Concept mapping as a method to enhance evidence-based public health

Impact of paediatric cochlear implantation on family life: a conceptual framework informed by parents

PURPOSE

While the impact of paediatric cochlear implantation on parents and siblings are recognised, limited evidence exists regarding the effect of paediatric cochlear implantation on the entire family life (e.g., routine interactions, family activities). This study aimed to describe the impact of paediatric cochlear implantation on family life as perceived by parents, using concept mapping.

MATERIALS AND METHODS

Parents of paediatric cochlear implant (CI) recipients (n = 29) participated in this concept mapping study to generate, group, and rate statements regarding the impact of paediatric cochlear implantation on family life.

RESULTS

In total, 99 unique statements described the impact of paediatric cochlear implantation on family life. The concept map revealed six concepts, namely (i) Financial Outlay and Supports; (ii) Education and Therapy; (iii) Responsibilities and Sacrifices; (iv) Extended Family and Community; (v) Spouses and Siblings and (vi) Achievements and Enrichments.

CONCLUSIONS

This study highlights the multiple areas of family life affected by paediatric cochlear implantation. To improve patient-and-family-centered care, these factors must be considered during pre-operative and successive counselling of paediatric CI recipients and their families.

The intersection of health and housing: Analysis of the research portfolios of the National Institutes of Health, Centers for Disease Control and Prevention, and U.S. Department of Housing and Urban Development

BACKGROUND

Housing is a major social determinant of health that affects health status and outcomes across the lifespan.

OBJECTIVES

An interagency portfolio analysis assessed the level of funding invested in "health and housing research" from fiscal years (FY) 2016-2020 across the National Institutes of Health (NIH), the United States Department of Housing and Urban Development (HUD), and the Centers for Disease Control and Prevention (CDC) to characterize the existing health and housing portfolio and identify potential areas for additional research and collaboration.

METHODS/RESULTS

We identified NIH, HUD, and CDC research projects that were relevant to both health and housing and characterized them by housing theme, health topic, population, and study design. We organized the assessment of the individual housing themes by four overarching housing-to-health pathways. From FY 2016-2020, NIH, HUD, and CDC funded 565 health and housing projects combined. The Neighborhood pathway was most common, followed by studies of the Safety and Quality pathway. Studies of the Affordability and Stability pathways were least common. Health topics such as substance use, mental health, and cardiovascular disease were most often studied. Most studies were observational (66%); only a little over one fourth (27%) were intervention studies.

DISCUSSION

This review of the research grant portfolios of three major federal funders of health and housing research in the United States describes the diversity and substantial investment in research at the intersection between housing and health. Analysis of the combined portfolio points to gaps in studies on causal pathways linking housing to health outcomes. The findings highlight the need for research to better understand the causal pathways from housing to health and prevention intervention research, including rigorous evaluation of housing interventions and policies to improve health and well-being.

Measuring the Burden of Infodemics: Summary of the Methods and Results of the Fifth WHO Infodemic Management Conference

Background

An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention.

Objective

In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics.

Methods

An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health-implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified.

Results

The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions.

Conclusions

Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers.

Promoting Factors to Stay at Work Among Employees With Common Mental Health Problems: A Multiple-Stakeholder Concept Mapping Study

Most individuals affected by common mental health problems are employed and actually working. To promote stay at work by workplace interventions, it is crucial to understand the factors perceived by various workplace stakeholders, and its relative importance. This concept mapping study therefore explores perspectives of employees with common mental health problems (n = 18), supervisors (n = 17), and occupational health professionals (n = 14). Per stakeholder group, participants were interviewed to generate statements. Next, each participant sorted these statements on relatedness and importance. For each group, a concept map was created, using cluster analysis. Finally, focus group discussions were held to refine the maps. The three concept maps resulted in several clustered ideas that stakeholders had in common, grouped by thematic analysis into the following meta-clusters: (A) Employee’s experience of autonomy in work (employee’s responsibility, freedom to exert control, meaningful work), (B) Supervisor support (being proactive, connected, and involved), (C) Ways to match employee’s capacities to work (job accommodations), (D) Safe social climate in workplace (transparent organizational culture, collective responsibility in teams, collegial support), and (E) professional and organizational support, including collaboration with occupational health professionals. Promoting stay at work is a dynamic process that requires joined efforts by workplace stakeholders, in which more attention is needed to the interpersonal dynamics between employer and employee. Above all, a safe and trustful work environment, in which employee’s autonomy, capacities, and needs are addressed by the supervisor, forms a fundamental base to stay at work.

Collective imaginaries of caring landscapes for rural youth: a concept mapping study in northern Sweden

Background

In the current study, the approach of ‘utopia as method’ was combined with the concept ‘landscapes of care’ to explore collective imaginaries of caring landscapes in relation to young people living in rural northern Sweden, while focusing specifically on what such landscapes should ideally look like, and how various strategies could help to realise the visions.

Methods

The research was conducted using a modified concept mapping methodology comprising three phases of data collection and analysis. This facilitated the integration of tacit knowledge and utopian visions of young people, professionals and policymakers living and working in various parts of northern Sweden.

Results

The results indicated that caring landscapes should: ‘provide services responsive to young people’s wishes and needs’, ‘be organised around values of safety, equity and youth participation’, and ‘rework metro-centredness’ in order to care for, with and about rural youth.

Conclusions

The findings can be viewed as an imaginary reconstitution of communities in rural northern Sweden, but also as hypothetical building blocks to be used for developing caring landscapes and a ‘good countryside’ where young people have the possibility to live a good life in decent health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12223-4.

Conceptualizing Vulnerability for Health Effects of the COVID-19 Pandemic and the Associated Measures in Utrecht and Zeist: A Concept Map

The COVID-19 pandemic and the associated measures have impacted the health of many. Not all population groups are equally vulnerable to such health effects, possibly increasing health inequalities. We performed a group concept mapping procedure to define a common, context-specific understanding of what makes people vulnerable to health effects of the pandemic and the measures. We organized a two-step, blended brainstorming session with locally involved community members, using the brainstorm focus prompt 'What I think makes people vulnerable for the COVID-19 pandemic and the measures is…'. We asked participants to generate as many statements as possible. Participants then individually structured (sorted and ranked) these statements. The structuring data was analysed using the groupwisdom^TM software and then interpreted by the researchers to generate the concept map. Ninety-eight statements were generated by 19 participants. Sixteen participants completed both structuring tasks. The final concept map consisted of 12 clusters of vulnerability factors, indicating a broad conceptualization of vulnerability during the pandemic. It is being used as a basis for future research and local supportive interventions. Concept mapping is an effective method to arrive at a vulnerability assessment in a community in a short time and, moreover, a method that promotes community engagement.

What does a family who is "engaged" in early intervention look like? Perspectives of Australian speech-language pathologists

PURPOSE

To build a description of what engagement in early speech-language pathology intervention looks like, by exploring speech-language pathologists' (SLPs) perceptions of (1) what characteristics best describe families who are "engaged" in early speech-language pathology intervention and (2) which characteristics are most important for engagement.

METHOD

Group concept mapping, a participatory mixed-methods research approach, was used to represent the perspectives of Australian SLPs working with children aged 0-8 years and their families in early intervention. Using Concept Systems software, participants: (1) brainstormed responses to a focus question (n = 58); (2) grouped statements into categories (n = 34); and (3) rated the importance of each statement (n = 29).

RESULT

SLPs identified 108 characteristics of engagement in early speech-language pathology intervention, which were grouped into seven key concepts: (1) the family is reliable and ready for therapy; (2) the family has an open, honest relationship with the SLP; (3) the family actively participates and takes initiative; (4) the family works in partnership to plan and set goals together; (5) the family sees and celebrates progress; (6) the family invests in intervention at home; and (7) the family understands intervention and advocates for their child. All aspects of engagement were considered important by participants, with the family-SLP relationship and families continuing to invest in intervention at home being rated most highly.

CONCLUSION

Results present a picture of engagement which has been informed by stakeholders, and which goes beyond aspects of engagement which have previously been identified in the literature. Families who are engaged in early speech-language pathology intervention are actively invested and involved in intervention in various ways, both inside and outside the clinic room.

Factors affecting clinicians' adherence to principles of diagnosis documentation: A concept mapping approach for improved decision-making

BACKGROUND

The quality of data in electronic health records (EHRs) depends on adherence of clinicians to principles of diagnosis documentation.

OBJECTIVE

A concept mapping (CM) approach was used to extract factors related to quality of clinicians' documentation that govern EHR data quality.

METHOD

Influential factors extracted from brainstorming sessions were sorted by individual participants, followed by a quantitative analysis using multidimensional scaling and cluster analysis to categorise sorted factors. Finally, a questionnaire was used to elicit the importance-feasibility of the extracted factors. Results were visualised by cluster maps and Go-Zone plots.

RESULT

Factors were classified into seven clusters: "knowledge about International Classification of Diseases and clinical coding," "need for facilitators and guidelines," "explaining the importance of the issue and defining responsibilities," "cooperation of other personnel," "codify legal requirements," "workload" and "clinical obstacles," as ranked by importance.

CONCLUSION

To enhance the quality of EHR data, a collaboration between physicians, nurses, managers and EHR developers is required. CM is an acceptable approach to meet this objective. Our findings highlight the significance of clinical coding knowledge, awareness about its importance and applicability and use of well-structured information systems. In combination, these three factors can have a strong positive impact on the quality of EHR data.

IMPLICATIONS

A list of solutions is provided for policymakers, and two interventions suggested, based on the findings of this study, including the adoption of EHRs that incorporate documentation guidelines. We further propose updated clinical training programs and a monitoring and feedback mechanism to facilitate the EHR documentation process.

A systems map of the determinants of child health inequalities in England at the local level

Children and young people in the UK have worse health outcomes than in many similar western countries and child health inequalities are persistent and increasing. Systems thinking has emerged as a promising approach to addressing complex public health issues. We report on a systems approach to mapping the determinants of child health inequalities at the local level in England for young people aged 0-25, and describe the resulting map. Qualitative group concept mapping workshops were held in two contrasting English local authorities with a range of stakeholders: professionals (N = 35); children and young people (N = 33) and carers (N = 5). Initial area maps were developed, and augmented using data from qualitative interviews with professionals (N = 16). The resulting local maps were reviewed and validated by expert stakeholders in each area (N = 9; N = 35). Commonalities between two area-specific system maps (and removal of locality-specific factors) were used to develop a map that could be applied in any English local area. Two rounds of online survey (N = 21; N = 8) experts in public health, local governance and systems science refined the final system map displaying the determinants of child health inequalities. The process created a map of over 150 factors influencing inequalities in health outcomes for children aged 0-25 years at the local area level. The system map has six domains; physical environment, governance, economic, social, service, and personal. To our knowledge this is the first study taking a systems approach to addressing inequalities across all aspects of child health. The study shows how group concept mapping can support systems thinking at the local level. The resulting system map illustrates the complexity of factors influencing child health inequalities, and it may be a useful tool in demonstrating to stakeholders the importance of policies that tackle the systemic drivers of child health inequalities beyond those traditionally associated with public health.

Determining the importance and feasibility of various aspects of healthy ageing among older adults using concept mapping

Research shows that healthy ageing is defined differently by older adults and researchers, who may put more or less weight on the physiological, psychological, societal and personal aspects of ageing. Although there is growing interest in the research literature on lay models of healthy ageing in socio-cultural context, little work has been done to determine how important or feasible the various components of healthy ageing are viewed to be by older adults. This study asked a convenience sample of 54 older adults in the circumpolar North to rate the importance and feasibility of 36 previously identified components of healthy ageing in their community. Results indicate that seniors in the sample place the most importance on aspects of the social and physical environment, while least important concepts included psychological and individual behaviours. However, most feasible aspects were individual behaviours and least feasible were aspects of the social and physical environment. Although older adults are able to construct a model of what healthy ageing should look like in their community, they do not always view the most important aspects of healthy ageing to be the most feasible to achieve, providing ample opportunity for public and social policy change.

Care Staff Perspectives on Using Mobile Technology to Support Communication in Long-Term Care: Mixed Methods Study

BACKGROUND

Long-term care (LTC) homes provide 24-hour care for people living with complex care needs. LTC staff assist older adults living with chronic conditions such as Alzheimer disease, related dementias, and stroke, which can cause communication disorders. In addition to the complex cognitive challenges that can impact communication, further difficulties can arise from cultural-language differences between care staff and residents. Breakdowns in caregiver-resident communication can negatively impact the delivery of person-centered care. Recent advances in mobile technology, specifically mobile devices (tablets and smartphones) and their software apps, offer innovative solutions for supporting everyday communication between care staff and residents. To date, little is known about the care staff's perspectives on the different ways that mobile technology could be used to support communication with residents.

OBJECTIVE

This study aims to identify care staff's perspectives on the different ways of using devices and apps to support everyday communication with adults living in LTC homes and the priority care areas for using mobile technology to support communication with residents.

METHODS

This descriptive study employed concept mapping methods to explore care staff's perspectives about ways of using mobile technology with residents and to identify the usefulness, practicality, and probable uses of mobile technology to support communication in priority care areas. Concept mapping is an integrated mixed methods approach (qualitative and quantitative) that uses a structured process to identify priority areas for planning and evaluation. In total, 13 care staff from a single LTC home participated in this study. Concept mapping includes 2 main data collection phases: (1) statement generations through brainstorming and (2) statement structuring through sorting and rating. Brainstorming took place in person in a group session, whereas sorting and rating occurred individually after the brainstorming session. Concept mapping data were analyzed using multidimensional scaling and cluster analysis to generate numerous interpretable data maps and displays.

RESULTS

Participants generated 67 unique statements during the brainstorming session. Following the sorting and rating of the statements, a concept map analysis was performed. In total, 5 clusters were identified: (1) connect, (2) care management, (3) facilitate, (4) caregiving, and (5) overcoming barriers. Although all 5 clusters were rated as useful, with a mean score of 4.1 to 4.5 (Likert: 1-5), the care staff rated cluster 2 (care management) as highest on usefulness, practicality, and probable use of mobile technology to support communication in LTC.

CONCLUSIONS

This study provided insight into the viewpoints of care staff regarding the different ways mobile technology could be used to support caregiver-resident communication in LTC. Our findings suggest that care management, facilitating communication, and overcoming barriers are 3 priority target areas for implementing mobile health interventions to promote person-centered care and resident-centered care.

"We Don't Assume That Everyone Has the Same Idea About Health, Do We?" Explorative Study of Citizens' Perceptions of Health and Participation to Improve Their Health in a Low Socioeconomic City District

In community health promotion programs that aim to reduce health inequities, citizen participation is recommended, as it strengthens citizens’ active involvement and has a positive impact on health. A prerequisite for citizen participation is recognizing and incorporating citizens’ perceptions of health. Therefore, this study aimed to explore these perceptions and actions needed to improve the health of citizens living in a low socioeconomic city district. Concept mapping was used to actively engage community members as part of the action research method. Eleven community groups (n = 89 citizens) together with community workers participated in the study. Participants in all groups agreed that health entails more than the absence of disease, and therefore it is a multidimensional concept. Social relations, physical activity, positive life attitude, healthy eating, and being in control were important perceptions about health. Although the participants were aware of the relation between lifestyle and health, actions to improve health included doing things together, collaboration, self-confidence, focusing on possibilities, and socially shared meanings. Creating a supportive environment to address health behavior appeared to be the most important action for citizens to facilitate behavior change. Concept mapping helped to involve citizens and provided community workers with valuable information to shape the program together with citizens.

Stakeholders' perspectives on how to improve the support for persons with an intellectual disability and challenging behaviors: a concept mapping study

INTRODUCTION

People with an intellectual disability (ID) are at risk of developing challenging behavior. Although previous research provided important insights into how to support people with an ID and challenging behavior, it remains unclear what various stakeholders consider to be the most essential aspects to further improve their support.

METHOD

Statements regarding aspects perceived necessary to improve the support to people with an ID and challenging behavior were collected in focus groups. Afterwards participants individually prioritized and clustered these statements, resulting in concept maps for people with an ID, direct support workers, and psychologists. Since only three relatives participated in the entire concept mapping procedure, no concept map could be composed based on their input.

RESULTS

Participants generated 200 statements. In the concept map of clients, statements were mentioned regarding relational aspects, providing clarity and structure, characteristics of support staff, and professional attitude of direct support workers. Direct support workers provided statements related to their own personal competencies, the necessity of feeling supported and appreciated, and a physical safe environment. Psychologists provided statements regarding their support for direct support workers, the support for the clients, the perspective on the client, and their role as psychologists.

CONCLUSION

The results of this study may be a starting point to foster increased evidence based practice for the support for persons with an ID and challenging behavior. Moreover, it provides opportunities to create care founded on mutual attunement, based on listening to each other's ideas and insight into perspectives and needs of various stakeholders.

Adverse Childhood Experiences: Concept Mapping in the Bachelor of Science in Nursing Curriculum

BACKGROUND

Adverse childhood experiences (ACEs) have deleterious effects on health across the lifespan. Educating health professionals for ACEs awareness and prevention facilitates quality care. Literature documents concept mapping as an effective teaching strategy used in health professions to stimulate learning and foster students' critical thinking. However, ACEs curricular concept mapping remains unexplored.

METHOD

Content analysis with manifest coding was used to identify key concepts based on faculty narratives and discussion notes about ACEs content.

RESULTS

Major and minor themes emerged to support the ACEs Curricular Concept Map development with direct and indirect paths to culture of health and health equity.

CONCLUSIONS

The ACEs Curricular Concept Map was developed to guide teaching ACEs knowledge in a Bachelor of Science in Nursing program. Future studies are needed to evaluate the impact of ACEs curricular concepts on nursing students' learning and graduates' ability to translate knowledge to practice ACEs awareness and prevention toward health equity for all. [J Nurs Educ. 2019;58(4):193-200.].

The BOND Framework: A Practical Application of Visual Communication Design and Marketing to Advance Evaluation Reporting

Despite growing interest in data visualization and graphically aided reporting, the evaluation literature could benefit from additional guidance on systematically integrating visual communication design and marketing into comprehensive communication strategies to improve data dissemination. This article describes the role of targeted communication strategies-based on visual communications, design, and marketing theory-in producing more effective reports. In evaluation practice, well-synthesized and translated reports often require the integration of data from multiple sources, methods, and/or time points to communicate complex findings in ways that elicit productive responses. Visual communication strategies, such as project branding or designing actionable tools with marketing principles in mind, can be applied to optimize effective reporting of complex evaluation findings. This article references a longitudinal, mixed-method evaluation of public school administrators in Michigan to illustrate the application of a systematic communication design framework to produce several graphically aided project materials and subsequent findings reports.

Eliciting patient-important outcomes through group brainstorming: when is saturation reached?

PURPOSE

Group brainstorming is a technique for the elicitation of patient input that has many potential uses, however no data demonstrate concept saturation. In this study we explore concept saturation in group brainstorming performed in a single session as compared to two or three sessions.

METHODS

Fifty-two predominately African American adults patients with moderately to poorly controlled Diabetes Mellitus participated in three separate group brainstorming sessions as part of a PCORI-funded group concept mapping study examining comparing methods for the elicitation of patient important outcomes (PIOs). Brainstorming was unstructured, in response to a prompt designed to elicit PIOs in diabetes care. We combined similar brainstormed responses from all three sessions into a 'master list' of unique PIOs, and then compared the proportion obtained at each individual session, as well as those obtained in combinations of 2 sessions, to the master list.

RESULTS

Twenty-four participants generated 85 responses in session A, 14 participants generated 63 in session B, and 14 participants generated 47 in session C. Compared to the master list, the individual sessions contributed 87%, 76%, and 63% of PIOs. Session B added 3 unique PIOs not present in session A, and session C added 2 PIOs not present in either A or B. No single session achieved >90% saturation of the master list, but all 3 combinations of 2 sessions achieved > 90%.

CONCLUSIONS

Single sessions elicited only 63-87% of the patient-important outcomes obtained across all three sessions, however all combinations of two sessions elicited over 90% of the master list, suggesting that 2 sessions are sufficient for concept saturation.

TRIAL REGISTRATION

NCT02792777 . Registered 2 June 2016.

Incidence, characteristics and geographical distributions of canine and human non-Hodgkin's lymphoma in the Porto region (North West Portugal)

Lymphoma is one of the most common neoplasms in dogs and it is one of the top five causes of cancer-related deaths, similar to human lymphoma. Companion animal epidemiological studies define dogs as sentinels of potential risk factors for human health, mainly due to shared environments, shorter disease latencies, and spontaneous disease. The aims of this study were to describe human and canine epidemiologic features of non-Hodgkin's lymphoma (NHL) and their similarities, and to investigate a possible geographical association in the incidence risks in the Greater Porto area, in north-western Portugal. The postal codes of human NHL patients diagnosed between 2005 and 2010 residing in the Greater Porto, Portugal, were obtained from North and Central Region Cancer Registries of Portugal. Available data from dogs diagnosed with lymphoma between 2005 and 2016 from several veterinary centres were also collected. Descriptive epidemiology, mapping cases, and age-standardised risks of NHL incidence (ASR) were determined for both species. The results showed a higher risk (P<0.05) of NHL in men (ASR men: 18.1 cases/100,000 inhabitants; women: 14.2 cases/100,000 inhabitants) and in male dogs (ASR males: 82 cases/100,000 dogs; females: 70 cases/100,000 dogs). The geographical distribution of human and canine ASR was well correlated (r=0.664, P<0.05), with the highest values for human and canine ASR detected in the same urban municipalities of the Greater Porto: Porto, Matosinhos and Maia. These findings suggest the existence of exposure similarities, supporting the relevance of cancer surveillance in pet animals as efficient tools to predict health hazards for humans.

Developing priorities to achieve health equity through diabetes translation research: a concept mapping study

INTRODUCTION

The goal of diabetes translation research is to advance research into practice and ensure equitable benefit from scientific evidence. This study uses concept mapping to inform and refine future directions of diabetes translation research with the goal of achieving health equity in diabetes prevention and control.

RESEARCH DESIGN AND METHODS

This study used concept mapping and input from a national network of diabetes researchers and public health practitioners. Concept mapping is a mixed-method, participant-based process. First, participants generated statements by responding to a focus prompt ("To eliminate disparities and achieve health equity in the prevention and treatment of diabetes, research should…"). Participants then sorted statements by conceptual similarity and rated each statement on importance and feasibility (Likert scale of 1-5). A cluster map was created using multidimensional scaling and hierarchical cluster analysis; statements were plotted by average importance and feasibility.

RESULTS

Ten clusters were identified containing between 6 and 12 statements from 95 total generated statements. The ranges of average importance and feasibility ratings for clusters were fairly high and narrow (3.62-4.09; 3.10-3.93, respectively). Clusters with the most statements in the "go-zone" quadrant (above average importance/feasibility) were community and partner engagement (n=7), dissemination and implementation principles (n=4), and enrichment and capacity building (n=4). Clusters with the most statements in the "innovative-targets" quadrant (above average importance, below average feasibility) included next generation interventions (n=6), policy approaches (n=4), and interventions for specific populations (n=4).

CONCLUSIONS

This study created a framework of 10 priority areas to guide current and future efforts in diabetes translation research to achieve health equity. Themes rated as highly important and feasible provide the basis to evaluate current research support. Future efforts should explore how to best support innovative-targets, those rated highly important but less feasible.

Using concept mapping to develop a human rights based indicator framework to assess country efforts to strengthen rehabilitation provision and policy: the Rehabilitation System Diagnosis and Dialogue framework (RESYST)

BACKGROUND

Rehabilitation is crucial for the realization of the right to health and a proper concern of global health. Yet, reliable information to guide rehabilitation service planning is unavailable in many countries in part due to the lack of appropriate indicators. To ensure universal health coverage and meet the central imperative of "leaving no one behind" countries must be able to assess key aspects of rehabilitation policy and provision and monitor how they have discharged their human rights responsibilities towards those most disadvantaged, including people with disability. This article describes the process of developing an expert guided indicator framework to assess governments' efforts and progress in strengthening rehabilitation in line with the Convention on the Rights of Persons with Disabilities.

METHODS

A systems methodology - concept mapping - was used to capture, aggregate and confirm the knowledge of diverse stakeholders on measures thought to be useful for monitoring the implementation of the Convention with respect to health related rehabilitation. Fifty-six individuals generated a list of 107 indicators through online brainstorming which were subsequently sorted by 37 experts from the original panel into non overlapping categories. Forty-one participants rated the indicators for importance and feasibility. Multivariate statistical techniques where used to explore patterns and themes in the data and create the indicators' organizing framework which was verified and interpreted by a select number of participants.

RESULTS

A concept map of 11 clusters of indicators emerged from the analysis grouped into three broader themes: Governance and Leadership (3 clusters); Service Delivery, Financing and Oversight (6 clusters); and Human Resources (2 clusters). The indicator framework was comprehensive and well aligned with the Convention. On average, there was a moderately positive correlation between importance and feasibility of the indicators (r = .58) with experts prioritizing the indicators contained in the clusters of the Governance and Leadership domain. Two of the most important indicators arose from the Service Delivery, Financing and Oversight domain and reflect the need to monitor unmet needs and barriers in access to rehabilitation. In total, 59 indicators achieved above average score for importance and comprised the two-tiered priority set of indicators.

CONCLUSION

Concept mapping was successful in generating a shared model that enables a system's view of the most critical legal, policy and programmatic factors that must be addressed when assessing country efforts to reform, upscale and improve rehabilitation services. The Rehabilitation Systems Diagnosis and Dialogue framework provides a data driven basis for the development of standardized data collection tools to facilitate comparative analysis of rehabilitation systems. Despite agreement on the importance and feasibility of 59 indicators, further research is needed to appraise the applicability and utility of the indicators and secure a realistic assessment of rehabilitation systems.

Do conceptualisations of health differ across social strata? A concept mapping study among lay people

OBJECTIVES

The legitimacy of policies that aim at tackling socioeconomic inequalities in health can be challenged if they do not reflect the conceptualisations of health that are valued in all strata. Therefore, this study analyses how different socioeconomic groups formulate their own answers regarding: what does health mean to you?

DESIGN

Concept mapping procedures were performed in three groups that differ in educational level. All procedures followed exactly the same design.

SETTING

Area of the city of Utrecht, the Netherlands.

PARTICIPANTS

Lay persons with a lower, intermediate and higher educational level (±15/group).

RESULTS

The concept maps for the three groups consisted of nine, eight and seven clusters each, respectively. Four clusters occurred in all groups: absence of disease/disabilities, health-related behaviours, social life, attitude towards life. The content of some of these differed between groups, for example, behaviours were interpreted as having opportunities to behave healthily in the lower education group, and in terms of their impact on health in the higher education group. Other clusters appeared to be specific for particular groups, such as autonomy (intermediate/higher education group). Finally, ranking ranged from a higher ranking of the positively formulated aspects in the higher education group (eg, lust for life) to that of the negatively formulated aspects in the lower education group (eg, having no chronic disease).

CONCLUSION

Our results provide indications to suggest that people in lower socioeconomic groups are more likely to show a conceptualisation of health that refers to (1) the absence of health threats (vs positive aspects), (2) a person within his/her circumstances (vs quality of own body/mind), (3) the value of functional (vs hedonistic) notions and (4) an accepting (vs active) attitude towards life.