Public health informatics: A consensus on core competencies

Richards, Janise Elaine The University of Texas at Austin 2000 해외박사(DDOD)

This descriptive study identified competencies and the supporting skills and knowledge in public health informatics for public health informaticians and for general public health practitioners. Within the study's integrationist research design, which combines both qualitative and quantitative methods, the methods used were telephone interviews and a web-based Delphi survey. The interviews were substituted for round one of the traditional Delphi method. The interview data were analyzed using a constant comparison method and the final results were used to develop the Delphi survey items. A snowball sampling technique identified the study participants who met the selection criteria of expertise in public health informatics, public health education, public health practice or informatics education. Nine experts participated in the interview process and 23 in the Web-based Delphi. The interview results provided a new definition for public health informatics: Public health informatics is the innovative application of information science, computer science and information technology to improve management of information in public health practice and research, ultimately improving the health of the community. The interview results also indicated that public health informatics had four core domains: organizational and systems management, information systems, information technology, and public health sciences. Within these domains were 12 competencies and 60 supporting skills and knowledge items. After two rounds of the Web-based Delphi survey, the items reached consensus. Nine of the 12 competencies were determined to be critical and three were determined to be important for public health informaticians. For the general public health practitioner, two competencies were determined to be important, eight moderately important, and two insignificant. Of the supporting skills and knowledge, 55% were considered critical, 42% important, and 3% moderately important for public health informaticians. For general public health practitioners 20% were critical, 26% important, 36% moderately important and 18% insignificant or not important. This research can provide a foundation for developing public health informatics curricula in graduate programs and schools of public health and public health workforce training programs.

Preference values for health states associated with colon cancer and its treatment

Best, Jennie H University of Washington 2007 해외박사(DDOD)

The goal of our study was to develop health state descriptions and then use those descriptions to elicit preferences for the spectrum of health states associated with Stage III colorectal cancer (CRC) and to explore the effect of neuropathy associated with current standard of care for adjuvant treatment. To develop health state descriptions, we used published data to first develop a draft survey instrument. We then administered the survey to CRC patients. Based on the survey results, published data and input from four clinicians, we developed health states. We then used time trade-off (TTO) techniques to elicit preferences from a convenience sample of CRC patients and community members. We elicited preferences for seven health states: remission (REM); adjuvant therapy with no (ADJ_NO), mild (ADJ_MLD), moderate (ADJ_MOD), and severe (ADJ_SEV) neuropathy; metastatic stable (MET_ST); and metastatic progressive (MET_PR) disease. Each subject valued a randomly selected subset of 5 health states. T-tests were used to test for differences in preferences. Mean ages of the 49 patients and 49 community members were 60.6 and 59.8 years, respectively. 51% and 57% were male, respectively. Adjusted mean TTO values were estimated based on a multivariate regression analysis that included dummy variables for the seven chronic health states and the covariates age, race, gender, education, and current health. The adjusted mean TTO values for patients/community members, respectively, were: REM 0.80/0.71; ADJ_NO 0.58/0.48; ADJ_MLD 0.57/0.40; ADJ_MOD 0.50/0.35; ADJ_SEV 0.45/0.24; MET_ST 0.37/0.41; MET_PR 0.34/0.10. Significant differences were observed for both groups between TTO for REM and all adjuvant health states (p<0.001) and between ADJ_NO and metastatic health states (p≤0.001). Patients' values were 0.12 higher on average than community members (p<0.05). Exploratory analyses suggested that stage at diagnosis is systematically related to TTO preference values. After controlling for current health, patients diagnosed at later stages provided lower values. These findings highlight the trade-offs between the disutility of adjuvant treatment (particularly with moderate to severe neuropathy) and the higher utility of remission, and the severe utility loss during metastatic disease. The preference values obtained from this study should be useful for informing cost-utility analyses of treatment through progression of colon cancer.

The Frictions and Flows of Data-Intensive Transformations: A Comparative Study of Discourses, Practices, and Structures of Digital Health in the U.S. and India

Fiore-Silfvast, Brittany University of Washington 2014 해외박사(DDOD)

This dissertation examined the social and organizational implications of data-intensive transformations in healthcare through studying digital health and processes of informationalization in the U.S. and India. These transformations bring challenges of how to mobilize digital health data across different contexts of use and make data valuable for multiple stakeholders. To study these challenges I employed a combination of discourse analysis, ethnographic methods, and a comparative case study analysis to investigate digital health innovation across rural healthcare and urban consumer health and wellness settings in the U.S. and India. Through a communication lens this research examines sociotechnical interoperability for data across domains on three levels: discourses, communicative practices, and organizational structures and labor. Across the discourses and practices of different communities, I found communication gaps around health and wellness data. To explain these gaps I propose the concept of data valence to represent the different expectations and social values that mediate the social performance of data. Analysis through a data valence lens generated the following typology: actionability, connection, self-evidence, truthiness, discovery, accountability, and transparency. Mapping the multiple, and sometimes conflicting valences across contexts accounts for the multiple social and material lives of data and highlights tensions across stakeholder groups. I argue that this typology is portable to other fields of data-intensive work. In comparing cases of digital health pilot projects, the differences between reinforcing and redrawing professional boundary relations, and in the role of intermediary labor in translation of digital health data for clinical and administrative sensemaking, patient engagement, and algorithmic calibration, at one time support polyvalent data in the U.S. Telehealth case and hinder it in India mHealth. Further, in the aftermath of the terminated U.S. Telehealth project, aspects of the technology continued to materialize within organizational practices and structures, such that organizational changes became the technological residue of the pilot projects. This suggests digital health's emphasis on technological innovation overlooks essential organizational and communicative dimensions of informationalizing healthcare and needs to be expanded beyond measures of success and failure to account for how technological innovation extends into and co-evolves with a wider network of organizational practice.

Our Health Counts -- Unmasking Health and Social Disparities among Urban Aboriginal People in Ontario

Firestone, Michelle University of Toronto (Canada) 2013 해외박사(DDOD)

In Canada, accessible and culturally relevant population health data for urban First Nations, Metis and Inuit people are almost non-existent. There is a need for Aboriginal community centric research and data systems, specifically in the area of mental health and substance misuse. The goal of this research was to address these knowledge gaps. The three linked studies being presented were nested in the Our Health Counts (OHC) project, a multi-partnership study aimed at developing a baseline population health database for urban Aboriginal people living in Ontario. In the first study, concept mapping was used to engage urban Aboriginal stakeholders from three culturally diverse communities in identifying health priorities. After completing brainstorming, sorting and rating, and map interpretation sessions, three unique community specific maps emerged. Map clusters and their ratings reflected First Nations, Inuit, and Metis understandings of health. Concept mapping encouraged community participation and informed the development of three health assessment surveys. The second study generated a representative sample of First Nations adults and children living in Hamilton, Ontario by utilizing Respondent Driven Sampling (RDS), a modified chain-referral sampling approach. Population estimates were generated for household and personal income, mobility, over-crowding and food availability. Results revealed striking disparities in social determinants of health between First Nations and the general population. The third study used the RDS generated sample to examine mental health and substance misuse among First Nations adults living in Hamilton. Prevalence estimates were generated for diagnosis and treatment of a mental illness, depression, anxiety, post-traumatic stress disorder (PTSD), suicide, alcohol and substance misuse, and access to emotional supports. Findings indicated that First Nations adults living in Hamilton experience a disproportionate burden of mental health and substance misuse challenges. The three linked studies make innovative contributions to Aboriginal health research. Results clearly exemplify the effective application of community-based research methods that are grounded in local knowledge and built on existing community strengths and capacities. Representative population health data for urban First Nations will contribute to current deficiencies in health information; will shape policy and programming priorities as well as future research directions, particularly with respect to health and social disparities among this population.

Pathways to poor health outcomes for children of low income teen mothers

Liberatos, Penny Columbia University 2007 해외박사(DDOD)

Background. Child-bearing during adolescence is a serious social and public health concern with well-documented negative consequences for adolescent mothers and their children. Two causal hypotheses have been proposed to explain negative health consequences for offspring: (1) parenting: young maternal age and suboptimal parenting behaviors; and (2) social factors: social/family characteristics (e.g., poverty, single parenthood, low education, stress). Purpose. To identify and assess variables and causal pathways that influence the health of children of adolescent mothers and to evaluate the two causal hypotheses above. Methods. Subjects were 162 predominantly African-American and Latino adolescent mother-child dyads from low-income families receiving care from mainly publicly-funded facilities in New York City. Interviews were conducted with mothers about their health and that of their child. Pediatricians conducted medical examinations of the children (ages 12-48 months). The Notre Dame Parenting Project model of adolescent parenting was modified and expanded to focus more broadly on child health. Relationships among constructs in the revised model (i.e., stress, social support, maternal health, parenting) and their role in affecting child health outcomes were explored. Causal pathways supporting the influence of the social factors and parenting hypotheses on these outcomes were compared. Direct and indirect effects of model constructs were identified through a series of multivariate linear models organized sequentially using an approach by Alwin and Hauser (1975). Results. Key findings: (1) stress played an important role influencing the mother's and child's health both directly and indirectly; (2) role of social support was independent of stress and inconsistent, especially from the grandmother and child's father; and (3) education and poverty both influenced the mother's parenting behaviors and child health. Overall, findings showed that model constructs play an important role in child health. Comparison of pathways for the two causal hypotheses showed that both made an almost equal contribution in explaining child health outcomes. Conclusion. This study has combined the disciplines of public health and developmental psychology to address a serious public health issue. Future work can focus more closely on the pathways identified to gain a better understanding of the determinants of child health for offspring of adolescent mothers.

Psychological Health and Smoking in Young Adulthood: Smoking Trajectories and Responsiveness to State Cigarette Excise Taxes

Schmidt, Allison M ProQuest Dissertations & Theses The University of 2017 해외박사(DDOD)

While smoking rates have significantly decreased among the general population in the past several decades, they have not significantly decreased among those with poorer psychological health. As posited by theories such as the Transactional Model of Stress and Coping, smoking may represent an important coping mechanism for individuals who experience stress or unpleasant feelings related to poorer psychological health. If poorer psychological health is experienced during young adulthood, a critical time for tobacco use experimentation and uptake, individuals may be particularly likely to become dependent on nicotine and develop longer term smoking habits. In addition, tobacco control policies that have reduced tobacco use in the general population, like raising the price of cigarettes, may be less effective among people with poorer psychological health. Using two indicators of psychological health, a continuum of psychological distress and ever diagnosis of a mental illness, this dissertation explored first, how psychological health accounts for variability within and between individuals in trajectories of smoking (status and amount) across the ages of 18 to 30, and second, whether psychological health moderates the effectiveness of cigarette excise taxes in preventing and reducing smoking. Using a longitudinal national sample across years 2007 to 2013, between-individual effects were found such that individuals with poorer psychological health were more likely to be smokers and to smoke greater numbers of cigarettes over young adulthood than those with better psychological health (Aim 1 and Aim 2). Additionally, the positive effect of having a diagnosed mental illness on smoking amount increased with age, suggesting older young adults may be important targets for intervention (Aim 1). While the effect of cigarette excise taxes encouragingly was not shown to differ by psychological health, cigarette excise taxes showed little effect on smoking at all, perhaps suggesting taxes need to be raised higher than they have been to meaningfully impact smoking (Aim 2). Interventions should aim to target high-risk young adults with poorer psychological health to treat unpleasant psychological symptoms simultaneously with smoking prevention and cessation programs. Overall, this work helps us understand the relationships between psychological health, smoking, and tobacco control policy, with implications for interventions.

Health-related characteristics of American urban environments: Description, measurement, and associations with healthy behaviors

Smiley, Melissa J University of Michigan 2011 해외박사(DDOD)

Though research has consistently found associations between aspects of the built environment and human health, the mechanisms underlying these associations are not fully understood. This dissertation adds to the literature in this field that seeks to explore these mechanisms, as well as some inconsistencies in findings, by critically examining how environments are measured and analyzed. The first analysis found that health-related resources (i.e., supermarkets, recreational facilities, retail areas) were clustered at the block group level. The Health Opportunities Score, a combined measure of resource density, was diminished in block groups with higher minority populations. To the extent that resources were associated with health and healthy behaviors, the results suggested that the locations of a range of health-related resources have the potential to contribute to or exacerbate race/ethnic health inequalities. The second analysis found both an association between Health Opportunities and healthy behaviors (i.e., diet, physical activity, walking for transport) and evidence that this association was synergistic. Residence near multiple health-related resources was associated with healthy behaviors above and beyond the association with individual resources. This finding could at least partially explain persistent health disparities because the data indicated that residents of resource-poor areas were at an even greater resource-related disadvantage than might have been expected. The third analysis examined variation in people's perception of the built environment (i.e., aesthetic quality, access to healthy food, safety, walkability). These data revealed that variation in perception could be associated with characteristics of the environmental context, such as median income or population density. At the same time, varied perceptions of a single environment could also be due to actual environmental heterogeneity, which could not be controlled for in this analysis. These findings still suggested that common environmental indicators might be better measures of the environment in some census tracts (e.g., where there is little variation in self-reports) as compared to others. Collectively, the entire dissertation posed novel questions about environmental measures. The analyses revealed much about the patterning of multiple health-related resources, their relationship to healthy behaviors, and the importance of accounting for varied perceptions within a given environmental context.

Health disparities under market transition: Evidence from nine provinces in China, 1991--2004

Liang, Ke University of Pennsylvania 2008 해외박사(DDOD)

Existing research on socioeconomic inequality in health has documented significant associations between health and socioeconomic status (SES). Typically, income, education, and occupation are employed to measure the three major dimensions of stratification, including property, prestige, and power. Yet, it remains unclear how state power influences health status. Despite the large body of literature on the developed world, the developing countries have only recently come to the attention of researchers. As such, it has become increasingly interesting and important to explore the socioeconomic inequalities in health in developing countries, especially in countries where state policy has important influences on social stratification. This dissertation investigates social and economic inequalities in health in contemporary China, with a focus on the health implications of traditional SES components, as well as state policies. My findings indicate significant associations between health and the three major SES components. Income acts as a robust promoter of health, as well as an important mediator for associations between health and marriage, education, and political capital. Education impacts health in multiple ways. When other sociodemographic factors are considered, direct educational returns to health are only observed in rural areas. Meanwhile, in both rural and urban areas, the well educated are more likely to be hired and keep their jobs, to have higher income and more health knowledge, and to enter into and be promoted in the Chinese bureaucratic system. Through these pathways, education influences health indirectly. Being out of the labor force shows a negative influence on health. A dramatic increase in the unemployment rate in cities partially accounts for an emerging urban disadvantage in self-reported health between 1991 and 2004. Findings regarding self-reported health suggest a decline in health in both urban and rural areas between 1991 and 2004, as a consequence of continuous industrialization and social transition. During this period, urban residents are more likely to be exposed to physical, socioeconomic and psychological health risks, which accounts for an emerging urban-rural difference in self-reported health, in favor of rural residents. An increasing level of health expectation and awareness of disease among urban residents further inflates this urban health disadvantage. Political capital has significant and robust influences on health as well. Membership in the Communist Party shows considerable direct rewards for health. Being a cadre is associated with better monetary and non-monetary rewards, both of which are important health-promoting resources.

Social media and public health: Perspectives on implementing a social media presence for a public health organization

Hart, Mark University of Florida 2013 해외박사(DDOD)

Using the theoretical framework of Rogers' Diffusion on Innovation Model, the purpose of this study was to capture and describe the decision-making process of a start-up public health organization determining whether to implement a social media presence through the perspective of various stakeholders. Using Rogers' model allowed for an examination of the elements of social media as an innovation as well as examining the decision making process, the process of diffusion of social media in public health, and understanding the different characteristics of adopters of this innovation. The five designated decision-makers for a new public health training center, supported by two large public universities, were interviewed on three occasions to gauge their personal experience with social media, their thoughts on social media and public health, as well as their perceived positive and negative outcomes implementation could bring to their center. Documenting this process allows other public health organizations, and perhaps organizations outside of public health, the opportunity to see which factors caused the most deliberation by the stakeholders in their efforts towards a decision. The results of this study, guided by the experience and knowledge of successful public health educators and administrators gives an accurate description of the issues related to using social media more within the field of public health. In conclusion an action plan for the center was shared and suggestions for future research are provided.

Ethnic community health promotion and well-being: Relational and cultural praxis of Cape Verdean women health advocates

De Jesus, Maria Boston College 2006 해외박사(DDOD)

Health care researchers, policy makers, and providers are increasingly interested in the delivery of more culturally responsive services to ethnically and racially diverse immigrant populations. Important influences include the nation's changing demographics, ethnic and racial disparities in health care access, service utilization and outcomes, and competitive market forces. The present qualitative study explored and analyzed interviews with nine Cape Verdean women health advocates about their perspectives and daily experiences of working with Cape Verdean women on disease prevention and health promotion. It constructed a bottom-up, culturally-centered grounded theory of the women health advocates' praxis with community women with whom they work. In addition, it cast a critical perspective on universalist models of disease prevention and health promotion that privilege mainstream Western/ized understandings and experiences and are premised on the assumption that health-related preventative behaviors operate primarily within the realm of the individual. By beginning with and centering the marginalized voices and experiences of Cape Verdean women health advocates, the present study filled some of the gaps in the literature about the relational and cultural health praxis of culturally savvy community-based women health advocates. The constructivist grounded theory reflected the dynamic processes through which Cape Verdean women health advocates develop mutually engaging relationships with the women in their community. Overall, health and health promotion for Cape Verdean immigrant women were viewed as functions of the women's relationships with the women health advocates. Specifically, the health advocates referred to the effects of psychosocial, cultural, economic, and sociohistorical factors on community women's health as well as the different forms of community and structural violence that the women face on a daily basis. These contextual understandings informed how the health advocates make meaning of health for the women both at the individual and at the community level. The limitations of the study along with the implications of the findings for future health research, policy, and practice are discussed.