Translating evidence into population health improvement: strategies and barriers

Examining the Feasibility, Acceptability, and Effectiveness of Remote Training on Community-Based Participatory Research: Single-Arm Pre-Post Pilot Study

BACKGROUND

Over the past decade, a growing body of scientific evidence has demonstrated that community engagement in research leads to more relevant research, enhances the uptake of research findings, and improves clinical outcomes. Despite the increasing need for the integration of community engagement methodologies into the scientific inquiry, doctoral and master's level competencies in the field of psychiatry often lack dedicated training or coursework on community engagement methodologies.

OBJECTIVE

A total of 13 service users, peer support specialists, caregivers of people with mental health challenges, and scientists (with specialties ranging from basic science to implementation science) aged 18 and older participated in remote training on community-based participatory research. Data were collected at baseline, 2 days, and 3 months.

METHODS

A total of 13 service users, peer support specialists, caregivers of people with mental health challenges, and scientists (with specialties ranging from basic science to implementation science) aged 18 and older participated in remote training on community-based participatory research. Data were collected at baseline, 2 days, and 3 months.

RESULTS

The pilot study demonstrated that a 3-month remote training on community-based participatory research ("Partnership Academy") was deemed feasible and acceptable by service users, peer support specialists, caregivers of people with mental health challenges, and scientists. Improvements were found in research engagement and the quality of partnership. A marked increase in distrust in the medical system was also found. Groups submitted 4 grant applications and published 1 peer-reviewed journal at a 3-month follow-up.

CONCLUSIONS

This pre- and postpilot study demonstrated it is possible to train groups of service users, peer support specialists, caregivers of people with mental health challenges, and scientists in community-based participatory research. These findings provide preliminary evidence that a 3-month remote training on community-based participatory research ("Partnership Academy") is feasible, acceptable, and potentially associated with improvements in research engagement as well as the quality of partnership and output, such as manuscripts and grant applications.

Pre-pandemic trends and Black:White inequities in life expectancy across the 30 most populous U.S. cities: a population-based study

BACKGROUND

Racial inequities in life expectancy, driven by structural racism, have been documented at the state and county levels; however, less information is available at the city level where local policy change generally happens. Furthermore, an assessment of life expectancy during the decade preceding COVID-19 provides a point of comparison for life expectancy estimates and trends post COVID-19 as cities recover.

METHODS

Using National Vital Statistics System mortality data and American Community Survey population estimates, we calculated the average annual city-level life expectancies for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations. We then calculated the absolute difference between the Black and White life expectancies for each of the 30 cities and the U.S. We analyzed trends over four time periods (2008-2010, 2011-2013, 2014-2016, and 2017-2019).

RESULTS

In 2017-2019, life expectancies ranged from 72.75 years in Detroit to 83.15 years in San Francisco (compared to 78.29 years for the U.S.). Black life expectancy ranged from 69.94 years in Houston to 79.04 years in New York, while White life expectancy ranged from 75.18 years in Jacksonville to 86.42 years in Washington, DC. Between 2008-2010 and 2017-2019, 17 of the biggest cities experienced a statistically significant improvement in life expectancy, while 9 cities experienced a significant decrease. Black life expectancy increased significantly in 14 cities and the U.S. but decreased significantly in 4 cities. White life expectancy increased significantly in 17 cities and the U.S. but decreased in 8 cities. In 2017-2019, the U.S. and all but one of the big cities had a significantly longer life expectancy for the White population compared to the Black population. There was more than a 13-year difference between Black and White life expectancies in Washington, DC (compared to 4.18 years at the national level). From 2008-2010 to 2017-2019, the racial gap decreased significantly for the U.S. and eight cities, while it increased in seven cities.

CONCLUSION

Urban stakeholders and equity advocates need data on mortality inequities that are aligned with city jurisdictions to help guide the allocation of resources and implementation of interventions.

Are public health researchers designing for dissemination? Findings from a national survey in China

BACKGROUND

Research findings are not always disseminated in ways preferred by audiences, and research dissemination is not always considered a priority by researchers. While designing for dissemination (D4D) provides an active process to facilitate effective dissemination, use of these practices in China is largely unknown. We aimed to describe the designing for dissemination activities and practices among public health researchers in China.

METHODS

In January 2022, we conducted a cross-sectional survey in 61 sub-committees of four national academic societies which include a wide range of health disciplines. The sample mainly involved researchers at universities or research institutions, the Centers for Disease Control and Prevention at national or regional levels, and hospitals. Participants completed a 42-item online questionnaire. Respondent characteristics, dissemination routes, dissemination barriers, organizational support, and personal practice of D4D were examined with descriptive analyses.

RESULTS

Of 956 respondents, 737 were researchers. Among these researchers, 58.1% had disseminated their research findings. Although there were some variation in the commonly used routes among different groups, academic journals (82.2%) and academic conferences (73.4%) were the most frequently used routes. Barriers to dissemination to non-research audiences existed at both organizational level (e.g., a lack of financial resources, platforms, and collaboration mechanisms) and individual level (e.g., a lack of time, knowledge, and skills, and uncertainty on how to disseminate). About a quarter of respondents (26.7%) had a dedicated person or team for dissemination in their unit or organization, with university researchers reporting a significantly higher proportion than their counterparts (P < 0.05). Only 14.2% of respondents always or usually used frameworks or theories to plan dissemination activities, 26.2% planned dissemination activities early, and 27.1% always or usually involved stakeholders in the research and dissemination process. Respondents with working experience in a practice or policy setting or dissemination and implementation training experience were more likely to apply these D4D strategies (P < 0.05).

CONCLUSION

Considerable room exists for improvement in using impactful dissemination routes, tackling multiple barriers, providing organizational support, and applying D4D strategies among Chinese public health researchers. Our findings have implications for structural changes in academic incentive systems, collaborations and partnerships, funding priorities, and training opportunities.

Strategies for communicating scientific evidence on healthcare to managers and the population: a scoping review

BACKGROUND

Health evidence needs to be communicated and disseminated in a manner that is clearly understood by decision-makers. As an inherent component of health knowledge translation, communicating results of scientific studies, effects of interventions and health risk estimates, in addition to understanding key concepts of clinical epidemiology and interpreting evidence, represent a set of essential instruments to reduce the gap between science and practice. The advancement of digital and social media has reshaped the concept of health communication, introducing new, direct and powerful communication platforms and gateways between researchers and the public. The objective of this scoping review was to identify strategies for communicating scientific evidence in healthcare to managers and/or population.

METHODS

We searched Cochrane Library, Embase®, MEDLINE® and other six electronic databases, in addition to grey literature, relevant websites from related organizations for studies, documents or reports published from 2000, addressing any strategy for communicating scientific evidence on healthcare to managers and/or population.

RESULTS

Our search identified 24 598 unique records, of which 80 met the inclusion criteria and addressed 78 strategies. Most strategies focused on risk and benefit communication in health, were presented by textual format and had been implemented and somehow evaluated. Among the strategies evaluated and appearing to yield some benefit are (i) risk/benefit communication: natural frequencies instead of percentages, absolute risk instead relative risk and number needed to treat, numerical instead nominal communication, mortality instead survival; negative or loss content appear to be more effective than positive or gain content; (ii) evidence synthesis: plain languages summaries to communicate the results of Cochrane reviews to the community were perceived as more reliable, easier to find and understand, and better to support decisions than the original summaries; (iii) teaching/learning: the Informed Health Choices resources seem to be effective for improving critical thinking skills.

CONCLUSION

Our findings contribute to both the knowledge translation process by identifying communication strategies with potential for immediate implementation and to future research by recognizing the need to evaluate the clinical and social impact of other strategies to support evidence-informed policies. Trial registration protocol is prospectively available in MedArxiv (doi.org/10.1101/2021.11.04.21265922).

Mixed-Methods Evaluation of Father Participation in an Adolescent Obesity Prevention Program With Multiple Delivery Methods

Padres Preparados, Jóvenes Saludables was a Latino family-based obesity prevention intervention implemented from 2017 to 2020 across eight programs in-person only, in a blended format (online/in-person), and online only. The intervention aimed to enhance father parenting skills to improve adolescent diet and activity behaviors. Mothers were encouraged to attend. Factors associated with participation were explored using a mixed-methods, qualitative (focus group/individual interviews by Zoom) and quantitative (process evaluation) design. Eleven focus group and 24 individual interviews were completed after participation with 24 fathers, 27 mothers, and 40 adolescents with responses not sorted by delivery method before analysis. Binomial logistic regression models examined associations between fathers' program completion and predictor variables of delivery characteristics, father demographic characteristics, and family attendance patterns. Parents were married (96% fathers, 76% mothers), had low income, a high school education or less (68% fathers, 81% mothers), and had lived in the United States a mean of 19 years. Parents were motivated to participate to improve health, and to be involved with and improve communication with their child. Common barriers to participation were work and life priorities and programmatic factors including scheduling conflicts and technological issues. Participation was greater for fathers attending sessions in-person compared with online only (OR = 11.6). Fathers were more likely to participate if they attended sessions with family members vs. not attending with family members (OR = 7.2). To maximize participation, findings suggest involving multiple parents/caregivers and adolescents, addressing contextual and programmatic barriers, and promoting benefits of better health and relations with family members.

Translating Research into Child Health Policy: Aligning Incentives and Building a New Discourse

Research has led to major achievements in public policy and child health. Despite the gains, the need for research to inform policy remains paramount against a backdrop of inadequate public health investments, health inequities, and public skepticism toward science. However, the translation of research into child health policy has often been slow due to misalignments in incentives between researchers and policy makers and a paucity of conceptual models to inform translation. This article outlines barriers to translation, provides examples of discordance between evidence and policy, summarizes models to inform translation, and offers strategies to improve translation of research to policy.

Examining the influences on the use of behavioural science within UK local authority public health: Qualitative thematic analysis and deductive mapping to the COM-B model and Theoretical Domains Framework

Background

Behavioural science and its contribution towards improving public health is receiving increased recognition. Yet, the translation of these insights into public health practice is under-researched. This study explored the factors influencing the use of behavioural science within public health at a local authority level.

Methods

Fourteen local authority staff (n = 13 female) in the south of England participated in semi-structured interviews, which were analysed inductively to identify key themes. These were later mapped deductively to the COM-B model and Theoretical Domains Framework.

Findings

Nine themes were identified as factors that influence the use of behavioural science in local authority public health: (1) "Limited past experience," (2) "Narrow understanding," (3) "Perceived value of behavioural science," (4) "Translational gap from theory-to-practice," (5) "No protected time," (6) "Old ways of working," (7) "Political influence and organisational culture," (8) "Relationships with key stakeholders," (9) "Access to behavioural science resources". Deductive mapping of these themes revealed that five of the COM constructs (excluding Physical Capability) and eleven of the TDF domains influenced behavioural science use, with "Social influences" and "Knowledge" being the most prominent.

Discussion

Use of behavioural science within local authority public health practice is limited and inconsistent. For it to be successfully implemented, there must be an understanding of its role and value, alongside strategies to overcome a translational gap from theory to practice. Public health teams would benefit from protected time to enable application and strategies to break old habits of using a common-sense approach. System-wide buy-in, particularly related to senior leadership and system partners is needed, which would benefit from organisational and political culture change. Training opportunities, practical resources and expert in-house support should be considered a priority across public health teams.

The Use of Research for Health Systems Policy Development and Implementation in Mozambique: A Descriptive Study

There are still considerable gaps in the process of using research evidence for policy making in Mozambique. We recommend key actions to take to improve the research-to-policy pipeline.

Health policy and systems research (HPSR) is generating an increasing amount of evidence in Mozambique, where implementation of a wide range of public health policies and interventions, and innovative technologies and solutions, is underway. We used qualitative methods to explore the relationship between HPSR and policy development and implementation in Mozambique. We conducted a literature review and in-depth interviews with researchers, experts, and policy makers. Through our analysis, we assessed barriers to the use of research evidence in the development and implementation of national health policies and identified potential opportunities to improve evidence use in this context.

We found an increasing number of research institutions producing solid scientific evidence in the country, with activities in health in general and health systems specifically. There is also a growing trend for decision makers and policy makers to use the results of research during the design, formulation, and implementation of health policies. Most HPSR conducted in Mozambique is funded by international donors and focused on research questions of international interest. Therefore, research generated in Mozambique does not always address questions that are relevant to the local health system development agenda.

While Mozambique has a lot of “gray literature” outlets, few of its publications support the translation of research evidence into policy. Much of the evidence generated in country is disseminated through project reports and briefings, not peer-reviewed literature. Furthermore, when the research evidence generated is not locally relevant, results may be published only in English and in scientific articles, instead of in formats useful to Mozambican policy makers—to the detriment of national-level understanding and use. We recommend that research institutions and policy makers in Mozambique collaborate on developing a platform that consolidates HPSR, making it more accessible and useful to policy makers.

Paper 4: a review of reporting and disseminating approaches for rapid reviews in health policy and systems research

BACKGROUND

Transparent reporting of rapid reviews enables appropriate use of research findings and dissemination strategies can strengthen uptake and impact for the targeted knowledge users, including policy-makers and health system managers. The aim of this literature review was to understand reporting and dissemination approaches for rapid reviews and provide an overview in the context of health policy and systems research.

METHODS

A literature review and descriptive summary of the reporting and disseminating approaches for rapid reviews was conducted, focusing on available guidance and methods, considerations for engagement with knowledge users, and optimizing dissemination. MEDLINE, PubMed, Google scholar, as well as relevant websites and reference lists were searched from January 2017 to March 2021 to identify the relevant literature with no language restrictions. Content was abstracted and charted.

RESULTS

The literature review found limited guidance specific to rapid reviews. Building on the barriers and facilitators to systematic review use, we provide practical recommendations on different approaches and methods for reporting and disseminating expedited knowledge synthesis considering the needs of health policy and systems knowledge users. Reporting should balance comprehensive accounting of the research process and findings with what is "good enough" or sufficient to meet the requirements of the knowledge users, while considering the time and resources available to conduct a review. Typical approaches may be used when planning the dissemination of rapid review findings; such as peer-reviewed publications or symposia and clear and ongoing engagement with knowledge users in crafting the messages is essential so they are appropriately tailored to the target audience. Consideration should be given to providing different products for different audiences. Dissemination measures and bibliometrics are also useful to gauge impact and reach.

CONCLUSIONS

Limited guidance specific to the reporting and dissemination of rapid reviews is available. Although approaches to expedited synthesis for health policy and systems research vary, considerations for the reporting and dissemination of findings are pertinent to all.

Use of implementation science to plan adoption of a tobacco-free policy on a historically black college/university (HBCU) campus

Objective: Implementation science tools were used to identify facilitators and barriers to adopting a tobacco-free policy on a historically Black college/university (HBCU). Participants: Study participants included 13 University staff, two students, and two public health educators/school alumni. Data were collected in 2015-2016. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to develop questions for focus groups and individual interviews. The CFIR was also used by two research team members to code transcripts independently, using an iterative deduction process to achieve ≥85% agreement on CFIR domains. Coded quotations were evaluated using the Qualitative Implementation Framework (QIF) to ascertain next adoption planning steps. Results: Qualitative data suggested that building capacity for tobacco control, linking policy to HBCU identity and priorities such as addressing marijuana use might facilitate adoption of a tobacco-free campus policy. Conclusions: Implementation science tools may be useful for planning adoption of comprehensive tobacco-free policies at HBCUs.

Multi-disciplinary Evaluation of Sexual Assault Referral Centres (SARCs) for better Health (MESARCH): protocol for a 1-year cohort study examining health, well-being and cost outcomes in adult survivors of sexual assault attending SARCs in England

INTRODUCTION

Sexual violence is commonplace and has serious adverse consequences for physical and mental health. Sexual Assault Referral Centres (SARCs) are viewed as a best practice response. Little is known about their effectiveness and cost-effectiveness. Long-term data on the health and well-being of those who have experienced rape and sexual assault are also lacking.

METHODS AND ANALYSIS

This is a mixed-methods protocol for a 1-year cohort study aiming to examine the health and well-being in survivors of sexual violence after attending a SARC in England. Quantitative measures are being taken at baseline, 6 and 12 months. Post-traumatic stress (PTS) is the primary outcome (target N=270 at 12-month follow-up). Secondary measures include anxiety, depression, substance use and sexual health and well-being. Using mixed-effects regression, our main analysis will examine whether variation in SARC service delivery and subsequent mental healthcare is associated with improvement in trauma symptoms after 12 months. An economic analysis will compare costs and outcomes associated with different organisational aspects of SARC service delivery and levels of satisfaction with care. A nested qualitative study will employ narrative analysis of transcribed interviews with 30 cohort participants and 20 survivors who have not experienced SARC services.

ETHICS AND DISSEMINATION

The research is supported by an independent study steering committee, data monitoring and ethics committee and patient and public involvement (PPI) group. A central guiding principle of the research is that being involved should feel diametrically opposed to being a victim of sexual violence, and be experienced as empowering and supportive. Our PPI representatives are instrumental in this, and our wider stakeholders encourage us to consider the health and well-being of all involved. We will disseminate widely through peer-reviewed articles and non-academic channels to maximise the impact of findings on commissioning of services and support for survivors.

TRIAL REGISTRATION NUMBER

ISRCTN30846825.

Using behavioural science in public health settings during the COVID-19 pandemic: The experience of public health practitioners and behavioural scientists

INTRODUCTION

The emergence of COVID-19 and the importance of behaviour change to limit its spread created an urgent need to apply behavioural science to public health. Knowledge mobilisation, the processes whereby research leads to useful findings that are implemented to affect positive outcomes, is a goal for researchers, policy makers and practitioners alike. This study aimed to explores the experience of using behavioural science in public health during COVID-19, to discover barriers and facilitators and whether the rapidly changing context of COVID-19 influenced knowledge mobilisation.

METHODS

We conducted a semi-structured interview study, with ten behavioural scientists and seven public health professionals in England, Scotland, Wales, The Netherlands and Canada. We conducted an inductive thematic analysis.

RESULTS

We report three key themes and 10 sub-themes: 1.Challenges and facilitators of translation of behavioural science into public health (Methods and frameworks supported translation, Lack of supportive infrastructure, Conviction and sourcing of evidence and Embracing behavioural science) 2. The unique context of translation (Rapid change in context, the multi-disciplinary team and the emotional toll). 3. Recommendations to support future behavioural science translation (Embedding experts into teams, Importance of a collaborative network and showcasing the role of behavioural science).

DISCUSSION

Barriers and facilitators included factors related to relationships between people, such as networks and teams; the expertise of individual people; and those related to materials, such as the use of frameworks and an overwhelming amount of evidence and literature.

CONCLUSION

People and frameworks were seen as important in facilitating behavioural science in practice. Future research could explore how different frameworks are used. We recommend a stepped competency framework for behavioural science in public health and more focus on nurturing networks to facilitate knowledge mobilisation in future emergencies.

Peer and Non-Peer Academic Scientists and Peer Support Specialist Community of Practice: Stakeholder Engagement to Advance the Science of Peer Support

Community of Practice, a community-engagement method that encourages a group of people to interact regularly towards a common goal, may promote satisfying experiences in patient-outcomes research among marginalized populations. Peer support specialists are increasingly being involved in peer-informed mental health research due to their lived experiences of mental illness and are an asset in co-designing healthcare programs along with researchers. In 2015, ten scientists and ten mental health service users joined as a Community of Practice that trained to engage in patient-centered outcomes research. The group has so far has presented at 20 conferences, published three book chapters and 30 peer-reviewed publications, and developed two smartphone applications. Of note are the co-production of a smartphone application, a digital peer support certification program, an app decision support tool, and an instrument to assess the value of patient-research partnerships. Future research will assess the feasibility of incorporating more stakeholders to enhance research outcomes.

A Structured Pathway Toward Disruption: A Novel HealthTec Innovation Design Curriculum With Entrepreneurship in Mind

The typical curriculum of training and educating future clinicians, biomedical engineers, health IT, and artificial intelligence experts lacks needed twenty first-century skills like problem-solving, stakeholder empathy, curiosity stimulation, entrepreneurship, and health economics, which are essential generators and are pre-requirements for creating intentional disruptive innovations. Moreover, the translation from research to a valuable and affordable product/process innovation is not formalized by the current teachings that focus on short-term rather than long-term developments, leading to inaccurate and incremental forecasting on the future of healthcare and longevity. The Stanford Biodesign approach of unmet clinical need detection would be an excellent starting methodology for health-related innovation work, although unfortunately not widely taught yet. We have developed a novel lecture titled HealthTec Innovation Design (HTID) offered in an interdisciplinary setup to medical students and biomedical engineers. It teaches a future-oriented view and the application and effects of exponential trends. We implemented a novel approach using the Purpose Launchpad meta-methodology combined with other innovation generation tools to define, experiment, and validate existing project ideas. As part of the process of defining the novel curriculum, we used experimentation methods, like a global science fiction event to create a comic book with Future Health stories and an Innovation Think Tank Certification Program of a large medical technology company that is focused on identifying future health opportunities. We conducted before and after surveys and concluded that the proposed initiatives were impactful in developing an innovative design thinking approach. Participants' awareness and enthusiasm were raised, including their willingness to implement taught skills, values, and methods in their working projects. We conclude that a new curriculum based on HTID is essential and needed to move the needle of healthcare activities from treating sickness to maintaining health.

The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study

Background

Good nutrition affects children’s health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children’s eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones.

Objective

The aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices.

Methods

This population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project.

Results

This study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention.

Conclusions

The opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent.

International Registered Report Identifier (IRRID)

DERR1-10.2196/30899

The Sexual and Reproductive Health Burden Index: Development, Validity, and Community-Level Analyses of a Composite Spatial Measure

The Sexual and Reproductive Health Burden Index (SRHBI) was developed to provide a composite spatial measure of sexual and reproductive health (SRH) indicators that can be widely adopted by urban public health departments for the planning of SRH services. The index was constructed using eight indicators: teen births, low birthweight, infant mortality, new HIV diagnoses, people living with HIV, and incidences of gonorrhea, chlamydia, and syphilis. Chicago Department of Public Health data (2014-2017) were used to calculate index scores for Chicago community areas; scores were mapped to provide geovisualization and global Moran's I was calculated to assess spatial autocorrelation. Cronbach's alpha was calculated to assess internal reliability of the SRHBI. Pearson correlations were conducted to assess concurrent validity and correlation with community-level factors. Linear regression was conducted to assess community-level predictors of the SRHBI. Application of the SRHBI in Chicago demonstrates substantial variation in SRH burden across Chicago's urban landscape with significant spatial autocorrelation of scores (I = .580, p = .001). Internal reliability of the measure was excellent with α = .937. The SRHBI was significantly correlated with other indicators of SRH including rate of prenatal care initiation in the first trimester, rate of preterm births, reported sexual assault incidence, cervical cancer incidence, prostate cancer incidence, and rate of smoking during pregnancy. This suggests good concurrent validity of the measure. Linear regression revealed that the percent of Black residents, percent of household couples that are same-sex, community violence, economic hardship, and population density were significant predictors of the SRHBI. The SRHBI provides a valid, useful, and replicable measure to assess and communicate community-level SRH burden in urban environments. The SRHBI may be scaled through a multi-city public data dashboard and utilized by urban public health departments to optimally target and tailor SRH interventions to communities.

How to disseminate national recommendations for physical activity: a qualitative analysis of critical change agents in Germany

Background

Physical activity recommendations are reached by only a small part of the population. A common problem is that research findings on public health-related topics such as physical activity promotion are oftentimes not translated into practice. The involvement of relevant stakeholders, such as change agents (role models, decision-makers, and/or knowledge mediators), is a common strategy to implement physical activity recommendations in specific settings, as they have the necessary knowledge of contextual factors. However, dissemination and implementation of physical activity recommendations are often prevented by focusing exclusively on the health sector and by underestimating the individual perceptions and needs of change agents. Therefore, the purpose of this study was to address the problem of how physical activity recommendations can be translated into practice through comprehensive consideration of the situation and context of change agents from various sectors of society at different administrative levels. This allows for deriving recommendations for action on how a national dissemination strategy of physical activity recommendations should be designed.

Methods

Qualitative expert interviews were conducted with change agents from different sectors of society and administrative levels in Germany (N = 21). Case selection took place via a sampling plan. The interviews were recorded, transcribed verbatim, and analysed by two trained researchers using qualitative content analysis.

Results

The change agents’ perceived relevance of physical activity and physical activity promotion and their knowledge of physical activity recommendations varied across different sectors. Nine themes were identified covering the change agents’ needs for the implementation of physical activity recommendations: strengthening of political will and cooperation, availability of public space for physical activity, change in awareness and health education, professional qualification, financial incentives, development of physical activity-promoting programmes and structures, provision of resources, bridging the theory–practice gap, and knowledge of physical activity recommendations.

Conclusions

This exploratory study contributes to the development of an evidence-based dissemination strategy of physical activity recommendations involving change agents from various sectors. Cross-sectoral needs and obstacles were identified indicating gaps that have to be addressed. Future research should choose practice-oriented approaches to develop dissemination strategies that are adapted to the needs of local contexts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00729-7.

Expanding Implementation Research to Prevent Chronic Diseases in Community Settings

Chronic disease prevention continues to be inadequate, overall and in achieving health equity, in spite of the many evidence-based practices and policies (EBPPs) available to address risk behaviors such as unhealthful eating, lack of physical activity, and tobacco use. Although clinical settings are needed for EBPPs that involve medical procedures such as immunization or early detection, dissemination of EBPPs can be effective in a variety of settings such as schools and childcare centers, worksites, social service organizations, and religious organizations. More implementation research is needed to meet challenges of effective application of EBPPs in such community settings, in which primary missions, capacity, cultures, and values do not focus on health services delivery. To address health equity, consideration of social and economic contexts of people reached in these settings is essential. This review presents lessons learned from past studies to guide future implementation research and practice across diverse settings and geographies.

Engaging Community and Academic Partners to Explore Adolescent Emotional Well-Being

In an under-resourced area of the South Bay of Los Angeles, partnerships were formed between community advocates with extensive research experience, less experienced academic investigators, and an urban public high school without partnered research experience. This article outlines the process of developing these partnerships through a community-academic research conference addressing a priority area identified by the local community to define and understand the importance and relevance of adolescent emotional well-being. Teen participants from the high school identified support from the community as the most crucial ingredient for achieving adolescent emotional well-being.

Linking Data on Constituent Health with Elected Officials' Opinions: Associations Between Urban Health Disparities and Mayoral Officials' Beliefs About Health Disparities in Their Cities

Policy Points Mayoral officials' opinions about the existence and fairness of health disparities in their city are positively associated with the magnitude of income-based life expectancy disparity in their city. Associations between mayoral officials' opinions about health disparities in their city and the magnitude of life expectancy disparity in their city are not moderated by the social or fiscal ideology of mayoral officials or the ideology of their constituents. Highly visible and publicized information about mortality disparities, such as that related to COVID-19 disparities, has potential to elevate elected officials' perceptions of the severity of health disparities and influence their opinions about the issue.

CONTEXT

A substantive body of research has explored what factors influence elected officials' opinions about health issues. However, no studies have assessed the potential influence of the health of an elected official's constituents. We assessed whether the magnitude of income-based life expectancy disparity within a city was associated with the opinions of that city's mayoral official (i.e., mayor or deputy mayor) about health disparities in their city.

METHODS

The independent variable was the magnitude of income-based life expectancy disparity in US cities. The magnitude was determined by linking 2010-2015 estimates of life expectancy and median household income for 8,434 census tracts in 224 cities. The dependent variables were mayoral officials' opinions from a 2016 survey about the existence and fairness of health disparities in their city (n = 224, response rate 30.3%). Multivariable logistic regression was used to adjust for characteristics of mayoral officials (e.g., ideology) and city characteristics.

FINDINGS

In cities in the highest income-based life expectancy disparity quartile, 50.0% of mayoral officials "strongly agreed" that health disparities existed and 52.7% believed health disparities were "very unfair." In comparison, among mayoral officials in cities in the lowest disparity quartile 33.9% "strongly agreed" that health disparities existed and 22.2% believed the disparities were "very unfair." A 1-year-larger income-based life expectancy disparity in a city was associated with 25% higher odds that the city's mayoral official would "strongly agree" that health disparities existed (odds ratio [OR] = 1.25; P = .04) and twice the odds that the city's mayoral official would believe that such disparities were "very unfair" (OR = 2.24; P <.001).

CONCLUSIONS

Mayoral officials' opinions about health disparities in their jurisdictions are generally aligned with, and potentially influenced by, information about the magnitude of income-based life expectancy disparities among their constituents.

Big Data and Digital Solutions: Laying the Foundation for Cardiovascular Population Management CME

There are huge gaps in evidence-based cardiovascular care at the national, organizational, practice, and provider level that can be attributed to variation in provider attitudes, lack of incentives for positive change and care standardization, and observed uncertainty in clinical decision making. Big data analytics and digital application platforms-such as patient care dashboards, clinical decision support systems, mobile patient engagement applications, and key performance indicators-offer unique opportunities for value-based healthcare delivery and efficient cardiovascular population management. Successful implementation of big data solutions must include a multidisciplinary approach, including investment in big data platforms, harnessing technology to create novel digital applications, developing digital solutions that can inform the actions of clinical and policy decision makers and relevant stakeholders, and optimizing engagement strategies with the public and information-empowered patients.

Comparison of All-Cause Mortality Rates and Inequities Between Black and White Populations Across the 30 Most Populous US Cities

IMPORTANCE

To address elevated mortality rates and historically entrenched racial inequities in mortality rates, the United States needs targeted efforts at all levels of government. However, few or no all-cause mortality data are available at the local level to motivate and guide city-level actions for health equity within the country's biggest cities.

OBJECTIVES

To provide city-level data on all-cause mortality rates and racial inequities within cities and to determine whether these measures changed during the past decade.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used mortality data from the National Vital Statistics System and American Community Survey population estimates to calculate city-level mortality rates for the non-Hispanic Black (Black) population, non-Hispanic White (White) population, and total population from January 2016 to December 2018. Changes from January 2009 to December 2018 were examined with joinpoint regression. Data were analyzed for the United States and the 30 most populous US cities. Data analysis was conducted from February to November 2020.

EXPOSURE

City of residence.

MAIN OUTCOMES AND MEASURES

Total population and race-specific age-standardized mortality rates using 3-year averages, mortality rate ratios between Black and White populations, excess Black deaths, and annual average percentage change in mortality rates and rate ratios.

RESULTS

The study included 26 295 827 death records. In 2016 to 2018, all-cause mortality rates ranged from 537 per 100 000 population in San Francisco to 1342 per 100 000 in Las Vegas compared with the overall US rate of 759 per 100 000. The all-cause mortality rate among Black populations was 24% higher than among White populations nationally (rate ratio, 1.236; 95% CI, 1.233 to 1.238), resulting in 74 402 excess Black deaths annually. At the city level, this ranged from 6 excess Black deaths in El Paso to 3804 excess Black deaths every year in Chicago. The US rate remained constant during the study period (average annual percentage change, -0.10%; 95% CI, -0.34% to 0.14%; P = .42). The racial inequities in rates for the US decreased between 2008 and 2019 (annual average percentage change, -0.51%; 95% CI, -0.92% to -0.09%; P =0.02). Only 14 of 30 cities (46.7%) experienced improvements in overall mortality rates during the past decade. Racial inequities increased in more cities (6 [20.0%]) than in which it decreased (2 [6.7%]).

CONCLUSIONS AND RELEVANCE

In this study, mortality rates and inequities between Black and White populations varied substantially among the largest US cities. City leaders and other health advocates can use these types of local data on the burden of death and health inequities in their jurisdictions to increase awareness and advocacy related to racial health inequities, to guide the allocation of local resources, to monitor trends over time, and to highlight effective population health strategies.

Engaging with the Richmond Community to Reduce Pediatric Asthma Disparities: Findings from a Community-engaged Needs Assessment

Childhood asthma disparities persist, with children living in low-income areas experiencing worse morbidity. We partnered with a community-academic research team and stakeholders to conduct a needs assessment to understand barriers and supports to asthma treatment. We convened a community advisory board, comprised of parents of children with asthma, youth with asthma, and members of key community organizations. Two focus groups with parents of children with asthma and four focus groups with youth with asthma were conducted, and a survey was administered to 100 parents. A visual mapping process was used to gather qualitative data about barriers, strategies, and outcomes, and allowed advisory board members to interpret focus group and survey data within the lived experiences of families. Focus group themes included parent stress/anxiety, concerns about school nurses, and lack of trust in providers. Findings from focus groups and surveys suggested that emergency department visits were not perceived negatively by families, although health providers and researchers generally view them as such. Public health implications include systemic changes that allow the healthcare system to address families' acute needs and worry. A community program focused on education and coordination among families, schools, and medical homes might improve asthma outcomes at the population level.

The use of an impact framework to evaluate the impact of research on policy and practice: Screening questionnaires for intellectual disability

There is an increasing emphasis on the importance of research having an impact on policy and practice. This can be more difficult to evidence in intellectual disability services because of the wide range of stakeholders involved. We evaluated whether an impact questionnaire covering: knowledge production, capacity building, informing policy and practice, social and economic benefits could successfully be used to evaluate the impact of research into and use of two screening questionnaires: the Learning Disability Screening Questionnaire (LDSQ) and Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q). We conducted an online search for published peer reviewed and grey literature, and Internet resources that referenced LDSQ and/or CAIDS-Q. The resultant literature and resources were assessed for relevance and organized according to the categories outlined in the impact questionnaire. Evidence was found for all the areas of impact, with the largest body of evidence being in relation to informing policy and practice and social benefits and the least for economic benefits. The impact questionnaire provided the basis for a comprehensive and useful evaluative framework to assess impact, although there was some overlap between the different categories. The process of using it highlighted some wider issues to consider when attempting to evaluate impact. The results indicated that the research underpinning the LDSQ and CAIDS-Q had resulted in significant, generally positive, and wide-reaching impact on policy and practice in intellectual disability and other services, resulting in a number of positive outcomes.

Diversity and Political Leaning: Considerations for Epidemiology

The positive effects of increased diversity and inclusion in scientific research and practice are well documented. In this issue, DeVilbiss et al. (Am J Epidemiol. 2020;189(10):998-1010) present findings from a survey used to collect information to characterize diversity among epidemiologists and perceptions of inclusion in the epidemiologic profession. They capture identity across a range of personal characteristics, including race, gender, socioeconomic background, sexual orientation, religion, and political leaning. In this commentary, we assert that the inclusion of political leaning as an axis of identity alongside the others undermines the larger project of promoting diversity and inclusion in the profession and is symptomatic of the movement for "ideological diversity" in higher education. We identify why political leaning is not an appropriate metric of diversity and detail why prioritizing ideological diversity counterintuitively can work against equity building initiatives. As an alternative to ideological diversity, we propose that epidemiologists take up an existing framework for research and practice that centers the voices and perspectives of historically marginalized populations in epidemiologic work.

Translating research evidence into clinical practice: a reminder of important clinical lessons in management of resistant hypertension through a case study in general practice

A case of a 59-year-old man with resistant hypertension, despite 8 months of non-pharmacological and pharmacological management up to maximal doses of triple antihypertensive therapy. Review of the literature found a study that reported improved blood pressure control with bedtime dosing of antihypertensive treatment. Changing to bedtime dosage of antihypertensives resulted in significant improvement in blood pressure control to below target levels. This highlights the importance of the clinicians' awareness and implementation of research findings and hence delivery of best evidence-based care.

A review and synthesis of frameworks for engagement in health research to identify concepts of knowledge user engagement

BACKGROUND

Engaging those who influence, administer and/or who are active users ("knowledge users") of health care systems, as co-producers of health research, can help to ensure that research products will better address real world needs. Our aim was to identify and review frameworks of knowledge user engagement in health research in a systematic manner, and to describe the concepts comprising these frameworks.

METHODS

An international team sharing a common interest in knowledge user engagement in health research used a consensus-building process to: 1) agree upon criteria to identify articles, 2) screen articles to identify existing frameworks, 3) extract, analyze data, and 4) synthesize and report the concepts of knowledge user engagement described in health research frameworks. We utilized the Patient Centered Outcomes Research Institute Engagement in Health Research Literature Explorer (PCORI Explorer) as a source of articles related to engagement in health research. The search includes articles from May 1995 to December 2017.

RESULTS

We identified 54 articles about frameworks for knowledge user engagement in health research and report on 15 concepts. The average number of concepts reported in the 54 articles is n = 7, and ranges from n = 1 to n = 13 concepts. The most commonly reported concepts are: knowledge user - prepare, support (n = 44), relational process (n = 39), research agenda (n = 38). The least commonly reported concepts are: methodology (n = 8), methods (n = 10) and analysis (n = 18). In a comparison of articles that report how research was done (n = 26) versus how research should be done (n = 28), articles about how research was done report concepts more often and have a higher average number of concepts (n = 8 of 15) in comparison to articles about how research should be done (n = 6 of 15). The exception is the concept "evaluate" and that is more often reported in articles that describe how research should be done.

CONCLUSIONS

We propose that research teams 1) consider engagement with the 15 concepts as fluid, and 2) consider a form of partnered negotiation that takes place through all phases of research to identify and use concepts appropriate to their team needs. There is a need for further work to understand concepts for knowledge user engagement.

Digital Segmentation of Priority Populations in Public Health

The rapid growth and diffusion of digital media technologies has changed the landscape of market segmentation in the last two decades, including its use in promoting prosocial and behavior change. New, population-specific and culturally appropriate prevention strategies can leverage the potential of digital media to influence health outcomes, especially for the greatest users of digital technology, including youth and young adults. Health behavior change campaigns are increasingly shifting resources to social media, creating opportunities for innovative interventions and new research methods. This article examines three case studies of digital segmentation: (1) tobacco control from the Truth Initiative, (2) community-based public health programs from the Centers for Disease Control and Prevention, and (3) substance use (including opioids) and other risk behavior prevention from Public Good Projects. These case studies of recent digital segmentation efforts in the not-for-profit, government, and academic sectors show that it increases reach and frequency of messages delivered to priority populations. The practice of digital segmentation is rapidly growing, shows early signs of effectiveness, and may enhance future public health campaigns. Additional research could optimize its use and effectiveness in promoting prosocial and behavior change campaign outcomes.

Co-Creation of Knowledge: A Community-Based Approach to Multilevel Dissemination of Health Information

Background. Conventionally, public health researchers disseminate their work to peers via academic journals and conferences, with little emphasis on sharing results across sectors or with community members. To improve translation of health research into practice, it is essential to use a broader "solutions-focused" approach that includes strategic dissemination of findings. Methods. An urban research institute in Chicago, IL, leveraged knowledge transfer and community engagement principles to disseminate the results of a large, community-driven population health survey to a diverse set of stakeholders. We designed dissemination activities that (1) co-created knowledge by, for, and with communities; (2) shared survey results widely; and (3) minimized barriers to accessing and using public health data. Results. We tailored dissemination to specific audiences, including community residents, public health practitioners, and academic partners. We communicated key messages via various mechanisms, such as community forums, health profiles and videos, and a media event. Conclusions. With dedicated planning, staff, and funding, it is feasible for public health researchers to disseminate findings to diverse audiences using a community-engaged approach. To improve the capacity of public health practitioners in this critical skill, more examples of community-focused dissemination activities are warranted.

Co-design of a patient experience survey for arthritis central intake: an example of meaningful patient engagement in healthcare design

BACKGROUND

To describe the process of patient engagement to co-design a patient experience survey for people with arthritis referred to central intake.

METHODS

We used a participatory design to engage with patients to co-design a patient experience survey that comprised three connected phases: 1) Identifying the needs of patients with arthritis, 2) Developing a set of key performance indicators, and 3) Determining the survey items for the patient experience survey.

RESULTS

Patient recommendations for high quality healthcare care means support to manage arthritis, to live a meaningful life by providing the right knowledge, professional support, and professional relationship. The concept of integrated care was a core requirement from the patients' perspective for the delivery of high quality arthritis care. Patients experience with care was ranked in the top 10 of 28 Key Performance Indicators for the evaluation of central intake, with 95% of stakeholders rating it as 9/10 for importance. A stakeholder team, including Patient and Community Engagement Researchers (PaCER), mapped and rated 41 survey items from four validated surveys. The final patient experience survey had 23 items.

CONCLUSION

The process of patient engagement to co-design a patient experience survey, for people with arthritis, identified aspects of care that had not been previously recognized. The linear organization of frameworks used to report patient engagement in research does not always capture the complexity of reality. Additional resources of cost, time and expertise for patient engagement in co-design activity are recognized and should be included, where possible, to ensure high quality data is captured.

Public Health Entrepreneurship: A Novel Path for Training Future Public Health Professionals

Background: As schools of public health adapt to the new Council on Public Health (CEPH) competencies there is increased relevance in training public health professionals in public health entrepreneurship. Public health entrepreneurship provides an alternate process to traditional academic approaches focusing on translating public health knowledge into effective, sustainable, and scalable solutions. Objective: This study reports student perceptions of public health entrepreneurship and training needs for successfully equipping future public health professionals. Methods: Focus groups were conducted in April 2018 with graduate public health students in pilot entrepreneurship courses at two U.S.-based CEPH-accredited schools of public health. Results: Participating students (n = 29) were mainly pursing MPH degrees (62%) within Health Management and Policy (38%) or Health Promotion/Global Health (31%) departments. Most students (52%) were between 21 and 30 years old. For 71% of students this was their first academic course with a focus on entrepreneurial thinking. Four themes emerged regarding public health entrepreneurship and training needs for becoming a successful public health professional of the future. Students confirmed a place for public health entrepreneurship in the emerging educational paradigm because it is action-oriented, skills-driven, and fosters innovation through inter-professional collaboration and cross-pollination of knowledge and skills between professional disciplines. Conclusions: The competencies required for public health entrepreneurship are in alignment with CEPH competencies and are well-received by the next generation of public health professionals as an adjunct but nascent approach to stimulate public health innovation.

Utilizing public health core competencies to share data effectively with community organizations to promote health equity

OBJECTIVES

This article utilizes an adapted model for research transfer to highlight the important role of Local Public Health Agencies (LPHAs) to share data more effectively with local community organizations to advance health equity.

METHODS

A literature review related to public health data sharing with local community partners was conducted using Medline, Embase, and CINAHL databases and grey literature sources with 12 articles included for analysis. Six LPHAs distributed an online survey to 405 local community organizations to define their current data uses and needs. Survey and literature review findings informed a one-day deliberative dialogue event with 19 participants who brought multiple perspectives together on the barriers and potential solutions for data sharing.

RESULTS

Results are discussed utilizing the three stages of data sharing: awareness, communication, and collaboration. Awareness of the barriers and needs of community partners related to data, and the public health core competency of assessment and analysis is the first stage. More effective is the second stage, where LPHAs proactively communicate to understand and meet the needs of community partners. Data sharing is the most effective when LPHAs use the third stage of collaboration to work with community partners to mutually benefit from data sharing.

CONCLUSION

When LPHAs utilize their core competencies of assessment and analysis, communication, and collaboration to share data with community partners, they are able to share data more effectively. This allows community partners to modify programs to better serve priority populations and improve population health.

Decision makers' experience of participatory dynamic simulation modelling: methods for public health policy

BACKGROUND

Systems science methods such as dynamic simulation modelling are well suited to address questions about public health policy as they consider the complexity, context and dynamic nature of system-wide behaviours. Advances in technology have led to increased accessibility and interest in systems methods to address complex health policy issues. However, the involvement of policy decision makers in health-related simulation model development has been lacking. Where end-users have been included, there has been limited examination of their experience of the participatory modelling process and their views about the utility of the findings. This paper reports the experience of end-user decision makers, including senior public health policy makers and health service providers, who participated in three participatory simulation modelling for health policy case studies (alcohol related harm, childhood obesity prevention, diabetes in pregnancy), and their perceptions of the value and efficacy of this method in an applied health sector context.

METHODS

Semi-structured interviews were conducted with end-user participants from three participatory simulation modelling case studies in Australian real-world policy settings. Interviewees were employees of government agencies with jurisdiction over policy and program decisions and were purposively selected to include perspectives at different stages of model development.

RESULTS

The 'co-production' aspect of the participatory approach was highly valued. It was reported as an essential component of building understanding of the modelling process, and thus trust in the model and its outputs as a decision-support tool. The unique benefits of simulation modelling included its capacity to explore interactions of risk factors and combined interventions, and the impact of scaling up interventions. Participants also valued simulating new interventions prior to implementation in the real world, and the comprehensive mapping of evidence and its gaps to prioritise future research. The participatory aspect of simulation modelling was time and resource intensive and therefore most suited to high priority complex topics with contested options for intervening.

CONCLUSION

These findings highlight the value of a participatory approach to dynamic simulation modelling to support its utility in applied health policy settings.

Examining the readiness of best evidence in medical education guides for integration into educational practice: A meta-synthesis

BACKGROUND

To support evidence-informed education, health professions education (HPE) stakeholders encourage the creation and use of knowledge syntheses or reviews. However, it is unclear if these knowledge syntheses are ready for translation into educational practice. Without understanding the readiness, defined by three criteria-quality, accessibility and relevance-we risk translating weak evidence into practice and/or providing information that is not useful to educators.

METHODS

A librarian searched Web of Science for knowledge syntheses, specifically Best Evidence in Medical Education (BEME) Guides. This meta-synthesis focuses on BEME Guides because of their explicit goal to inform educational practice and policy. Two authors extracted data from all Guides, guided by the 25-item STructured apprOach to the Reporting In healthcare education of Evidence Synthesis (STORIES).

RESULTS

Forty-two Guides published in Medical Teacher between 1999 and 2017 were analyzed. No Guide met all STORIES criteria, but all included structured summaries and most described their literature search (n = 39) and study inclusion/exclusion (n = 40) procedures. Eleven Guides reported the presence of theory and/or educational principles, and eight consulted with external subject matter experts. Accessibility to each Guide's full-text and supplemental materials was variable.

DISCUSSION

For a subset of HPE knowledge syntheses, BEME Guides, this meta-synthesis identifies factors that support readiness and indicates potential areas of improvement, such as consistent access to Guides and inclusion of external subject matter experts on the review team. This analysis is useful for understanding the current readiness of HPE knowledge syntheses and informing future reviews to evolve so they can catalyze translation of evidence into educational practice.

Integrated knowledge translation in population health intervention research: a case study of implementation and outcomes from a school-based project

BACKGROUND

Integrated knowledge translation (IKT) is encouraged in population health intervention research (PHIR) to ensure the co-production of policy-relevant research, yet there is little published literature that reports its implementation and outcomes. The purpose of this study was to describe and evaluate the IKT approach used in a school-based PHIR project to understand how the research informed policy and practice and identify what influenced the IKT process.

METHODS

A case study approach was used to provide an in-depth description of the IKT process and understand the co-production and application of research evidence. Data were collected through document review, a survey with all elementary school principals in the school board (n = 18) following dissemination of School Reports and interviews with the IKT research team (including two researchers and three knowledge users).

RESULTS

Approximately half of the principals reported reading their School Report (52%) and almost all of these principals attributed the partial or full adoption, or implementation, of a new practice as a result of using the information (89%). Key themes related to the IKT process emerged across the interviews, including supportive relationships, role clarity, competing priorities and the complexities of population health interventions.

CONCLUSIONS

The findings suggest that, while IKT can support policy and practice, it can be challenging to maintain engagement due to differing priorities and role ambiguity. Additional recognition, investment and research would enable better implementation of the approach, thereby bridging the gap between research, policy and practice.

Overcoming challenges to dissemination and implementation of research findings in under-resourced countries

Louis Pasteur once commented on the happiness that a scientist finds when, besides making a discovery, study results find practical application. Where health status is poor and resources are limited, finding such applications is a necessity, not merely a joy.

Dissemination, or the distribution of new knowledge gained through research, is essential to the ethical conduct of research. Further, when research is designed to improve health, dissemination is critical to the development of evidence-based medicine and the adoption of evidence-supported interventions and improved practice patterns within specific settings. When dissemination is lacking, research may be considered a waste of resources and a useless pursuit unable to influence positive health outcomes.

Effective translation of the findings of health research into policy and the practice of medicine has been slow in many countries considered low or lower middle-income (as defined by the World Bank). This is because such countries often have health care systems that are under-resourced (e.g., lacking personnel or facilities) and thus insufficiently responsive to health needs of their populations. However, implementation research has produced many tools and strategies that can prompt more effective and timelier application of research findings to real world situations.

A conscientious researcher can find many suggestions for improving the integration of research evidence into practice. First and foremost, the truthful reporting of results is emphasized as essential because both studies with desirable findings as well those with less than ideal results can provide new and valuable knowledge. Consideration in advance of the audience likely to be interested in study findings can result in suitable packaging and targeted communication of results. Other strategies for avoiding the barriers that can negatively impact implementation of research evidence include the early involvement of stakeholders as research is being designed and discussion before initiation of proposed research with those who will be affected by it. It is also important to recognize the role of education and training for ensuring the skills and knowledge needed for not only the conduct of high quality research but also for the meaningful promotion of results and application of research findings to achieve intended purposes.

Using the Healthy Community Assessment Tool: Applicability and Adaptation in the Midwest of Western Australia

Population-based studies have associated poor living conditions with the persistent disparity in the health of Aboriginal and non-Aboriginal Australians. This project assesses the applicability of the Health Community Assessment Tool and its role in improving the environment of a small community in the Midwest of Western Australia (WA). The action research cycles started with the initial reflection on the suitability of the HCAT version 2 for the local community context and whether it was fit-for-purpose. The researcher provided ‘critical companionship’, while the participants of the study were invited to be co-researchers (the Assessors) who critically examined the HCAT and assess the community. The relevant domains to the serviced town (an outer regional community) were pest control and animal management; healthy housing; food supply; community vibrancy, pride and safety; reducing environmental tobacco smoke; and promoting physical activity. The Assessors found the HCAT descriptors mostly aligned with their community context but found some of the items difficult to apply. Based on participant’s suggestions, some of the original scoring scales were reformatted. School attendance and illicit drug use were identified as a key outcome indicator for youth but were missing from the HCAT. The HCAT domains applied helped streamlining core business of agencies in the local community. The face validity of HCAT items were confirmed in this research with minor adjustments to reflect local context. Youth engagement to education is of high community concern and the development of an item would create similar interagency collaborative dialogues.

Have we increased our efforts to identify strategies which encourage colorectal cancer screening in primary care patients? A review of research outputs over time

Globally, colorectal cancer (CRC) screening rates remain suboptimal. Primary care practitioners are supported by clinical practice guidelines which recommend they provide routine CRC screening advice. Published research can provide evidence to improve CRC screening in primary care, however this is dependent on the type and quality of evidence being produced. This review aimed to provide a snapshot of trends in the type and design quality of research reporting CRC screening among primary care patients across three time points: 1993-1995, 2003-2005 and 2013-2015. Four databases were searched using MeSH headings and keywords. Publications in peer-reviewed journals which reported primary data on CRC screening uptake among primary care patients were eligible for inclusion. Studies meeting eligibility criteria were coded as observational or intervention. Intervention studies were further coded to indicate whether or not they met Effective Practice and Organisation of Care (EPOC) study design criteria. A total of 102 publications were included. Of these, 65 reported intervention studies and 37 reported observational studies. The proportion of each study type did not change significantly over time. The majority of intervention studies met EPOC design criteria at each time point. The majority of research in this field has focused on testing strategies to increase CRC screening in primary care patients, as compared to research describing rates of CRC screening in this population. Further research is needed to determine which effective interventions are most likely to be adopted into primary care.

Racial/Ethnic Variation in the Impact of the Affordable Care Act on Insurance Coverage and Access Among Young Adults

OBJECTIVES

To examine the impact of the Affordable Care Act's (ACA's) 2010 parental insurance coverage extension to young adults aged 19 to 25 years on health insurance coverage and access to care, including racial/ethnic disparities.

METHODS

We pooled data from the Behavioral Risk Factor Surveillance System for the periods 2007 to 2009 and 2011 to 2013 (n = 402 777). We constructed quasiexperimental difference-in-differences models in which adults aged 26 to 35 years served as a control group. Multivariable statistical models controlled for covariates guided by the Andersen model for health care utilization.

RESULTS

On average, insurance rates among young adults increased 6.12 percentage points after ACA implementation (P < .001). All racial/ethnic groups experienced increases in coverage. However, the impact varied by race/ethnicity and was largest for Whites. Young adults had a 2.61 percentage point (P < .001) decrease in experiencing barriers to health care because of cost issues after the ACA, with variation by race/ethnicity.

CONCLUSIONS

The ACA's expansion had a significant positive effect for young adults acquiring health insurance and reducing cost-related barriers to accessing health care. However, racial/ethnic disparities in coverage and access persist. Public Health Implications. Policies not dependent on parental insurance could further increase access and reduce disparities.

US Mayors' and Health Commissioners' Opinions About Health Disparities in Their Cities

OBJECTIVES

To characterize US mayors' and health commissioners' opinions about health disparities in their cities and identify factors associated with these opinions.

METHODS

We conducted a multimodal survey of mayors and health commissioners in fall-winter 2016 (n = 535; response rate = 45.2%). We conducted bivariate analyses and multivariable logistic regression.

RESULTS

Forty-two percent of mayors and 61.1% of health commissioners strongly agreed that health disparities existed in their cities. Thirty percent of mayors and 8.0% of health commissioners believed that city policies could have little or no impact on disparities. Liberal respondents were more likely than were conservative respondents to strongly agree that disparities existed (mayors: odds ratio [OR] = 7.37; 95% confidence interval [CI] = 3.22, 16.84; health commissioners: OR = 5.09; 95% CI = 3.07, 8.46). In regression models, beliefs that disparities existed, were avoidable, and were unfair were independently associated with the belief that city policies could have a major impact on disparities.

CONCLUSIONS

Many mayors, and some health commissioners, are unaware of the potential of city policies to reduce health disparities. Ideology is strongly associated with opinions about disparities among these city policymakers. Public Health Implications: Information about health disparities, and policy strategies to reduce them, needs to be more effectively communicated to city policymakers.

Preferences and interests of diabetes social media users regarding a health-promotion intervention

BACKGROUND

Nowadays, rapid and accessible participatory research on diabetes can be carried out using social media platforms. The objective of this study was to identify preferences and interests of diabetic social media users regarding a health-promotion intervention targeting them.

METHODS

Social media followers of the Norwegian Diabetes Association were invited to participate in the creation of a health-promotion intervention on diabetes by expressing their opinions through an online questionnaire posted on Facebook, Twitter, and Instagram. The questionnaire asked participants about their demographics and preferences regarding type of health content: format, frequency, and channels to deliver content. Questions regarding the perceived quality of diabetes-related information and satisfaction with content on social media were also included.

RESULTS

The questionnaire was answered by 346 participants: 332 (96%) of those were reached via Facebook, 66.5% of respondents (n=230) identified themselves as women, 54% (n=187) as individuals diagnosed with type 1 diabetes, and 71% (n=235) were aged 30-64 years. The preferred type of content was "research and innovation on diabetes", selected by 78.0% of the respondents. "Text format" was the choice for 93.4%, and 97.3% would prefer to find health-promotion content on Facebook. There was heterogeneity in the desired frequency of this content. In a scale ranging from 0 to 100, the perceived quality of diabetes-related information on social media was 62.0±1.2 and satisfaction with such content 61.9±1.3.

CONCLUSION

The approach used in this study was successful in reaching and involving participants quickly, and could also potentially increase diabetes patients' engagement and satisfaction with health-promotion interventions, enhance their sense of community, and thus help people attain healthier lifestyles. It is a limitation that our sample might not have been fully representative, as the most interested social media users might have chosen to participate.

Who votes for public health? U.S. senator characteristics associated with voting in concordance with public health policy recommendations (1998-2013)

BACKGROUND

The voting behaviors of elected officials shape the public's health. Little is known, however, about the characteristics of elected officials who vote in concordance with public health policy recommendations. This article presents the results of study conducted with the aims of: 1) testing the hypothesis that US Democrat Senators vote in concordance with American Public Health Association (APHA) policy recommendations more frequently than US Republican Senators, 2) identifying US Senator characteristics independently associated with voting in concordance with APHA, and 3) assessing trends in APHA voting concordance by political party.

METHODS

We created a legislative dataset of 1434 votes cast on 111 legislative proposals by 184 US Senators during the years 1998 through 2013. Mixed effects linear regression models were used to estimate the independent contributions of political party, gender, geographic region, and year effects to annual APHA voting concordance. Votes were nested within Senators who were nested within States to account for non-independence and models considered potential for time and spatial patterns in the data.

RESULTS

Adjusting for covariates and accounting for serial and spatial autocorrelation, Democrats averaged 59.1 percentage points higher in annual APHA voting concordance than Republicans (95% CI: 55.5, 62.7), females averaged 7.1 percentage points higher than males (95% CI: 1.9, 12.3), and Northeastern Senators averaged 16.1 percentage points higher than Southern Senators (95% CI: 9.1, 23.1).

CONCLUSIONS

Elected official's political party affiliation, gender, and geographic region are independently associated with public health voting decisions and should be considered when targeting and tailoring science-based policy dissemination strategies.

Knowledge mobilisation for policy development: implementing systems approaches through participatory dynamic simulation modelling

BACKGROUND

Evidence-based decision-making is an important foundation for health policy and service planning decisions, yet there remain challenges in ensuring that the many forms of available evidence are considered when decisions are being made. Mobilising knowledge for policy and practice is an emergent process, and one that is highly relational, often messy and profoundly context dependent. Systems approaches, such as dynamic simulation modelling can be used to examine both complex health issues and the context in which they are embedded, and to develop decision support tools.

OBJECTIVE

This paper reports on the novel use of participatory simulation modelling as a knowledge mobilisation tool in Australian real-world policy settings. We describe how this approach combined systems science methodology and some of the core elements of knowledge mobilisation best practice. We describe the strategies adopted in three case studies to address both technical and socio-political issues, and compile the experiential lessons derived. Finally, we consider the implications of these knowledge mobilisation case studies and provide evidence for the feasibility of this approach in policy development settings.

CONCLUSION

Participatory dynamic simulation modelling builds on contemporary knowledge mobilisation approaches for health stakeholders to collaborate and explore policy and health service scenarios for priority public health topics. The participatory methods place the decision-maker at the centre of the process and embed deliberative methods and co-production of knowledge. The simulation models function as health policy and programme dynamic decision support tools that integrate diverse forms of evidence, including research evidence, expert knowledge and localised contextual information. Further research is underway to determine the impact of these methods on health service decision-making.

Active involved community partnerships: co-creating implementation infrastructure for getting to and sustaining social impact

Active involved community partnerships (AICPs) are essential to co-create implementation infrastructure and translate evidence into real-world practice. Across varied forms, AICPs cultivate community and tribal members as agents of change, blending research and organizational knowledge with relationships, context, culture, and local wisdom. Unlike selective engagement, AICPs enable active involvement of partners in the ongoing process of implementation and sustainability. This includes defining the problem, developing solutions, detecting practice changes, aligning organizational supports, and nurturing shared responsibility, accountability, and ownership for implementation. This paper builds on previously established active implementation and scaling functions by outlining key AICP functions to close the research-practice gap. Part of a federal initiative, California Partners for Permanency (CAPP) integrated AICP functions for implementation and system change to reduce disproportionality and disparities in long-term foster care. This paper outlines their experience defining and embedding five AICP functions: (1) relationship-building; (2) addressing system barriers; (3) establishing culturally relevant supports and services; (4) meaningful involvement in implementation; and (5) ongoing communication and feedback for continuous improvement. Planning for social impact requires the integration of AICP with other active implementation and scaling functions. Through concrete examples, authors bring multilevel AICP roles to life and discuss implications for implementation research and practice.