On the 25 March 2017, leaders of the EU27 and European Union (EU) institutions ratified the Rome Declaration. They committed to invite citizens to discuss Europe's future and to provide recommendations that would facilitate their decision-makers in shaping their national positions on Europe. In response, citizens' dialogues on the future of Europe were instituted across the Union to facilitate public participation in shaping Europe. This paper explores Ireland's set of dialogues which took place during 2018. Although event organisers in Ireland applied a relatively atypical and more systematic and participatory approach to their dialogues, evidence suggests that Irelands' dialogues were reminiscent of a public relations exercise which showcased the country's commitment to incorporating citizens into the debate on Europe while avoiding a deliberative design which could have strengthened the quality of public discourse and the quality of public recommendations. Due to an absence of elite political will for a deliberative process, as well as structural weaknesses in design, participants' recommendations lacked any clear and prescriptive direction which could shape Ireland's national position on the future of Europe in any constructive or meaningful way.
There is now no serious scientific debate: human actions are changing the world’s climate, and are set to do so at an increasing rate in coming decades. Urgent action is now required to reduce emissions of carbon dioxide (the dominant long acting greenhouse gas), if global temperature rises are not to exceed 2°C—the International Energy Authority warns that “the door to 2°C is closing.” Indeed, emissions must be hugely curtailed within just two decades, and then zero net emissions achieved by later this century, assisted by increased biosequestration of carbon dioxide from the atmosphere. However, emissions continue to rise, having increased by 49% since 1990 and by an accelerated annual rate of 5.9% in 2010.
The Global strategy for women’s, children’s and adolescents’ health (2016–2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals.
Abstract Background In India, Village Health Sanitation and Nutrition Committees (VHSNCs) are participatory community health forums, but there is little information about their composition, functioning and effectiveness. Our study examined VHSNCs as enablers of participatory action for community health in two rural districts in two states of eastern India – West Singhbhum in Jharkhand and Kendujhar, in Odisha. Methods We conducted a cross-sectional survey of 169 VHSNCs and ten qualitative focus group discussions with purposively selected better and poorer performing committees, across the two states. We analysed the quantitative data using descriptive statistics and the qualitative data using a Framework approach. Results We found that VHSNCs comprised equitable representation from vulnerable groups when they were formed. More than 75 % members were women. Almost all members belonged to socially disadvantaged classes. Less than 1 % members had received any training. Supervision of committees by district or block officials was rare. Their work focused largely on strengthening village sanitation, conducting health awareness activities, and supporting medical treatment for ill or malnourished children and pregnant mothers. In reality, 62 % committees monitored community health workers, 6.5 % checked sub-centres and 2.4 % monitored drug availability with community health workers. Virtually none monitored data on malnutrition. Community health and nutrition workers acted as conveners and record keepers. Links with the community involved awareness generation and community monitoring of VHSNC activities. Key challenges included irregular meetings, members’ limited understanding of their roles and responsibilities, restrictions on planning and fund utilisation, and weak linkages with the broader health system. Conclusions Our study suggests that VHSNCs perform few of their specified functions for decentralized planning and action. If VHSNCs are to be instrumental in improving community health, sanitation and nutrition, they need .
Men with prostate cancer are not routinely offered psychosocial support despite strong evidence that being diagnosed with prostate cancer poses significant quality of life concerns and places the patient at elevated risk of developing a range of mental health disorders. The objective of this study was to develop an online psychological intervention for men with prostate cancer and to pilot test the feasibility and acceptability of the intervention. Development of the intervention involved a multidisciplinary collaboration, adapting face-to-face and group intervention strategies for an online format. The full online intervention and moderated forum were pilot tested with 64 participants who were recruited from urology practices in Melbourne, Victoria, Australia. After consenting to participate and creating a personal account in the online programme, participants completed baseline demographic questionnaires. Participants were provided access to the programme for 6-12. weeks. After completing the programme participants completed an online survey to assess intervention and forum utilisation and satisfaction, as well as suggest intervention refinements following their use of the intervention. Patient satisfaction was calculated using mean responses to the satisfaction questionnaire. The intervention was received positively with 47.82% of participants highly satisfied with the programme, and 78.26% said they would recommend it to a friend. Participants' qualitative feedback indicated good acceptability of the online intervention. A number of technical and participant engagement issues were identified and changes recommended as a result of the feasibility testing.
Background: Prostate cancer (PCa) poses many emotional and physical challenges for men following treatment. The unmet support needs of these men are well documented, and access to psychosocial support remains problematic. Objectives: To assess the efficacy of an online psychological intervention for men who have localised PCa. Design, setting, and participants: We undertook a randomised controlled trial to evaluate the intervention. Participants were randomly allocated to one of three conditions: My Road Ahead (MRA) alone (MRA Only), MRA plus access to an online forum (MRA. +. Forum), and access to the forum alone (Forum). Intervention: The intervention was a 10-week self-guided online psychological intervention called . My Road Ahead that consisted of six themed modules designed to facilitate improved emotional well-being in the context of PCa as well as a moderated peer forum. Outcome measurements and statistical analysis: Pre- and postintervention assessments of psychological distress (the 21-question Depression, Anxiety and Stress Scale)  and the Prostate Cancer-related Quality of Life scale  were conducted. Multivariate analysis of variance, regression, and structural equation modelling were used to analyse the data. Results and limitations: In total, 142 participants were randomly allocated to one of the three intervention arms. The mean age of participants was 61 yr of age (standard deviation: 7), and 88% had undergone radical prostatectomy. A significant improvement in psychological distress was observed for participants who had access to the combined condition (MRA+Forum) with a moderate effect size (p =0.02; partial η 2 =0.07). In particular, the decline in the mean level of psychological distress was 8.8 units larger for the MRA+Forum group than the Forum group (95% confidence interval [CI], 0.9-16.7). Although the decline in the mean level of psychological distress was 7.0 units larger for the MRA+Forum group than for the MRA Only group, this difference was not significant (95% CI, 1.1-15.1). Structural equation modelling indicated that reductions in health worry and regret contributed significantly to the reductions in psychological distress for the MRA+Forum condition. Conclusions: This study is the first, to our knowledge, that has evaluated a self-guided online psychological intervention tailored to the specific needs of men who have PCa. The findings of this study indicate the potential for this programme to deliver support that men may not otherwise receive. Patient summary: This study found that men who have localised prostate cancer who received access to the online psychological intervention called . My Road Ahead combined with the online peer discussion forum had significantly improved reductions in distress compared with those who received access to the online intervention alone or the forum alone. The delivery of an online psychological intervention combined with a peer support forum is effective in reducing psychological distress for men following treatment for localised prostate cancer.