Concept mapping as a promising method to bring practice into science

Objective

Concept mapping is a method for developing a conceptual framework of a complex topic for use as a guide to evaluation or planning. In concept mapping, thoughts and ideas are represented in the form of a picture or map, the content of which is determined by a group of stakeholders. This study aimed to explore the suitability of this method as a tool to integrate practical knowledge with scientific knowledge in order to improve theory development as a sound basis for practical decision-making.

Method

Following a short introduction to the method of concept mapping, five Dutch studies, serving different purposes and fields in public health, will be described. The aim of these studies was: to construct a theoretical framework for good regional public health reporting; to design an implementation strategy for a guideline for integral local health policy; to guide the evaluation of a local integral approach of overweight and obesity in youth; to guide the construction of a questionnaire to measure the quality of postdisaster psychosocial care; and to conceptualize an integral base for formulation of ambitions and targets for the new youth healthcare programme of a regional health service.

Results

The studies showed that concept mapping is a way to integrate practical and scientific knowledge with careful selection of participants that represent the different perspectives. Theory development can be improved through concept mapping; not by formulating new theories, but by highlighting the key issues and defining perceived relationships between topics. In four of the five studies, the resulting concept map was received as a sound basis for practical decision-making.

Conclusions

Concept mapping is a valuable method for evidence-based public health policy, and a powerful instrument for facilitating dialogue, coherence and collaboration between researchers, practitioners, policy makers and the public. Development of public health theory was realized by a step-by-step approach, considering both scientific and practical knowledge. However, the external validity of the concept maps in place and time is of importance.     

Exploring conceptualizations of knowledge translation,transfer and exchange across public health in one UK region: a qualitative mapping study

Objectives

Knowledge translation (KT) is becoming common vocabulary, but as a concept it is not clearly defined. Many related terms exist; these are often used interchangeably and given multiple interpretations. While there is a growing body of literature exploring these concepts, using it to inform public health practice, strategy, research and education is challenging given the range of sources and need for local ‘contextual fit’. This study explores how various public health stakeholders make sense of, and experience, KT and related concepts.

Study design

A qualitative mapping study using a phenomenographic approach.

Methods

Thirty-four academics, students and practitioners working in public health across the north east of England participated in six focus groups and five one-to-one interviews. Discussions were audio-recorded, transcribed and analysed using a thematic framework approach. The framework drew on findings from reviews of the existing literature, whilst allowing unanticipated issues to emerge.

Results

Three main themes were identified from the stakeholder discussions:

(i)

Definitions: there was some agreement in terms of meanings and interpretations of core concepts relating to KT, although stakeholders spoke of the differing ‘languages’ across disciplines and sectors;

(ii)

Process issues: access to funding, targeted messages, the nature of the evidence base, and wider contextual factors were identified as barriers or facilitators to KT; and

(iii)

People: various KT roles and responsibilities were highlighted for the different stakeholder groups.

Conclusions

This study has enabled further development of theoretical understandings of the KT discourses at play in public health, and identified the ways in which these may be bound by discipline and context. Ironically, the findings suggest that terms such as knowledge translation, transfer and exchange are seen as themselves requiring translation, or at least debate and discussion.     

Competencias y contenidos comunes de salud pública en los programas universitarios de grado: fisioterapia,terapia ocupacional,ciencias ambientales,odontología y veterinaria

Objective

To identify the basic competencies and contents related to public health to be included in degree programs according to the perspective of lecturers from various Spanish universities.

Method

In the context of the Second Workshop on Public Health Contents in Degree Programs (Mahon, 19 to 20 September 2012), 20 lecturers from different Spanish universities were distributed in five working groups. The lecturers had been selected from the instructional guides on public health and epidemiology published on the web sites of the Rectors’ Conference of Spanish Universities. Each group worked on a degree program and the results were discussed in plenary sessions.

Results

The activities and competencies related to the three basic functions of public health were identified in all degree programs. Most of the professional competencies identified were related to the function of «assessment of population health needs». The contents proposed by the working groups related to epidemiology, basic concepts in public health, public health intervention, health management, and health policy. The main common topics among the degrees concerned the first three contents.

Conclusions

Public health professional competencies and contents were identified in the degree programs examined. These results may serve as a starting point for a more detailed review of public health programs across degree levels and the search for a consensus on the common content that should be included in each of them.     

Housing,health and master planning: rules of engagement

Objectives

Knowledge about health focussed policy collaboration to date has been either tactical or technical. This article focusses on both technical and tactical issues to describe the experience of cross-sectoral collaboration between health and housing stakeholders across the life of a housing master plan, including but not limited to a health impact assessment (HIA).

Study design

A single explanatory case study of collaboration on a master plan to regenerate a deprived housing estate in Western Sydney was developed to explain why and how the collaboration worked or did not work.

Methods

Data collection included stakeholder interviews, document review, and reflections by the health team. Following a realist approach, data was analysed against established public policy theory dimensions.

Results

Tactically we did not know what we were doing. Despite our technical knowledge and skills with health focussed processes, particularly HIA, we failed to appreciate complexities inherent in master planning. This limited our ability to provide information at the right points. Eventually however the HIA did provide substantive connections between the master plan and health. We use our analysis to develop technical and tactical rules of engagement for future cross-sectoral collaboration.

Conclusions

This case study from the field provides insight for future health focussed policy collaboration. We demonstrate the technical and tactical requirements for future intersectoral policy and planning collaborations, including HIAs, with the housing sector on master planning. The experience also suggested how HIAs can be conducted flexibly alongside policy development rather than at a specific point after a policy is drafted.     

The economic burden of sixteen measles outbreaks on United States public health departments in 2011

Background

Despite vaccination efforts and documentation of elimination of indigenous measles in 2000, the United States (US) experienced a marked increase in imported cases and outbreaks of measles in 2011. Due to the high infectiousness and potential severity of measles, these outbreaks require a vigorous response from public health institutions. The effort and resources required to respond to these outbreaks are likely to impose a significant economic burden on these institutions.

Objective

To estimate the economic burden of measles outbreaks (defined as ≥3 epidemiologically linked cases) on the local and state public health institutions in the US in 2011.

Methods

From the perspective of local and state public health institutions, we estimated personnel time and resources allocated to measles outbreak response in local and state public health departments, and estimated the corresponding costs associated with these outbreaks in the US in 2011. We used cost and resource utilization data from previous studies on measles outbreaks in the US and, relying on outbreak size classification based on a case-day index, we estimated costs incurred by local and state public health institutions.

Results

In 2011, the US experienced 16 outbreaks with 107 confirmed cases. The average duration of an outbreak was 22 days (range: 5–68). The total estimated number of identified contacts to measles cases ranged from 8936 to 17,450, requiring from 42,635 to 83,133 personnel hours. Overall, the total economic burden on local and state public health institutions that dealt with measles outbreaks during 2011 ranged from an estimated $2.7 million to $5.3 million US dollars.

Conclusion

Investigating and responding to measles outbreaks imposes a significant economic burden on local and state health institutions. Such impact is compounded by the duration of the outbreak and the number of potentially susceptible contacts.     

Public Participation in the Process of Local Public Health Policy,Using Policy Network Analysis

Objectives:

To assess the current public participation in-local health policy and its implications through the analysis of policy networks in health center programs.

Methods:

We examined the decision-making process in sub-health center installations and the implementation process in metabolic syndrome management program cases in two districts (‘gu’s) of Seoul. Participants of the policy network were selected by the snowballing method and completed self-administered questionnaires. Actors, the interactions among actors, and the characteristics of the network were analyzed by Netminer.

Results:

The results showed that the public is not yet actively participating in the local public health policy processes of decision-making and implementation. In the decision-making process, most of the network actors were in the public sector, while the private sector was a minor actor and participated in only a limited number of issues after the major decisions were made. In the implementation process, the program was led by the health center, while other actors participated passively.

Conclusions:

Public participation in Korean public health policy is not yet well activated. Preliminary discussions with various stakeholders, including civil society, are needed before making important local public health policy decisions. In addition, efforts to include local institutions and residents in the implementation process with the public officials are necessary to improve the situation.     

Assessing public health policy approaches to level-up the gradient in health inequalities: the Gradient Evaluation Framework

Objectives

This paper seeks to introduce and analyse the development of the Gradient Evaluation Framework (GEF) to facilitate evaluation of policy actions for their current or future use in terms of their ‘gradient friendliness’. In particular, this means their potential to level-up the gradient in health inequalities by addressing the social determinants of health and thereby reducing decision-makers' chances of error when developing such policy actions.

Study design

A qualitative developmental study to produce a policy-based evaluation framework.

Methods

The scientific basis of GEF was developed using a comprehensive consensus-building process. This process followed an initial narrative review, based on realist review principles, which highlighted the need for production of a dedicated evaluation framework. The consensus-building process included expert workshops, a pretesting phase, and external peer review, together with support from the Gradient project Scientific Advisory Group and all Gradient project partners, including its Project Steering Committee.

Results

GEF is presented as a flexible policy tool resulting from a consensus-building process involving experts from 13 European countries. The theoretical foundations which underpin GEF are discussed, together with a range of practical challenges. The importance of systematic evaluation at each stage of the policy development and implementation cycle is highlighted, as well as the socio-political context in which policy actions are located.

Conclusions

GEF offers potentially a major contribution to the public health field in the form of a practical, policy-relevant and common frame of reference for the evaluation of public health interventions that aim to level-up the social gradient in health inequalities. Further research, including the need for practical field testing of GEF and the exploration of alternative presentational formats, is recommended.     

Developing model-based public health policy through knowledge translation: the need for a ‘Communities of Practice’

Objectives

The 2009 influenza A (H1N1) pandemic prompted public health agencies worldwide to respond in a context of substantial uncertainty. While many lessons around successful management strategies were learned during the influenza A (H1N1) pandemic, the usefulness and impact of mathematical models to optimize policy decisions in protecting public health were poorly realized. The authors explored the experiences of modellers and public health practitioners in trying to develop model-based public health policies in the management of the 2009 influenza A (H1N1) pandemic in Canada.

Study design

A qualitative case study design based on interviews and other textual data was used.

Methods

Individual interviews were conducted with mathematical modellers and public health professionals from academia and government health departments during the second wave of the 2009 influenza A (H1N1) pandemic (both prior to and following the vaccine roll-out), using a convergent interviewing process. Interviews were supplemented with discussions held during three separate workshops involving representatives from these groups on the role of modelling in pandemic preparedness and responses. NVivo9™ was used to analyse interview data and associated notes.

Results

Mathematical models were underutilized during the response phase of the 2009 influenza A (H1N1) pandemic, largely because many public health professionals were unaware of modelling infrastructure in Canada. Challenges were reflected in three ways: 1) the relevance of models to public health priorities; 2) the need for clear communication and plain language around modelling and its contributions and limitations; and 3) the need for increased trust and collaboration to develop strong working relationships.

Conclusions

Developing a ‘Communities of Practice’ between public health professionals and mathematical modellers during inter-pandemic periods based on common targeted goals, using plain language, and where relationships between individuals and organizations are developed early, could be an effective strategy to assist the process of public health policy decision-making, particularly when characterized by high levels of uncertainty.     

An exploration of artists' perspectives of participatory arts and health projects for people with mental health needs

Objectives

This study addresses the views and experiences of artists who run participatory arts and health courses for those with mental health or social problems.

Study design

Qualitative research with 11 artists from three different organizations providing participatory arts and health courses.

Methods

Semi-structured in-depth interviews were conducted. Participants provided oral contributions that were transcribed and then thematically analysed by the authors.

Results

Participants described perceived positive benefits of participatory arts and health courses, including developing friendships, self-expression and creativity, a non-judgemental environment, along with key issues arising, including managing challenging behaviours and provision of follow-on options.

Conclusions

Results indicate that improvements in well-being can be identified by artists during courses, the activity can help develop friendships, courses can be well managed in community settings, and benefits of follow-on activities should be investigated in future.     

Promotion of a healthy public living environment: participatory design of public toilets with visually impaired persons

Objectives

The principal objective of a healthy living environment is to improve the quality of everyday life. Visually impaired persons (VIPs) encounter many difficulties in everyday life through a series of barriers, particularly in relation to public toilets. This study aimed to explore the concerns of VIPs in accessing public toilets, and identify methods for improvement. Considerations about user participation are also discussed.

Study design

Adopting a case study approach, VIPs were invited to participate in the research process.

Methods

In addition to in-depth interviews and field visits, models and a simulated full-scale environment were produced to facilitate the VIPs to voice their opinions.

Results

The key findings indicate that the design of public toilets for promoting public health should be considered and tackled from a three-level framework: plain, line and point. Governments, professionals and the public need to consider the quality of public toilets in terms of policy, implementation and management.

Conclusions

VIPs have the right to access public toilets. Governments and professionals should respect the particular needs and concerns of VIPs. A three-level framework (plain, line and point) is required to consider the needs of VIPs in accessing public toilets, and user participation is a good way to reveal the actual needs of VIPs.     

A systematic review of medical practice variation in OECD countries

Background

Major variations in medical practice have been documented internationally. Variations raise questions about the quality, equity, and efficiency of resource allocation and use, and have important implications for health care and health policy.

Objective

To perform a systematic review of the peer-reviewed literature on medical practice variations in OECD countries.

Methods

We searched MEDLINE to find publications on medical practice variations in OECD countries published between 2000 and 2011. We present an overview of the characteristics of published studies as well as the magnitude of variations for select high impact conditions.

Results

A total of 836 studies were included. Consistent with the gray literature, there were large variations across regions, hospitals and physician practices for almost every condition and procedure studied. Many studies focused on high-impact conditions, but very few looked at the causes or outcomes of medical practice variations.

Conclusion

While there were an overwhelming number of publications on medical practice variations the coverage was broad and not often based on a theoretical construct. Future studies should focus on conditions and procedures that are clinically important, policy relevant, resource intensive, and have high levels of public awareness. Further study of the causes and consequences of variations is important.     

GoWell: The challenges of evaluating regeneration as a population health intervention

Objective

Urban regeneration can be considered a population health intervention (PHI). It is expected to impact on population health but the evidence is limited or weak, in part due to the difficulties of evaluating PHIs. We explore these challenges using GoWell as a case study.

Method

A 10-year evaluation of housing improvement and urban regeneration in 15 deprived areas in Glasgow, Scotland (2005–2015).

Results

Challenges faced include: definition and changing nature of the intervention; identifying the recipients of the intervention; and constraints of study design affecting capacity to attribute effects. We have met these challenges by: adapting the evaluation to take account of changing intervention plans and delivery; making pragmatic choices about which populations to focus on for different parts of the study; and taking advantage of delayed delivery of some components to identify controls.

Conclusion

Commitment to a long-term evaluation by the Scottish Government and other partners has enabled us to develop a package of studies to investigate health and other outcomes, and the processes of a PHI. GoWell will contribute to the evidence base for interventions focused on tackling the wider determinants of health and help policymakers to be more explicit and realistic about what regeneration might achieve.     

Making Every Contact Count: an evaluation

Objectives

To conduct an initial evaluation of a behaviour change programme called ‘Making Every Contact Count’ (MECC).

Study design

Retrospective interview study.

Methods

In depth qualitative interviews with key stakeholders engaged in the delivery of MECC which were digitally recorded, transcribed and analysed thematically using framework analysis.

Results

The responses of those involved were generally favourable and although the ‘intuitive’ nature of the idea of Making Every Contact Count clearly resonated with interviewees, the take up was variable across different organisations.

Conclusions

The approach to MECC described here was based on some of the principles outlined in the NICE Guidance on behaviour change published in 2007. The report shows that MECC has considerable potential for changing staff behaviour in relation promoting health enhancing behaviour among members of the general public coming into contact with services.     

Environmental attitudes and political partisanship

Objective

To explore the impact of political partisanship on environmental attitudes related to climate change in United States and its implications for public health.

Study design

An integrative literature review.

Methods

A literature review of English articles was performed from January 2013 to March 2013 using the following databases: CINAHL, PubMed, Academic Search Premier, Business Source Premier, ERIC, psychINFO, and Wiley Online Library. Empirical and review articles and Internet sources were included.

Results

Continued mass emission of carbon dioxide and other greenhouse gases will exacerbate the consequences of global warming and climate change. As one of the key global contributors of carbon emissions, the lack of climate change policy and regulatory practices at the federal level in the United States is of great concern. Political partisanship in the US is largely to blame for this inaction, as efforts for drastic remediation action is met with rejection from conservative groups who do not believe that global warming and climate change are a problem, despite scientific evidence to the contrary. To promote the health of the entire population, there needs to be a paradigm shift from consumption driven economic growth as advocated by the Republicans to a realization of true prosperity beyond growth in order to create a sustainable world.

Conclusion

This presents a critical challenge to public health professionals as political partisanship has the power to impact environmental attitudes and have serious implications for public health. Preserving the environment must take precedence over economic growth if we want a habitable planet low in carbon.     

Potential unintended pregnancies averted and cost savings associated with a revised Medicaid sterilization policy

Objective

Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers.

Study Design

We constructed a cost-effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a postpartum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively.

Results

With the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and $215 million saved.

Conclusion

A revised Medicaid sterilization policy could potentially honor women’s reproductive decisions, reduce the number of unintended pregnancies and save a significant amount of public funds.

Implication

Compared to the current federal Medicaid sterilization policy, a hypothetical, revised policy that reduces logistical barriers for women who desire publicly funded, postpartum sterilization could potentially avert over 29,000 unintended pregnancies annually and therefore lead to cost savings of $215 million each year.     

Population-level interventions to reduce alcohol-related harm: An overview of systematic reviews

Objective

To analyse available review-level evidence on the effectiveness of population-level interventions in non-clinical settings to reduce alcohol consumption or related health or social harm.

Method

Health, social policy and specialist review databases between 2002 and 2012 were searched for systematic reviews of the effectiveness of population-level alcohol interventions on consumption or alcohol-related health or social outcomes. Data were extracted on review research aim, inclusion criteria, outcome indicators, results, conclusions and limitations. Reviews were quality-assessed using AMSTAR criteria. A narrative synthesis was conducted overall and by policy area.

Results

Fifty-two reviews were included from ten policy areas. There is good evidence for policies and interventions to limit alcohol sale availability, to reduce drink-driving, to increase alcohol price or taxation. There is mixed evidence for family- and community-level interventions, school-based interventions, and interventions in the alcohol server setting and the mass media. There is weak evidence for workplace interventions and for interventions targeting illicit alcohol sales. There is evidence of the ineffectiveness of interventions in higher education settings.

Conclusion

There is a pattern of support from the evidence base for regulatory or statutory enforcement interventions over local non-regulatory approaches targeting specific population groups.     

Economic impact of the 2009–2010 Guam mumps outbreak on the public health sector and affected families

Background

The United States Territory of Guam reported a large mumps outbreak of 505 cases during 2009–2010. We assessed the economic impact of the outbreak from the perspectives of the local public health sector and affected families.

Methods

Using standard cost analysis methods, we retrospectively identified all public health personnel involved in the outbreak response and surveyed them about their outbreak-related activities. We then estimated the costs of outbreak-related personnel hours and materials. We also assessed out-of-pocket costs and costs incurred for work-time missed for persons with mumps and their families. We defined the analysis period as February 25–October 22, 2010.

Results

Seventy-six public health personnel were involved in outbreak response activities. Overall, the response required approximately 8264 person-hours, 2380 miles driven, and 3000 doses of measles-mumps-rubella vaccine ordered. The cost to the public health sector was 256,785 U.S. dollars (USD). Families of 102 persons with mumps were interviewed. An estimated 761 USD per person with mumps was spent by families; 88% of this cost was due to missed days of work. The estimated total cost to families of the 470 persons with mumps during the analysis period was 357,670 USD. Total outbreak-related costs were 614,455 USD.

Conclusions

The costs reported underscore the impact of mumps outbreaks in highly vaccinated populations and the need for effective mumps prevention and control strategies.     

Fine-cut tobacco: a priority for public health and consumer advocacy

Objectives

To study whether fine-cut tobacco poses a problem for public health and consumer affairs.

Methods

We analyzed up to 70% of the fine-cut tobacco market in Spain. Regarding public health, the contents of nicotine, tar and carbon monoxide were analyzed and compared with levels in conventional cigarettes. Concerning consumer affairs, the labeling of samples was checked.

Results

The contents of nicotine, tar and carbon monoxide reached values of 70%, 85% and 84%, respectively. These values are higher than those allowed in conventional cigarettes. A total of 67% of the samples analyzed did not show nicotine and tar contents on the labeling. None of the labels showed carbon monoxide contents. The presence of labeling per se did not guarantee sufficient information for consumers.

Conclusions

Fine-cut tobacco is a problem in both public health and consumer affairs. Solutions are required to resolve both problems.     

Lyme disease and post-treatment Lyme disease syndrome: the neglected disease in our own backyard

Objectives

A survey was developed to assess experience and opinions about Lyme disease and post-treatment Lyme disease syndrome (PTLDS) among faculties in public health. No previous surveys of public health faculties have been found in the literature.

Study design

This is a cross sectional study of public health school faculty members designed to measure knowledge and experience with Lyme disease and PTLDS using an internet survey instrument.

Methods

Participants were recruited using all the publicly available e-mail addresses of faculty members in all the 50 accredited Schools of Public Health in the United States.

Results

A 15% response rate was seen for the survey. 50% of respondents were from Lyme endemic states. Less than 5% of faculty members consider themselves expert in Lyme or PTLDS. Many faculty members had known someone with Lyme disease or PTLDS, but few had been diagnosed themselves. Most believe that PTLDS can be severe and chronic, is not easy to treat, and does not resolve on its own, but were uncertain about its aetiology. Most respondents also felt that the incidence of Lyme disease will increase and that more education is needed.

Conclusions

The need for further understanding and communication presents an opportunity for public health research and education in Lyme disease and the sequelae of PTLDS.