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Balán IC, Cheshure A, Green S, Coyle K, Cook C, Pooler-Burgess M, Wang Y, Morgan J, George A, Naar S. Building an HIV Learning Health Care Community for Youth in Florida: Opportunities and Challenges. AIDS Behav 2024; 28:951-962. [PMID: 37922033 PMCID: PMC11068034 DOI: 10.1007/s10461-023-04201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/05/2023]
Abstract
In Florida, 33% of new HIV infections among men and 21% of new infections among women are among those younger than 29 years of age. We describe the development of a Learning Health Care Community for youth (Y-LHCC) in Orange County, FL. Its core implementation team (iTeam) was composed of representatives from community agencies and academics, whose work was informed by data from the Florida Department of Health (FDOH) and regional research, in-depth interviews (IDIs) with agency representatives, and a pilot implementation of Tailored Motivational Interviewing (TMI) to improve service provision. IDIs revealed limited programming specifically for youth, significant structural challenges providing them with PrEP, and differences in use of evidence-based behavioral interventions to improve HIV services. FDOH provided data on new HIV infections, linkage to care, viral suppression, and PrEP coverage, however, limitations such as minimal data on PrEP referrals and use, agency level data, and inability to generate data quarterly (which would facilitate program improvement) were encountered. Thirty staff members from five agencies serving youth in Orange County participated in TMI training. About half the agency staff (n = 16) completed at least three of the four online training sessions. MI skills improved from pre- (n = 28; M = 1.96) to post TMI training (n = 11; M = 2.48, SD = 0.57); (t(37) = - 3.14, p = 0.0033). The iTeam held seven remote meetings and two in-person half-day meetings at the end of the study, during which they reassessed areas of focus for improving youth services. They also reiterated their commitment to continuing to meet beyond the study period and to engage other agencies in the newly established coalition. Findings highlight the potential of creating a Y-LHCC in Florida as well as some of the challenges that will need to be overcome to achieve ending the HIV Epidemic goals for young people in the region.
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Affiliation(s)
- Iván C Balán
- Department of Behavioral Science and Social Medicine, Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA.
| | - Andrea Cheshure
- Department of Behavioral Science and Social Medicine, Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Sara Green
- Department of Behavioral Science and Social Medicine, Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Karin Coyle
- Education, Training, and Research (ETR), Scott Valley, CA, USA
| | - Christa Cook
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Meardith Pooler-Burgess
- Department of Behavioral Science and Social Medicine, Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Yuxia Wang
- Department of Behavioral Science and Social Medicine, Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Jonathan Morgan
- Department of Behavioral Science and Social Medicine, Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Avery George
- Department of Behavioral Science and Social Medicine, Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Sylvie Naar
- Department of Behavioral Science and Social Medicine, Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA
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Duda-Sikuła M, Kurpas D. Barriers and Facilitators in the Implementation of Prevention Strategies for Chronic Disease Patients-Best Practice GuideLines and Policies' Systematic Review. J Pers Med 2023; 13:jpm13020288. [PMID: 36836522 PMCID: PMC9959826 DOI: 10.3390/jpm13020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Visits of chronically ill patients account for 80% of primary care consultations. Approximately 15-38% of patients have three or more chronic diseases, and 30% of hospitalisations result from the deteriorating clinical condition of these patients. The burden of chronic disease and multimorbidity is increasing in combination with the growing population of elderly people. However, many interventions found to be effective in health service studies fail to translate into meaningful patient care outcomes across multiple contexts. With the growing burden of chronic diseases, healthcare providers, health policymakers, and other healthcare system stakeholders are re-examining their strategies and opportunities for more effective prevention and clinical interventions. The study aimed to find the best practice guidelines and policies influencing effective intervention and making it possible to personalize prevention strategies. Apart from clinical treatment, it is essential to increase the effectiveness of non-clinical interventions that could empower chronic patients to increase their involvement in therapy. The review focuses on the best practice guidelines and policies in non-medical interventions and the barriers to and facilitators of their implementation into everyday practice. A systematic review of practice guidelines and policies was conducted to answer the research question. The authors screened databases and included 47 full-text recent studies in the qualitative synthesis.
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Affiliation(s)
- Marta Duda-Sikuła
- Clinical Trial Department, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Correspondence:
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
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Guglielmin M, Shankardass K, Bayoumi A, O’Campo P, Kokkinen L, Muntaner C. A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland. Int J Health Policy Manag 2022; 11:2651-2659. [PMID: 35247936 PMCID: PMC9818123 DOI: 10.34172/ijhpm.2022.6355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Health in All Policies (HiAP) encompasses collaboration across government and the consideration of health in various governmental sector's policies and decisions. Despite increasing advocacy, interest, and uptake in HiAP globally, empirical and evaluative studies are underrepresented in this growing literature, particularly literature on HiAP implementation at the local level. Finland has been a pioneer in and champion for HiAP. METHODS A realist explanatory case study design was used to test hypotheses about how HiAP is implemented in Kuopio, Finland. Semi-structured interviews with ten government employees from various sectors were conducted. Data from interviews and literature were analyzed with the aims of uncovering explanatory mechanisms in the form of context-strategy-mechanism-outcome (CSMO) configurations related to implementation strategies. Evidence was evaluated for quality based on triangulation of sources and strength of evidence. We hypothesized that having or creating a common goal between sectors and having committed staff and local leadership would facilitate implementation. RESULTS Strong evidence supports our hypothesis that having or creating a common goal can aid in positive implementation outcomes at the local level. Common goals can be created by the strategies of having a city mandate, engaging in cross-sectoral discussions, and/or by working together. Policy and political elite leadership led to HiAP implementation success because leaders supported HiAP work, thus providing justification for using time to work intersectorally. How and why the wellbeing committee facilitated implementation included by providing opportunities for discussion and learning, which led to understanding of how non-health decisions impact community wellbeing, and by acting as a conduit for the communication of wellbeing goals to government employees. CONCLUSION At the municipal level, having or creating a common goal, leadership from policy and political elites, and the presence of committed staff can facilitate HiAP implementation. Inclusion of not only strategies for HiAP, but also the explanatory mechanisms, aids in elucidating how and why HiAP is successfully implemented in a local setting.
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Affiliation(s)
- Maria Guglielmin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ahmed Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Carles Muntaner
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloomberg School of Nursing University of Toronto, Toronto, ON, Canada
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Evaluating ‘Health in All Policies’ in Norwegian Municipalities. SOCIETIES 2022. [DOI: 10.3390/soc12030092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Health in All Policies (HiAP) approach has emerged as a central strategy for promoting health at local, regional, and state levels in different countries. Representing a complex and complicated strategy, evaluations of HIAP at the local level are scarce, and scholars call for more knowledge and critical discussions regarding how to evaluate at this level. In this conceptual paper, I discuss how summative and formative evaluation approaches might supplement each other when evaluating HiAP at the local level. First, I discuss the possibilities of using summative and formative evaluation of HiAP. Further, I discuss how formative-dialogue research might represent possibilities for evaluation by combining the two approaches. Finally, I ask if there has been a shift in the Norwegian evaluation discourse, from the promotion of summative evaluation alone to a combination of both summative and formative methods.
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Zhang YQ, Zhou MY, Jiang MY, Zhang XY, Wang X, Wang BG. Awareness of initiative practice for health in the Chinese population: A questionnaire survey based on a network platform. World J Clin Cases 2022; 10:5241-5252. [PMID: 35812685 PMCID: PMC9210912 DOI: 10.12998/wjcc.v10.i16.5241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/21/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In 2016, the Chinese government issued the Healthy China 2030 plan, which also produced the initiative practice for health (IPFH) concept. However, people’s knowledge and awareness of the IPFH are unclear.
AIM To investigate awareness of IPFH in the Chinese population and explore the relevant influential factors.
METHODS An internet-based self-designed questionnaire survey was used to collect respondents’ demographic characteristics and awareness of health and the IPFH from March 26 to April 18, 2020. IPFH consciousness was assessed by the scores for different related questions. The Student’s t test, the Chi-square test, and multiple logistic regression analysis were performed to analyze the differences and influencing factors.
RESULTS A total of 2678 valid questionnaires were collected. Of the respondents, 973 (36.3%) had heard of the IPFH concept. In addition, 89.5% of participants agreed with the view that the IPFH is beneficial to improving quality of life, and over half thought that a regular schedule, a reasonable diet, tobacco and alcohol control, a cheerful mood, specific life goals and plans, taking the initiative to accept health-related education and implement health knowledge, good interpersonal relationships, and regular physical examinations were closely related to the IPFH. The majority of respondents paid attention to their health and usually obtained health-related knowledge via social media and were also willing to promote the IPFH. Most of the participants underestimated the role of hospitals, family doctors, and health managers in promoting the IPFH. Age, monthly income, and medical-related work experience were the influencing factors for IPFH awareness.
CONCLUSION The Chinese population has limited knowledge of the IPFH. People with strong IPFH awareness are older, earn more, and have medical-related work experience.
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Affiliation(s)
- Yi-Qiang Zhang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing 100095, China
| | - Ming-Yue Zhou
- Department of Subject Development, Sanbo Brain Hospital, Capital Medical University, Beijing 100095, China
| | - Meng-Yang Jiang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing 100095, China
| | - Xiao-Yu Zhang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Xin Wang
- Department of Administrative Office, Sanbo Brain Hospital, Capital Medical University, Beijing 100095, China
| | - Bao-Guo Wang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing 100095, China
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Adsul P, Chambers D, Brandt HM, Fernandez ME, Ramanadhan S, Torres E, Leeman J, Baquero B, Fleischer L, Escoffery C, Emmons K, Soler M, Oh A, Korn AR, Wheeler S, Shelton RC. Grounding implementation science in health equity for cancer prevention and control. Implement Sci Commun 2022; 3:56. [PMID: 35659151 PMCID: PMC9164317 DOI: 10.1186/s43058-022-00311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute's Consortium for Cancer Implementation Science convened an action group focused on 'health equity and context' to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions. DISCUSSION In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity. To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.
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Affiliation(s)
- Prajakta Adsul
- Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - David Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD USA
| | - Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Essie Torres
- East Carolina University, 2309 Carol Belk Bldg, Greenville, NC 27858 USA
| | | | - Barbara Baquero
- University of Washington, 3980 15th Ave. NE, Seattle, WA 98195 USA
| | | | - Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Karen Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Montserrat Soler
- Ob/Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, OH USA
| | - April Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - Stephanie Wheeler
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7411, Chapel Hill, NC 27599 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, 722 W 168th Street, New York, NY 10032 USA
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‘Health in All Policies’ and the Urge for Coordination: The Work of Public Health Coordinators and Their Impact and Influence in Local Public Health Policies: A Cross-Sectional Study. SOCIETIES 2022. [DOI: 10.3390/soc12010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Building heavily on the Health in All Policies (HiAP) approach, Norway implemented the Public Health Act in 2012 to reduce social inequalities in health. Local public health coordinators (PHCs) at municipal levels were seen as tools to provide local intersectoral public health work. In this study, we examine factors related to intersectoral agency and if intersectoral work is understood as relevant to securing social justice in local policy outcomes. A national web-based survey in 2019 of all Norwegian PHCs (n = 428) was conducted with a response rate of 60%. Data were analysed through multiple linear regression, hierarchical regression modelling and structural equation modelling. Neither factors relating to community contexts nor individual characteristics were associated with intersectoral agency. Organisational factors, especially position size, being organised at the top level and having a job description, were significantly associated with perceptions of intersectoral agency. PHCs seeing themselves as intersectoral agents also found themselves able to affect annual budgets and policy outcomes. We conclude that municipal PHC positions can be important HiAP tools in local public health policies. However, organisational factors affect how PHCs perceive their influence and role in the municipal organisation and thereby their possibilities to influence local policymaking through intersectoral agency.
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Glandon D, Leoutsakos JM, Gupta S, Marsteller J, Paina L, Bennett S. Development and psychometric testing of the FLW-MSC scale for measuring frontline worker multisectoral collaboration in rural India. BMJ Open 2021; 11:e037800. [PMID: 33664062 PMCID: PMC7934724 DOI: 10.1136/bmjopen-2020-037800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Multisectoral collaboration (MSC) is widely recognised as a critical aspect of policies, programmes and interventions addressing complex public health issues, yet it is undertheorised and difficult to measure. Limited understanding of the intermediate steps linking MSC formation to intended health outcomes leaves a substantial knowledge gap about the types of strategies that may be most effective in making such collaborations successful. This paper, which reports the quantitative strand of a broader mixed-methods study, takes a step toward filling in this 'missing middle' of MSC evaluation by developing and testing the FLW-MSC scale, an instrument to assess collaboration among the frontline workers of one of India's largest and most widely known MSCs: the Integrated Child Development Services (ICDS) scheme. DESIGN This study involved development, field-testing and psychometric testing of an 18-item, Likert-type frontline worker collaboration scale, including internal consistency, construct validity and criterion validity. SETTING Village-level primary healthcare in rural Uttar Pradesh, India. PARTICIPANTS 281 anganwadi workers, 266 accredited social health activists and 124 auxiliary nurse midwives selected based on random sampling of anganwadi catchment areas from 346 gram panchayats (GPs), including 173 intervention GPs and 173 pair-matched control GPs from a parent evaluation study. RESULTS Results support the scale's internal consistency (ordinal α=0.92-0.95), construct validity (reasonable exploratory factor analysis model fit for five of the six dyadic relationships Tucker-Lewis Index=0.84-0.88; Root Mean Squared Error of Approximation=0.09-0.11), and criterion validity (regression of collaboration score on an information-sharing indicator β=3.528; p=0.006). CONCLUSIONS The scale may be useful for ICDS managers to detect and address poor collaboration as the Indian government redoubles its efforts to strengthen and monitor MSC, or 'convergence', with important implications for the critical priority of child development. Further, the FLW-MSC scale may be adapted for measuring frontline worker collaboration across sectors in many other scenarios and low/middle-income country contexts.
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Affiliation(s)
- Douglas Glandon
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeannie-Marie Leoutsakos
- Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shivam Gupta
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jill Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ligia Paina
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sara Bennett
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ron S, Dimitri N, Ginzburg SL, Reisner E, Martinez PB, Zamore W, Echevarria B, Brugge D, Martinez LS. Health Lens Analysis: A Strategy to Engage Community in Environmental Health Research in Action. SUSTAINABILITY 2021; 13. [PMID: 33981451 DOI: 10.3390/su13041748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health Lens Analysis is a tool to facilitate collaboration among diverse community stakeholders. We employed HLA as part of a community based participatory research (CBPR) and action study to mitigate the negative health effects of TRAP and ultrafine particles (UFPs) in Somerville, MA. HLA is a Health in All Policies tool with previously limited implementation in a North American context. As part of the HLA, community and academic partners engaged residents from across near-highway neighborhoods in a series of activities designed to identify health concerns and generate recommendations for policies and projects to improve health over an 18-month planning period. Noise barriers, which may reduce TRAP exposure among residents in addition to reducing traffic noise, were seen as an acceptable solution by community stakeholders. We found HLA to be an effective means to engage stakeholders from across sectors and diverse community residents in critical discourse about the health impacts of near-roadway exposures. The iterative process allowed the project team to fully explore the arguments for noise barriers and preferred health interventions, while building a stakeholder base interested in the mitigation of TRAP, thus, creating a shared language and understanding of the issue.
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Affiliation(s)
- Sharon Ron
- Metropolitan Area Planning Council 60 Temple Place, Boston, MA, 02111, USA
| | - Noelle Dimitri
- Boston University School of Social Work 264 Bay State Rd., Boston, MA 02215, USA
| | - Shir Lerman Ginzburg
- UConn Health, Department of Public Health Sciences 263 Farmington Ave., Farmington, CT 06032, USA
| | - Ellin Reisner
- Somerville Transportation Equity Partnership, Somerville, MA 02145, USA
| | - Pilar Botana Martinez
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Ave., Boston, MA 02118, USA
| | - Wig Zamore
- Somerville Transportation Equity Partnership, Somerville, MA 02145, USA
| | - Ben Echevarria
- The Welcome Project, 530 Mystic Ave., Somerville, MA, 02145, USA
| | - Doug Brugge
- Department of Public Health Sciences, University of Connecticut School of Medicine 263 Farmington Ave., Farmington, CT 06030, USA
| | - Linda Sprague Martinez
- Macro Department, Boston University School of Social Work, 264 Bay State Rd., Boston, MA 02215, USA
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Alegría M, Frank RG, Hansen HB, Sharfstein JM, Shim RS, Tierney M. Transforming Mental Health And Addiction Services. Health Aff (Millwood) 2021; 40:226-234. [DOI: 10.1377/hlthaff.2020.01472] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Margarita Alegría
- Margarita Alegría is a professor of psychology in the Departments of Medicine and Psychiatry at Harvard Medical School, chief of the Disparities Research Unit in the Department of Medicine at Massachusetts General Hospital, and the Harry G. Lehnert, Jr. and Lucille F. Cyr Endowed Chair of the Mass General Research Institute, all in Boston, Massachusetts
| | - Richard G. Frank
- Richard G. Frank is the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School
| | - Helena B. Hansen
- Helena B. Hansen is a professor of psychiatry and anthropology; chair of the Research Theme in Translational Social Science and Health Equity, David Geffen School of Medicine, University of California Los Angeles (UCLA); and associate director of the UCLA Center for Social Medicine and Humanities, all in Los Angeles, California. When this work was performed, she was an associate professor of psychiatry at the NYU Grossman School of Medicine, in New York, New York
| | - Joshua M. Sharfstein
- Joshua M. Sharfstein is a Professor of the Practice in Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Ruth S. Shim
- Ruth S. Shim is the Luke and Grace Kim Professor in Cultural Psychiatry in the Department of Psychiatry and Behavioral Sciences at the University of California Davis, in Davis, California
| | - Matt Tierney
- Matt Tierney is the clinical director of substance use treatment and education in the Office of Population Health, UCSF Health, University of California San Francisco, in San Francisco, California
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Glandon D, Mondal S, Okeyo I, Zaidi S, Khan MS, Dar O, Bennett S. Methodological gaps and opportunities for studying multisectoral collaboration for health in low- and middle-income countries. Health Policy Plan 2020; 34:ii7-ii17. [PMID: 31723973 DOI: 10.1093/heapol/czz116] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
The current body of research into multisectoral collaborations (MSCs) for health raises more questions than it answers, both in terms of how to implement MSCs and how to study them. This article reflects on current methodological gaps and opportunities for advancing MSC research, based on a targeted review of existing literature and qualitative input from researchers and practitioners at the 2018 Health Systems Research (HSR) Symposium in Liverpool. Through framework analysis of 205 MSC research papers referenced in a separately published MSC 'overview of reviews' paper, this article identifies six broad MSC question domains ('meta questions') and applies content analysis to estimate the relative frequency with which these meta questions and the research method(s) used to answer them are present in the literature. Results highlight a preponderance of research exploring MSC implementation using case study methods, which, in aggregate, does not seem to adequately meet policymakers' and practitioners' needs for generalizable or transferable insights. The content analysis is complemented by qualitative insights from HSR Symposium participants and the authors' own experience to identify six key methodological gaps in research on MSC for health. For each of these gaps, we propose areas in which we believe there are opportunities for methodological development and innovation to help advance this field of study, including: better understanding the role of power dynamics in shaping MSCs; development of a classification framework (or frameworks) of governance arrangements; exploring divergence of perspective and experience among MSC partners; identifying or generating theoretical frameworks for MSC that work across sectors and disciplines; developing intermediate indicators of collaboration; and increasing transferability of insights to other contexts. Collaboration with researchers outside of the health sector will enhance efforts in each of these areas, as will the establishment and strengthening of pluralistic MSC evidence networks also involving policymakers and practitioners.
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Affiliation(s)
- Douglas Glandon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA
| | - Shinjini Mondal
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Montreal, QC, Canada
| | - Ida Okeyo
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Republic of South Africa
| | - Shehla Zaidi
- Department of Community Health Sciences and Women & Child Health Division, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Mishal S Khan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Osman Dar
- Global Public Health Directorate, Public Health England, 7th Floor Wellington House, 133-155 Waterloo Road, London, UK
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA
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12
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Klinker CD, Agger A. Perceptions of public health and cross-sectoral collaboration in low SES neighbourhoods in Denmark. Health Promot Int 2020; 35:e21-e31. [PMID: 30590555 DOI: 10.1093/heapro/day098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cross-sectoral interventions in low socio-economic status (SES) neighbourhoods are an important contribution to reducing social inequities in health. This article investigates the health perceptions among professionals from public health, social and place-based initiatives, all working in low SES neighbourhoods in Denmark, and what implications these perceptions have on their work with health promotion and on collaboration between the initiatives. Empirically, we draw on 63 semi-structured interviews with frontline professionals across area-based initiatives (ABIs), social housing development plans (SHDPs) and municipal public health departments (PHDs). Our study shows that professionals across all sectors perceive it as important to work with a broad understanding of health to motivate and reach hard-to-reach groups in low SES neighbourhoods as opposed to a more narrow perspective on health and health promotion focussed on lifestyles and monitoring risks. The aims and practice of ABIs and SHDPs support work in line with a broad understanding of health, whereas frontline workers from the PHDs in practice more often end up applying a more narrow understanding of health. Consequently, real collaboration is infrequent and often confined to the coordination of activities. This limits the possibilities of implementing effective interventions in low SES neighbourhoods to reduce inequities in health. This article claims that there is a greater potential for synergy among different initiatives in low SES neighbourhoods if a broad understanding of health can be applied in practice across sectors.
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Affiliation(s)
- Charlotte D Klinker
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens vej 6, Gentofte, Denmark
| | - Annika Agger
- Department of Social Science and Business, Roskilde University, Universitetsvej 1, Roskilde, Denmark
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Mundo W, Manetta P, Fort MP, Sauaia A. A Qualitative Study of Health in All Policies at the Local
Level. INQUIRY: A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019. [PMCID: PMC6728655 DOI: 10.1177/0046958019874153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health in All Policies (HiAP) encourage health-conscious policymaking in
non-health sectors; however, there are no standardized measures or guides for
assessing progress in HiAP implementation. The purpose of this study was to
describe how HiAP in local public health agencies (LPHAs) are implemented at the
local level in Colorado and identify challenges and opportunities for
implementation. We conducted semi-structured interviews with 13 key informants
identified through purposive sampling. Interviews were recorded, double-coded,
and analyzed using thematic analysis. The themes we identified relating to the
implementation of different HiAP approaches were as follows: the importance of
building trusting relationships, a need to understand the work of LPHAs and
public health, and LPHA structure and role clarity. Tools and tactics that
respondents identified in their implementation and practice of HiAP are sharing
data and data platforms, community dashboarding, providing services to partners,
sharing programs or services, attending meetings regularly, and measurement
instruments. This study demonstrates HiAP approach variation and the need for a
state-wide standardized framework for initiatives and progress. Future HiAP
implementation research should focus on county-level analysis using outcomes
that LPHAs are targeting based on their health priorities and should also
capture the activities of sectors outside of public health.
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Affiliation(s)
- William Mundo
- University of Colorado Anschutz Medical
Campus, Aurora, USA,William Mundo, Department of Health Systems,
Management & Policy, University of Colorado Anschutz Medical Campus, 13120
E. 19th Avenue, Box A-049, Room 5223-1, Aurora, CO 80045, USA.
| | - Peter Manetta
- University of Colorado Anschutz Medical
Campus, Aurora, USA,Colorado Association of Local Public
Health Officials, Denver, USA
| | | | - Angela Sauaia
- University of Colorado Anschutz Medical
Campus, Aurora, USA
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Pollack Porter KM, Lindberg R, McInnis-Simoncelli A. Considering health and health disparities during state policy formulation: examining Washington state Health Impact Reviews. BMC Public Health 2019; 19:862. [PMID: 31269934 PMCID: PMC6610847 DOI: 10.1186/s12889-019-7165-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/13/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND As part of efforts to expand Health in All Policies (HiAP) in Washington State in the U.S., the Washington State Board of Health (BOH) received statutory authority in 2006 to conduct Health Impact Reviews (HIRs). HIRs analyze the potential impacts of proposed legislation and budget decisions on health and health disparities. Public health professionals who are aware of HIRs are interested in adopting a similar process in their states; however, there is limited information about HIRs, how they are perceived, and how they could advance HiAP. METHODS This research involved a descriptive analysis of a sample of HIRs and semi-structured interviews with a purposive sample of 17 key informants. For the descriptive analysis, all HIRs requested or completed between January 1, 2007 and April 1, 2016 that had a request form submitted by a legislator or the governor that was available in the BOH's online database were reviewed. Information was collected on several variables including the bill number and title, sponsor and political affiliation, and the sector to which the bill or budgetary proposal pertained. A purposeful sample of legislators, staff, advocates, and lobbyists who were involved with HIRs during the study period were invited to participate in semi-structured interviews. Topic coding was used to identify key themes from the qualitative data. RESULTS During the study period, 20 legislators requested 36 HIRs; 32 HIRs were completed. HIRs were requested for several bill topics, including education (11/36) and labor and employment (9/36). Legislators who requested HIRs felt they provided valuable data on health and health disparities for proposed bills. Individuals who were less supportive of HIRs perceived them as an advocacy or political tool. The main barrier to widespread use of HIRs in Washington was a lack of awareness among legislators. CONCLUSIONS HIRs are one strategy to advance HiAP for state policy decisions. HIRs are a potentially effective tool for highlighting how legislative proposals and budgets positively and negatively impact health and health disparities. Future efforts should promote awareness and highlight shared benefits of HIRs among legislators and their staff, as well as their scientific integrity, methodological rigor, and objectivity.
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Affiliation(s)
- Keshia M Pollack Porter
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Rom 380A, Baltimore, MD, 21205, USA.
| | - Ruth Lindberg
- Health Impact Project, The Pew Charitable Trusts, 901 E Street NW, Washington, DC, 20004, USA
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Glandon D, Meghani A, Jessani N, Qiu M, Bennett S. Identifying health policy and systems research priorities on multisectoral collaboration for health in low-income and middle-income countries. BMJ Glob Health 2018; 3:e000970. [PMID: 30364329 PMCID: PMC6195136 DOI: 10.1136/bmjgh-2018-000970] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
Introduction While efforts to achieve Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) have reinvigorated interest in multisectoral collaborations (MSCs) among the global health and development community, there remains a plethora of questions about how best to conceptualise, plan, implement, evaluate and sustain MSCs. The objective of this paper is to present research priorities on MSC for health from researchers and policymakers around the globe, with an emphasis on low-income and middle-income countries. Methods The authors identified 30 priority research questions from two sources: (1) 38 review articles on MSC for health, and (2) interviews and focus groups with a total of 81 policymakers, including government officials (largely from ministries of health and state/provincial departments of health, but also offices of planning, public service, social development, the prime minister and others), large multilateral or bilateral organisations, and non-governmental organisations. In a third phase, questions were refined and ranked by a diverse group of researchers from around the globe using an online voting platform. Results The top-ranked questions focused predominantly on pragmatic questions, such as how best to structure, implement and sustain MSCs, as well as how to build stakeholder capacity and community partnerships. Despite substantial variation between review articles, policymakers’ reflections and online ranking by researchers, two topics emerged as research priorities for all three: (1) leadership, partnership and governance structures for MSCs; and (2) MSC implementation strategies and mechanisms. The review articles underscored the need for more guidance on appropriate study designs and methods for investigating MSCs, which may be a prerequisite for other identified research priorities. Conclusion These findings could inform efforts within and beyond the health sector to better align research objectives and funding with the evidence needs of policymakers grappling with questions about how best to leverage MSCs to achieve UHC and the SDGs.
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Affiliation(s)
- Douglas Glandon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ankita Meghani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nasreen Jessani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Qiu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Mullins CD, Wingate LT, Edwards HA, Tofade T, Wutoh A. Transitioning from learning healthcare systems to learning health care communities. J Comp Eff Res 2018; 7:603-614. [PMID: 29478331 DOI: 10.2217/cer-2017-0105] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The learning healthcare system (LHS) model framework has three core, foundational components. These include an infrastructure for health-related data capture, care improvement targets and a supportive policy environment. Despite progress in advancing and implementing LHS approaches, low levels of participation from patients and the public have hampered the transformational potential of the LHS model. An enhanced vision of a community-engaged LHS redesign would focus on the provision of health care from the patient and community perspective to complement the healthcare system as the entity that provides the environment for care. Addressing the LHS framework implementation challenges and utilizing community levers are requisite components of a learning health care community model, version two of the LHS archetype.
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Affiliation(s)
- C Daniel Mullins
- Pharmaceutical Health Services Research, University of Maryland, Baltimore, 220 Arch Street, 12th Floor, Baltimore, MD 21201, USA
| | - La'Marcus T Wingate
- Department of Clinical & Administrative Pharmacy Sciences, Howard University College of Pharmacy, Washington, DC 20059, USA
| | - Hillary A Edwards
- Pharmaceutical Health Services Research, University of Maryland, Baltimore, 220 Arch Street, 12th Floor, Baltimore, MD 21201, USA
| | - Toyin Tofade
- Department of Clinical & Administrative Pharmacy Sciences, Howard University College of Pharmacy, Washington, DC 20059, USA
| | - Anthony Wutoh
- Department of Clinical & Administrative Pharmacy Sciences, Howard University College of Pharmacy, Washington, DC 20059, USA
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Mui Y, Jones-Smith JC, Thornton RLJ, Pollack Porter K, Gittelsohn J. Relationships between Vacant Homes and Food Swamps: A Longitudinal Study of an Urban Food Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111426. [PMID: 29160811 PMCID: PMC5708065 DOI: 10.3390/ijerph14111426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 12/04/2022]
Abstract
Research indicates that living in neighborhoods with high concentrations of boarded-up vacant homes is associated with premature mortality due to cancer and diabetes, but the mechanism for this relationship is unclear. Boarded-up housing may indirectly impact residents’ health by affecting their food environment. We evaluated the association between changes in vacancy rates and changes in the density of unhealthy food outlets as a proportion of all food outlets, termed the food swamp index, in Baltimore, MD (USA) from 2001 to 2012, using neighborhood fixed-effects linear regression models. Over the study period, the average food swamp index increased from 93.5 to 95.3 percentage points across all neighborhoods. Among non-African American neighborhoods, increases in the vacancy rate were associated with statistically significant decreases in the food swamp index (b = −0.38; 90% CI, −0.64 to −0.12; p-value: 0.015), after accounting for changes in neighborhood SES, racial diversity, and population size. A positive association was found among low-SES neighborhoods (b = 0.15; 90% CI, 0.037 to 0.27; p-value: 0.031). Vacant homes may influence the composition of food outlets in urban neighborhoods. Future research should further elucidate the mechanisms by which more distal, contextual factors, such as boarded-up vacant homes, may affect food choices and diet-related health outcomes.
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Affiliation(s)
- Yeeli Mui
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Jessica C Jones-Smith
- Department of Health Services & Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA 98195, USA.
| | - Rachel L J Thornton
- Center for Child and Community Health Research, Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
| | - Keshia Pollack Porter
- Department of Health Policy and Management, Institute for Health and Social Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Joel Gittelsohn
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
- Global Obesity Prevention Center (GOPC) at Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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