overview of online survey findings - university of victoria · public health services research:...

2011

Advancing Public Health Services Research in Canada: Developing a Pan-Canadian Agenda

Public Health Services Research: Overview of Survey Findings 1

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Overview of Online Survey Findings

Background

Public health services research (PHSR), sometimes called public health systems research, is an emerging subset of health services research, described as “the new kid on the block”

1, and

defined as “a field of study that examines the organisation, funding and delivery of public health services within communities, and the impact of these services on public health”

2, p.180. Its

importance has been recognised in the US by the Institute of Medicine3 and the Department of

Health and Human Services4. At the same time, funding for health services research in the US is

directed primarily at the health care system in general, and much less at public health services per se.

1 This creates a “public health system knowledge disparity”

5, p.571 which also seems to be true

in Canada. Mays and colleagues

2 note that “A persistent obstacle to public health system improvement has

been the lack of information about what constitutes effective public health practice, and how best to organise, finance and implement these activities.”

p. 179 Lenaway and colleagues

6 have argued

that a PHSR agenda is important to: 1) catalyze new research and practice based initiatives; 2) establish a framework that would create opportunities “to better coordinate, leverage, and identify resources and activities”

(p. 411); and 3) provide a scientific basis for making decisions about the

health of the nation. We believe that a PHSR agenda in Canada will provide similar benefits. PHSR is needed to assist the research and policy community in understanding “how the level of development of national public health infrastructure and the multiplicity of organizational arrangements in public health affect health outcomes”

6, p.410. Currently, we do not have a PHSR

agenda in Canada and there is very little in the Canadian literature to identify PHSR priorities, although there have been some efforts to catalyze the development of such an agenda. In BC, a large interdisciplinary group of researchers and knowledge users has come together to develop a PHSR agenda in BC, which we believe represents one of the first attempts to develop a comprehensive PHSR agenda in Canada. This group, the Core Public Health Functions Research Initiative (CPHFRI, see http://web.uvic.ca/~cphfri/), comprises researchers from four universities, and decision makers and practitioners from all six health authorities, as well as the Ministry of Health Services. It is co-led by Trevor Hancock and Marjorie MacDonald. Over the past three years, funded by two infrastructure grants from the BC Michael Smith Foundation for Health Research, CPHFRI has engaged in an extensive team-building process, established a set of research priorities for PH services/systems renewal in BC

7, and successfully leveraged peer

reviewed funding from CIHR to carry-out this agenda. At the 2009 Canadian Public Health Association Conference, CPHFRI members held a workshop to “float” the idea of developing a PHSR agenda for Canada. This session was very well attended and participants from across the country confirmed this need and expressed interest in participating in the process. At that time, the Ontario Agency for Health Promotion and Protection, the Public Health Agency of Canada, and two of CIHR’s Applied Public Health Chairs (Paradis, MacDonald) all expressed interest in partnering and funding the process to establish a Canadian agenda for PHSR. Since then, one more CIHR Applied Public Health Chair (Martens) joined the team and additional funding was committed from the BC Centres for Disease Control and Research Western (Kothari). We also received a CIHR Meetings, Planning and Dissemination grant to fund the think tank (PIs: MacDonald, Hancock and Paradis).

http://web.uvic.ca/~cphfri/

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Purpose and Objectives of the Think Tank

The purpose of this invitational Think Tank is to bring together a group of key stakeholders from across Canada with an interest and expertise in PHSR, as well as international PHSR consultants to engage in discussion and debate about public health services research priorities in Canada. The meeting will provide a forum for discussion of PHSR priorities. The objectives of the entire process are:

1. To identify research priorities in public health services/systems.

2. To establish clear linkages between the strategic directions of funders to ensure a place for PHSR in the research landscape.

3. To establish consensus on a Canadian PHSR agenda.

4. To develop a five year plan to advance the agenda.

5. To establish a Canada wide network of PHSR researchers and supporters.

Overview of Survey Findings

In preparation for the Think Tank, a literature review was compiled and a national survey conducted. The online survey was developed based on priorities identified in a preliminary review of the literature. This was a brief ten minute survey available in both French and English that was distributed widely through a variety of public health listserves across the country. The survey was not intended to be a population-based representative sample but rather a wide sampling of public health stakeholders to provide a broad spectrum of perspectives. It was intended to be an online “brainstorming” opportunity for participants to identify PHSR priorities. A total of 338 respondents participated in the survey with varying numbers completing each question because some questions were skipped over by participants. The breakdown of participants by province is illustrated in Table 1.

Table 1: Total Survey Respondents by Province (n = 332)

Province Frequency Percent

1 Ontario 111 33.4

2 British Columbia 90 27.1

3 Manitoba 49 14.8

4 Quebec 29 8.7

5 Alberta 26 7.8

6 Newfoundland 9 2.7

7 Saskatchewan 8 2.4

8 Nova Scotia 5 1.5

9 New Brunswick 4 1.2

10 Yukon 1 0.3

11 Northwest Territories 0 0

12 Prince Edward Island 0 0

13 Nunavut 0 0

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The second survey question asked participants to identify their primary affiliation; responses are illustrated in Figure 1.

Figure 1: Respondents’ Primary Affiliation

Participants were also asked at which level they primarily work (local, provincial, national, or

international) and their responses are presented in Figure 2.

Figure 2: Primary Level of Work

Academic 16%

Policymaker 10%

Practitioner 24%

Policy Analyst 9%

Manager/ Administrator

19%

Consultant 10%

Other 12%

Local 59%

Provincial 29%

National 10%

International 2%

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Participants were then asked how familiar they are (on a scale from one to ten) with three concepts: a) Public Health Systems/Services; b) Public Health Research; and c) Public Health Systems/Services Research. Table 2 outlines respondents’ familiarity with the three concepts based on their employment category. Overall, participants were most familiar with Public Health Systems/Services and least familiar with Public Health Systems/Services Research. In other words, participants know a lot about public health services and the systems for delivery of public health services, but much less about research relating to this topic.

Table 2: Mean Familiarity with Concepts by Employment Category (n = 259)

Academics Practitioners Managers/ Administrators

Policy Makers

Policy Analysts

Consultants Other MEAN TOTAL

Public health services/systems

8.0 7.9 8.2 8.7 8.1 8.1 7.3 7.8

Public health research

8.0 6.3 6.4 7.2 7.1 6.9 6.8 6.7

Public health services/systems research

7.0 5.3 5.4 6.2 6.1 6.1 5.9 5.8

Note: Participants were asked how familiar they are with the three concepts using a scale from one to ten (1 = ‘not familiar at all’ & 10 = ‘very familiar’)

In the final question of the survey, participants were provided with the following list of PHSR

priorities with examples of possible research questions to explore within each area. This list was

developed based on a preliminary review of the literature:

Public Health Performance How do we create theoretically based performance indicators and measurement tools to evaluate the efficiency, equity and effectiveness of public health services, while improving quality and safety?

Public Health Finance

How do we identify the effects of finance on public health performance and organization?

Health Disparities How can public health performance and public health services/systems research create an opportunity to reduce disparities in health?

Public Health Infrastructure How do we ensure the infrastructure resources (organizational structures, financing systems, workforce characteristics, and delivery mechanisms) necessary to implement effective and appropriate interventions for individuals and communities?

Public Health Organization and Structure How do the size, boundaries and structures of public health agencies/departments impact the delivery and performance of public health services?

Emergency Preparedness How can public health integrate emergency preparedness with a wider range of general public health initiatives?

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Workforce How do we recruit and retain public health professionals, while addressing the issues of education and accreditation?

Information Systems

How can we create and utilize information systems that will improve public health performance?

Partnerships/Linkages How do we create and mobilize partnerships/linkages to improve public health system performance (i.e., within and between government, public health agencies, community-based organizations, health care providers, educational institutions and private sector organizations)?

Evidence-based Practice How do we use existing data to create the foundation for future research initiatives? How do we ensure that public health services and decision-making processes are guided by evidence-based practice?

Individual & Community Health Services How do we assess, monitor and align individual and community issues with public health priorities?

Policy and Legislation Development Who should be involved in policy and legislation development for individual and community health?

Essential/Core Functions of Public Health What should be included as essential/core functions for public health? How are essential/core functions implemented and what factors influence implementation? What is the impact of essential/core functions implementation on population health?

Health Assessment and Surveillance What are the most efficient and effective ways of tracking, forecasting, and disseminating health events and health determinants?

Public Health and Primary Care To what extent does collaboration between these two sectors occur? What influences collaboration? What areas are most important for collaboration to occur?

After reading the PHSR topics listed above, participants were asked to select the three areas that they believe should be assigned highest priority in terms of public health services/systems research. The PHSR priorities for the total sample are presented in Table 3, and Table 4 provides the top five PHSR priorities for each employment category. In both tables, the percentages do not add up to 100 because respondents were allowed to select up to three choices. Therefore, the percent value in the tables indicates the percent of respondents who selected each area as one of their top three priorities. As indicated at the top of Table 3, for example, 37.2% of respondents chose ‘Evidence-based Practice’ as one of their top three PHSR priorities.

Table 3: Public Health Services/Systems Research Priorities: Total Sample (n = 250)

Rank PHSR Priority Frequency Percent*

1 Evidence-based Practice 93 37.2

2 Public Health Performance 90 36.0

3 Public Health Infrastructure 74 29.6

4 Health Disparities 69 27.6

5 Essential/Core Functions of Public Health 61 24.4

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6 Public Health Organization & Structure 50 20.0

6 Partnerships/Linkages 50 20.0

7 Health Assessment & Surveillance 49 19.6

8 Public Health & Primary Care 41 16.4

9 Policy & Legislation Development 36 14.4

9 Public Health Workforce 36 14.4

10 Individual & Community Health Services 30 12.0

10 Information Systems 30 12.0

11 Emergency Preparedness 26 10.4

12 Public Health Finance 22 8.8

*Note: Percentages do not add up to 100 because participants were asked to choose up to three top priorities.

Table 4: Public Health Services Research Priorities by Employment Category

Top 5 PHSR Priorities by Employment Category Frequency Percent*

ACADEMICS

Evidence-based Practice 27 30.7

Public Health Performance 27 30.7

Health Disparities 27 30.7

Public Health Infrastructure 21 23.9

Partnerships / Linkages 18 20.5

PRACTITIONERS




Essential / Core Functions of Public Health 30 21.7

Public Health Workforce 23 16.7

MANAGERS / ADMINISTRATORS






POLICY MAKERS





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Health Assessment & Surveillance 10 19.6

POLICY ANALYSTS





Policy & Legislation Development 11 22.0

CONSULTANTS


Health Assessment & Surveillance 14 25.0




OTHER





Public Health & Primary Care 9 14.3

*Note: Percentages do not add up to 100 because participants were asked to choose up to three top priorities.

Next Steps

Following the Think Tank, a full report will be compiled documenting the proceedings of the meeting. This report will include a copy of the literature review and survey findings and will detail the emerging PHSR agenda.

Members of the team are holding a pre-conference workshop at the Canadian Public Health Association Conference on June 19, 2011 from 1:00-4:00pm. The goal of this workshop is to present the findings of the work leading up to and including the Think Tank to engage a broader audience and expand our fledgling network.

The findings from the entire process will be disseminated at other conferences and written up for publication to share the preliminary agenda with the public health community and seek feedback and confirmation.

Finally, we will work with funders, specifically the CIHR Institute of Public and Population Health (IPPH) and the CIHR Institute of Health Services and Policy Research (IHSPR), as well as the Canadian Health Services and Research Foundation (CHSRF), to ensure a place for PHSR in the funding landscape. In particular, we hope to work with funders to develop strategic Requests for Proposals aimed at public health services/systems research. Without openness on the part of either CIHR or CHSRF to embrace an explicit public health services focus, we believe that this area of research will continue to be marginalized within the larger field of health services research.

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References

1. Scutchfield, F. & Patrick, K. (2007). “Public health systems research: The new kid on the block” American Journal of Preventive Medicine 32(2), 173-174.

2. Mays, G., Halverson, P. & Scutchfield, F. (2003). Behind the curve? What we need to know from public health systems research. Journal of Public Health Management and Practice, 9(3), 179-82.

3. Institute of Medicine (2002). The Future of the Public's Health in the 21st Century Washington, DC: National Academies Press.

4. Department of Health and Human Services (2001). Healthy People 2010: Understanding and Improving Health. Washington, DC: US Department of Health and Human Services.

5. Honoré, P.A. & Amy, B.W. (2005). Public Health Finance: Advancing a Field of Study Through Public Health Systems Research. Journal of Public Health Management & Practice, 11(6), 571 -573.

6. Lenaway, D., Halverson, P., Sotnikov, S., Tilson, H., Corso, L. & Millington, W. (2006). Public health systems research: Setting a national agenda. American Journal of Public Health, 96(3), 410-3.

7. MacDonald, M., Hancock, T., Strosher, H. and the Core Public Health Functions Research Initiative (2007). Developing a research program on the implementation and impact of Core Public Health Functions in British Columbia: Proceedings from Core Public Health Functions Research Priority Think Tank. Submitted to Public Health Agency of Canada. Available at: http://web.uvic.ca/~cphfri/publications/docs/Core_Functions_Research_Think_Tank_report.pdf

http://web.uvic.ca/~cphfri/publications/docs/Core_Functions_Research_Think_Tank_report.pdf

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