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The policy on mass childhood immunization is an established element of the UK's approach to public health. During the late 1990s the triple measles, mumps and rubella (MMR) vaccine was the subject of widespread concern vis-a-vis its possible link with bowel disorders and autism. The government resisted calls for policy change despite a decline in MMR uptake. Why did the government continue to support MMR? The article explores this question and advances a possible explanation of policy stability in the face of pressure for policy change. It draws on the advocacy coalition framework to examine the immunization policy process, analyse the role of expert advice and contrast the relative strength of the government's case with the relative weakness of those actors advocating policy change. While the advocacy coalition framework helps to frame the analysis, it is an imperfect fit for the case study. Instead of a policy subsystem of competing advocacy coalitions, the case reveals a dominant group of actors (likened to a policy fortress) presiding over immunization policy. It is suggested that the presence of such a group would make it difficult for all but the most highly organized, strategically minded actors to advance their cause.

"Dieser Artikel untersucht Muster der Zusammenarbeit von Interessensgruppen auf EU-Ebene und erforscht potentielle Einflussfaktoren für das kooperative Verhalten. Ideen aus der Literatur zu collective action, Interessensgruppenkoalitionen, amerikanischer und europäischer Interessensvertretung und neuem Institutionalismus bilden den Rahmen für die Analyse der verschiedenen Foren der Zusammenarbeit auf EU-Ebene sowie der Faktoren, die die Zusammenarbeit zwischen Gruppen befördern, die das Ziel haben, die öffentliche EU-Politik zu beeinflussen. Empirische Belege aus einer Fallstudie zur Zusammenarbeit von europäischen Umweltgruppen führen zu einer Reihe von Schlussfolgerungen über die Natur und die Gründe für Zusammenarbeit. Die europäischen Umweltgruppen bevorzugen informell organisierte, flexible Koalitionen, in denen die Mitglieder ihr Beteiligungsniveau selbst festlegen. Die Fallstudie identifiziert kollektive und selektive Anreize, Themen und Alliierte (Koalitionspartner) als kooperationsfördernde Faktoren. Die Fallstudie zeigt weiterhin die Wichtigkeit des potentiellen Einflusses von Akteuren der Gegenseite sowie des institutionellen EU-Rahmens auf die Zusammenarbeit von Interessensgruppen auf." (Autorenreferat)

Business Interest Associations vary widely in their governability – defined as their ability to unify members' interests and ensure goal compliance. How can these variations be explained? To what extent is associational 'effectiveness' governed by factors in the external environment of an association and of its members, and to what extent can improvement programmes undertaken by associations themselves make a difference? Drawing upon interviews undertaken with 50 EU business associations in the autumn of 1998 and ongoing subsequent member interviews, analysis enables researchers to ascertain the conditions under which associations are likely to be in a position to contribute to the process of European integration. Comprehensive directory research is also used to settle a long-standing dispute about the number of 'Euro groups'.

"Interessenverbände der Wirtschaft variieren erheblich in ihrer 'Regierbarkeit'. Regierbarkeit wird dabei definiert als ihre Fähigkeit, die Mitgliederinteressen zu vereinheitlichen und die Übereinstimmung von Zielen sicherzustellen. Wie können diese Divergenzen erklärt werden? Inwieweit ist die 'Effektivität' eines Verbandes von Faktoren im externen Umfeld des Verbandes bzw. seiner Mitglieder abhängig, und inwieweit können Verbesserungsprogramme, die durch die Verbände selbst durchgeführt werden, zu Veränderungen führen? Auf der Basis von Interviews mit 50 EU-Wirtschaftsverbänden im Herbst 1998 sowie von laufenden Interviews mit Mitgliedern kann die vorliegende Analyse die Bedingungen erhellen, unter denen die Verbände in der Lage wären, zum Prozess der europäischen Integration beizutragen. Ferner wird eine umfassende Untersuchung der Verbandsverzeichnisse zur Schlichtung des bereits lange fortdauernden Disputs hinsichtlich der Anzahl der 'Euro-Verbände' genutzt." (Autorenreferat)

Highlights: - Despite clinical evidence of its effectiveness in secondary prevention of cardiovascular disease, uptake of fixed dose combination therapy (FDCs) for CVD has been poor.- A symposium was held bringing together stakeholders on this issue, including from academia, government and NGOs.- The conclusion made was that what is now needed to improve implementation of FDCs is country-specific health systems analyses to design appropriate implementation strategies.- Implementation strategies must look beyond listing on the WHO Essential Medicines List to consider approaches to improving FDC availability, accessibility, affordability, and adherence.- Strategies might include incorporation of FDCs into the WHO HEARTS technical package, simplified treatment and monitoring algorithms, decentralisation of medicine dispensing and task-sharing for treatment management.

Background: The Global Alliance for Chronic Diseases comprises the majority of the world's public research funding agencies. It is focussed on implementation research to tackle the burden of chronic diseases in low- and middle-income countries and amongst vulnerable populations in high-income countries. In its inaugural research call, 15 projects were funded, focussing on lowering blood pressure-related disease burden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategies undertaken in each of these projects. Methods: Using the Behaviour Change Wheel framework, each team rated the capability, opportunity and motivation of the various actors who were integral to each project (e.g. community members, non-physician health workers and doctors in projects focussed on service delivery). Teams then mapped the interventions they were implementing and determined the principal policy categories in which those interventions were operating. Guidance was provided on the use of Behaviour Change Wheel to support consistency in responses across teams. Ratings were iteratively discussed and refined at several group meetings. Results: There was marked variation in the perceived capabilities, opportunities and motivation of the various actors who were being targeted for behaviour change strategies. Despite this variation, there was a high degree of synergy in interventions functions with most teams utilising complex interventions involving education, training, enablement, environmental restructuring and persuasion oriented strategies. Similar policy categories were also targeted across teams particularly in the areas of guidelines, communication/marketing and service provision with few teams focusing on fiscal measures, regulation and legislation.Conclusions: The large variation in preparedness to change behaviour amongst the principal actors across these projects suggests that the interventions themselves will be variably taken up, despite the similarity in approaches taken. The ...

BACKGROUND: The Global Alliance for Chronic Diseases comprises the majority of the world's public research funding agencies. It is focussed on implementation research to tackle the burden of chronic diseases in low- and middle-income countries and amongst vulnerable populations in high-income countries. In its inaugural research call, 15 projects were funded, focussing on lowering blood pressure-related disease burden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategies undertaken in each of these projects. METHODS: Using the Behaviour Change Wheel framework, each team rated the capability, opportunity and motivation of the various actors who were integral to each project (e.g. community members, non-physician health workers and doctors in projects focussed on service delivery). Teams then mapped the interventions they were implementing and determined the principal policy categories in which those interventions were operating. Guidance was provided on the use of Behaviour Change Wheel to support consistency in responses across teams. Ratings were iteratively discussed and refined at several group meetings. RESULTS: There was marked variation in the perceived capabilities, opportunities and motivation of the various actors who were being targeted for behaviour change strategies. Despite this variation, there was a high degree of synergy in interventions functions with most teams utilising complex interventions involving education, training, enablement, environmental restructuring and persuasion oriented strategies. Similar policy categories were also targeted across teams particularly in the areas of guidelines, communication/marketing and service provision with few teams focussing on fiscal measures, regulation and legislation. CONCLUSIONS: The large variation in preparedness to change behaviour amongst the principal actors across these projects suggests that the interventions themselves will be variably taken up, despite the similarity in approaches taken. The findings highlight the importance of contextual factors in driving success and failure of research programmes. Forthcoming outcome and process evaluations from each project will build on this exploratory work and provide a greater understanding of factors that might influence scale-up of intervention strategies.

15 p. ; Background The Global Alliance for Chronic Diseases comprises the majority of the world's public research funding agencies. It is focussed on implementation research to tackle the burden of chronic diseases in low- and middle-income countries and amongst vulnerable populations in high-income countries. In its inaugural research call, 15 projects were funded, focussing on lowering blood pressure-related disease burden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategies undertaken in each of these projects. Methods Using the Behaviour Change Wheel framework, each team rated the capability, opportunity and motivation of the various actors who were integral to each project (e.g. community members, non-physician health workers and doctors in projects focussed on service delivery). Teams then mapped the interventions they were implementing and determined the principal policy categories in which those interventions were operating. Guidance was provided on the use of Behaviour Change Wheel to support consistency in responses across teams. Ratings were iteratively discussed and refined at several group meetings. Results There was marked variation in the perceived capabilities, opportunities and motivation of the various actors who were being targeted for behaviour change strategies. Despite this variation, there was a high degree of synergy in interventions functions with most teams utilising complex interventions involving education, training, enablement, environmental restructuring and persuasion oriented strategies. Similar policy categories were also targeted across teams particularly in the areas of guidelines, communication/marketing and service provision with few teams focussing on fiscal measures, regulation and legislation. Conclusions The large variation in preparedness to change behaviour amongst the principal actors across these projects suggests that the interventions themselves will be variably taken up, despite the similarity in approaches taken. The findings highlight the importance of contextual factors in driving success and failure of research programmes. Forthcoming outcome and process evaluations from each project will build on this exploratory work and provide a greater understanding of factors that might influence scale-up of intervention strategies.