Search

Background: Low-quality care for low back pain (LBP) is pervasive in Australia. Drivers of low-quality care have been identified elsewhere and include misconceptions about LBP, vested interests and limited funding for evidence-based interventions. Yet, the literature that identified such drivers is not specific to the Australian context, and therefore, it is likely to represent only part of the local problem. This study aimed to determine where the most influential drivers of LBP care are in the Australian healthcare system and what could be done to address them., Methods: Clinical leaders from various disciplines, academics, hospital managers, policy-makers, consumers involved in LBP advocacy, board members of relevant health profession boards and private insurers were invited to participate in one-on-one interviews. Interviews were transcribed verbatim. Interview data were analysed using content analysis., Results: We interviewed 37 stakeholders. Challenges that hinder LBP care in Australia included variability in care and inconsistent messages, funding models that are not supportive of appropriate care for LBP, the community's understanding of LBP, vested interests and commercial forces, difficulties in accessing timely and affordable conservative care, neglect of social determinants and health inequities, short consultations, siloed practices, uncertainties that stem from gaps in evidence and the experience of having LBP, individual and contextual variability, the mismatch between evidence and practice, the Australian healthcare system itself, the lack of political will and acknowledgement of LBP as a public health issue, stigma, the need to improve human aspects and the compensation system. When discussing factors that could improve LBP care, participants raised collaboration, changes in funding, improvement of access to - and affordability of - models of care and care pathways, public health campaigns targeting LBP, enhancement of policy and governance, increasing and better training the workforce, consideration of inequities, making improvements in information sharing and reforming the worker's compensation sector., Conclusions: LBP is a wicked problem, influenced by several systemic factors. An agenda for system change in the LBP landscape should be guided by a collaborative, coherent and integrated approach across sectors to enhance quality of care and system efficiency for those who seek and provide care., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Evidence on the impact of policies that regulate unhealthy food marketing demonstrates a need for a shift from pure industry self-regulation toward statutory regulation. Institutional rules, decision-making procedures, actor practices, and institutional norms influence the regulatory choices made by policy-makers. This study examined institutional processes that sustain, support, or inhibit change in the food marketing regulation in Australia using the three pillars of institutions framework - regulatory, normative, and cultural cognitive pillars., Methods: This was a qualitative study. Twenty-four in-depth semi-structured interviews were conducted with industry, government, civil society, and academic actors who are involved in nutrition policy in Australia., Results: The regulatory pillar was perceived to inhibit policy change through the co-regulation and self-regulation frameworks that assign rulemaking, monitoring and enforcement to industry bodies with minimal oversight by regulatory agencies and no involvement of health actors. The normative pillar was perceived to provide pathways for comprehensive statutory regulation through institutional goals and norms for collaboration that centre on a whole-of-government approach. The framing of food marketing policies to highlight the vulnerability of children is a cultural cognitive element that was perceived to be essential for getting support for policy change; however, there was a lack of shared understanding of food marketing as a policy issue. In addition, government ideologies that are perceived to be reluctant to regulate commercial actors and values that prioritize economic interest over public health make it difficult for health advocates to argue for statutory regulation of food marketing., Conclusion: Elements of all three pillars (regulatory, normative, and cultural-cognitive) were identified as either inhibitors or pathways that support policy change. This study contributes to the understanding of factors that inhibit policy change and potential pathways for implementing comprehensive statutory regulation of unhealthy food marketing., (© 2024 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Low back pain (LBP) is a major cause of disease burden around the world. There is known clinical variation in how LBP is treated and addressed; with one cited reason the lack of availability, or use of, evidence-based guidance for clinicians, consumers, and administrators. Despite this a considerable number of policy directives such as clinical practice guidelines, models of care and clinical tools with the aim of improving quality of LBP care do exist. Here we report on the development of a repository of LBP directives developed in the Australian health system and a content analysis of those directives aimed at deepening our understanding of the guidance landscape. Specifically, we sought to determine: (1) What is the type, scale, and scope of LBP directives available? (2) Who are the key stakeholders that drive low back pain care through directives? (3) What content do they cover? (4) What are their gaps and deficiencies?, Methods: We used online web search and snowballing methods to collate a repository of LBP policy documents collectively called 'directives' including Models of Care (MOC), information sheets, clinical tools, guidelines, surveys, and reports, from the last 20 years. The texts of the directives were analysed using inductive qualitative content analysis adopting methods from descriptive policy content analysis to categorise and analyse content to determine origins, actors, and themes., Results: Eighty-four directives were included in our analysis. Of those, 55 were information sheets aimed at either healthcare providers or patients, nine were clinical tools, three were reports, four were guidelines, four were MOC, two were questionnaires and five were referral forms/criteria. The three main categories of content found in the directives were 1. Low back pain features 2. Standards for clinical encounters and 3. Management of LBP, each of which gave rise to different themes and subthemes. Universities, not-for-profit organizations, government organisations, hospitals/Local Health Districts, professional organisations, consumers, and health care insurers were all involved in the production of policy directives. However, there were no clear patterns of roles, responsibilities or authority between these stakeholder groups., Conclusion: Directives have the potential to inform practice and to contribute to reducing evidence-policy-practice discordance. Documents in our repository demonstrate that while a range of directives exist across Australia, but the evidence base for many was not apparent. Qualitative content analysis of the directives showed that while there has been increasing attention given to models of care, this is not yet reflected in directives, which generally focus on more specific elements of LBP care at the individual patient and practitioner level. The sheer number and variety of directives, from a wide range of sources and various locations within the Australian health system suggests a fragmented policy landscape without clear authoritative sources. There is a need for clearer, easily accessible trustworthy policy directives that are regularly reviewed and that meet the needs of care providers, and information websites need to be evaluated regularly for their evidence-based nature and quality., (© 2023. The Author(s).)

The Codex Alimentarius has approved ongoing work for international guidance on front-of-pack (FoP) nutrition labelling, which is a core intervention for prevention of diet-related noncommunicable disease. This guidance will have implications for national policy decision-making regarding this important public health issue. However, FoP nutrition labelling is also a trade and commerce policy issue. In this study, we analyze the global governance of FoP nutrition labelling and current policy processes, to inform public health policy and advocacy. We present findings from a qualitative governance and institutional analysis, based on key informant interviews with 28 global actors. The study found that Codex guidance was perceived as likely to have a high impact on FoP nutrition labelling globally. However, a small and highly interconnected "regime complex" of international institutions surrounds FoP nutrition labelling at the global level, and influence on Codex discussions is being exerted differentially by actors at the national and global level, particularly by government and industry actors. There are thus risks associated with conflicts of interests in the development of global guidance on FoP nutrition labelling. There are also opportunities for more strategic and coordinated public health engagement., Competing Interests: The authors declare they have no conflicts of interest.