Putting the public (back) into public health: leadership, evidence and action

Learning from public health practice: the development of a library of community-centered practice examples

BACKGROUND

Valuable learning derived from public health practice can be captured through practice-based case studies, also known as practice examples. Practice examples of participatory interventions supplement the evidence base by providing information on the complexities of implementation in communities. This paper reports on a Public Health England project to build a bank of community-centered practice examples based on robust processes of collection and curation.

METHODS

The multidisciplinary project had three phases: (i) development and piloting a process to collect practice examples, (ii) refining review processes and gathering further examples via national and regional teams (iii) maintenance of an accessible collection on the library platform.

RESULTS

The project resulted in a searchable collection of 55 practice examples illustrating participatory approaches in public health practice. The collection shows diversity in terms of settings, population, focus and type of approach used to work with communities. A secondary outcome was the development of generic guidance and templates for further collections on public health topics.

CONCLUSIONS

This project illustrates how information on the implementation of community-centered approaches in real-life contexts can be gathered and disseminated through a transferable process. Having collections of practice examples supports knowledge exchange in public health as learning is shared.

The understanding, application and influence of complexity in national physical activity policy-making

Background

Complexity theory and systems-thinking are increasingly popular in physical activity (PA) research and policy discourse. The impact of this perspective shift, across many sectors, may be underwhelming. We explore why, by focusing on how these concepts are understood and applied by PA policy-makers. This is of particular interest given the challenges of multisectoral interest and poorly defined stakeholder boundaries that are associated with PA promotion. In this study, we critique key elements of complexity theory and consider how it is understood and put into practice in PA policy-making.

Methods

We adopted a complex realist position. Ten semi-structured interviews were conducted with national-level policy-makers from United Kingdom government settings (five civil servants, three politicians, two policy advisors). An inductive thematic analysis was conducted, and managed with NVivo 10 software.

Results

Three overarching themes were constructed to reflect policy-makers’ uncertainty about complexity and the application of such perspectives to this policy space, their sense that PA was an unexceptionable yet unclaimed policy issue, and their desire for influence and change. Participants discussed complexity in contrasting ways. Its meaning was context-dependent and dynamic, which generated uncertainty about applying the concept. Participants also perceived an increasingly diverse but ill-defined PA policy system that spans the domains of expertise and responsibility. Collaborative practices may contribute to a previously unobserved sense of detachment from the systems’ complexity. Nevertheless, participants suggested potentially effective ways to stimulate system change, which require passionate and enterprising leadership, and included varied evidence use, a focus on localised implementation and different ways to connect people.

Conclusions

This research highlighted the importance of extending complexity theory and systems-thinking. While emphasizing the prevalence of these ideas across the PA sector, there is uncertainty as to their meaning and implications. This may prevent their use in ways that enhance PA policies and programmes. Participants conceptualised PA as a tool, which was imposed on the system. While this may support participative decision-making and localised implementation, further research is needed to understand how local systems foster leadership, the practical application of complexity and systems-thinking, and how to support system-wide change in the development and implementation of PA policies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-022-00864-9.

Collaborative Leadership, Collective Action, and Community Governance against Public Health Crises under Uncertainty: A Case Study of the Quanjingwan Community in China

In the face of a public health crisis full of uncertainty, how should the community respond in order to effectively reduce the negative impact of the epidemic on public health? This article takes a Chinese rural community located near Wuhan City as an example to explore the mechanism of how collaborative leadership enhanced collective action in community governance against the COVID-19 pandemic. Early blockading to prevent transmission into the community, strict maintenance of social distance to prevent internal diffusion, timely elimination of public panic, and efficient guarantees of household supplies have proven effective in preventing the spread of the epidemic. Our research shows that collaborative leadership can achieve these goals mainly by effectively integrated local knowledge, modern information technology, and social self-organization, and then promoting the realization of collective action of community epidemic prevention and control. The lessons and implications for public health are discussed.

Ampliando vozes sobre violência obstétrica: recomendações de advocacy para enfermeira(o) obstetra

Resumo Objetivos explorar as demandas das mulheres, bem como do público em geral, para melhorar a qualidade da assistência obstétrica; discutir as mudanças potenciais sugeridas pelos respondentes para tal prática assistencial. Método pesquisa multicêntrica realizada por meio da plataforma Opinio, explorando opiniões dos participantes de três cidades da região Sudeste do Brasil. Tratamento dos dados por estatística descritiva e análise temática. Resultados respondentes (n=414) na faixa etária 33-37 anos (26%), incluindo mulheres (75%) com mais de 15 anos de escolaridade, casadas (45%) e com um filho (35%), revelaram lacuna de conhecimentos sobre a violência obstétrica e os direitos da mulher. Jornal, rádio e televisão são as principais fontes de informação. O enfrentamento da violência obstétrica dar-se-ia por apoio familiar. Para a práxis renovada sugeriu-se a educação coletiva sobre direitos aos cuidados obstétricos (53,1%) e o atendimento humanizado (38,2%) mobilizando o poder profissional para consolidar a humanização. Temas analíticos centrais incluíram situação vivenciada pelas mulheres e contexto idealizado de prática. Conclusão e Implicações para a prática o debate incrementa a humanização e a governança compartilhada. Recomendações propostas para advocacy coadunam com a perspectiva global da promoção de saúde das mulheres e liderança social.

Family-Centered Health Promotion: Perspectives for Engaging Families and Achieving Better Health Outcomes

Communities and populations are comprised of individuals and families who together affect the health of the community. The family unit is an unparalleled player for maintaining health and preventing disease for public health because members may support and nurture one another through life stages. Preliminary research confirms that family-oriented health promotion and disease prevention are promising strategies because the family unit is both a resource and a priority group needing preventative and curative services across the life course. Although there are growing numbers of successful efforts, family health systems are generally underutilized in health promotion practice. This lack of utilization in policy and practice have hampered the collection of robust evidence for family health. This paper purports that families are important actors in public health. Yet, since no one pattern for healthy families is known, public health practitioners can consider six principle-based approaches to legitimately and respectfully advance the families’ innate potential for health promotion and disease prevention. Each perspective aims to foster higher capacity for family health systems to function appropriately in public health practice. Health promotion practitioners and researchers can explore family health perspectives with the potential for systems policy and practice adjustments in public health.

What are the elements of a whole system approach to community-centred public health? A qualitative study with public health leaders in England's local authority areas

OBJECTIVES

The aim of the study was to identify key elements of whole system approaches to building healthy communities and putting communities at the heart of public health with a focus on public health practice to reduce health inequalities.

DESIGN

A mixed-method qualitative study was undertaken. The primary method was semi-structured interviews with 17 public health leaders from 12 local areas. This was supplemented by a rapid review of literature, a survey of 342 members of the public via Public Health England's (PHE) People's Panel and a round-table discussion with 23 stakeholders.

SETTING

Local government in England.

RESULTS

Eleven elements of community-centred public health practice that constitute taking a whole system approach were identified. These were grouped into the headings of involving, strengthening, scaling and sustaining. The elements were underpinned by a set of values and principles.

CONCLUSION

Local public health leaders are in a strong position to develop a whole system approach to reducing health inequalities that puts communities at its heart. The elements, values and principles summarise what a supportive infrastructure looks like and this could be further tested with other localities and communities as a framework for scaling community-centred public health.

Using concept mapping to identify policy options and interventions towards people-centred health care services: a multi stakeholders perspective

BACKGROUND

People-centred health care (PCC) services are identified by the WHO as important building blocks towards universal health coverage. In 2016 the WHO formulated a comprehensive framework on integrated PCC services based on an international expert consultation. Yet, expert opinions may fail to recognize the needs of all health system stakeholders. Therefore, a consultation method that includes the health workforce and laypersons, can be instrumental to elaborate this framework more in-depth. This research sought to identify participants' perspectives on policy options and interventions to achieve people-centred health care services from a multi stakeholder perspective.

METHODS

Study participants, both laypersons and health professionals, were recruited in Belgium. A total of 53 participants engaged in one of the seven concept mapping workshops. In this workshop the concept mapping methodology developed by Trochim, a highly structured qualitative group method for brainstorming and idea sharing, was used to generate and structure participants´ perspectives on what is needed to achieve PCC services. The method was validated using the WHO framework.

RESULTS

The seven workshops together resulted in 452 different statements that were structured in a framework forming 35 clusters and four overarching domains. The four domains with their most prominent clusters were: (1) governance & policy with intersectoral health policies and affordable health for all; (2) health workforce with excellent communication skills, appreciation of health literacy challenges and respectful attitude based on cultural self-awareness; (3) integrated health services with a greater emphasis on prevention, health promotion and the availability of health education and (4) patient, person and community empowerment and participation with support for informal care, promotion of a healthy lifestyle and contextualised health education. Additionally, this study generated ideas that fitted into every single approach described in the WHO framework.

DISCUSSION AND CONCLUSION

This study shows that in order to achieve PCC a participative approach involving all stakeholders at all levels is needed. The concept mapping process is one of these approaches that brings together diverse stakeholders and foments their egalitarian and respectful participation. The framework that resulted from this study can inform future debate regarding planning, implementation and monitoring of PCC.