Learning in the zone: toward workforce development of evidence-based public policy communication.

BACKGROUND: Evidence-based policy communication (EBPC) is an important, emerging focus in public health research. However, we have yet to understand public health workforce ability to develop and/or use it. The study objective was to characterize capacity to develop and use EBPC and identify cooperative learning and development opportunities using the case of Human papillomavirus (HPV). METHODS: Vygotsky's Zone of Proximal Development (ZPD) informed guided interviews with 27 advocates in Indiana from government, industry, research, state associations and individuals. Participants focused on HPV, cancer, women's health, school health and minority health. RESULTS: Capacity to develop and use EBPC was reported to develop through cooperative learning opportunities on the job or in advocacy focused coalitions. Coalition learning appeared to translate across health topics. Notably, policy experience did not assure understanding or use of EBPC. CONCLUSIONS: The ZPD framework can inform workforce EBPC interventions by focusing on actual development, potential development and factors for learning and development in the ZPD. Future studies should further clarify and evaluate emerging indicators in additional public health policy areas with a larger sample.

Electronic Health Record (EHR)-Based Community Health Measures: An Exploratory Assessment of Perceived Usefulness by Local Health Departments.

BACKGROUND: Given the widespread adoption of electronic health record (EHR) systems in health care organizations, public health agencies are interested in accessing EHR data to improve health assessment and surveillance. Yet there exist few examples in the U.S. of governmental health agencies using EHR data routinely to examine disease prevalence and other measures of community health. The objective of this study was to explore local health department (LHD) professionals' perceptions of the usefulness of EHR-based community health measures, and to examine these perceptions in the context of LHDs' current access and use of sub-county data, data aggregated at geographic levels smaller than county. METHODS: To explore perceived usefulness, we conducted an online survey of LHD professionals in Indiana. One hundred and thirty-three (133) individuals from thirty-one (31) LHDs participated. The survey asked about usefulness of specific community health measures as well as current access to and uses of sub-county population health data. Descriptive statistics were calculated to examine respondents' perceptions, access, and use. A one-way ANOVA (with pairwise comparisons) test was used to compare average scores by LHD size. RESULTS: Respondents overall indicated moderate agreement on which community health measures might be useful. Perceived usefulness of specific EHR-based community health measures varied by size of respondent's LHD [F(3, 88) = 3.56, p = 0.017]. Over 70% of survey respondents reported using community health data, but of those < 30% indicated they had access to sub-county level data. CONCLUSION: Respondents generally preferred familiar community health measures versus novel, EHR-based measures that are not in widespread use within health departments. Access to sub-county data is limited but strongly desired. Future research and development is needed as LHD staff gain access to EHR data and apply these data to support the core function of health assessment.

Incorporating geospatial capacity within clinical data systems to address social determinants of health.

Linking electronic health record (EHR) systems with community information systems (CIS) holds great promise for addressing inequities in social determinants of health (SDH). While EHRs are rich in location-specific data that allow us to uncover geographic inequities in health outcomes, CIS are rich in data that allow us to describe community-level characteristics relating to health. When meaningfully integrated, these data systems enable clinicians, researchers, and public health professionals to actively address the social etiologies of health disparities.This article describes a process for exploring SDH by geocoding and integrating EHR data with a comprehensive CIS covering a large metropolitan area. Because the systems were initially designed for different purposes and had different teams of experts involved in their development, integrating them presents challenges that require multidisciplinary expertise in informatics, geography, public health, and medicine. We identify these challenges and the means of addressing them and discuss the significance of the project as a model for similar projects.

Community health status indicators: adding a geospatial component.

An Internet mapping application is being introduced in conjunction with the release of the second version of the Community Health Status Indicators (CHSI) Report. The CHSI Geographic Information Systems (GIS) Analyst is an easy-to-use Web-based mapping application that provides new opportunities for the visualization, exploration, and understanding of the indicators. Indicators can be mapped and compared visually to other areas, including peer counties and neighboring counties. The Web site is accessible from a link on the CHSI Report Web site or directly from an Internet Web browser. In this paper, we discuss the conceptualization and implementation of this public health mapping application.

It's Not Just a Yes or No Answer: Expressions of Local Health Department Accreditation.

UNLABELLED: The identification and exploration of moderators of health department accreditation remain limited by current dichotomous conceptualizations of pursuit. METHODS: A 2015 survey measured Indiana local health department (LHD) accreditation pursuit and progress, classifying respondents by progress evidence. Covariates included attitudes about the future impact of accreditation on funding and performance, health department size, geography, health outcome ranking, and quality improvement (QI) programing. RESULTS: Four classifications of accreditation pursuit emerged and were found to have greater association with covariates than standard dichotomous measures. "Active Pursuit" was associated with formal QI programing and a belief that accreditation will impact future funding and performance. "Intent Only" was associated with no QI programing and no completion of accreditation prerequisites. "Discontinued" was associated with the belief that accreditation will not impact future performance. "Not Pursuing" was associated with no interest or plan to complete prerequisites and reported belief that accreditation will not impact future health department funding or performance. CONCLUSION: More granular characterizations of accreditation pursuit may improve understanding of influential factors. This measurement framework should be validated in studies of LHDs in other states.

Measuring Population Health Using Electronic Health Records: Exploring Biases and Representativeness in a Community Health Information Exchange.

Assessment is a core function of public health. Comprehensive clinical data may enhance community health assessment by providing up-to-date, representative data for use in public health programs and policies, especially when combined with community-level data relevant to social determinants. In this study we examine routinely collected and geospatially-enhanced EHR data to assess population health at various levels of geographic granularity available from a regional health information exchange. We present preliminary findings and discuss important biases in EHR data. Future work is needed to develop methods for correcting for those biases to support routine epidemiology work of public health.

Implementation of a journal prototype for pregnant and parenting adolescents.

Teenage pregnancy and childbearing remain pressing public health issues that have garnered attention from public health officials and social services agencies. This paper reports on the initial implementation and formative evaluation of a journaling program used as a means of communicating health information to pregnant and parenting adolescents (young women age 15-19) while also providing participants with a means of self-expression. The journaling prototype was implemented in a community-based agency in the Midwest by Family Support Specialists (FSSs) who made home visits on a monthly basis to assist pregnant and parenting adolescents (n=52) with successful family planning and public health education. A mixed method approach of qualitative (analysis of journals, field notes, and responses of semi-structured interviews with FSSs) and quantitative (questionnaires from pregnant and parenting adolescent respondents) data with purposive sampling was employed to evaluate the implementation of the journaling intervention. Twenty of the 52 study participants were pregnant when the journaling intervention was implemented, while 32 were not pregnant, but recently had a child and were currently parenting. Two core themes emerged from analysis of the data after the implementation of the journals: (1) usefulness of the journal and responsiveness to participants' information needs and (2) functionality challenges. The results offer practical starting points to tailor the implementation of journaling in other contexts. Further, areas for improvement emerged regarding the distribution timeline for the journal and the content of the journal itself. As such, we discuss the lessons learned through this collaborative project and suggest opportunities for future phases of the journal intervention.

Promotion and tenure for community-engaged research: an examination of promotion and tenure support for community-engaged research at three universities collaborating through a Clinical and Translational Science Award.

INTRODUCTION: Community-engaged health research, an approach to research which includes the participation of communities, promotes the translation of research to address and improve social determinants of health. As a way to encourage community-engaged research, the National Institutes of Health required applicants to the Clinical and Translational Science Award (CTSA) to include a community engagement component. Although grant-funding may support an increase in community-engaged research, faculties also respond to the rewards and demands of university promotion and tenure standards. This paper measures faculty perception of how three institutions funded by a CTSA support community-engaged research in the promotion and tenure process. METHODS: At three institutions funded by a CTSA, tenure track and nontenure track faculty responded to a survey regarding perceptions of how promotion and tenure committees value community-engaged research. RESULTS: Faculty view support for community-engaged research with some reserve. Only 36% agree that community-engaged research is valued in the promotion and tenure process. DISCUSSION: Encouraging community-engaged scholarship requires changing the culture and values behind promotion and tenure decisions. Institutions will increase community-engaged research and more faculty will adopt its principles, when it is rewarded by promotion and tenure committees.