Ross C. Brownson’s research while affiliated with University of Washington and other places

Background Designing for Dissemination and Sustainability (D4DS) principles and methods can support the development of research products (interventions, tools, findings) that match well with the needs and context of the intended audience and setting. D4DS principles and methods are not well-known or used during clinical and public health research; research teams would benefit from applying D4DS. This paper presents the development of a new digital platform for research teams to learn and apply a D4DS process to their work. Methods A user-centered design (UCD) approach engaged users (n = 14) and an expert panel (n = 6) in an iterative design process from discovery to prototyping and testing. We led five design sessions using Zoom and Figma software over a 5-month period. Users (71% academics; 29% practitioners) participated in at least 2 sessions. Following design sessions, feedback from users was summarized and discussed to generate design decisions. A prototype was then built and heuristically tested with 11 users who were asked to complete multiple tasks within the platform while verbalizing their decision-making using the ‘think aloud’ procedure. The System Usability Scale (SUS) was administered at the end of each testing session. After refinements to the platform were made, usability was reassessed with 7 of 11 same users to examine changes. Results The interactive digital platform (the D4DS Planner) has two main components: 1) the Education Hub (e.g., searchable platform with literature, videos, websites) and 2) the Action Planner. The Action Planner includes 7 interactive steps that walk users through a set of activities to generate a downloadable D4DS action plan for their project. Participants reported that the prototype tool was moderately usable (SUS = 66) but improved following refinements (SUS = 71). Conclusions This is a first of its kind tool that supports research teams in learning about and explicitly applying D4DS to their work. The use of this publicly available tool may increase the adoption, impact, and sustainment of a wide range of research products. The use of UCD yielded a tool that is easy to use. This tool's future use and impact will be evaluated with a broader sample of community partners and projects and the tool will continue to be refined and improved.

Objective This article focuses on supports and challenges to health equity that small local health departments (LHDs) experienced while working toward national reaccreditation or Pathways Recognition with the Public Health Accreditation Board’s Standards & Measures Version 2022 (PHAB S&M v2022). Design The study team conducted 22 qualitative interview sessions with members of health department leadership teams. Setting In the spring of 2024, participants from 4 small LHDs in the western and midwestern regions of the United States participated in individual remote interview sessions. Participants Participants were members of leadership teams in LHDs with population jurisdictions less than 50 000. Main Outcome Measure(s) Common challenges relating to the health equity measures in the PHAB S&M v2022 included external influences on equity language; lack of small population data; and racially and ethnically homogeneous populations and staff. The main support was the national equity standards provided justification for pursuing equity work. Results Strategies to overcome challenges associated with the equity measures included staff training, seeking alternative equity language, and examining socioeconomic inequities in addition to race and ethnicity. Internal workforce understanding of health equity was improved through department-wide training initiatives. When working under restrictive language requirements for state agencies, grants, and other funding sources, staff suggested using alternative phrases and keywords such as level playing field and equal access . When addressing racially and ethnically homogenous populations, staff pursued equity in terms of income and focused on those living with pre-existing conditions (ie, diabetes). Conclusions Ensuring that LHDs can work toward health equity is crucial for reducing health inequities. While the equity focus of PHAB S&M v2022 proved challenging, for this selection of LHDs, participants affirmed that PHAB accreditation allowed them to solidify their equity work to better serve their communities.

Background As dissemination and implementation (D&I) research increases, we must continue to expand training capacity and research networks. Documenting, understanding, and enhancing advice networks identifies key connectors and areas where networks are less established. In 2012 Norton et al. mapped D&I science advice and collaboration networks. The current study builds on this work and aims to map current D&I research advice networks. Methods D&I researchers in the United States (US) and Canada were identified through a combination of publication metrics, and key persons identified networks and were invited to participate (n = 1,576). In this social network analysis study, participants completed an online survey identifying up to 10 people from whom they sought and/or gave advice on D&I research. Participants identified four types of advice received: research methods, grant, career, or another type (e.g., work/life balance). We used descriptive statistics to characterize the sample and network metrics and visualizations to describe the composition of advice networks. Results A total of 482 individuals completed the survey. Eighty-six (18%) worked in Canada and 396 (82%) in the US. Respondents had varying D&I research expertise levels; 14% beginner expertise, 45% intermediate, 29% advanced, and 12% expert. The advice network included 978 connected nodes/individuals. For all research types, out-degree, or advice giving, was higher for those with advanced or expert-level expertise (6.9 and 11.9, respectively) than those with beginner or intermediate expertise (0.8 and 2.2, respectively). Respondents reporting White race reported giving (out-degree = 5.2) and receiving (in-degree = 6.1) more advice compared to individuals reporting Asian (out-degree = 2.9, in-degree = 5.3), Black (out-degree = 2.3, in-degree = 5.2), or other races (out-degree = 2.5, in-degree = 5.4). Assortativity analyses revealed 98% of network ties came from individuals within the same country. The top two reasons for advice seeking were trusting the individual to give good advice (78%) and the individual’s knowledge/experience in specific D&I content (69%). Conclusions The D&I research network is becoming more dispersed as the field expands. Findings highlight opportunities to further connect D&I researchers in the US and Canada, individuals with emerging skills in D&I research, and minoritized racial groups. Expanding peer mentoring opportunities, especially for minoritized groups, can enhance the field’s capacity for growth.

Context This paper describes experiences and views of leadership teams from 4 small local health departments (LHDs) seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022. The Pathways program launched in 2022 provides additional supports for improvement of public health practice. Objective Given the need to accelerate accreditation among small health departments, the purpose of this study is to share small health departments’ strategies for overcoming accreditation challenges and actionable advice for use by other health departments. Design In this descriptive qualitative study, the study team conducted 22 individual interviews with 4 small LHDs from January to March 2024. Setting Participating small health departments were located in the Midwestern and Western United States with staff sizes ranging from 3 to 47. Participants Interview participants included small health department leadership teams, a local board of health member, and a contracted external accreditation consultant. Main Outcome Measures We used a semi-structured interview guide to elicit participant experiences and views on accreditation processes, benefits, facilitators, strategies for overcoming challenges, and advice for other small health departments. Results Participants suggested that accreditation benefits far outweighed the challenges. Perceived benefits included improved organizational procedures, equitable delivery of needed effective programs and services, and enhanced public perception. Key strategies to overcome staff capacity challenges were establishing a team approach and orienting and mentoring new staff in the “why” and “how” of accreditation. Advice included learning what is involved, taking the time to lay a foundation beforehand, and not waiting for a perfect time as accreditation is about improvement, not perfection. Conclusions Small health departments can achieve and maintain PHAB accreditation by strategically implementing strategies to overcome staff capacity and other challenges. The Pathways Recognition program is a supportive option for small health departments wanting to improve public health practice.

This paper explores how small local health departments (LHDs) motivated staff members, communicated progress toward Public Health Accreditation Board accreditation or Pathways Recognition, and celebrated interim and final accreditation accomplishments. Qualitative key informant interviews were conducted with 22 employees and affiliates of 4 LHDs with jurisdiction populations <50 000. LHDs motivated staff through ownership, creative strategies to monitor and record progress, and meaningful no- or low-cost incentives. Participants communicated accreditation progress internally and externally through in-person and electronic communication. Individuals described small rituals and large, community-wide celebrations to express collective investment in and ownership of the accreditation process. Strategies to motivate staff were top-down and bottom-up, and accreditation status updates were communicated through multiple channels. Participants viewed celebrations as valuable aspects of the accreditation process. Reaccreditation participants deemed Public Health Accreditation Board accreditation worthy of celebration and an accomplishment to share with the community.

Introduction There is increasing pressure on the federal research budget and shifting public opinions about the value of the academic enterprise. We must develop and apply metrics that demonstrate the broad benefits of research for health and society. The Translational Science Benefits Model (TSBM) measures the impact of large-scale translational science initiatives, such as the National Cancer Institute’s Cancer Moonshot. TSBM provides the scaffolding to illustrate how science has real-world health impacts. We propose an expansion of the TSBM to explicitly include implementation-focused outcomes. Methods TSBM includes four categories of benefits, including (1) clinical and medical, (2) community and public health, (3) economic, and (4) policy and legislative. Implementation science outcomes serve as a precursor to the model’s established domains of impact and can help to sharpen focus on the translational steps needed to achieve a broad range of impacts. We provide several examples of studies that illustrate these implementation outcomes and other clinical and community benefits. Conclusions It is important to consider a broad range of scientific impacts and the conditions that are necessary to achieve them. The expansion of the TSBM to include implementation science outcomes may help to accelerate the cancer community’s ability to achieve the goal of preventing 4 million cancer deaths by 2047.

Background Researchers generally do an excellent job tracking the scientific impacts of their scholarship in ways that are relevant for academia (e.g., publications, grants) but too often neglect to focus on broader impacts on population health and equity. The National Cancer Institute’s Implementation Science Centers in Cancer Control (ISC3) includes 7 P50 Centers that are interested in broad measures of impact. We provide an overview of the approach underway within the ISC3 consortium to identify health and social impacts. Methods ISC3 adapted and applied the Translational Science Benefits Model (TSBM) to identify the impact on the discipline of D&I science and to consider dissemination and implementation (D&I) impacts in the four original TSBM domains: (1) clinical; (2) community; (3) economic; and (4) policy. To collect data from all Centers, we: (1) co-developed a set of detailed impact indicators with examples; (2) created a data collection template; and (3) summarized the impact data from each center. Results Based on data from 48 ISC3 pilot studies, cores, or consortium activities, we identified 84 distinct benefits. The most common impacts were shown for implementation science (43%), community (28%), and clinical (18%). Frequent audiences included primary care providers, public health practitioners, and community partners. ISC3 members highlighted the need for product feedback, and storytelling assistance to advance impact. Conclusions The ISC3 consortium is using a participatory approach to successfully apply the TSBM, thus seeking to maximize the real-world impacts of D&I science. The D&I field needs to prioritize ways to more fully document and communicate societal impacts.

Purpose The Physical Activity Policy at the National and City Levels Project aimed to develop and test a tool to assess how national and subnational (city and region) governments collaborate to develop and implement health-enhancing physical activity (HEPA) policies. Project Description The development of the “Interaction between National and Local Government Levels in Development and Implementation of Physical Activity Policies Tool” (INTEGRATE-PA-Pol) took place in three phases: 1) scoping review to identify local government physical activity promotion policies and instruments for assessing them, 2) questionnaires development, and 3) cognitive response testing (validity testing and item modification) with local physical activity experts. The final tool comprises six questionnaires assessing how national and subnational governments (city and region) collaborate to develop and implement HEPA policies. An observational cross-sectional study was conducted in four Latin American countries and eight of their cities to test the feasibility of the tool used for global surveillance. GoPA! Country Contacts from each country were invited to serve as their country’s principal investigators. Country Contacts identified the main sectors, key actors, and policymakers from each sector involved in HEPA policy development and implementation at the national level, the capital city, and an additional city for participant recruitment. Between August 2022 and February 2023, online snowball sampling surveys collected data on national and subnational government informants' perspectives on the development and implementation stages of national and local HEPA policies. The pilot study demonstrated the feasibility of collecting national and subnational HEPA policy data across countries with the active collaboration of GoPA! Country Contacts. We also successfully identified governmental interactions throughout the PA policy process, suggesting suboptimal engagement between national and subnational levels. Conclusions This tool can assist in better understanding how government levels and sectors collaborate during the HEPA policy process and will help uncover policy gaps and improve policy translation between national and subnational (city and region) governments. Our tool will contribute to developing and implementing a global public policy monitoring system to enable benchmarking and priority setting for HEPA policies.

Background Research dissemination is essential to accelerate the translating of evidence into practice. Little is known about dissemination among Chinese public health researchers. This study aimed to explore the understanding and practices of disseminating research findings and to identify barriers and facilitators that influence dissemination activities to non-research audiences. Methods This study deployed an exploratory qualitative design with purposive and snowball sampling. One focus group with 5 participants and 12 in-depth interviews were conducted with participants working in diverse fields from universities (n = 10), the National Chinese Center for Disease Control and Prevention (n = 4), the Chinese National Cancer Center (n = 1), the Chinese National Center for Cardiovascular Disease (n = 1), and China office of a global research institute (n = 1) from May to December 2021 to reach saturation. Data were initially analyzed using inductive thematic analysis. The designing for dissemination (D4D) logic model was then used to organize themes and subthemes. Two coders independently coded all transcripts and discussed disparities to reach a consensus. Results Out of 17 participants, 12 misunderstood the concept of dissemination; 14 had disseminated to non-research audiences: 10 to the public, 10 to practitioners, and 9 to policymakers. We identified multiple barriers to dissemination to non-research audiences across four phases of the D4D logic model, including low priority of dissemination, limited application of D4D strategies, insufficient support from the research organizations, practice settings, and health systems, and overemphasis on academic publications. Conclusions There was a lack of understanding and experience of dissemination, indicating a lack of emphasis on active dissemination in China. We provide implications for raising awareness, building capacity, facilitating multidisciplinary collaboration, providing incentives and infrastructure, changing climate and culture, establishing communication and executive networks, and accelerating systematic shifts in impact focus.

Context This article focuses on 4 small local health departments (LHDs) that were in the process of seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022. Objective The objective of this study was to explore the experiences of 4 small LHDs related to Quality Improvement (QI) and Performance Management (PM) in their pursuit of PHAB reaccreditation or Pathways Recognition. Design A team of researchers conducted 22 qualitative interviews with health department leaders and staff. Findings relative to QI/PM represent an embedded case study since they were part of a larger investigation. Setting The research team conducted interviews remotely with health departments located in the West and Midwest. Participants Participants included adults at least 18 years old and employed in 1 of 4 health departments. Main Outcome Measures Emergent themes from this qualitative investigation included using QI/PM tracking systems, building staff buy-in for QI/PM, integrating QI/PM into daily work, and advice for other health departments regarding QI/PM. Results Participants suggested that tracking systems helped them manage QI/PM processes. Staff buy-in for QI/PM was strengthened by building a sense of ownership of the process and connecting improvement processes to outcomes. Health departments integrated QI/PM into daily work by leadership modeling and communicating expectations. Advice for other health departments included finding a QI system that was easy to follow and recognizing the role of QI/PM in improving performance to better support the wellbeing of the community. Conclusions QI/PM are important tools for health department effectiveness. Participants affirmed that the primary purposes of QI/PM are to enhance internal processes and improve community health outcomes. Study findings demonstrate how 4 small health departments integrated QI/PM into their public health practice.