Enhancing the Science of Discovery in Public Health Systems and Services Research Through Participatory Research Methods

Abstract

The objective was to combine cost analysis and participatory research to identify actionable cost-saving opportunities in public health services for sexually transmitted infections (STI). This study used a mixed-methods approach of analyzing Florida public health data, combined with participatory research approaches to data collection including quantitative web-based surveys, qualitative in-depth interviews, and group discussions. Florida surveillance and administrative data on STIs and county health department (CHD) costs of services for 2012 were analyzed in addition to primary data collected from all Florida CHDs during 2014 and 2015. Variations in STI service delivery practices were the primary variables of concern. Variations in practices, rather than demographic factors such as size of county or STI rates, were associated with variations in cost. Five identified variations in practices were rated for cost savings, no or minimal adverse health impact, and ease of implementation. Following discussion of the ratings by CHDs, texting STI test results was ranked highest for quality improvement implementation initiatives. This study provides a compelling example of how in-depth qualitative and quantitative follow-up research focused on discovery and development with the practice community provides critical insights for interpreting administrative data and drawing accurate reality-based conclusions. The research design was intended to be a highly adaptive research approach that adjusts to the political and technical circumstances of delivering public health services. The extensive stakeholder engagement throughout all phases the study enables this research to address and overcome potential barriers and challenges to actionable findings.

Implementation Research as Applied Science: Bridging the Research to Practice Gap

“…This study was not intended to be a conclusive intervention study that would typically require an experimental (randomized control) design. However, a primary concern in deciding the focus of this intervention was the potential impact on public health outcomes from practitioners' perspective (Livingood et al, 2018). Therefore, monitoring the outcome was critical to clarify that the intervention did not result in negative consequences.…”

“…CHDs were recruited through an ongoing Public Health Practice Based Research Network that involved both the Florida county health agencies and the FDOH (Livingood et al, 2018). The invitation included the stated “purpose of this project is to monitor, support and assess CHD QI efforts to implement a STI texting initiative.” Invitations came from a CHD director who was chairing the FDOH supported Infectious Disease Council, and who also served as a co–prinicipal investigator for the project.…”

“…CHDs were recruited through an ongoing Public Health Practice Based Research Network that involved both the Florida county health agencies and the FDOH (Livingood et al, 2018). The invitation included the stated "purpose of this project is to monitor, support and assess CHD QI efforts to implement a STI texting initiative."…”

“…In particular, it is presented to demonstrate and stimulate discussion of an applied approach to implementation research that is focused on adapting principles and technology to unique settings rather than to develop and test theoretical principles. This opportunity to use QI to adopt and adapt mobile health technology to increase efficiency and improve outcomes was identified through a participatory research process involving state and county public health agency officials (Livingood, Bilello, Choe, & Lukens-Bull, 2018). Data were collected in 2016 and 2017 and analyzed in 2017.…”

Adjust your own oxygen mask before helping those around you: an autoethnography of participatory research

“…In translating research findings to real-world benefit, participatory research [1][2][3][4] purportedly embodies the spirit of a quote often attributed to cultural anthropologist Margaret Mead: "Never doubt that a small group of thoughtful, committed citizens can change the world: indeed, it is the only thing that ever has" [5] (p. 111). As a vehicle for change, participatory research is characterized by active collaboration between researchers and diverse stakeholders [1].…”