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This paper takes a new look at the importance of context - institutional and political - in effective public engagement processes. It does so through a rare comparative opportunity to examine the effectiveness of processes of public engagement in two UK waste authorities, where the same waste company was involved as both the primary contractor for the delivery of the waste management service (including new energy-from-waste facilities) and, furthermore, the same staff delivered the public engagement. Interrogating these cases affords the opportunity to place flesh on the bones of the sometimes 'abstract' skeleton of context. While engagement processes support effective local governance in an era of partnerships and deliberative democracy, the paper identifies that the methods adopted cannot be played out devoid of detailed understanding and response to local context, including the strength of partnership working between the public and private sector, the degree of political support for engagement, and the extent to which a traditional institutional paternalism still dominates. [ABSTRACT FROM AUTHOR]

Background: If UK healthcare services are to respond effectively to pandemic influenza, levels of absenteeism amongst healthcare workers (HCWs) must be minimised. Current estimates of the likelihood that HCWs will continue to attend work during a pandemic are subject to scientific and predictive uncertainty, yet an informed evidence base is needed if contingency plans addressing the issues of HCW absenteeism are to be prepared. Methods: This paper reports the findings of a self-completed survey of randomly selected HCWs across three purposively sampled healthcare trusts in the West Midlands. The survey aimed to identify the factors positively or negatively associated with willingness to work during an influenza pandemic, and to evaluate the acceptability of potential interventions or changes to working practice to promote the continued presence at work of those otherwise unwilling or unable to attend. 'Likelihood' and 'persuadability' scores were calculated for each respondent according to indications of whether or not they were likely to work under different circumstances. Binary logistic regression was used to compute bivariate and multivariate odds ratios to evaluate the association of demographic variables and other respondent characteristics with the self-described likelihood of reporting to work. Results: The survey response rate was 34.4% (n = 1032). Results suggest absenteeism may be as high as 85% at any point during a pandemic, with potential absence particularly concentrated amongst nursing and ancillary workers (OR 0.3; 95% CI 0.1 to 0.7 and 0.5; 95% CI 0.2 to 0.9 respectively). Conclusion: Levels of absenteeism amongst HCWs may be considerably higher than official estimates, with potential absence concentrated amongst certain groups of employees. Although interventions designed to minimise absenteeism should target HCWs with a low stated likelihood of working, members of these groups may also be the least receptive to such interventions. Changes to working conditions which reduce barriers to the ability to work may not address barriers linked to willingness to work, and may fail to overcome HCWs' reluctance to work in the face of what may still be deemed unacceptable risk to self and/or family. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers (HCWs) will play a key role in any response to pandemic influenza, and the UK healthcare system's ability to cope during an influenza pandemic will depend, to a large extent, on the number of HCWs who are able and willing to work through the crisis. UK emergency planning will be improved if planners have a better understanding of the reasons UK HCWs may have for their absenteeism, and what might motivate them to work during an influenza pandemic. This paper reports the results of a qualitative study that explored UK HCWs' views (n = 64) about working during an influenza pandemic, in order to identify factors that might influence their willingness and ability to work and to identify potential sources of any perceived duty on HCWs to work. Methods: A qualitative study, using focus groups (n = 9) and interviews (n = 5). Results: HCWs across a range of roles and grades tended to feel motivated by a sense of obligation to work through an influenza pandemic. A number of significant barriers that may prevent them from doing so were also identified. Perceived barriers to the ability to work included being ill oneself, transport difficulties, and childcare responsibilities. Perceived barriers to the willingness to work included: prioritising the wellbeing of family members; a lack of trust in, and goodwill towards, the NHS; a lack of information about the risks and what is expected of them during the crisis; fear of litigation; and the feeling that employers do not take the needs of staff seriously. Barriers to ability and barriers to willingness, however, are difficult to separate out. Conclusion: Although our participants tended to feel a general obligation to work during an influenza pandemic, there are barriers to working, which, if generalisable, may significantly reduce the NHS workforce during a pandemic. The barriers identified are both barriers to willingness and to ability. This suggests that pandemic planning needs to take into account the possibility that staff may be absent for reasons beyond those currently anticipated in UK planning documents. In particular, staff who are physically able to attend work may nonetheless be unwilling to do so. Although there are some barriers that cannot be mitigated by employers (such as illness, transport infrastructure etc.), there are a number of remedial steps that can be taken to lesson the impact of others (providing accommodation, building reciprocity, provision of information and guidance etc). We suggest that barriers to working lie along an ability/willingness continuum, and that absenteeism may be reduced by taking steps to prevent barriers to willingness becoming perceived barriers to ability. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers (HCWs) will be key players in any response to pandemic influenza, and will be in the front line of exposure to infection. Responding effectively to a pandemic relies on the majority of medical, nursing, laboratory and hotel services staff continuing to work normally. Planning assumes that during a pandemic normal healthcare service levels will be provided, although it anticipates that as caseloads increase only essential care will be provided. The ability of the NHS to provide expected service levels is entirely dependent upon HCWs continuing to work as normal. Methods/design: This study is designed as a two-phase multi-method study, incorporating focus groups and a questionnaire survey. In phase one, qualitative methods will be used to collect the views of a purposive sample of HCWs, to determine the range of factors associated with their responses to the prospect of working through pandemic influenza. In phase two, the findings from the focus groups, combined with the available literature, will be used to inform the design of a survey to determine the generalisability of these factors, enabling the estimation of the likely proportion of HCWs affected by each factor, and how likely it is that they would be willing and/or able to continue to work during an influenza pandemic. Discussion: There are potentially greater than normal health risks for some healthcare workers working during a pandemic, and these workers may be concerned about infecting family members/ friends. HCWs will be as liable as other workers to care for sick family members and friends. It is vital to have information about how motivated HCWs will be to continue to work during such a crisis, and what factors might influence their decision to work/not to work. Through the identification and subsequent management of these factors it may be possible to implement strategies that will alleviate the concerns and fears of HCWs and remove potential barriers to working. [ABSTRACT FROM AUTHOR]

Assessing the social risks associated with climate change requires an understanding of how humans will respond because it affects how well societies will adapt. In the case of rapid or dangerous climate change, of particular interest is the potential for these responses to cross thresholds beyond which they become maladaptive. To explore the possibility of such thresholds, a series of climate change scenarios were presented to U.K. participants whose subjective responses were recorded via interviews and surveyed using Q methodology. The results indicate an initially adaptive response to climate warming followed by a shift to maladaptation as the magnitude of change increases. Beyond this threshold, trust in collective action and institutions was diminished, negatively impacting adaptive capacity. Climate cooling invoked a qualitatively different response, although this may be a product of individuals being primed for warming because it has dominated public discourse. The climate change scenarios used in this research are severe by climatological standards. In reality, the observed responses might occur at a lower rate of change. Whatever the case, analysis of subjectivity has revealed potential for maladaptive human responses, constituting a dangerous or rapid climate threshold within the social sphere. [ABSTRACT FROM AUTHOR]

Immunisation is the cornerstone of childhood disease prevention. In this context the combined measles, mumps and rubella vaccination (MMR) has proved a world-wide success, although in the UK it has been at the centre of public controversy since 1998. Through the media, the public domain has witnessed contestation among expert views about the relative risks associated with the diseases vs. the potential side-effects of the vaccination. Attainment of health protection targets has been compromised. The UK Department of Health sought to redress this through a major communication exercise. This paper reports the findings of a study of information strategies that parents use to make sense of health risk issues, particularly MMR. The findings identify the importance of social networks in reinforcing parental understanding and beliefs. While the media are identified as important sources of information, there is no evidence to suggest that parents passively receive and act upon such risk messages. Official information has been able to capitalise on the strong social normalisation of vaccination, but has not responded fully to the evolving social interpretation of risks. The study reveals a preference for personal and face-to-face engagement with health professionals, stressing the importance of user-centred health risk communication. [ABSTRACT FROM AUTHOR]

Public participation in decision making through the use of deliberative processes is now widely promoted as the means of enhancing institutional legitimacy, citizen influence and social responsibility and learning. Different methods are being tried but key questions remain about what works best and how practice could be improved. This paper discusses four examples of the application of community advisory committees and citizens' juries to waste strategy development by English local authorities. It evaluates the processes using criteria based on the concept of the fair and competent process, and identifies lessons for the optimum process. [ABSTRACT FROM AUTHOR]

Investigates management and nonmanagement attitudes in English and Welsh small and medium-sized enterprises regarding environmental policy. Doubts cast on the effectiveness of regulation; Nonmanagement's demand for strong enforcement; Management's demand for consistent regulation to ensure a `level playing field.'

Examines the links between management and non-management attitudes to the environment and organizational responses with small and medium sized enterprises in Great Britain. Identification of strong personal attitudes; Structural elements of organizational learning in proactive companies; Limits of development.

There is recognition that trust is a significant basis for effective risk communication. However, there is still a need to understand not only the relative importance of different trust dimensions but also their basis and the components which are affecting the persuasiveness of messages in different decision contexts. This paper includes the results of a small survey of people in interest groups in the United Kingdom (UK) in terms of their views of different waste management information sources. It identifies that the extent to which expectations of the performance of different institutions are supported by observation appears to have a significant impact on trust. In this regard waste management regulators in the UK appear to have the potential to engender particularly low levels of trust. [ABSTRACT FROM AUTHOR]