Engaging Adolescents Through Participatory and Qualitative Research Methods to Develop a Digital Communication Intervention to Reduce Adolescent Obesity.

BACKGROUND: The complexity of the childhood obesity epidemic requires the application of community-based participatory research (CBPR) in a manner that can transcend multiple communities of stakeholders, including youth, the broader community, and the community of health care providers. AIM: To (a) describe participatory processes for engaging youth within context of CBPR and broader community, (b) share youth-engaged research findings related to the use of digital communication and implications for adolescent obesity intervention research, and (c) describe and discuss lessons learned from participatory approaches. METHOD: CBPR principles and qualitative methods were synergistically applied in a predominantly African American part of the city that experiences major obesity-related issues. A Youth Research Advisory Board was developed to deeply engage youth in research that was integrated with other community-based efforts, including an academic-community partnership, a city-wide obesity coalition, and a primary care practice research network. Volunteers from the youth board were trained to apply qualitative methods, including facilitating focus group interviews and analyzing and interpreting data with the goal of informing a primary care provider-based obesity reduction intervention. RESULTS: The primary results of these efforts were the development of critical insights about adolescent use of digital communication and the potential importance of messaging, mobile and computer apps, gaming, wearable technology, and rapid changes in youth communication and use of digital technology in developing adolescent nutrition and physical activity health promotion. CONCLUSIONS: The youth led work helped identify key elements for a digital communication intervention that was sensitive and responsive to urban youth. Many valuable lessons were also learned from 3 years of partnerships and collaborations, providing important insights on applying CBPR with minority youth populations.

Comparison of practice based research network based quality improvement technical assistance and evaluation to other ongoing quality improvement efforts for changes in agency culture.

BACKGROUND: Public health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance. Many of the functional and structural barriers to effective use of QI can be found in the organizational culture of public health agencies. The purpose of this study was to assess the impact of public health practice based research network (PBRN) evaluation and technical assistance for QI interventions on the organizational culture of public health agencies in Georgia, USA. METHODS: An online survey of key informants in Georgia's districts and county health departments was used to compare perceptions of characteristics of organizational QI culture between PBRN supported QI districts and non-PBRN supported districts before and after the QI interventions. The primary outcomes of concern were number and percentage of reported increases in characteristics of QI culture as measured by key informant responses to items assessing organizational QI practices from a validated instrument on QI Collaboratives. Survey results were analyzed using Multi-level Mixed Effects Logistic Model, which accounts for clustering/nesting. RESULTS: Increases in QI organizational culture were consistent for all 10- items on a QI organizational culture survey related to: leadership support, use of data, on-going QI, and team collaboration. Statistically significant odds ratios were calculated for differences in increased QI organizational culture between PBRN-QI supported districts compared to Non-PBRN supported districts for 5 of the 10 items, after adjusting for District clustering of county health departments. CONCLUSIONS: Agency culture, considered by many QI experts as the main goal of QI, is different than use of specific QI methods, such as Plan-Do-Study-Act (PDSA) cycles or root-cause analyses. The specific use of a QI method does not necessarily reflect culture change. Attempts to measure QI culture are newly emerging. This study documented significant improvements in characteristics of organizational culture and demonstrated the potential of PBRNs to support agency QI activities.

Evaluation of Diverse Community Asthma Interventions: Balancing Health Outcomes with Developing Community Capacity for Evidence-Based Program Measurement.

The challenge of evaluating community asthma management programs is complicated by balancing the emphasis on health outcomes with the need to build community process capacity for conducting and monitoring evidence-based programs. The evaluation of a Georgia Childhood Asthma Management Program, a Healthcare Georgia Foundation-supported initiative for multiple diverse programs and settings, provides an example of an approach and the results that address this challenge. A "developmental evaluation" approach was applied, using mixed methods of quantitative and qualitative data collection and analysis, to assess the progress of community asthma prevention programs in building community within the context of: where the community is starting, community-level systems changes, and the community's progress toward becoming more outcome measurement oriented and evidence based. Initial evaluation efforts revealed extensive mobilization of community assets to manage childhood asthma. However, there were minimal planned efforts to assess health outcomes and systems changes, and the lack of a logic model-based program design linking evidence-based practices to outcomes. Following developmental technical assistance within evaluation efforts, all programs developed logic models, linking practices to outcomes with data collection processes to assess progress toward achieving the selected outcomes. This developmental approach across diverse projects and communities, along with a quality improvement benchmarking approach to outcomes, created a focus on health status outcome improvement. Specifically, this approach complemented an emphasis on an improved community process capacity to identify, implement, and monitor evidence-based asthma practices that could be used within each community setting.

A merged model of quality improvement and evaluation: maximizing return on investment.

Quality improvement (QI) and evaluation are frequently considered to be alternative approaches for monitoring and assessing program implementation and impact. The emphasis on third-party evaluation, particularly associated with summative evaluation, and the grounding of evaluation in the social and behavioral science contrast with an emphasis on the integration of QI process within programs or organizations and its origins in management science and industrial engineering. Working with a major philanthropic organization in Georgia, we illustrate how a QI model is integrated with evaluation for five asthma prevention and control sites serving poor and underserved communities in rural and urban Georgia. A primary foundation of this merged model of QI and evaluation is a refocusing of the evaluation from an intimidating report card summative evaluation by external evaluators to an internally engaged program focus on developmental evaluation. The benefits of the merged model to both QI and evaluation are discussed. The use of evaluation based logic models can help anchor a QI program in evidence-based practice and provide linkage between process and outputs with the longer term distal outcomes. Merging the QI approach with evaluation has major advantages, particularly related to enhancing the funder's return on investment. We illustrate how a Plan-Do-Study-Act model of QI can (a) be integrated with evaluation based logic models, (b) help refocus emphasis from summative to developmental evaluation, (c) enhance program ownership and engagement in evaluation activities, and (d) increase the role of evaluators in providing technical assistance and support.

Crosswalking public health and health education competencies: implications for professional preparation and practice.

This article highlights similarities and differences between the public health competencies recently developed by the Association of Schools of Public Health (ASPH) and one public health specialty, health education (HE), which has used competencies in its quality assurance systems for more than 20 years. Based on a crosswalk methodology developed for this analysis, some 50 percent to 61 percent of the HE and ASPH competencies had similarities of varying degrees; 18 percent were deemed matches due to sameness in skill or content. Most similarities were found between the ASPH social and behavioral sciences competencies and the HE competencies. Significant domains of "no match" were found between the HE and ASPH competencies in the areas of Systems Thinking, Leadership, and Public Health Biology. The study results have implications for academic programs related to curricula review and revision, continuing education providers who are developing training agendas for the workforce, employers anticipating competencies in new job hires, and prospective students and practitioners who are considering a form of certification. Qualitative insights from the study related to professional culture, purpose, age, and consistency of the scope or depth of the two competency sets, as well as the crosswalk methodology itself, may be useful to those comparing other competency sets.

Building health promotion capacity in developing countries: strategies from 60 years of experience in the United States.

The Galway Consensus Conference articulated key definitions, principles, values, and core domains of practice as the foundation for the diffusion of health promotion across the globe. The conference occurred in the context of an urgent need for large numbers of trained health workers in developing countries, which face multiple severe threats to the health of their people. In this article, the authors draw on the experience acquired by the health promotion profession in the United States to illustrate what might be done to build health promotion capacity in developing countries. They examine the profession's experience in the areas of accreditation and certification, research and publications, advocating for the profession, and advocating for public health policy. Finally, the authors direct a challenge to the profession in the United States to extend a hand to developing countries to assist them in expanding their capacity to prepare health promotion professionals and deliver health promotion services.

Implementation of possession laws and the social ecology of tobacco control.

The objective of this evaluation research was to assess the impact of programs intended to support the enforcement component of a comprehensive youth tobacco control. The research method was a survey of a randomly stratified cluster sample of law enforcement officers. Results of the evaluation showed that the enforcement behaviors of officers were increased through the state programs to support tobacco enforcement activities. The study showed that support for implementing a policy is important to achieve the objectives of a policy. The results of a study of the enforcement component of a Florida tobacco control program are reported and discussed within the ecological context of previously reported enforcement-linked decreases in youth tobacco use and funding and defunding of the Florida Tobacco Control Program.

A community-centered model of the academic health department and implications for assessment.

The academic health department, also referred to as the teaching health department, is receiving increased attention as an organizational structure to enhance public health workforce development. Traditionally, academic institutions have been viewed by major funders, and reported in the literature, to be the innovators of these partnerships, in part to extend the academic institution's education role in the workplace. However, the role of the local health department as innovator is emerging with implications beyond workforce development. This report illustrates how a local agency-initiated community-centered approach to an academic health department enhances the core public health function of assessment, a frequently underdeveloped function at the local level. This agency-initiated, community-centered academic health department model builds assessment capacity through a partnership that integrates academic research and public health surveillance capacity to provide comprehensive assessment, including community assessment, community-based participatory research, data analysis, and program evaluation. This organizational structure, focused on systems approaches to building community capacity rather than focusing on disease categories or high-risk populations, illustrates how a local health department can substantially enhance its assessment capacity using available resources.

Thematic analysis of documents from the SOPHE health disparity elimination research agenda summit: illuminating competencies for future researchers and practitioners.

Public health education researchers are adopting a view that disparities are a product of social systems exposures. As a result, the researchers are facilitating a review of the research questions asked and highlighting underlying assumptions informing the interpretation of results. It is within this view that the Society for Public Health Education (SOPHE) Health Disparities Elimination Research Agenda Summit was implemented. Aspects of planning for the Summit are described elsewhere in this journal. This article describes an effort to facilitate additional learning from the Summit through qualitative analysis of documents from the Summit. This analysis processes records and verifies the consistently highlighted ideas or the content that offers guidance on how to move toward engaging in research that supports change. In addition, the analysis illuminates insights about the context in which research strategies can develop and suggests skill development that can foster this important research in the emerging public health education workforce.

Framing a Transdisciplinary Research Agenda in Health Education to address Health Disparities and Social Inequities: a road map for SOPHE action.

SOPHE leaders continue to challenge us to be true to the call for an "open society." SOPHE has supported the Healthy People 2010 goal of eliminating health disparities through its Strategic Plan. SOPHE held an Inaugural Health Education Research Disparities Summit, Health Disparities and Social Inequities: Framing a Transdisciplinary Research Agenda in Health Education, August 8 and 9, 2005. This article explains the process used at the Summit where more than 80 researchers, academicians, practitioners, and students from across the country convened to ask fundamental questions about health disparity associated with race and ethnicity and how a health education research agenda could help in eliminating these disparities. From this Summit, about a dozen questions and/or recommendations have been developed to frame our future discussions about health disparities. Through its Research Agenda Committee, SOPHE has developed a process of translation and dissemination, including community participation, review, dialogue, and action.

Survey of accredited master of public health (MPH) programs with health education concentrations: a resource for strengthening the public health workforce.

The authors designed survey research to assess accredited master of public health (MPH) programs with health education concentrations. A Web-based survey was distributed to program directors and was used to collect characteristics of program faculty, students, graduates, internships, employment, and competency development. Results indicate that students and graduates are diverse; 72% of students complete internships and 61% of graduates work in government or community public health-related agencies; 98% of faculty hold a doctoral degree and 67% have at least one degree from an accredited public health school or program; and 85% of programs build competencies in most of the Institute of Medicine-suggested areas. The authors conclude that accredited MPH programs with a concentration in health education train diverse public health practitioners highly likely to work in a government or community public health agency with competencies to enhance public health.

Transforming a Master of Public Health program to address public health practice needs.

The future of the constantly changing public health profession is tied to the development of practice skills through competency-based training. In this article, we describe a program change in the Master of Public Health program at East Stroudsburg University in northeastern Pennsylvania. The first goal of the program transition was to ensure that all program elements included the relevant vision, values, mission, goals, and objectives. The second goal was to use continuous data input and evaluation to incorporate opportunities for flexible assessments. The change process helped the university faculty define the program's vision and fostered an environment of community collaboration that guides training for public health professionals.