1940 and subsequent separation of a single ethnic group on changes in their folk use of medicinal and wild food plants. The Hutsuls of Bukovina had been homogenous for centuries, but were separated in 1940 as a result of the formation of state borders between Romania and the former Soviet Union (now Ukraine). The aim of the study is to analyse if the belonging to this different states for 75 years have induced different changes in local plant use within communities that share a common historical legacy and environment. Materials and methods In depth semi-structured interviews were conducted with 42 people in May 2015. Collected data were analysed, and comparisons were made between the data gathered on the two sides of the border for different use categories: medicinal, wild food and veterinary plants, as well as other remedies. Recently collected data were also compared with historical data obtained for the region, medicinal plant folk uses in Romania and medicinal plant uses of The State Pharmacopeia of the Soviet Union. Results Divergences in current medicinal plant use are much greater than in the use of wild food plants. The majority of the wild food taxa, including those used for making recreational teas, are also used for medicinal purposes and hence contribute to the food-medicine continuum, representing emergency foods in the past and serving as memory markers for possible future food shortages. Compared with the historical data, considerable changes have occurred within specific medicinal applications and less in the taxa used. The influence of the Soviet State Pharmacopeia on present ethnomedicine on the Ukrainian side is minimal. Conclusions Hutsul herbal ethnomedicine on the Ukrainian side of the border has continued to evolve (the abandonment of some uses and the adoption of others), whereas on the Romanian side it has undergone significant erosion with a proportionally smaller adoption of new uses and the leaving behind of possibly more “traditional” uses than on the Ukrainian side. In sum, current ethnomedicinal practices of Hutsuls living on both sides of the border are more extensive than those reported in historical sources. Yet the unknown sampling method employed to collect the historical data and possible skipping of “ordinary” uses by folklorists and ethnographers does not allow for definitive conclusions to be drawn. Cross-cultural and cross-border ethnobotany represents one of the most powerful means for addressing the issue of change and variability of medicinal plant uses and heritage, and further studies in other areas of Eastern Europe and beyond need to address the trajectory proposed by the present study. [ABSTRACT FROM AUTHOR]

What is the relationship between community trust and household health? Scholars working to understand the effects of trust and social capital on human health tend to focus on individual characteristics or social environments, frequently without integrating these two dimensions. In light of this, the present paper makes contributions in both conceptualization and measurement. First, I develop a spatially-based approach for operationalizing community trust as the product of individual orientation and social environment. This approach highlights the need for a household to trust its neighbors and for those neighbors to reciprocate trust in order to constitute the psychological and material mechanisms critical for linking social context to individual health. Second, I illustrate the utility of this measure by evaluating the relationship between community trust and self-rated health status using an original population census survey from 2009 to 2010 for two municipalities in western Honduras (approximately 2800 households with a response rate of 94.9%). I implement spatial regression analysis and show that there is a positive and substantively meaningful relationship between community trust and household health; households that are trusting and surrounded by similarly trusting neighbors report better health status, while those in uncertain or mutually distrusting environments report worse health. The theory and results presented here suggest an important link between trust and social capital at the community level, which is particularly salient for rural regions in developing countries where health resources are scarce and community-based interventions are common. [ABSTRACT FROM AUTHOR]

Budget experiments can provide additional guidance to health system reform requiring the identification of a subset of programs and services that accrue the highest social value to ‘communities’. Such experiments simulate a realistic budget resource allocation assessment among competitive programs, and position citizens as decision makers responsible for making ‘collective sacrifices’. This paper explores the use of a participatory budget experiment (with 88 participants clustered in social groups) to model public health care reform, drawing from a set of realistic scenarios for potential health care users. We measure preferences by employing a contingent ranking alongside a budget allocation exercise (termed ‘willingness to assign’) before and after program cost information is revealed. Evidence suggests that the budget experiment method tested is cognitively feasible and incentive compatible. The main downside is the existence of ex-ante “cost estimation” bias. Additionally, we find that participants appeared to underestimate the net social gain of redistributive programs. Relative social value estimates can serve as a guide to aid priority setting at a health system level. [ABSTRACT FROM AUTHOR]

In recent years, allopathy (ALP) and naturopathy (NAP) have become a favorite topic, source of argument, and the subject discussed when it comes to choosing treatment modality. Various attempts have been made to elucidate this issue, yet limited advancement has been achieved. To this day, the dispute remains active, and the debate over what to do about it continues to damnify us. The presented qualitative analysis aims to identify existing views or else expand on or uncover already known differences. Ourexamination or position is not about the conflict, finding a superior method (ALP vs. NAP), but aims at inductive reasoning, making broader generalizations from scientific observations. Subjects and Methods. We explore the philosophical and psychological foundation of the prevailing ideologies and perspectives in the contemporary society using the Straussian grounded theory approach. The study had no subjects. Results. We outline the path for the future direction. Conclusion. Our examination concludes that it is essential to acknowledge not only the difference between ALP and NAP but also how they both act on our health. We emphasize that, by identifying our perspective, our inner reflection, and our view on this topic, we can undertake a new paradigm, new road to improve our health, and perhaps the well-being throughout our culture and society. [ABSTRACT FROM AUTHOR]

With the prevalence of osteoarthritis (OA) increasing internationally, there is a need to study the impact of this disease on culturally diverse populations. Individuals of Asian descent make up more than 60% of the world population, yet comprehensive information on the cultural factors that impact OA care is not available. Scoping review methodology using directed content analysis was employed to identify and analyze existing research on OA care for Asians. A categorization matrix was developed using the six care areas from the OA clinical practice guidelines along with an additional three non-clinical areas (cross-cultural adaptation of clinical tools; psychological well-being; family systems and informal care) identified in an initial scan resulting in a total of nine OA care areas to guide initial coding. A full scoping review was conducted across five databases resulting in 656 abstracts screened. All text was coded using the categorization matrix and resulting subthemes were identified. A total of 74 articles were analyzed with 23 subthemes identified across the nine categories. Four new perspectives emerged to support OA care for Asian populations: (1) the importance of family and peer assistance, (2) the importance of culturally specific activities, (3) distrust in western medicine, and (4) impact of positive coping mechanisms on health appraisals. While Asians are more susceptible to knee and hand OA because of their cultural lifestyle factors (e.g. squatting for chores, hygiene and religious activities), and traditional beliefs on OA management (e.g. traditional diet, topical oils, physical therapy), many do not present themselves for conventional treatments (e.g. surgery) until all traditional treatments are exhausted. The results suggest that cultural factors influence the uptake of OA management practices among Asians. Greater awareness of these cultural factors may improve diagnosis, treatment, and management of OA among Asian patients. [ABSTRACT FROM AUTHOR]

Aims To evaluate patient outcomes for a novel integrated primary/specialist model of community care for complex Type 2 diabetes mellitus management compared with outcomes for usual care at a tertiary hospital for diabetes outpatients. Methods This was a prospective open controlled trial performed in a primary and tertiary care setting in Australia. A total of 330 patients with Type 2 diabetes aged >18 years were allocated to an intervention ( n=185) or usual care group ( n=145). The intervention arm was a community-based model of care led by a general practitioner with advanced skills and an endocrinologist partnership. Usual care was provided via the hospital diabetes outpatient department. The primary end point was HbA1c concentration at 12 months. Secondary end points included serum lipids and blood pressure. Results The mean change in HbA1c concentration in the intervention group was −9 mmol/mol (−0.8%) at 12 months and in the usual care group it was −2 mmol/mol (−0.2%) (95% CI −5,1). The percentage of patients in the intervention group achieving the HbA1c target of ≤53 mmol/mol (7%) increased from 21 to 42% ( P<0.001); for the usual care group there was a 1% increase to 39% of patients attaining this target ( P=0.99). Patients in the intervention group experienced significant improvements in blood pressure and total cholesterol compared with those in the usual care group. The percentage of patients achieving clinical targets was greater in the intervention group for the combined target of HbA1c concentration, blood pressure and LDL cholesterol. Conclusions A community-based, integrated model of complex diabetes care, delivered by general practitioners with advanced skills, produced clinical and process benefits compared with a tertiary diabetes outpatient clinic. [ABSTRACT FROM AUTHOR]

A utilização de agentes comunitários nos programas de atenção primária à saúde é uma experiência amplamente difundida, principalmente nos países do Terceiro Mundo. É importante, entretanto, discriminar o perfil de atuação destes agentes em função da área onde atuam, principalmente no que diz respeito às diferenças entre o meio rural e o urbano. A simples substituição de profissionais de medicina, odontologia, psicologia etc, por agentes comunitários pode significar uma abordagem limitada do conceito de atenção primária, levando ao desenvolvimento de modelos assistenciais distintos, determinados em função da classe social a que se dirigem. Neste artigo, é apontada a necessidade de formação de recursos humanos de nível superior para a atenção primária à saúde, buscando-se também identificar o lugar dos agentes comunitários nesta área, sua especificidade técnica, bem como alguns obstáculos percebidos neste campo profissional.The employment of community-based health workers (CHWs) in primary health care projects is a widespread experience, mainly in Third World countries. However, it is important to differentiate between the rural and urban profiles of these professionals. The replacement of medical/odontological/psychological professionals by CHWs alone may represent a limited approach to primary health care problems, leading to the development of different health care patterns, depending on the social class they are addressed. This paper points to need for the qualification of high-level health personnel also trying to identify the location of CHWs in this field, their technical specificity, as well as some difficulties observed in this practice.

Trachoma programs have dramatically reduced the prevalence of the ocular chlamydia that cause the disease. Some have hypothesized that immunity to the infection may be reduced because of program success in reducing the incidence of infection, and transmission may then increase. Longitudinal studies of multiple communities would be necessary to test this hypothesis. Here, we quantify transmission using an estimated basic reproduction number based on 32 communities during the first, second, and third years of an antibiotic treatment program. We found that there is little to no increase in the basic reproduction number over time. The estimated linear trend in the basic reproduction number, , was found to be −0.025 per year, 95% CI −0.167 to 0.117 per year. We are unable to find evidence supporting any loss of immunity over the course of a 3-year program. This is encouraging, as it allows the possibility that repeated mass antibiotic distributions may eliminate infection from even the most severely affected areas. [ABSTRACT FROM AUTHOR]

This article provides a commentary, from a community pharmacy perspective, on the policy environment for the pharmacy sector in Australia, with a particular focus on present challenges arising from proposals to achieve substantial PBS cost savings from an anticipated surge of new generic drugs. Some $2 billion of medicines currently on the PBS will come off patent in the next 4 years. This growth comes from a low base where generics currently account for only 15% of the total PBS budget. Remuneration for PBS dispensing is fixed through five year agreements with the government, so trading terms on generics are important for the cross-subsidy of other dispensing activities and professional services. These trading terms (discounts provided by generics suppliers) have become part of the overall cost and revenue structure of pharmacies. Despite these arrangements, generic substitution rates in Australia are lower than in most comparable countries, which the government views as an opportunity to promote generic use. The future of generic drug supply via the PBS is important to allow consumers access to medications at the lowest possible price and to provide space for PBS listing of new and expensive drugs. But considerations of PBS reform need to take account of the role and viability of community pharmacy sector as provider of pharmaceuticals in a timely and efficient manner to Australian residents. [ABSTRACT FROM AUTHOR]

The model of prevention science advocated by the Institute of Medicine (P. J. Mrazek&R. J. Haggerty, 1994) has not lead to widespread adoption of prevention and promotion programs for four reasons. The model of dissemination of programs to communities fails to consider community and organizational capacity to implement programs, ignores the need for congruence in values between programs and host sites, displays a pro-innovation bias that undervalues indigenous practices, and assumes a simplistic model of how community organizations adopt innovations. To address these faults, researchers should locate, study, and help disseminate successful indigenous programs that fit community capacity and values. In addition, they should build on theoretical models of how locally developed programs work to make existing programs and polices more effective. [ABSTRACT FROM AUTHOR]

Objective. To conceptualize and measure community contextual influences on population health and health disparities. Data Sources. We use traditional and nontraditional secondary sources of data comprising a comprehensive array of community characteristics. Study Design. Using a consultative process, we identify 12 overarching dimensions of contextual characteristics that may affect community health, as well as specific subcomponents relating to each dimension. Data Collection. An extensive geocoded library of data indicators relating to each dimension and subcomponent for metropolitan areas in the United States is assembled. Principal Findings. We describe the development of community contextual health profiles, present the rationale supporting each of the profile dimensions, and provide examples of relevant data sources. Conclusions. Our conceptual framework for community contextual characteristics, including a specified set of dimensions and components, can provide practical ways to monitor health‐related aspects of the economic, social, and physical environments in which people live. We suggest several guiding principles useful for understanding how aspects of contextual characteristics can affect health and health disparities. [ABSTRACT FROM AUTHOR]

Daniel Callahan's concept of a “sustainable medicine” is examined by looking at experiences Old Order Amish communities have had with organ and bone marrow transplantation. The Amish possess many characteristics that might make them embrace limits on the use of expensive, life-prolonging medical treatments: they believe that the good of the individual should be subordinated to the good of the community, they are suspicious of progress as a goal, and they are more comfortable with dying than many other modern Americans. However, the Amish actively pursue these treatments without the benefit of private or government insurance. Although the Amish affective response to sick individuals is worthy of emulating, their commitment to help individuals obtain and pay for transplants has had negative financial and cultural effects on some Amish communities. The Amish experience can thus teach us lessons about how to care for one another when we are sick and dying, but it can also teach us how difficult but important it is to limit some forms of expensive care for the good of our communities. [ABSTRACT FROM AUTHOR]

The current situation in health care organizations, among providers and for people, dramatically challenges the "business as usual" roles of medicine, government, insurance companies, the community, and the university. Health care reform marks the first attempt in a century to consider a reconstruction of the social contract between society and medicine. While sociology stands as one of the earliest social sciences to systematically study the health care arena and create a health-focused subfield, there is a perception, not without support, of a desertion of identity from within, an encroachment by other areas from without, and abandonment by the parent discipline. We argue that these situations in medical arenas and in research fields require serious rethinking. The key lies in understanding how these phenomena are related to each other and to larger social forces, and how they offer opportunities, rather than signal limitations, to medical sociologists. We turn to the theoretical tools of sociology to help unravel the complicated challenges that face both policymakers and researchers. After framing these issues in a sociology of knowledge perspective, we use the case of "utilization theory" to illustrate the connections between society and systems of care (as well as studies of them) and to create a future agenda. We end by raising three basic questions: (1) Why is a sociological perspective critical to the understanding of change and reform in health care? (2) Why is medical sociology critical to the survival of the general sociological enterprise? and (3) Why is general sociology critical to the research agenda in medical sociology? [ABSTRACT FROM AUTHOR]

Background: The question of how to measure, assess and optimise the returns from investment in health and medical research (HMR) is a highly policy-relevant issue. Research Impact Assessment Frameworks (RIAFs) provide a conceptual measurement framework to assess the impact from HMR. The aims of this study were (1) to elicit the views of Medical Research Institutes (MRIs) regarding objectives, definitions, methods, barriers, potential scope and attitudes towards RIAFs, and (2) to investigate whether an assessment framework should represent a retrospective reflection of research impact or a prospective approach integrated into the research process. The wider objective was to inform the development of a draft RIAF for Australia's MRIs.Methods: Purposive sampling to derive a heterogeneous sample of Australian MRIs was used alongside semi-structured interviews with senior executives responsible for research translation or senior researchers affected by research impact initiatives. Thematic analysis of the interview transcriptions using the framework approach was then performed.Results: Interviews were conducted with senior representatives from 15 MRIs. Participants understood the need for greater research translation/impact, but varied in their comprehension and implementation of RIAFs. Common concerns included the time lag to the generation of societal impacts from basic or discovery science, and whether impact reflected a narrow commercialisation agenda. Broad support emerged for the use of metrics, case study and economic methods. Support was also provided for the rationale of both standardised and customised metrics. Engendering cultural change in the approach to research translation was acknowledged as both a barrier to greater impact and a critical objective for the assessment process. Participants perceived that the existing research environment incentivised the generation of academic publications and track records, and often conflicted with the generation of wider impacts. The potential to improve the speed of translation through prospective implementation of impact assessment was supported, albeit that the mechanism required development.Conclusion: The study found that the issues raised regarding research impact assessment are less about methods and metrics, and more about the research activities that the measurement of research translation and impact may or may not incentivise. Consequently, if impact assessment is to contribute to optimisation of the health gains from the public, corporate and philanthropic investment entrusted to the institutes, then further inquiry into how the assessment process may re-align research behaviour must be prioritised. [ABSTRACT FROM AUTHOR]