Towards quality criteria for regional public health reporting: concept mapping with Dutch experts

Overview of national health reporting in the EU and quality criteria for public health reports - results of the Joint Action InfAct

BACKGROUND

Health reporting shall provide up-to-date health-related data to inform policy-makers, researchers and the public. To this end, health reporting formats should be tailored to the needs and competencies of the target groups and provide comparable and high-quality information. Within the Joint Action on Health Information 'InfAct', we aimed at gaining an overview of health reporting practices in the EU Member States and associated countries, and developed quality criteria for the preparation of public health reports. The results are intended to facilitate making health information adequately available while reducing inequalities in health reporting across the EU.

METHODS

A web-based desk research was conducted among EU Member States and associated countries to generate an overview of different formats of national health reporting and their respective target groups. To identify possible quality criteria for public health reports, an exploratory literature review was performed and earlier projects were analysed. The final set of criteria was developed in exchange with experts from the InfAct consortium.

RESULTS

The web-based desk research showed that public health reports are the most frequently used format across countries (94%), most often addressed to scientists and researchers (51%), politicians and decision-makers (41%). However, across all reporting formats, the general public is the most frequently addressed target group. With regards to quality criteria for public health reports, the literature review has yielded few results. Therefore, two earlier projects served as main sources: the 'Evaluation of National and Regional Public Health Reports' and the guideline 'Good Practice in Health Reporting'from Germany. In collaboration with experts, quality criteria were identified and grouped into eight categories, ranging from topic selection to presentation of results, and compiled in a checklist for easy reference.

CONCLUSION

Health reporting practices in the EU are heterogeneous across Member States. The assembled quality criteria are intended to facilitate the preparation, dissemination and access to better comparable high-quality public health reports as a basis for evidence-based decision-making. A comprehensive conceptual and integrative approach that incorporates the policy perspective would be useful to investigate which dissemination strategies are the most suitable for specific requirements of the targeted groups.

The foundations of the working alliance in assertive community treatment teams

BACKGROUND

In this study, we aimed to identify and define the fundamental components of the working alliance in multidisciplinary (Flexible) Assertive Community Treatment teams with shared caseloads, in order to support their daily practice and further research.

METHODS

After reviewing the literature, concept mapping with professionals and clients was used to define the working alliance in (F) ACT teams. The resulting concept maps formed the basis for the working alliance assessment instrument, which was pilot tested with professionals and clients through cognitive interviews with a think-aloud procedure.

RESULTS

The study led to the development of a twenty five-item assessment instrument to evaluate working alliances in multidisciplinary teams (WAM) that was comprised of three subscales: bond, task/goal and team. Two different versions were developed for clients and professionals.

CONCLUSIONS

The WAM instrument was developed to determine the quality of the working alliance in (F) ACT teams. Future research will focus on testing its psychometric properties and predictive value.

[Subnational population health monitoring and reporting: public health at the grassroots level]

Population health monitoring and reporting provides regular and up-to-date information on health outcomes and its determinants. The outputs of population health monitoring aim to inform policymakers and other stakeholders to develop fact-based decisions. Population health monitoring is located at the national, but also federal state and county level. This paper describes the legal basis for population health monitoring in the federal states' public health acts as well as current challenges and possibilities for further development from a federal state and county perspective on population health monitoring.A legal basis for population health monitoring on the federal state and county level exists for almost all federal states in Germany. The level of detail of these laws varies in terms of responsibility, periodicity of population health monitoring and reporting, content, and designated use. Population health monitoring needs to respond to challenges in the areas of population health monitoring resources, data sources, (intersectoral) reporting, and impact. Practical examples illustrate how the challenges can be handled and further development can take place.Based on its solid legal basis, being a routine task, and its close link to the living conditions of the population, population health monitoring on the federal state and county level has the possibility for cocreating public health at the grassroots level and to be a pioneer for health equity.

Towards local implementation of Dutch health policy guidelines: a concept-mapping approach

To develop a targeted implementation strategy for a municipal health policy guideline, implementation targets of two guideline users [Regional Health Services (RHSs)] and guideline developers of leading national health institutes were made explicit. Therefore, characteristics of successful implementation of the guideline were identified. Differences and similarities in perceptions of these characteristics between RHSs and developers were explored. Separate concept mapping procedures were executed in two RHSs, one with representatives from partner local health organizations and municipalities, the second with RHS members only. A third map was conducted with the developers of the guideline. All mapping procedures followed the same design of generating statements up to interpretation of results with participants. Concept mapping, as a practical implementation tool, will be discussed in the context of international research literature on guideline implementation in public health. Guideline developers consider implementation successful when substantive components (health issues) of the guidelines, content are visible in local policy practice. RHSs, local organizations and municipalities view the implementation process itself within and between organizations as more relevant, and state that usability of the guideline for municipal policy and commitment by officials and municipal managers are critical targets for successful implementation. Between the RHSs, differences in implementation targets were smaller than between RHSs and guideline developers. For successful implementation, RHSs tend to focus on process targets while developers focus more on the thematic contents of the guideline. Implications of these different orientations for implementation strategies are dealt with in the discussion.

Participatory epidemiology: the contribution of participatory research to epidemiology

Background

Epidemiology has contributed in many ways to identifying various risk factors for disease and to promoting population health. However, there is a continuing debate about the ability of epidemiology not only to describe, but also to provide results which can be better translated into public health practice. It has been proposed that participatory research approaches be applied to epidemiology as a way to bridge this gap between description and action. A systematic account of what constitutes participatory epidemiology practice has, however, been lacking.

Methods

A scoping review was carried out focused on the question of what constitutes participatory approaches to epidemiology for the purpose of demonstrating their potential for advancing epidemiologic research. Relevant databases were searched, including both the published and non-published (grey) literature. The 102 identified sources were analyzed in terms of comparing common epidemiologic approaches to participatory counterparts regarding central aspects of the research process. Exemplary studies applying participatory approaches were examined more closely.

Results

A highly diverse, interdisciplinary body of literature was synthesized, resulting in a framework comprised of seven aspects of the research process: research goal, research question, population, context, data synthesis, research management, and dissemination of findings. The framework specifies how participatory approaches not only differ from, but also how they can enhance common approaches in epidemiology. Finally, recommendations for the further development of participatory approaches are given. These include: enhancing data collection, data analysis, and data validation; advancing capacity building for research at the local level; and developing data synthesis.

Conclusion

The proposed framework provides a basis for systematically developing the emergent science of participatory epidemiology.

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

In this paper we explore the suitability of concept mapping as a method for integrating knowledge from science, practice, and policy. In earlier research we described and analysed five cases of concept mapping procedures in the Netherlands, serving different purposes and fields in public health. In the current paper, seven new concept mapping studies of co-produced work are added to extend this analysis. For each of these twelve studies we analysed: (1) how the method was able to integrate knowledge from practice with scientific knowledge by facilitating dialogue and collaboration between different stakeholders in the field of public health, such as academic researchers, practitioners, policy-makers and the public; (2) how the method was able to bring theory development a step further (scientific relevance); and (3) how the method was able to act as a sound basis for practical decision-making (practical relevance). Based on the answers to these research questions, all but one study was considered useful for building more evidence-based public health, even though the extent to which they underpinned actual decision-making varied. The chance of actually being implemented in practice seems strongly related to the extent to which the responsible decision-makers are involved in the way the concept map is prepared and executed.

Using concept mapping in the development of the EU-PAD framework (EUropean-Physical Activity Determinants across the life course): a DEDIPAC-study

Background

A large proportion of European children, adults and older adults do not engage in sufficient physical activity (PA). Understanding individual and contextual factors associated with PA behaviours is essential for the identification and implementation of effective preventative environments, policies, and programmes that can promote an active lifestyle across life course and can potentially improve health. The current paper intends to provide 1) a multi-disciplinary, Pan-European and life course view of key determinants of PA behaviours and 2) a proposal of how these factors may cluster.

Methods

After gathering a list of 183 potential PA behaviours-associated factors and a consensus meeting to unify/consolidate terminology, a concept mapping software was used to collate European experts’ views of 106 identified factors for youth (<19 years), adults (19–64 years), and older adults (≥65 years). The analysis evaluated common trends in the clustering of factors and the ratings of the distinct factors’ expected modifiability and population-level impact on PA behaviours across the life course. Priority for research was also assessed for each cluster.

Results

The concept mapping resulted in six distinct clusters, broadly merged in two themes: 1) the ‘Person’, which included clusters ‘Intra-Personal Context and Wellbeing’ and ‘Family and Social Economic Status’ (42 % of all factors) and 2) the ‘Society’, which included the remaining four clusters ‘Policy and Provision’, ‘Cultural Context and Media’, ‘Social Support and Modelling’, and ‘Supportive Environment’ (58 % of all factors). Overall, 25 factors were rated as the most impactful on PA behaviours across the life course and being the most modifiable. They were mostly situated in the ‘Intra-Personal Context and Wellbeing’ cluster. Furthermore, 16 of them were rated as top priority for research.

Conclusions

The current framework provides a preliminary overview of factors which may account for PA behaviour across the life course and are most relevant to the European community. These insights could potentially be a foundation for future Pan-European research on how these factors might interact with each other, and assist policy makers to identify appropriate interventions to maximize PA behaviours and thus the health of European citizens.

Key features of an EU health information system: a concept mapping study

BACKGROUND

Despite the acknowledged value of an EU health information system (EU-HISys) and the many achievements in this field, the landscape is still heavily fragmented and incomplete. Through a systematic analysis of the opinions and valuations of public health stakeholders, this study aims to conceptualize key features of an EU-HISys.

METHODS

Public health professionals and policymakers were invited to participate in a concept mapping procedure. First, participants (N = 34) formulated statements that reflected their vision of an EU-HISys. Second, participants (N = 28) rated the relative importance of each statement and grouped conceptually similar ones. Principal Component and cluster analyses were used to condense these results to EU-HISys key features in a concept map. The number of key features and the labelling of the concept map were determined by expert consensus.

RESULTS

The concept map contains 10 key features that summarize 93 statements. The map consists of a horizontal axis that represents the relevance of an 'organizational strategy', which deals with the 'efforts' to design and develop an EU-HISys and the 'achievements' gained by a functioning EU-HISys. The vertical axis represents the 'professional orientation' of the EU-HISys, ranging from the 'scientific' through to the 'policy' perspective. The top ranking statement expressed the need to establish a system that is permanent and sustainable. The top ranking key feature focuses on data and information quality.

CONCLUSIONS

This study provides insights into key features of an EU-HISys. The results can be used to guide future planning and to support the development of a health information system for Europe.

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.

Cochrane systematic reviews are useful to map research gaps for decreasing maternal mortality

OBJECTIVES

To use an "evidence-mapping" approach to assess the usefulness of Cochrane reviews in identifying research gaps in the maternal health.

STUDY DESIGN AND SETTING

The article describes the general mapping, prioritizing, reconciling, and updating approach: (1) identifying gaps in the maternal health research using published systematic reviews and formulating research questions, (2) prioritizing questions using Delphi method, (3) reconciling identified research priorities with the existing literature (i.e., searching of ongoing trials in trials registries), (4) updating the process. A comprehensive search of Cochrane systematic reviews published or updated from January 2006 to March 2011 was performed. We evaluated the "Implications for Research" section to identify gaps in the research.

RESULTS

Our search strategy identified 695 references; 178 systematic reviews identifying at least one research gap were used. We formulated 319 research questions, which were classified into 11 different categories based on the direct and indirect causes of maternal mortality: postpartum hemorrhage, abortion, hypertensive disorders, infection/sepsis, caesarean section, diabetes, pregnancy prevention, preterm labor, other direct causes, indirect causes, and health policies and systems. Most research questions concerned the effectiveness of clinical interventions, including drugs (42.6%), nonpharmacologic interventions (16.3%), and health system (14.7%).

CONCLUSION

It is possible to identify gaps in the maternal health research by using this approach.