Public Health Practice Settings Research Articles

Strategies for Preparing Future Public Health Leaders: Learning from Trailblazing Women in Health Education

Many female health education pioneers made seminal contributions to public health and social justice, yet these examples are not well documented in textbooks or integrated into public health curricula as pedagogical learning opportunities. Providing biographies and lessons learned from the past leaders within undergraduate health education curricula can help develop students’ skills as future leaders and address gender inequities in the field. Gender inequities in higher education as well as many public health practice settings result in lower salaries, slower career advancement opportunities, fewer supervisory positions, increased work-life conflicts, and heavier workloads. Developing women’s competencies in leadership and professionalism early in their careers is critical to meeting public health challenges such as COVID-19. We present four female health education trailblazers from different historical eras and various workforce sectors who exemplify leadership attributes (i.e., courage/risk taking, vision, advocacy, mentorship) and can be highlighted as a part of future health education curriculum. Innovative methods and approaches are provided for integrating these leadership lessons into undergraduate public health courses, in alignment with the HESPA II 2020 competencies. Learning from the past to inform the future is critical to inspiring and shaping the careers of emerging health educators.

Perceived benefits, challenges, and recommendations for HIV research dissemination and implementation science efforts in Tanzania: Findings from the HIV/AIDS Research Forum brainstorming session.

Although several international and national HIV/AIDS conferences exist, there was not a national conference in Tanzania focusing on HIV/AIDS disseminating and implementation research conducted in the country and abroad. This created a missed opportunity for researchers to share their research findings with local policymakers and HIV program implementers who can influence the adoption and implementation of promising research in public health and clinical practice settings. In response, the first HIV/AIDS D&I Research Forum designed to enhance local D&I efforts for HIV research, was organized in Tanzania in 2018. This paper explores the perceived benefits of the HIV/AIDS D&I Research Forum and potential challenges of developing similar forums and recommendation for future HIV research D&I conference in Tanzania. During the second day of the Forum, which was held in September 2018 in Morogoro, Tanzania, a 1-hour structured brainstorming session was conducted with the Forum attendees (n = 50), including researchers, medical professionals, policymakers, representatives from different ministries. Transcription of the brainstorming session was analyzed to identify benefits of the Forum, perceived challenges for organizing similar HIV/AIDS research dissemination events, and recommendations for addressing the challenges. Overall, participants perceived the forum to be beneficial because it provided opportunities for strategic collaborations between researchers, policymakers, and other stakeholders and for them to discuss challenges for D&I efforts. Forum attendees also identified several potential challenges for future D&I research forums such as the abstract requirement which may deter non-researchers, costs, meeting frequencies, and lack of funding and coordination between organizations involved in D&I research efforts. To address these concerns, a recommendation was made to host a biennial national conference in order to allow more time for ethical review and feedback that can enhance contribution of the project to D&I efforts and to raise funds. The benefits identified for the Forum highlight the importance of organizing similar D&I meetings for HIV-related research at the national level in Tanzania. However, the potential challenges discussed need to be addressed in order to develop a sustainable national D&I research conference by incorporating recommendations that forum attendees proposed.

Expanding Opportunities for Data Dissemination Through Collaborative Writing Teams in Public Health Practice Settings

Government health departments at all levels make meaningful contributions to advancing the public health of communities, yet state health departments lack the time and infrastructure to share their findings with the broader scientific community. To address this gap in data dissemination, the South Carolina Department of Health and Environmental Control developed a "collaborative writing team" (CWT) pilot. As part of this pilot program, teams of staff members leveraged existing data to advance the public health knowledge base, with an emphasis on public health practice. The six steps of the CWT included (1) identify team members' skills/strengths, (2) discuss available data, (3) determine opportunities to share data, (4) divide responsibilities based on team members' strengths, (5) write and submit product, and (6) debrief. Between December 2019 and November 2020, the team had six abstracts accepted to two national conferences, one abstract accepted to a state public health conference, and one editorial published in a peer-reviewed journal. Feedback from participants indicated that self-efficacy in areas including writing, project facilitation, and analysis had increased among team. CWTs are a framework for people working within public health practice settings to disseminate findings.

Strengthening collaborations at the public health system-academic interface: a call to action.

In Canada and globally, the COVID-19 pandemic has highlighted the importance of reliable and responsive public health systems. The pandemic has required decisive leadership and collaboration across all sectors of society informed by the best available evidence. In this commentary, we argue that in order to create a robust public health system equipped to address current and future public health challenges, we must prioritize and invest in stronger relationships between public health practice and academia. We briefly review key recommendations following the SARS outbreak, particularly those calling for stronger linkages between public health academia and practice settings in Canada. We then propose key actions for strengthening these linkages. Echoing other COVID-19-related calls, which request long-term reinvestment in public health education and training, we recommend the following actions: (1) Improve collaboration between education programs and public health agencies to address system needs (e.g., surge capacity) and persisting health inequities; (2) Fund a pan-Canadian public health training initiative that builds on a renewed set of public health competencies to address priority training needs (e.g., equity-oriented leadership); and (3) Prepare a cadre of certified public health leaders who can progress along public health career pathways, including those already in practice.

The Impact of Law on Syndromic Disease Surveillance Implementation.

Legal environments influence how health information technologies are implemented in public health practice settings. Syndromic disease surveillance (SyS) is a relatively new approach to surveillance that depends heavily on health information technologies to achieve rapid awareness of disease trends. Evidence suggests that legal concerns have impeded the optimization of SyS. To (1) understand the legal environments in which SyS is implemented, (2) determine the perceived legal basis for SyS, and (3) identify perceived legal barriers and facilitators to SyS implementation. Multisite case study in which 35 key informant interviews and 5 focus groups were conducted with 75 SyS stakeholders. Interviews and focus groups were audio recorded, transcribed, and analyzed by 3 coders using thematic content analysis. Legal documents were reviewed. Seven jurisdictions (5 states, 1 county, and 1 city) that were purposively selected on the basis of SyS capacity and legal environment. Health department directors, SyS system administrators, legal counsel, and hospital personnel. Federal (eg, HIPAA) and state (eg, notifiable disease reporting) laws that authorize traditional public health surveillance were perceived as providing a legal basis for SyS. Financial incentives for hospitals to satisfy Meaningful Use regulations have eased concerns about the legality of SyS and increased the number of hospitals reporting SyS data. Legal issues were perceived as barriers to BioSense 2.0 (the federal SyS program) participation but were surmountable. Major legal reforms are not needed to promote more widespread use of SyS. The current legal environment is perceived by health department and hospital officials as providing a firm basis for SyS practice. This is a shift from how law was perceived when SyS adoption began and has policy implications because it indicates that major legal reforms are not needed to promote more widespread use of the technology. Beyond SyS, our study suggests that federal monetary incentives can ameliorate legal concerns regarding novel health information technologies.

Photo-Texting, a Self-Assessment Technique for the Home Food Environment

This paper explores a methodology of photo-texting to assess and improve upon the home food environment (HFE); a method which aims to engage participants with nutrition and food security among households. Various approaches to assessing and intervening within the HFE have demonstrated the efficacy of strengthening household food practices, improving food security, and dietary behaviors. However, public health practitioners face barriers in assessing the HFE. These include the intimate nature of the home setting, as well as the significant time, labor, and costs required to complete a comprehensive HFE assessment. Photo elicitation, though, provides a flexible strategy, while also empowering participants and conserving the resources of practitioners. This technique permits the collection of reflective self-assessments and provides a platform for goal setting. In this paper, we describe the step-by-step method of a photo elicitation technique that was developed to overcome the challenges with HFE research techniques. Furthermore, the described method may be beneficial as a practice tool to coach participants to self-assess their nutrition environment and to recognize behavioral factors within their homes and families. A pilot study of the photo-texting technique was implemented to identify lessons learned and illustrate feasibility. Results from the pilot study reveal participant engagement in all photo assignment, food and nutrition trends within the HFE, and effective goal setting techniques. Furthermore, participants reported favorable attitudes toward this technique of community-participatory research. There are many opportunities to facilitate effective HFE changes by utilizing the photo-texting technique and applying it to public health practice and research settings.

Results from a psychometric assessment of a new tool for measuring evidence-based decision making in public health organizations

BackgroundIn order to better understand how to improve evidence-based decision making (EBDM) in state health departments, measurement tools are needed to evaluate changes in EBDM. The purpose of this study was to test the psychometric properties of a new measurement tool to assess EBDM in public health practice settings. MethodsA questionnaire was developed, pilot-tested and refined in an iterative process with the input of public health practitioners with the aim of identifying a set of specific measures representing different components of EBDM. Data were collected in a national survey of state health department chronic disease practitioners. The final dataset (n=879) for psychometric testing was comprised of 19 EBDM items that were first examined using exploratory factor analysis, and then confirmatory factor analysis. ResultsThe final model from confirmatory factor analysis includes five latent factors representing components of EBDM: capacity for evaluation, expectations and incentives for EBDM, access to evidence and resources for EBDM, participatory decision making, and leadership support and commitment. ConclusionsThis study addresses the need for empirically tested and theory-aligned measures that may be used to assess the extent to which EBDM is currently implemented, and further, to gauge the success of strategies to improve EBDM, in public health settings. This EBDM measurement tool may help identify needed supports for enhanced capacity and implementation of effective strategies.

The role of researchers in disseminating evidence to public health practice settings: a cross-sectional study.

BackgroundEvidence-based public health interventions, which research has demonstrated offer the most promise for improving the population’s health, are not always utilized in practice settings. The extent to which dissemination from researchers to public health practice settings occurs is not widely understood. This study examines the extent to which public health researchers in the United States are disseminating their research findings to local and state public health departments.MethodsIn a 2012, nationwide study, an online questionnaire was administered to 266 researchers from the National Institutes of Health, the Centers for Disease Control and Prevention, and universities to determine dissemination practices. Logistic regression analyses were used to examine the association between dissemination to state and/or local health departments and respondent characteristics, facilitators, and barriers to dissemination.ResultsSlightly over half of the respondents (58%) disseminated their findings to local and/or state health departments. After adjusting for other respondent characteristics, respondents were more likely to disseminate their findings to health departments if they worked for a university Prevention Research Center or the Centers for Disease Control and Prevention, or received their degree more than 20 years ago. Those who had ever worked in a practice or policy setting, those who thought dissemination was important to their own research and/or to the work of their unit/department, and those who had expectations set by their employers and/or funding agencies were more likely to disseminate after adjusting for work place, graduate degree and/or fellowship in public health, and the year the highest academic degree was received.ConclusionsThere is still room for improvement in strengthening dissemination ties between researchers and public health practice settings, and decreasing the barriers researchers face during the dissemination process. Researchers could better utilize national programs or workshops, knowledge brokers, or opportunities provided through academic institutions to become more proficient in dissemination practices.

Creating a New Generation of Pediatric Dentists: A Paradigm Shift in Training

The University of California, Los Angeles (UCLA) School of Dentistry has implemented a Health Resources and Services Administration-funded program to prepare dentists for the complex and comprehensive needs of pediatric patients within rapidly changing demographics and a paradigm shift in dentistry. Traditional dental education has focused on how to respond to oral disease, whereas UCLA's program shifts the paradigm to emphasize early assessment, risk-based prevention, and disease management. A holistic approach to dental care that considers social and environmental determinants is used with minimally invasive techniques for restorative care. To support this change, pediatric dental residents receive traditional training combined with new didactics, advocacy opportunities, and applied learning experiences at community-based organizations. These new elements teach residents to recognize the causal factors of disease and to identify interventions that promote oral health at the individual, family, community, and policy level. Consequently, they are better prepared to treat a diverse group of patients who historically have faced the greatest burden of disease as well as an increased number of barriers to accessing oral health care; these consist of low-income, minority, and/or pediatric populations including children with special health needs. The program's ultimate goal is for residents to deploy these skills in treating vulnerable populations and to demonstrate greater interest in collaborating with non-dental health providers and community organizations to increase access to dental services in private or public health practice settings.

The Utrecht Pharmacy Practice network for Education and Research: a network of community and hospital pharmacies in the Netherlands.

Practice-based networks can serve as effective mechanisms for the development of the profession of pharmacists, on the one hand by supporting student internships and on the other hand by collection of research data and implementation of research outcomes among public health practice settings. This paper presents the characteristics and benefits of the Utrecht Pharmacy Practice network for Education and Research, a practice based research network affiliated with the Department of Pharmaceutical Sciences of Utrecht University. Yearly, this network is used to realize approximately 600 student internships (in hospital and community pharmacies) and 20 research projects. To date, most research has been performed in community pharmacy and research questions frequently concerned prescribing behavior or adherence and subjects related to uptake of regulations in the pharmacy setting. Researchers gain access to different types of data from daily practice, pharmacists receive feedback on the functioning of their own pharmacy and students get in depth insight into pharmacy practice.

Public health research implementation and translation: evidence from practice-based research networks.

Research on how best to deliver efficacious public health strategies in heterogeneous community and organizational contexts remains limited. Such studies require the active engagement of public health practice settings in the design, implementation, and translation of research. Practice-based research networks (PBRNs) provide mechanisms for research engagement, but until now they have not been tested in public health settings. This study uses data from participants in 14 public health PBRNs and a national comparison group of public health agencies to study processes influencing the engagement of public health settings in research implementation and translation activities. A cross-sectional network analysis survey was fielded with participants in public health PBRNs approximately 1 year after network formation (n=357) and with a nationally representative comparison group of U.S. local health departments not participating in PBRNs (n=625). Hierarchic regression models were used to estimate how organizational attributes and PBRN network structures influence engagement in research implementation and translation activities. Data were collected in 2010-2012 and analyzed in 2012. Among PBRN participants, both researchers and practice agencies reported high levels of engagement in research activities. Local public health agencies participating in PBRNs were two to three times more likely than nonparticipating agencies to engage in research implementation and translation activities (p<0.05). Participants in less densely connected PBRN networks and in more peripheral locations within these networks reported higher levels of research engagement, greater perceived benefits from engagement, and greater likelihood of continued participation. PBRN networks can serve as effective mechanisms for facilitating research implementation and translation among public health practice settings.

An Evaluation of Community Assessment for Public Health Emergency Response (CASPER) in North Carolina, 2003-2010

Community Assessment for Public Health Emergency Response (CASPER) is a group of tools and methods designed by the US Centers for Disease Control and Prevention (CDC) to provide rapid, reliable, and accurate population-based public health information. Since 2003, North Carolina public health professionals have used CASPERs to facilitate public health emergency responses and gather information on other topics including routine community health assessments. To date, there has been no evaluation of CASPER use by public health agencies at the state or local level in the US. Local health departments of North Carolina reported when and how CASPERs were used during the period 2003 to 2010 via an online survey. Data on barriers and future plans for using CASPERs also were collected. Fifty-two of North Carolina's 85 local health departments (61%) completed the survey. Twenty-eight departments reported 46 instances of CASPER use during 2003 to 2010. The majority of CASPERs were performed for community health assessments (n = 20, 43%) or exercises (n = 11, 24%). Fifty-six percent of respondents indicated they were "likely" or "very likely" to use CASPERs in the future; those who had prior experience with CASPERs were significantly more likely (P = .02) to report planned future use of CASPERs compared to those without prior experience with the tool. Lack of training, equipment, and time were the most frequently reported barriers to using CASPERs. Local public health agencies with clear objectives and goals can effectively use CASPERs in both routine public health practice and disaster settings.

Dissemination and Implementation Research Funded by the US National Institutes of Health, 2005-2012.

Dissemination and implementation (D&I) research is a growing area of science focused on overcoming the science-practice gap by targeting the distribution of information and adoption of interventions to public health and clinical practice settings. This study examined D&I research projects funded under specific program announcements by the US National Institutes of Health (NIH) from 2005 to 2012. The authors described the projects' D&I strategies, funding by NIH Institute, focus, characteristics of the principal investigators (PIs) and their organizations, and other aspects of study design and setting. Results showed 46 R01s, 6 R03s, and 24 R21s funded totaling $79.2 million. The top funders were the National Cancer Institute and the National Institute of Mental Health, together providing 61% of funding. The majority of PIs were affiliated with Schools of Medicine or large, nonprofit research organizations and think tanks. Only 4% of projects were to PIs with appointments at Schools of Nursing, with 7% of the funding. The most commonly funded projects across all of the studies focused on cancer control and screening, substance abuse prevention and treatment, and mental health services. Typically implemented in community and organizational settings, D&I research provides an excellent opportunity for team science, including nurse scientists and interdisciplinary collaborators.

Khoury et al. Respond to "The Epicenter of Translational Science": Crossing All the T's

We agree with Dr. Hiatt that epidemiology belongs at the epicenter of translation (1), especially when integration of knowledge across disciplines is required to create the scientific basis for societal change. Although we recognize his concern that the “proliferation of T's” could get out of hand, we believe that our more granular description of translation helps to highlight epidemiology's role beyond the identification of risk factors (2). Unfortunately, the thesis that epidemiology is at the epicenter of translation science is not universally shared. Although it is difficult to think of any medical progress that really saved lives and has not required a key contribution from epidemiology, no Nobel Prize has ever been awarded to an epidemiologist (3). In a recent 37-chapter authoritative textbook entitled Clinical and Translational Science (4), we had to wait until chapter 35 to read an introduction to epidemiology, which relegates the contributions of epidemiology to an afterthought in the translational sciences. One wonders whether the oft-lamented lack of successes in translational research is due to the lack of wider understanding of epidemiologic methods among researchers of diverse disciplines. As Hiatt affirms, the point is that epidemiology has a central role throughout the translation continuum, regardless of what the overlapping phases are called. Epidemiologists come in all kinds of flavors. Some practice discovery research almost exclusively; others focus on development of evidence-based guidelines. Still more are engaged in clinical and public health practice, developing and implementing programs and measuring health impact at the national, state, and local levels. Their work is to measure factors that facilitate and impede the integration of proven interventions into practice (T3) and to assess the effectiveness of interventions in reducing morbidity and mortality at the population level (T4). Because both process and outcome measures are needed to evaluate interventions, T3 and T4 obviously overlap. Often T3 data are available years, if not decades, before T4 data, and the sources of data and methods used may differ. For example, surveillance systems are mainstays of public health programs that evaluate both process indicators, such as trends in the prevalence of cigarette smoking in the Behavioral Risk Factor Surveillance System (5), and outcome indicators, such as trends in lung cancer incidence using Surveillance, Epidemiology, and End Results (SEER) or state-based cancer registries (6). Many discoveries may look promising, managing to survive through T1 and T2 evaluations, and become widely accepted in medicine and public health only to be proven ineffective and harmful (7, 8). T3 assessments alone (collecting process indicators) would simply enhance wasted efforts, while T4 research can offer valuable hints that we have been misled and/or inform new discoveries (T0). Our reason for highlighting T3 and T4 is not to create new niches or to divide disciplines but to spotlight epidemiology as a common thread along the entire translation continuum. Our quick review of the Journal publications suggests much less emphasis on T3 and T4 compared with discovery and early translation. Our bottom line is simple. The road to translation is long and arduous. We need to cross all the T's even though we may disagree on what to call them. Epidemiologists should play a much larger role in this enterprise in academic, clinical, or public health practice settings.

Educational modules created to teach freshman and senior year nutrition students about nutritional genomics were effective

Nutritional genomics has potential to be used in both the clinical and public health practice settings. Developing educational tools to make dietetic students aware of nutritional genomics and its practical applications is a critical step in increasing the competency of future dietitians. Educational modules were developed to be incorporated into freshman and senior year nutrition courses at the University. The effectiveness of the modules was evaluated with the use of pre and post surveys. Statistical software was used to compare the survey results. Overall, students in both courses became more interested in nutrigenomics after the lesson, and the number of students who answered nutritional genomics questions correctly increased. In addition, over 70% of the students in both courses said the lecture helped them understand the concept of nutrigenomics. 74% of students said the lecture taught them valuable information on possible future job opportunities involving nutrigenomics. Given that the current education on nutritional genomics is limited within the dietetics curriculum, the modules developed are effective in teaching students about this cutting‐edge field.

The Local Public Health System Assessment of MAPP/The National Public Health Performance Standards Local Tool

The Local Public Health System Assessment (LPHSA) in Mobilizing for Action through Planning and Partnerships (MAPP), and the Local Tool of the National Public Health Performance Standards Program (LT/NPHPSP)--which are one in the same-attempt to assess the capacity to provide the essential public health services. Both tools have been utilized in various public health practice settings; however, users have been challenged with the complexity of the tools and time and human resource investment necessary to complete them. The recent Journal of Public Health Management and Practice issue focus on MAPP provided several examples of LPHSA implementation, both as a component of MAPP and as a stand-alone activity in the context of performance standards. The uniqueness in our approach involved a collaborative between a community-based organization, a public health academic program, and a governmental public health agency which conducted the LPHSA in a manner that did not require actual modification of the tool itself, was practical and feasible, and was of benefit and value to all partners.

Introduction to the Special Section on Dissemination: Dissemination Research and Research Dissemination: How Can We Close the Gap?

One of the greatest challenges facing health promotion and disease prevention is translating research findings into evidence-based public health and clinical practices that are actively disseminated and widely adopted. Despite the tremendous strides made in developing effective disease prevention and control programs, there has been little study of effective dissemination of evidence-based programs to and adoption by community, public health, and clinical practice settings. This special section provides a venue in which to highlight exemplary dissemination research efforts while also identifying limitations in research to date and framing important future research questions. This issue establishes a resource for investigators interested in dissemination research, with relevance to health psychology. In this sense, it can serve as a benchmark by which to examine subsequent progress. The 6 articles reflect the state of the science in dissemination research for the promotion and adoption of health behavior change interventions.

Use of Foldback Analysis to Foster Consolidation Between Academic and Public Health Practice

Departments of health can provide applied settings for students from academic public health programs to explore the connection of course work to real-life circumstances. Barriers exist for public health practitioners, however, that restrict their willingness to engage in joint efforts with academe. To address these barriers, they must be identified and characterized. That is, it is important for academics in public health to respect both barrier-issues and to understand underlying value constructs, if they hope to employ public health practice settings to advance their students' training. A 100% sample of all midmanagers was surveyed at the Hawaii Department of Health by the School of Public Health. Nine clusters of "key issues for continued collaboration" were identified and rank-ordered in importance. Further analysis of the rank-orders, using multidimensional scaling, distinguished important underlying value constructs crucial to improving joint activities between the school and department. Working together, representatives from the Department and School identified the first three value dimensions as cooperation, implying the need for true reciprocal and equal interaction; obligation, signifying mutual responsibility and parallel investment; and, professional practice, suggesting the balanced interdigitation of research with practice. These value dimensions account for three fifths (58%) of the variance in opinion. Detailed analysis of these dimensions suggests that low-cost strategies improve collaboration, and foster possible consolidation, between academic and clinical public health settings. A stronger partnership between the school and the department is likely, provided the two agencies can address these issues satisfactorily. Insights from the Hawaii experience may prove useful to other academic public health practice settings. Recommendations that may improve collaboration include holding joint semi-annual meetings, a school bulletin board listing practica at the department, a public health leadership course, improved electronic communications between the school and the department, joint appointments to the two agencies, faculty release time to conduct research to improve practices at the department, and the establishment of a steering committee for the collaboration.