Public Health Report Card Formats for Multiple, Diverse Audiences

California Sustainability Indicators Symposium - January 2011

Marcos Athanasoulis, MPH, Dr.PHSenior IT Advisor, Harvard Medical School

Chief Technology Officer, Healthy Communities Institute

Determinants Of Health

Medical Care 10% Genetics 20% Environment 20% Lifestyle 50%

Sources: U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. Understanding and Improving Health, and Objectives for Improving Health. Washington, DC: U.S. Government Printing Office, November 2000; Vol.1; pg 18. ; US Department of Health and Human Services, Washington, DC 20201.

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Organization: Healthy Communities Institute (HCI)

Mission: Improve the health, vitality and environmental sustainability of communities, counties and states

Products: Healthy Communities Network (HCN) – provide community indicator dashboards and best practice sharing tools – locally

History: Len Duhl, UC Berkeley, “Healthy Cities” 1990

Headquarters: Sausalito, California

Problem: lots of decentralized data, centralize, make understandable, lead to informed action (Change Theory)

Coverage: 25 million+ lives in USA (Counties and States)

Healthy Communities Institute Overview

Process: General research and interviewed Directors of HHS (County); Hospital Council members; Coalitions; CDC; WHO; NGOs, information technology suppliers, etc.

Question – How communities make change Question – How communities could better share best practices Finding: Most information about a community lives in organizational silos

and often reported only on paper. Finding: No system shows status of many variables affecting quality of life

(health, environmental sustainability, public safety, economic climate, etc) in a community, nor how to use that information to effect change.

Finding: General consensus was that to best achieve its goals, an organization – such as a city or county – must be able to see how it is doing over time.

How can IT be used to help communities better track health measures and manage the health of people in their communities?

RESEARCH

Grant Received 2002

Theory Change Process

Implied Feature

Implementation Technologies Examples

Health Belief Model

Perceptions of: susceptibility, severity, benefits, and barriers to health actions

• Awareness and evaluation of risks leads to action

• Communicate with peers & leaders in an appropriate framework

• Assessment of individual beliefs

Email, real-time chat groups, interactive questionnaires, and subject searching

HRAs, Therapeutic Learning Program (TLP); Health Decisions

Social Learning Theory

• Expectancies• Incentives• Self-efficacy

• Evaluating beliefs about how events are connected

• Consequences• Ability to change• Reinforcement

• Communication with peers & leaders in an appropriate framework

• Assessment of perceived capability to sustain change

• Contextual counseling

Email, real-time chat groups, interactive questionnaires, and subject searching

HRAs, TLP, social support groups; Health Decisions

Theory of Reasoned Action

• Seeing need for change

• Know which behaviors are safe & which are not

• Learn skills to change• Develop support for

implementing change

• Role of intention and perceived normative expectation in behavior

• “Choice” heavily influenced by social norms

• Communication with peers & leaders in an appropriate framework

• Assessment of perceived capability to sustain change

• Role-playing and simulation

Email, real-time chat groups, interactive questionnaires, subject searching, and simulation games

HRAs, TLP, social support groups, “Brothers” video (modeling behavior shows)

Trans-theoretical

• Precontemplation, contemplation, preparation, action maintenance

• Awareness and evaluation of risks

• Planning tools• Maintenance

tools

• Communication with peers & leaders in an appropriate framework

• Assessment of perceived capability to sustain change

• Contextual counseling

Email, real-time chat groups, subject searching, and simulation games

HRAs, TLP, social support groups

Theory Change Process

Implied Feature

Implementation Technologies Examples

Consensualist

• Evolving values of consensus

Taking person initiative for societal changeDeconstructing and reconstructing explicit norms

• Organization & mobilization of grass roots groups

• Discussion and debate

Email broadcast, newsgroups, lotus notesNeeded: large-scale decision making groupware

Political action based on values

Social Conflict

• Ideological differences between social units around materialism

• Making information publicly available (re: economic powers and population needs)

• Expanded access to electronic democratic forums, electronic “town halls”

• Freedom of Information Act

Email broadcast, newsgroups, lotus notesNeeded: large-scale decision making groupware

Political action based on materialism (via Internet)

Friere

• Ideological differences between social units around materialism

• Group health education

• Social activism

• Electronic: disclosure & role-playing groups

• Organization & mobilization of grass roots groups

Needed: software framework and method of engaging users

Political action for community (via Internet)

Diffusion

• Knowledge, persuasion, decision, implementation, confirmation

• Societal adoption and popularization of innovations

• Compatibility of CHINs

• Engage critical mass of users

Networked technologies and standardization

Internet

Change Theories

RESEARCH

Awareness

Assessment/Severity

Communication

Decision Support

Operationalizing Decisions

Tracking and Records

Summary Of The Change Process

RESEARCH

Community Change Process And Related Features

Community Health Assessment•Database of health indicators for communities•Interactive program(s) to help assess community health•Comparative analysis tools•Health risk assessment community aggregator•Community profiling

Communication • Database of people• Large scale discussions and chat tools• Linkages to people from all relevant databases in the Network• Contact database of “like interests”• Clearinghouse database for Cities regarding intervention projects that are

seeking partners and assistance

Decision Support• “What-If” simulator tools• Lists of key issues for major decision areas• Agents – a set of agents and other “proactive”

tools such as email reminders and alerts that will use latest agent technologies

• Toolbox – leadership skills, etc.

Operationalizing Decisions•QOL toolset for local Board of Supervisors for use in city planning •Database of promising practice interventions, contact information, stories, etc.•List of local resources

Tracking and Records•Community health records allowing longitudinal tracking, GIS and graphical front end•Electronic community tracking tool•Data aggregator - Is there community desire to change?•Longitudinal reporting of ‘intervention tools’ and Best Practices

Services To be provided by Healthy Cities Personnel as well as other product and service providers:•How to use the Network•How to start/sustain healthy city programs•How to find people•How to find low cost products and services •How to find local or virtual consultants

Awareness•Community health news and newsletters•GIS front end and Natural Language Processing front end as search mechanisms for health-related questions that cut across multiple databases:

–Searchable National, State and Local population databases–Searchable databases of best practices, return-on-investment analyses of various health interventions–Databases of stories–Databases of people & researchers (available for consultation or looking for projects)–Database of useful web sites and resources

RESEARCH

Criteria Of System Development

Find quality of life indicators that relate to health Create visual representation of the data Create locally relevant information (views) to support the change

process Help communities learn from each other Capture information over time to allow tracking and manage to goal Make easy for communities to use and implement (no programming

needed) Make inexpensive for communities to access Make useful to all key users/stakeholders

RESEARCH

Community Dashboard

Collaboration Centers

Evaluation & Tracking

Promising Practices

Based On Change Theory

HCN System Capabilities

Form working groups

Set local goals Manage

achievement of objectives

100-150 indicators

Color coded Constantly

updated

1400 in database

Programs and policies

Evaluation based

HP 2010/2020 tracker

Local priorities tracker

Comparative and longitudinal evaluation

Collaboration Centers

Evaluation & Tracking

Community Dashboard

Promising Practices

A “Living” Community Needs Assessment, understand what is working and not working in the community/state, move from data gathering to informed action Strategic planning PHAB assessments MAPP programs Link to GIS and data

warehouse systems

Promotes public health and community development best practice sharing

Brings stakeholders together, develop local goals, drive community engagement, facilitate communication to form and manage working groups

Track progress to goals:HP 2010/2020 goalsLocally defined goals

HCI CHNA System: Capabilities And Benefits

3 Pilots

Current Partners

Pending Partners

Demonstration

PROTO

TYPE

Private and Confidential

Benefits

Create transparency and accountability Support best practice sharing Offload system management to centralized group Helps meet mission/regulatory obligations of

community assessment and reporting Collects the knowledge of the community Helps all stakeholders make informed change

PROTO

TYPE

Private and Confidential

Facilitate Community Change Process

Challenges and opportunities

Indicator and content updating time consuming Over 100 data sources and 40-50% of data must be

gathered state by state Data still come as PDFs and non machine readable

formats Quality rating of promising practices Facilitating comparison between communities Reporting at detailed neighborhood levels (data

confidentiality) Moving towards the “cloud”

CHDI Open Gov

Creating better developer tools Leveraging social media

PROTO

TYPE

It’s hard work!

Questions?

EvaluationMetric Measurement source Description/Example Goals

Visits to Site Site log statistics Popularity of the website is one measure of success.

Length of stay Site log statistics Ability to engage users is a measure of the sites’ value and interest to users.

Newsletter signups Site database This metric measures distribution of data and content.

Return visits (prior users who return in a given month)

Site log statistics This metric demonstrates sustained value to a set of end users.

Popularity Google Page Rank Site consistently comes up in top 5 - 10 sites for searches on Google related to Marin and health care issues

Usage of resources Site log statistics Resources, such as promising practices, will have itemized measures of how many times specific content or resources have been viewed and/or downloaded. This is a measure of the most popular content and will help direct pilot system refinement.

User satisfaction Results of on-site polls This measure assesses satisfaction among site users.

Awareness Annual survey of a sample of users from targeted groups, including policy, and community leaders.

Important to measure whether the target audience is aware of the website and is an indicator successful site promotion.

Meets community needs Annual survey of a sample of users from targeted groups, including policy, and community leaders.

It is important to measure whether the key audiences find high value and usability of the website.

Quality of information architecture

Focus groups and usability testing with potential users

The term “information architecture” describes the combination of the websites’ user interface, functions and content. It is important to assess the acceptability (i.e. cultural acceptability), usability (literacy level, interface), and content (i.e. data quality or usefulness). Positive feedback and recommendations from focus groups at different stages during the development and and implementation process.

PROTO

TYPE

Private and Confidential

Opportunity!