Dissemination of Health = Engagement of the Community

Maria C. Mora Pinzon, MD, MS
Preventive Medicine Resident, UW-Madison, 2015-2017

On December 14-15, 2015, I had the opportunity to attend the 8th Annual Conference on the Science of Dissemination and Implementation sponsored by Academy Health and the National Institutes of Health.  The theme of this year’s conference was Optimizing Personal and Population Health. 

After two days of inspiring speakers, I feel motivated and encouraged for the future of health. I know there are still opportunities and challenges of integrating evidence-based practice and service delivery, but we are on the right path, and I hope that I can share what I learned with you.

These were the most common words used on Twitter in relation to the conference:

The major takeaway of this conference was “Engage your community”. In public health we know that the community is an important part of our work: they are one of the so-called stakeholders, but sometimes they are not at the table were decisions and plans are made. Dr. America Bracho (Executive Director of Latino Health Access) was the keynote speaker of the conference, and she gave wonderful examples of how to engage your community. They live the data and are the experts on the situation, and we need to see them as such. In her organization the “promotores” (health promoters) are leaders from the community that were recruited in the organization for their heart, then they were trained for their job. Check out her TED talk.  Here are some other examples of true community engagement: Grandmothers of Nepal, Gates Foundation, and particularly Melinda Gates’ work in contraception. 

What do all of these initiatives have in common? They asked the community what is important to them and worked together towards a goal. These examples are not about organizations going to a community and saying: You have a problem and here is how to solve it. They are about organizations going to a community and saying: What do you think of your community? Do you think you have a problem? How to you think it can be improved? Let us help you.

To put these ideas into practice, go beyond your comfort zone and engage your community in all stages of your research (Planning, Institutional Review Board (IRB), Dissemination, Implementation, Evaluation), as well as other experts (economists, social workers, anthropologists, journalists, lawyers, policymakers, sociologists, statisticians). There are people out there that can improve your work, and we need them to improve implementation research and health overall.

Another speaker was Dr. LaMar Hasbrouck (Executive Director of The National Association of County and City Health Officials – NACCHO), who said: “If you think that public health departments are important, please quantify their value”.  We need to prove that what we do in public health matters and that things are better because we are here. Because of that, it is important to engage experts early in the process of research/implementation of any initiative. We need to quantify what we do and the outcomes we get, Even if we show improved outcomes, we also need to show that those outcomes are cost-effective to the society and the economy overall. And whatever you do, don’t lose the human side of your research, don’t lose the history, because histories compel and relate to others in ways that data will never do.

There is so much to be said but there is not enough time, so find below some other thoughts and links for more information:
  • Equity is not equality. Work with your communities to decrease disparities, since some populations will need more investment than others to improve their health outcomes. Work with your policymakers to make sure that they understand that dividing resources equally might not be appropriate (one-size doesn’t fit all).
  • Learning communities (of practice) are not research communities (of discovery); the former uses a feedback tool, where data is analyzed and introduced back to the system to improve it, as shown in the graph below (The Knowledge-to-Action Framework).
  • You don’t need a randomized trial to show that your intervention works.  Sometimes researchers are not the ones applying the intervention, or randomization is not possible (e.g., living wage, health insurance coverage). Even in those cases you can quantify and estimate the value of your intervention. Work with people in academia, including statisticians, to identify the best way to evaluate your program and get the word out.
  • Sustainability is key, and it relies on leadership (#champions) and resources. You can assess the sustainability of your program using an online tool: https://sustaintool.org/
  • If we need “Translation Research” to disseminate your work, maybe it was not in the right language to begin with. The language of your research results is key; publishing in academic journals is appropriate, but your research needs to reach those that live it.
  • Policy has a significant impact on people’s lives. If you want to see a change, don’t forget to involve your policymaker or government representative. 

For more information, you can check Twitter with the hashtag #discience15, the blog for the conference, or the conference presentation slides at http://diconference.academyhealth.org/agenda/slides.  

Happy Holidays!