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A fuzzy set qualitative comparative analysis of 131 countries: which configuration of the structural conditions can explain health better?

ABSTRACT: BACKGROUND:According to the recommendations of the World Health Organization Commission On Social Determinants of Health (CSDH) for intersectoral action on health, the well-being of and equity in health within a population are achieved via a complex fusion of policies and actions. In this study, following the CSDH's approach and considering set-theoretic relations, we aimed to unravel this complexity and answer the kinds of questions that are outside the scope of conventional variable-oriented approach. METHODS:A fuzzy-set qualitative comparative analysis of 131 countries was conducted to examine the configurational effects of five macro-level structural conditions on life expectancy at birth. The potential causal conditions were level of country wealth, income inequality, quality of governance, education, and health system. The data collected from different international data sources were recorded during 2004-2015. RESULTS:The intermediate solution of the truth table analysis indicated a configuration of conditions including high level of governance, education, wealth, and affluent health system to be consistently sufficient for high life expectancy. On the other hand, four configurations, each containing two or three conditions, were consistent with being usually sufficient to cause low life expectancy. CONCLUSIONS:We were able to configurationally explore the cases and specify the combinations of potentially causal conditions which were usually sufficient to explain high or low life expectancy in different countries. As a result, particular cases were identified for further research. In addition, research may provide support for the CSDH's recommendations emphasizing the importance of intersectoral action for health.

SUBMITTER: Paykani T

PROVIDER: S-EPMC5778742 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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A fuzzy set qualitative comparative analysis of 131 countries: which configuration of the structural conditions can explain health better?

Paykani Toktam T Rafiey Hassan H Sajjadi Homeira H

International journal for equity in health 20180122 1

<h4>Background</h4>According to the recommendations of the World Health Organization Commission On Social Determinants of Health (CSDH) for intersectoral action on health, the well-being of and equity in health within a population are achieved via a complex fusion of policies and actions. In this study, following the CSDH's approach and considering set-theoretic relations, we aimed to unravel this complexity and answer the kinds of questions that are outside the scope of conventional variable-or ...[more]

PMID: 29357889

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Project description:BackgroundIntegrating mental health services into primary healthcare platforms is an established health systems strategy in low-to-middle-income countries. In South Africa, this was pursued through the Programme for Improving Mental Health Care (PRIME), a multi-country initiative that relied on task-sharing as a principle implementation strategy. Towards better describing the implementation processes, qualitative comparative analysis was adopted to explore causal pathways in the intervention.ObjectiveThis study aimed to explore factors that could have influenced key outcomes of an integrated mental healthcare intervention in South Africa.MethodsDrawing from an embedded multiple case study design, the analysis used qualitative comparative analysis. Focusing on nine PHC clinics in the Dr Kenneth Kaunda District as cases, with depression reduction scores set as outcome measures, trial data variables were modelled in a hypothetical causal process. A fuzzy-set qualitative comparative analysis was performed by 1) developing the research questions, 2) developing the fuzzy set, 3) testing necessity and 4) testing sufficiency. These steps were undertaken collaboratively among the research team.ResultsThe data were calibrated during several meetings among team members to gain a degree of consensus. Necessity analyses suggested that none of the causal conditions exceeded the threshold of necessity and triviality, and confirmed the inclusion of relevant variables in line with the proposed models. Sufficiency analyses produced two configurations, which were subjected to standard and specific analyses. Ultimately, the results suggested that none of the causal conditions were necessary for a reduction in depression scores to occur, while programme fidelity was identified as a sufficient condition for a reduction in scores to occur.ConclusionsThe study highlights the importance of understanding implementation pathways to enable better integration of mental health services within primary healthcare in low-to-middle-income settings. It underlines the importance of programme fidelity in achieving the goals of implementation.

Project description:BackgroundIn the context of globalization of science and technology, multidisciplinary cooperation plays an important role in enhancing national scientific research strength. Many countries issue policies and reports to promote the implementation of interdisciplinary research. Colleges play a central role in knowledge generation and scientific inquiry and thus frequently contain a variety of scientific research organizations. With rapid advances in science, large-scale scientific research cooperation across disciplines and institutions is increasingly common. Many factors can affect the performance of research collaboration, and the implementation paths of some key factors remain unclear. In addition, no standardized collaboration system has been established in relevant research. Further studies on interdisciplinary scientific research cooperation will be particularly valuable for improving the efficiency of resource allocation and increasing the level of academic research. Here we explored the "joint effect" of various influencing factors on interdisciplinary collaborative research in colleges and the "interactions" among these factors.MethodsWith stratified-cluster random sampling, 358 researchers from 181 research teams at 6 colleges across China were surveyed using a self-administered questionnaire. We used fuzzy-set qualitative comparative analysis (fsQCA) to analyze data to obtain more insight into the status quo of interdisciplinary cooperation among colleges.ResultsThe results showed that initiation and organization by an institution was a necessary condition for achieving high-performance scientific research collaboration. The performance incentive method of high-tech collaboration could be divided into four main paths: configuration organized by an institution; configuration organized by an institution, with high policy-based guarantees (PG); configuration organized by an institution, with high cooperation willingness (CW) and high cooperation ability (CA); and configuration organized by an institution, with high CW, abilities, and outputs. The drive mechanism of high performance in scientific cooperation could be divided into two types: organization-led and ability/willingness-driven.ConclusionsOnly the integration of internal changes with the support of the external environment can ensure the stable development of multidisciplinary scientific research cooperation among colleges.

Project description:BackgroundHealth promotion programs can only lead to improvements in health outcomes if they are effectively implemented. However, most studies assessing implementation success focus on only one condition, although more conditions influence this process. Therefore, evidence is scarce on what conditions play a role in successful implementation and how they interact. Hence, we aimed to identify which combinations of teacher and implementation process characteristics affected the emotional and social school experience (SCE) of pupils participating in a school-based health promotion program.MethodsThis study was part of an effectiveness and process evaluation including 24 intervention and 27 control classes. We used fuzzy-set qualitative comparative analysis (fsQCA) to identify combinations of conditions that were associated with either an increase or no increase in the outcome SCE in comparison to the control group at 20 months post intervention. We deductively selected five conditions based on the Consolidated Framework for Implementation Research: teachers' perceived self-efficacy, teachers' expectations of the benefits of the intervention, teachers' previous knowledge about the intervention, dosage of physical activity breaks, and quality of the implementation.ResultsWe identified five different pathways that led to no increase in the pupils' outcome (parameters of fit: consistency 94%, coverage 66%). The combination of an unsatisfying quality of implementing the intervention and a low previous knowledge about the intervention showed the highest empirical relevance. Similarly, fewer physical activity breaks in combination with other conditions impeded the program's success. Furthermore, we identified two different pathways characterizing ways to success (consistency: 81%, coverage: 52%). The most relevant combination was good quality implementation of physical activity breaks, implemented by teachers with a high self-efficacy, and a good previous knowledge about the intervention.ConclusionsQCA has potential for an in-depth analysis of complex interventions as it can rely on small to medium sample sizes and analyze pathways to success and non-success separately. The investigated program can be improved by considering the following suggestions: The quality of the implementation process should be monitored during the implementation phase, and regular feedback loops and learning opportunities for teachers should accompany a program. Clear recommendations regarding the dosage should be established.Trial registrationGerman register of clinical studies: DRKS00000622 . Retrospectively registered: December 3, 2010, ( http://www.drks.de/drks_web/setLocale_EN.do ). Approved by the Ethics Committee of Lower Austria (GS4-EK-4/107-2010).

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A fuzzy set qualitative comparative analysis of 131 countries: which configuration of the structural conditions can explain health better?

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A fuzzy set qualitative comparative analysis of 131 countries: which configuration of the structural conditions can explain health better?

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