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All areas in England are expected by National Health Service (NHS) England to develop integrated care systems (ICSs) by April 2021. ICSs bring together primary, secondary and community health services, and involve local authorities and the voluntary sector. ICSs build on previous pilots, including the Integrated Care Pioneers in 25 areas from November 2013 to March 2018. This analysis tracks the Pioneers’ self-reported progress, and the facilitators and barriers to improve service coordination over three years, longer than previous evaluations in England. The paper aims to discuss these issues.

Annual online key informant (KI) surveys, 2016–2018, are used for this study.

By the fourth year of the programme (2017), KIs had shifted from reporting plans to implementation of a wide range of initiatives. In 2018, informants reported fewer “significant” barriers to change than previously. While some progress in achieving local integration objectives was evident, it was also clear that progress can take considerable time. In parallel, there appears to have been a move away from aspects of personalised care associated with user control, perhaps in part because the emphasis of national objectives has shifted towards establishing large-scale ICSs with a particular focus on organisational fragmentation within the NHS.

Because these are self-reports of changes, they cannot be objectively verified. Later stages of the evaluation will look at changes in outcomes and user experiences.

The current study shows clearly that the benefits of integrating health and social care are unlikely to be apparent for several years, and expectations of policy makers to see rapid improvements in care and outcomes are likely to be unrealistic.

Integrating health and social care is a priority in England, although there is little evidence that previous initiatives have reduced hospital admissions or costs. In total, 25 Integrated Care Pioneers have been established to drive change “at scale and pace”. The early phases of the evaluation (April 2014-June 2016) aimed to identify their objectives, plans and activities, and to assess the extent to which they have overcome barriers to integration. In the longer term, the authors will assess whether integrated care leads to improved outcomes and quality of care and at what cost. The paper aims to discuss these issues.

Mixed methods involving documentary analysis, qualitative interviews and an online key informant survey.

Over time, there was a narrowing of the integration agenda in most Pioneers. The predominant approach was to establish community-based multi-disciplinary teams focussed on (older) people with multiple long-term conditions with extensive needs. Moving from design to delivery proved difficult, as many barriers are outside the control of local actors. There was limited evidence of service change.

Because the findings relate to the early stage of the 5+ years of the Pioneer programme (2014-2019), it is not yet possible to detect changes in services or in user experiences and outcomes.

The persistence of many barriers to integration highlights the need for greater national support to remove them.

The evaluation demonstrates that implementing integrated health and social care is not a short-term process and cannot be achieved without national support in tackling persistent barriers.

The use of mobile devices by children and adolescents is increasing significantly; therefore, it is relevant to research the level of advertising literacy (AL) of parents who act as mediators between children and mobile advertising. This study aims to explore the conceptual, moral and attitudinal dimensions of AL and its relationship with different styles of parental control.

A cross-sectional survey was applied simultaneously to a sample of parents with children between 5 and 16 years old in three Spanish-speaking countries: Mexico, Spain and Colombia. Participants from the three countries were recruited via online social media networks and were asked to fill in an online survey. A questionnaire, which has been adapted from previous literature to suit the mobile advertising context and the population of interest, was designed. Cross-country samples of varying sizes, with a predetermined quota of 200 participants for each country, were used. The total sample consisted of 1,454 participants.

Four factors of mobile AL were found, which, to a greater extent, correspond to the dimensions of AL proposed in the literature. The following are the dimensions that were identified: cognitive, moral, attitudinal and an emerging factor is known as “children’s perceived mobile AL.” Differences in parents’ perceived knowledge of mobile advertising, parental control styles and AL levels in the three countries were identified. Parents with an authoritative style were identified to have more knowledge than those with an indulgent style. Differences were also identified between countries concerning the amount of exposure that children have to mobile advertising, while no significant differences were found in the moral dimension.

Marketing practitioners and public policymakers must consider that parents differ in some dimensions of AL. Parents also seem to lack adequate knowledge about the advertising tools available to announcers that affect children and adolescents in a mobile communication environment. Therefore, government agencies should consider developing mobile digital media literacy programs for parents.

This paper explores the dimensions of AL applied to the mobile context and identifies the level of parental mobile AL in three Spanish-speaking countries, as well as the differences between these sub-samples concerning parental mobile AL profiles and parental control styles, thus expanding the literature on AL with a cross-cultural approach.