London South Bank University, 101 Borough Road, SE1 0AA, London, England.
BMC Public Health. 2023 Oct 2;23(1):1896. doi: 10.1186/s12889-023-16829-8.
With increasing recognition of the role of commercial determinants of health, local areas in England have sought to restrict the advertising of products high in fat, salt and sugar (HFSS) on council-owned spaces, as part of wider strategies to reduce obesity. While there is some evidence of the impact of such policy change on behaviour, little is known about what works in the process of implementing this policy change.
Guided by a realist evaluation framework that explores the interaction between context, mechanism and outcomes, this study aims to investigate the factors that influence the restriction of outdoor advertising of HFSS products in one region in England. It refines a programme theory co-produced with stakeholders from 14 local authorities within a region and uses multiple data sources from each area with an in-depth examination of four case study sites. Data sources include longitudinal realist interviews, focus groups and surveys with policy advocates and policy stakeholders. Data were analysed retroductively to understand the causal link between context, mechanism and outcomes.
Outcomes were driven by five dominant mechanisms: a strategic and staggered approach to stakeholder engagement, gathering intelligence, identifying policy champions, building relationships, reframing the issue; and two secondary mechanisms of amplifying the issue and increasing public will. These led to varied outcomes with no changes in formal policy position within the evaluation period but draft policy guidance in place and changes in political will demonstrated. Dominant context factors influencing change included having a named and resourced policy advocate in place supported by an external Community of Improvement and having existing aligned local objectives. Organisational complexity and change, financial concerns, lack of local examples, ideological positions and the pandemic were also influencing contextual factors.
Effecting policy change in this area requires the commitment of an extended period and the valuing of short-term policy outcomes, such as increasing political will. The importance of a resourced and well-supported policy advocate to lead this work is fundamental and the commercially sensitive nature of this policy change means that a complex interplay of mechanisms is required which may be dominated by a strategically staggered approach to stakeholder engagement.
随着人们对健康的商业决定因素的认识不断提高，英格兰的一些地方已经试图限制在议会拥有的空间中对高脂肪、高盐和高糖（HFSS）产品的广告宣传，这是减少肥胖的更广泛战略的一部分。虽然有一些证据表明这种政策变化对行为产生了影响，但对于实施这种政策变化的过程中什么有效知之甚少。
本研究以探索背景、机制和结果之间相互作用的现实主义评估框架为指导，旨在调查影响英格兰一个地区限制 HFSS 产品户外广告的因素。它借鉴了与该地区 14 个地方当局的利益相关者共同制定的方案理论，并利用每个地区的多个数据源对四个案例研究地点进行深入研究。数据来源包括对政策倡导者和政策利益相关者的纵向现实主义访谈、焦点小组和调查。数据是回溯性分析的，以了解背景、机制和结果之间的因果关系。
结果是由五个主要机制驱动的：与利益相关者接触的战略性和交错方法、收集情报、确定政策拥护者、建立关系、重新构建问题；以及两个次要机制，即放大问题和增强公众意愿。这些导致了不同的结果，在评估期间没有改变正式政策立场，但制定了政策指导意见，并表现出政策意愿的变化。影响变革的主要背景因素包括有一个有名称和资源的政策倡导者，并得到外部改进社区的支持，以及有现有的一致的地方目标。组织复杂性和变革、财务问题、缺乏本地范例、意识形态立场和大流行也是影响背景的因素。
在这一领域实施政策变革需要承诺一个较长的时期，并重视短期的政策成果，如增强政治意愿。有一个有资源和支持的政策倡导者来领导这项工作至关重要，而且这种政策变革的商业敏感性意味着需要一个复杂的机制相互作用，这可能由一个战略性的交错的利益相关者接触方法主导。
