Rebecca Zosel writes:

The second of the CEIPS (Centre of Excellence in Intervention and Prevention Science) Seminar Series was delivered by Dr Stephen McKenzie, CEIPS Research Officer on Monday 27 April: ‘Using health promotion practice records to inform practice’. The seminar profiled CEIPS’ long standing efforts to document public health practice so it is visible and can be shared, in order to build our understanding of effective practice and drive quality improvement.

Dr McKenzie illustrated the power of data on the nitty-gritty of public health practice by presenting an example of a recording method recently used in Healthy Together Geelong.

Healthy Together Geelong staff used three databases (healthy children, healthy workplaces, and other events) to document their practice. The databases – ‘Event Trackers’ – were an adaptation of the event logs recording method developed by CEIPS for use by Healthy Together Victoria health promotion teams, but their pedigree goes back much further. The original event logs were developed first by The University of Kansas Community Toolbox group. The team at CEIPS first adapted them to document community development practice in Australia in the mid-nineties.

The Geelong databases were likened to practice diaries and provided templates for both factual reporting and high-level reflections, including systems reflections. They allowed collection of qualitative and quantitative data on ‘events’ which were defined broadly and included phone calls, meetings, conferences and ideas. Data domains included:

  • Date of contact
  • Organisation name
  • Organisation size
  • Organisation postcode
  • Individual contacted
  • Position of individual contacted
  • Contact type (email, letter, phone, meeting, other)
  • Contact length
  • Event purpose
  • Event description
  • Comments, including on systems change potential, barriers and opportunities
  • Achievement Program uptake status
  • Staff’s rating of organisation’s health interest (1: No interest – 4: Strong interest)
  • Name of staff member entering the information.

Staff at Healthy Together Geelong used the databases to document their practice, with results analysed and reported back to staff by the team’s Research and Evaluation Officer. A key finding was that a greater depth of initial contact with an organisation resulted in a greater level of interest in health. Practice was subsequently changed to reflect this knowledge; staff made initial contact via telephone and face-to-face meetings as opposed to email.

The reflective exercise helped practitioners develop a systems level perspective on programs, policies, activities and people and their interconnections. For example, systems level insights showed how Healthy Together programs facilitated access to organisations, and provided further opportunities to work together on improving health and wellbeing.

Results of the staff’s activities, such as number of organisations signed up to and progressing through Healthy Together Victoria programs, gave staff useful indication of patterns of take up including refusal. Characteristics of ‘accepters’ and ‘refusers’ for example helped staff identify optimal organisations to target and ways of improving responses from organisations more reluctant to participate.

In closing, Stephen argued for the introduction of a routine recording method to capture aspects of public health practice in ways that can be shared to improve the quality of everyone’s actions. He restated CEIPS’ view that documenting public health practice and supporting the use of that information in reflective practice is critical to improving the quality of public health practice.

As a practitioner, I often have a good sense of what will work based on my experience in the field. Although some practice insights have been proven in other fields and others seem like common sense, in actual fact our knowledge of effective public health practice – the nitty gritty of our daily work – is still emerging and many aspects are not validated or proven to be effective.

Health promotion has few tools in the tool box and often the outcomes of interventions are disappointing. Over time, a routinely and widely applied practice recording method would validate what a lot of us intuitively know, and help to define what has traditionally been described as the intangible and elusive ‘art’ of our field. This would help us overcome a big challenge in health promotion: the fact that we often know what to do but not how to do it.

CEIPS has likened a routine practice recording system to routine hospital record keeping, which has significantly advanced clinical practice. Just imagine if we could collect the wealth of information residing in public health practice across the nation, and use the collective experiences of practitioners to improve our evidence base and practice. I am convinced that our impact on health would increase exponentially.

A method that allows convenient, standardised and widespread recording of aspects of public health practice would build the evidence base of the field and provide an ongoing source of practice data that captures the full impact of our efforts. Collecting and utilising practice data would drive continuous evidence-based quality improvement, helping to remove the gap between research and practice. By enhancing the evidence base, it would also lead to greater investment in the field.

In theory it sounds wonderful, however the reality, as always, poses some challenges. For example, a recording method would need to complement rather than duplicate existing systems (i.e. reporting requirements of funding bodies, organisational accountability frameworks, or other program monitoring obligations). It can’t be too resource intensive for time-poor practitioners to maintain. And it must have utility for practitioners, provide context-specific feedback in real-time and have widespread uptake. Variation in compliance and data analysis may also prove challenging.

Although still in its infancy, the potential of a practice recording method is exciting and I look forward to the concept evolving.

Rebecca Zosel is a public health practitioner, advocate and consultant. Rebecca tweets at @rzosel.

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