Navigating the evidentiary turn in public health: Sensemaking strategies to integrate genomics into state-level chronic disease prevention programs

Abstract

In the past decade, healthcare delivery has faced two major disruptions: the mapping of the human genome and the rise of evidence-based practice. Sociologists have documented the paradigmatic shift towards evidence-based practice in medicine, but have yet to examine its effect on other health professions or the broader healthcare arena. This article shows how evidence-based practice is transforming public health in the United States. We present an in-depth qualitative analysis of interview, ethnographic, and archival data to show how Michigan's state public health agency has navigated the turn to evidence-based practice, as they have integrated scientific advances in genomics into their chronic disease prevention programming. Drawing on organizational theory, we demonstrate how they managed ambiguity through a combination of sensegiving and sensemaking activities. Specifically, they linked novel developments in genomics to a long-accepted public health planning model, the Core Public Health Functions. This made cutting edge advances in genomics more familiar to their peers in the state health agency. They also marshaled state-specific surveillance data to illustrate the public health burden of hereditary cancers in Michigan, and to make expert panel recommendations for genetic screening more locally relevant. Finally, they mobilized expertise to help their internal colleagues and external partners modernize conventional public health activities in chronic disease prevention. Our findings show that tools and concepts from organizational sociology can help medical sociologists understand how evidence-based practice is shaping institutions and interprofessional relations in the healthcare arena.

Diversity in the Era of Precision Medicine - From Bench to Bedside Implementation

“…et al advocated organizational change using "sensemaking and sensegiving strategies" to translate novel scientific discoveries into practice in organizations with professionals of the diverse backgrounds. 19 The Michigan Genomics Program of the Michigan Department of Health and Human Services (DHHS) brought organizational change using these strategies to adopt recent genomic discoveries into practice. 19 To address inequalities in accessing genomic services, integration of "fundamental cause theory" and "implementation science framework" may help to bring changes at three broad levels: institutional level, health system level, and interpersonal level that includes both the patients and providers.…”

“…19 The Michigan Genomics Program of the Michigan Department of Health and Human Services (DHHS) brought organizational change using these strategies to adopt recent genomic discoveries into practice. 19 To address inequalities in accessing genomic services, integration of "fundamental cause theory" and "implementation science framework" may help to bring changes at three broad levels: institutional level, health system level, and interpersonal level that includes both the patients and providers. 20 This will address geographic maldistribution of health care services, inequalities in power to influence health care policy, and inequalities in demographic and socioeconomic factors in accessing genomic services.…”

<i>Public Health Genomics</i>: Time to Sharpen the Focus

“…ASTHO is an organization founded over 80 years ago to provide leadership nation-wide in supporting, equipping, and advocating for improvements in the collection and use of public health data, expanded access to care and treatment, and created new preparedness frameworks to respond to crises. ASTHO’s 10 essential public health services have been adapted for the field of public health genomics [ 25 , 33 ].…”

“…New “environmental jolts” of disruptive discovery and technology development will continue to emerge along with related speculations about their future translation potential [ 33 ]. Public Health Genomics can be a forum for airing, challenging, and clarifying these jolts to keep the field fresh and growing [ 33 ].…”

“…New “environmental jolts” of disruptive discovery and technology development will continue to emerge along with related speculations about their future translation potential [ 33 ]. Public Health Genomics can be a forum for airing, challenging, and clarifying these jolts to keep the field fresh and growing [ 33 ]. Indeed, Public Health Genomics has the opportunity to be a forum for what Senier et al [ 33 ] call sensemaking, that is, a forum for publications aimed to unpack new ideas and identify which are actionable and in what contexts.…”