A Lost Opportunity

by Rick Austin May 13, 2014 04:02 PM

So, I listened to the new podcast from NACCHO, and after just under six minutes, it ended. Wait, what?


NACCHO’s Ian Goldstein interviewed Dr. John Tassey about some of the lessons learned from the 1995 Oklahoma City terrorist bombing. It was fascinating. It was too short.


Tassey is an associate professor of psychiatry and behavioral science at the University of Oklahoma, and a first responder to the 1995 bombing. He remains involved to this day in the development and expansion of the city’s emergency response system, particularly the mental health aspect.


He’s potentially a fount of information, both historical and operational, about disaster response and the need for public- and mental-health capabilities. For instance, he mentioned that, 19 years after the bombing, there are still community mental health needs emerging from the aftermath. This is interesting from a number of standpoints. What are the mental health issues being uncovered? Are the expanded capabilities of the Oklahoma City mental health facilities able to handle them? What could be done better?


No answers to any of those questions, as the podcast moved on to the next topic with no further consideration. Similarly, a throwaway comment about the emergence of a medical reserve corps following the bombing went unexplored. How did the reserve corps emerge? How has it integrated with Oklahoma City’s disaster response capabilities? How has it helped? No answers here.


The skills and experiences of local public health and mental health professionals like John Tassey are an invaluable resource for all of us. I would have liked to hear a little more.

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What About the Elephants in the Room?

by Rick Austin May 1, 2014 04:22 PM

ResearchImpact honcho and long-time friend of Research Into Action, David Phipps, recently published a journal club discussion of this fairly widely-known article by Grimshaw, et al., “Knowledge translation of research findings,” about KT and its effectiveness.


The ResearchImpact journal club is intended to foster discussion, so David raises more questions than he answers, but then, that’s the point.


His very first question has to do with the Grimshaw article’s assertion that the most valuable unit of knowledge is the “up-to-date” systematic review. David points out that systematic reviews, by their nature, take time, cost lots of money, and are not popular projects for original researchers. He asks, who will pay for them, who will do them, and do we really know that they are influential in decision- and policy-making?


The Grimshaw article’s emphasis on systematic reviews reveals, in my mind, a narrow view of what is effective, and why. The implicit attitude is that if we can just get good evidence into people’s hands, they can’t help but make useful, evidence-informed decisions. Particularly in the political policy arena, evidence is never sufficient; politicians view policy through the lens of what’s good for them. Self-interest trumps science every time.


Since he’s writing a journal club review for ResearchImpact, of course David is going to point out that the Grimshaw article barely mentions the role of knowledge brokers in knowledge translation. That’s indeed a curious omission when you consider that three of the five authors of the paper are Canadian, and are intimately familiar with the goals of the Canadian Institutes for Health Research (CIHR).


Perhaps it was beyond the reach of either the Grimshaw article or David’s discussion, but two major considerations that receive no play here are the issues of scope and sustainability. A consideration of the scope of a KT effort is implied in the Grimshaw article’s fifth key question, “With what effect should research knowledge be transferred?” Unfortunately, this is disposed of in a single, brief paragraph. Scope considerations are also indirectly raised in Melanie Barwick’s KT Planning Template, as it asks questions about partner roles, goals, strategies, and impact. What’s needed is an explicit discussion of what the researcher or knowledge broker expects to achieve: how wide, how deep, how many people?


The other elephant in the room is sustainability. Human nature being what it is, no one-shot knowledge translation campaign is going to achieve much. If you dispute that, consider tobacco. The Surgeon General’s office, the CDC, the FDA, the National Cancer Institute, the American Lung Association, the Campaign for Tobacco-Free Kids, and innumerable local health departments have been flogging the dangers of tobacco for more than 40 years, and yet we still have more than 50 million Americans using tobacco in one form or  another.


Discussing these big issues up front carries no guarantee that they will be resolved; time, money and energy are all finite resources. But at least they can be part of a realistic debate. What other issues should we be including in a realistic discussion of knowledge translation goals?

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Is There a More Depressing Phrase Than “A New Study Reveals…”?

by Rick Austin April 4, 2014 02:57 PM

See, this is why we can’t have a nice talk with the public about scientific research.


First, a statistical analysis of some elements of the National Longitudinal Study of Adolescent Health (known as Add Health) gets published in the new issue of Social Science Research, under the rubric “Personal traits, cohabitation, and marriage.” Then, it gets picked up by major news outlets like Atlantic Monthly and Slate because, you know, Science! and Relationships! and Page Views!


According to the news outlets, science – or should we say Science! – says that the existence of certain traits makes it more likely that you will end up finding a partner for marriage. (Shades of the Science News Cycle.)


Here’s the problem: A closer reading of the original study reveals that some convoluted statistical meta-analysis may or may not disclose some correlation between marriageability and the subjectively described traits of physical attractiveness, personality, and grooming. Here’s another problem: How do you operationally define attractiveness, personality, and grooming for the purposes of this study? You don’t. Instead, you rely on your literature review to mention that other studies have found that inter-rater reliability is not a problem, so you can assert that it’s not a problem here.


Here’s yet another problem: The authors of this study tout their inquiry into the effects of attractiveness, personality, and grooming as a novel breakthrough for their study. Well, no. Interviewers conducting the third wave of Add Health (2001-2002) were asked to rate each of their interviewees on five-point scales for attractiveness, personality, and grooming. The authors of the current study are mining the available data, not innovating or breaking new ground.


So, despite caveats and qualifications from the authors of the study, and some vague conclusions about some ill-defined traits, we end up with headlines like: “New Study Reveals Secret to Romantic Success, and It Doesn’t Sound So Hard to Achieve.”


Our Internet-driven attention deficit disorder continues to degrade the discourse between researchers and the public. Is there a solution? Or is it too late?

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Is the Practical Playbook Ready for Prime Time?

by Rick Austin March 13, 2014 04:15 PM

A few days ago, the deBeaumont Foundation, Duke University, and the Centers for Disease Control (CDC) announced the launch of the Practical Playbook, an online tool to assist in integrating public health and primary care.


I’ve spent some time on the site, and I applaud the intent of the project. Giving primary care doctors and public health officers more tools for working together and understanding each other’s work can only lead to good things.


But… Was this project beta tested? It’s been my experience that CDC’s involvement in a venture of this type is usually a guarantee that the design and structure have been pretty rigorously tested. Even a cursory look at the Practical Playbook reveals confusing, non-intuitive architecture, misdirected internal links, and some oddball design choices.


When you arrive at the main page of the Practical Playbook, the major categories “Learn,” “Do,” and “Share” pop up. The implication of the page design is that you can choose any category to start. Since the intent here is for healthcare and public health principals to work together for the first time, shouldn’t everyone be “learning” to start off? This sounds like quibbling, but you’re vying for busy, distracted eyeballs here. If it’s not crystal clear where your reader should go, your reader is going to pack up and leave.  


Some things you expect to be incomplete. For example, certain “Success Stories” categories are still empty; not surprising, given how new this project is. But why does a success story about cancer care suggest, at its conclusion, that the next story you’ll be interested in is one about IT investments and electronic health records?


Staying with the “playbook” metaphor, Practical Playbook has bobbled the ball, and needs to go back to the drawing board.

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NACCHO Story Bank Misses the Target

by Rick Austin February 28, 2014 04:11 PM

I just spent some time browsing NACCHO’s “Stories From the Field,” and I’m simultaneously fascinated and confused. This standalone website is operated as a resource for NACCHO members, and it has some impressive fundamentals, as well as links to outside resources.


As I browsed the stories that have been submitted from NACCHO members, it became clear that this concept of storytelling as a public health information tool is a tough one to grasp.


The site introduces the concept of storytelling as an effective tool in “The Value of Stories,” and then walks the reader through the basics in “Storytelling 101.” NACCHO members who would like to try their hand at this unfamiliar discipline are even given a step-by-step template in “Tell Your Story.”


The sample stories that have been posted are wildly uneven, as you might expect from people who have a master’s degree in public health, not a master’s degree in creative writing. But many of the stories also betray a misunderstanding of who the story is for.  


As the site points out in “The Value of Stories,” we’re attempting to reach people on the street, communities, government officials, legislators. Our effectiveness as storytellers depends on personal impact, a recognizable face, a compelling tale of success, or adversity overcome. That’s a tough one to grasp if it’s not your background, and what we get on the “Stories From the Field” website is a lot of “insider baseball” about PIOs staffing the EOC, needs assessment, policy infrastructure, target populations, and plenty of acronyms (MCH, MRC, FEMA, CDC).


There is a review process before stories are posted, but I’m guessing that this entails evaluating the entry for appropriateness, not efficacy. Maybe it’s beyond the scope of this NACCHO tool, but it would be nice to see some of these stories wrestled into a form with more focus and impact.


Take a look at “Stories From the Field,” and tell me what you think in the comments.

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