Data, capacity-building, and training needs to address rural health inequities in the Northwest United States: a qualitative study

OBJECTIVE

Rural public health system leaders struggle to access and use data for understanding local health inequities and to effectively allocate scarce resources to populations in need. This study sought to determine these rural public health system leaders' data access, capacity, and training needs.

MATERIALS AND METHODS

We conducted qualitative interviews across Alaska, Idaho, Oregon, and Washington with individuals expected to use population data for analysis or decision-making in rural communities. We used content analysis to identify themes.

RESULTS

We identified 2 broad themes: (1) challenges in accessing or using data to monitor and address health disparities and (2) needs for training in data use to address health inequities. Participants faced challenges accessing or using data to address rural disparities due to (a) limited availability or access to data, (b) data quality issues, (c) limited staff with expertise and resources for analyzing data, and (d) the diversity within rural jurisdictions. Participants also expressed opportunities for filling capacity gaps through training-particularly for displaying and communicating data.

DISCUSSION

Rural public health system leaders expressed data challenges, many of which can be aided by informatics solutions. These include interoperable, accessible, and usable tools that help capture, access, analyze, and display data to support health equity efforts in rural communities.

CONCLUSION

Informatics has the potential to address some of the daunting data-related challenges faced by rural public health system leaders working to enhance health equity. Future research should focus on developing informatics solutions to support data access and use in rural communities.

Developing an evidence-based public health informatics course

OBJECTIVES

This study assessed the need to develop a public health informatics (PHI) introductory course and determine contents of such a course.

METHODS

Community assessments employing focus group interviews and an online survey were utilized to determine course need and content.

RESULTS

Results revealed a need to provide PHI training to graduate public health students and suggested broad course content requirements. Results indicated lack of awareness of libraries and librarians as sources of public health information.

CONCLUSIONS

A graduate PHI course was developed and delivered. Additionally, implementation of a subject guide increased the library's profile.

Public Health Information Systems: Priorities and Practices for Successful Deployments

A fast paced workshop designed for senior public health decision makers and clinical leaders implementing information systems to support delivery of public health programs. The tutorial will introduce public health information systems and provide best practices for implementing solutions related to immunization, communicable disease case management and outbreak management. Using a combination of formats, the tutorial will: • Highlight key functionality of public health information systems. • Review global crises currently exposing gaps and deficiencies in public health information. • Examine governance, planning, and implementation priorities. • Highlight considerations supporting implementations nationally and in special populations. • Provide real, actionable lessons learned to take away and apply in the real world.

Public Health and Epidemiology Informatics: Recent Research and Trends in the United States

OBJECTIVES

To survey advances in public health and epidemiology informatics over the past three years.

METHODS

We conducted a review of English-language research works conducted in the domain of public health informatics (PHI), and published in MEDLINE between January 2012 and December 2014, where information and communication technology (ICT) was a primary subject, or a main component of the study methodology. Selected articles were synthesized using a thematic analysis using the Essential Services of Public Health as a typology.

RESULTS

Based on themes that emerged, we organized the advances into a model where applications that support the Essential Services are, in turn, supported by a socio-technical infrastructure that relies on government policies and ethical principles. That infrastructure, in turn, depends upon education and training of the public health workforce, development that creates novel or adapts existing infrastructure, and research that evaluates the success of the infrastructure. Finally, the persistence and growth of infrastructure depends on financial sustainability.

CONCLUSIONS

Public health informatics is a field that is growing in breadth, depth, and complexity. Several Essential Services have benefited from informatics, notably, "Monitor Health," "Diagnose & Investigate," and "Evaluate." Yet many Essential Services still have not yet benefited from advances such as maturing electronic health record systems, interoperability amongst health information systems, analytics for population health management, use of social media among consumers, and educational certification in clinical informatics. There is much work to be done to further advance the science of PHI as well as its impact on public health practice.

Alumni's perception of public health informatics competencies: lessons from the Graduate Program of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Indonesia

Public health informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning [1]. Unfortunately, limited reports exist concerning to the capacity building strategies to improve public health informatics workforce in limited-resources setting. In Indonesia, only three universities, including Universitas Gadjah Mada (UGM), offer master degree program on related public health informatics discipline. UGM started a new dedicated master program on Health Management Information Systems in 2005, under the auspice of the Graduate Program of Public Health at the Faculty of Medicine. This is the first tracer study to the alumni aiming to a) identify the gaps between curriculum and the current jobs and b) describe their perception on public health informatics competencies. We distributed questionnaires to 114 alumni with 36.84 % response rate. Despite low response rate, this study provided valuable resources to set up appropriate competencies, curriculum and capacity building strategies of public health informatics workforce in Indonesia.

Gaps in the existing public health informatics training programs: a challenge to the development of a skilled global workforce

The objective of this study was to explore public health informatics (PHI) training programs that currently exist to meet the growing demand for a trained global workforce. We used several search engines, scientific databases, and the websites of informatics organizations; sources included PubMed, Google, the American Medical Informatics Organization, and the International Medical Informatics Organization. The search was conducted from May to July 2011 and from January to February 2012 using key words such as informatics, public health informatics, or biomedical informatics along with academic programs, training, certificate, graduate programs, or postgraduate programs. Course titles and catalog descriptions were gathered from the program or institution websites. Variables included PHI program categories, location and mode of delivery, program credits, and costs. Each course was then categorized based on its title and description as available on the Internet. Finally, we matched course titles and descriptions with the competencies for PHIs determined by Centers for Disease Control and Prevention (CDC). Descriptive analysis was performed to report means and frequency distributions for continuous and categorical variables. Stratified analysis was performed to explore average credits and cost per credit among both the public and private institutions. Fifteen PHI programs were identified across 13 different institutions, the majority of which were US-based. The average number of credits and the associated costs required to obtain PHI training were much higher in private as compared to public institutions. The study results suggest that a need for online contextual and cost-effective PHI training programs exists to address the growing needs of professionals worldwide who are using technology to improve public health in their respective countries.

What do women know about government services and benefits?

This article examines how much women know about government services and benefits and discusses why this type of knowledge matters. Using data from a survey as well as focus groups conducted in Montreal and Toronto, we show that the women who are most likely to need information about these programs are often the least likely to be aware of them. This is especially true of low-income women, older women, and women who came to Canada as immigrants. We end by suggesting some steps that could be taken to address these knowledge gaps.

A curious jumble: the Canadian approach to online consumer health information

As part of a larger e-health strategy, Canadian governments have invested millions in online health information services for the lay public. These services are intended to reduce demands on the primary health care system by encouraging greater individual responsibility for health and are often promoted using the language of personal empowerment. In this paper, we describe how lay searchers generally look for online health information and discuss the disempowering challenges they are likely to face in (a) locating Canadian government-sponsored health information sites and (b) finding useful information on these sites to address everyday health concerns. We conclude with several recommendations for policy changes.

Integrating information literacy into the education of public health professionals: roles for librarians and the library

OBJECTIVE

The paper reviews the core competencies for public health professionals presented in the Institute of Medicine's (IOM's) report, Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century; describes improving information literacy (IL) as a mechanism for integrating the core competencies in public health education; and showcases IL as an opportunity for solidifying partnerships between academic librarians and public health educators.

METHODS

The IOM competencies, along with explicit examples of library support from a literature review of current IL trends in the health sciences, are analyzed.

RESULTS

Librarians can play a fundamental role in implementing the IOM's core competencies in shaping public health education for the twenty-first century. A partnership between public health educators and librarians through a transdisciplinary approach is recommended.

CONCLUSIONS

IL skills and competencies integrated into public health curricula through a collaborative partnership between public health educators and librarians can help integrate the IOM's core competencies and improve public health education.

Importance of public health informatics: a survey of public health schools and graduate programs in the United States

This paper examines the importance of data, information, and informatics to public health practice. Forty public health academicians from 40 schools and graduate programs of public health were interviewed. All agreed that informatics was important to public health practice. A qualitative analysis of their comments revealed their beliefs on the importance of informatics skills and knowledge to the practice of public health. The resulting comment groups varied from "some skills are more important than others" to "need all the skills." Eight "importance" comment groups were formed: 1) skills for all professionals; 2) some skills more than others; 3) yes, they need all the skills; 4) skills to become better practitioners; 5) usefulness to practitioners; 6) communication with public; 7) they're [the public] are depending on us; and 8) the future.

Developing a Web-based Data Mining Application to Impact Community Health Improvement Initiatives

This article describes how a team from the Virginia Department of Health (VDH) and the Virginia Center for Healthy Communities (VCHC) attended the UNC Management Academy for Public Health to learn skills to address Virginia's commitment to using technology to improve the public's health. After creating a business plan for a food-safety information Web site, team members used that experience as well as Management Academy training in information technology, the management of data and finances, and strategic partnering to create a comprehensive tool with which to place customizable population data in the hands of anyone interested in pursuing population health improvement. The Virginia Atlas of Community Health, launched through the VCHC in 2003, places clear, compelling data in the hands of those who can influence decisions at the local level and create the most impact for health. Since the program's inception, more than 2,000 individuals have registered as ongoing users of the Virginia Atlas. Initially funded by a Turning Point grant from the Robert Wood Johnson Foundation, the program is sustained through a series of smaller grants and funding from the VDH.

Mini-symposium — Public Health Observatories

Local public health departments have variable access to a public health intelligence function, and information skills are scarce. Public health observatories are supporting the development of professional standards for public health intelligence specialists and offer training opportunities for both defined public health specialists and generalist public health specialists. In addition observatories support public health practice through educational programmes in health impact assessment, health equity audit, public health intelligence, and the provision of toolkits and advice on methods. Observatories have a key role in supporting and developing networks, in particular public health analysts, and the use of interoperable websites is enhancing these opportunities.

Use of on-line evidence databases by Australian public health practitioners

OBJECTIVE

To investigate use of a web-based portal, known as the Clinical Information Access Program (CIAP), and evidence databases in an Australian population health workforce.

METHODS

Self-administered postal survey of 104 staff in a regional Division of Population Health in Sydney, Australia. The main outcome measures were CIAP use and organization support for CIAP use. Two thirds of the respondents agreed that using CIAP was a legitimate part of their practice. However, half agreed that staff were encouraged to use it. One in five respondents (21%) used CIAP weekly. CIAP use was significantly associated with medical qualification or, among non-medical staff, with having at least a Masters qualification. CIAP use was not associated with occupational category, gender, age, employment status nor years of experience. Use of specific evidence databases such as Cochrane also differed significantly by respondents' characteristics.

CONCLUSIONS

There has been only partial uptake of on-line databases among this population health workforce, particularly according to attainment of relevant postgraduate qualifications. As CIAP is a resource for evidence-based practice, greater effort to increase its use is recommended to ensure population health does not fall behind hospital-based clinicians.

The public health workforce

The development of a fully-competent public health workforce as a key component of the nation's public health infrastructure has become the focus of increasing attention. The subject is included in one, and is the major topic of a second, report from the Institute of Medicine published late in 2002. Workforce issues have stimulated the convening of the majority of public health-related associations in a range of collaborations on the subjects of defining, enumerating, credentialing, educating, and studying the workforce. The authors review the major questions confronting the field and introduce key components of current thinking about approaches to improvement.

Public health workforce development: progress, challenges, and opportunities

The public health workforce is key to strengthening public health infrastructure. National partners have articulated a vision of a sustainable and competent workforce prepared to deliver essential public health services. Six strategic elements provide a framework for action: monitoring workforce composition; identifying competencies and developing related curriculum; designing an integrated life-long learning delivery system; providing individual and organizational incentives to ensure competency development; conducting evaluation and research and assuring financial support. Partners convened in January 2003 to review progress and to re-evaluate strategies in light of the recently released Institute of Medicine reports on infrastructure and workforce issues. Although significant challenges remain, there is convergence on priorities for competency development, research questions to be addressed and next steps in the national dialogue on certification and credentialing in public health.

Many a slip between cup and lip. Process evaluation of a program to promote and support evidence-based public health practice

The main aims of this study are to document whether an intervention for promoting evidence-based public health practice had been delivered as intended and to explore the reasons for its lack of impact. Process data from the implementation of the program and data from interviews with 40 public health physicians are analyzed. Although they expressed satisfaction with the service, the doctors experienced the program as rather irrelevant for their daily work. They did not perceive that they dealt with many issues relevant for the use of research information, and if they did, referring to research would not make any difference to the way others perceived their advice. There is a need to develop more overlying strategies for integrating evidence into decision making than addressing the individual level.

A framework for the biomedical informatics curriculum

The problem of developing a curriculum for biomedical informatics is highly dependent on how we choose to define and practice the field. Numerous authors have questioned how to position biomedical informatics along the continuum of formal, empirical and engineering disciplines. A concern with current educational programs in biomedical informatics is that students finish without a clear understanding of the relation between theory and practice, or worse, with the impression that the field does not possess any theoretical basis. In this paper, we propose that biomedical informatics curricula explicitly address skills and competencies at three levels: formal, empirical, and applied. We posit that that knowledge of formalization is necessary to build testable empirical models, and that model-driven approaches are necessary for deploying information systems that can be evaluated in a meaningful way. A curricular framework is proposed that identifies a set of methods, techniques and theories that have broad applicability within the domain of biomedicine, and which can span a wide range of application areas: bioinformatics, imaging informatics, clinical informatics and public health informatics. A stronger linkage between theory and practice will result in students who are empowered to create effective and lasting solutions to biomedical problems.

Development of competency-based on-line public health informatics tutorials: accessing and using on-line public health data and information

In response to training and information needs of the public health workforce, the New York City Department of Health and Mental Hygiene, in collaboration with the Department of Biomedical Informatics, Columbia University and the New York Academy of Medicine, is developing a series of on-line, interactive tutorials in public health informatics. The goal is to teach public health practitioners how to locate, use, and disseminate data and information on the Internet, while imparting basic informatics principles. Course content is based on Public Health Informatics Competencies, and evaluation will be performed by measuring changes in self-efficacy and knowledge as well as determining user satisfaction.

Measuring the Impact of a Public Health Data Training Program

In spring and fall of 2000, 109 community health professionals participated in "Public Health Data: Our Silent Partner," a training program developed by the Centers for Disease Control and Prevention (CDC). The two-day training was offered four times in different locations in New York State in response to local health departments and community partners identifying a need for data analysis training. Participants completed evaluations during the training, and they were surveyed within a year of completing the training. This article discusses the impact of the training and suggests ways to increase the value of the training.