DISPARITIES RANK HIGH IN PRIORITIZED MCH RESEARCH AGENDA IN MISSOURI

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DISPARITIES RANK HIGH IN PRIORITIZED MCH RESEARCH
AGENDA IN MISSOURI

• Pamela K. Xaverius1, Sherri Homan2, Paula
  Nickelson2, Leigh Tenkku1
• 1St. Louis University, School of Medicine,
  Department of Community and Family Medicine
• 2Missouri Department of Health and Senior Services

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Background

• Maternal and child health (MCH) has long been a
  focus of public health programs.
• Identifying and investigating health problems is
  at the core of essential public health services.
• A general plan for research can provide the
  overarching framework necessary for identifying
  interventions that can ameliorate health
  problems.

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Essential Public Health Services

• Monitor health status
• Diagnose and investigate health problems
• Inform, educate and empower people about health
• Mobilize community to solve health problems
• Develop policies and plans that support health
  efforts
• Enforce laws and regulations that protect health
• (a) Link people to needed personal health
  services (b) Assure the provision of health care
  
• Assure a competent public health workforce
• Evaluate effectiveness of health services
• Research new innovative solutions to health
  problems
• Source Essential Public Health Services Work
  Group of the Public Health Functions Steering
  Committee

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Essential Public Health Services

• Linked to the core functions
• Cyclical and continuous processes
• Managed at the systems level
• Enhanced through active research

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Research Agendas Previous Methods

1. Documentation of the gaps in the literature is
   required to establish innovative ideas for a
   research agenda.
2. Prioritization of agenda items, accomplished by
   a small group of experts prioritizing gaps in the
   literature review, is required to move an agenda
   to action.
3. Prioritization of agenda items should be
   contingent upon prevalence and incidence of
   morbidities and mortalities in communities

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Moving Research Agendas to Action

• Strategies towards this should
• Enlist the support of local leaders
• Assess available resources
• Ensure community readiness
• Identify practical acceptable innovations
• These strategies combat issues that could move an
  agenda away from the needs of the population it
  is meant to serve, such as
• Funding sources
• Vested researcher interests
• Publication bias
• Consumer pressure

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Consideration of Community Readiness

• A research agenda must consider not only consider
  the gaps in the literature, expert reviews, and
  burden on society but also how receptive and
  ready the community is to implement efficacious
  innovations.

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Study Question
This study aimed to identify a MCH research
agenda, geared towards identifying research
priorities as well as experts within the
community to carry out those priorities.
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The Initial Agenda

• Eleven MCH researchers identified and researched
  17 different topics, regarding potential MCH
  innovations
• Gaps in the literature
• Burden on society
• Burden of disease
• 130 specific research items were identified
  within one of 17 topics
• Community development
• School health
• Health care access
• Family support
• Immunizations
• Community education
• Pre/post natal care
• Environment

1. Nutrition/physical activity
2. Tobacco/alcohol
3. Injury/violence
4. Substance abuse
5. Oral health
6. Children w/ special health care needs
7. Chronic conditions
8. Mental health
9. Disparities

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The Survey

• In 2005, a survey was emailed maternal and child
  health (MCH) researchers through out the state.
• Participants were asked to
• Select research priorities
• Identify personal areas of expertise
• Identify new research items for the agenda

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The Participant The MCH Researcher

• 1,027 potential participants were identified
• Identified epidemiology specialists at local
  public health agencies
• Identified presenters at the Missouri Association
  of Local Public Health Agencies (MoALPHA)
• Identified Missourians funded to conduct MCH
  research by the National Institutes of Health,
  CDC, and March of Dimes
• Identified Missourians who authored recent
  (2001-2003) MCH research articles in
  peer-reviewed journals (names of first three
  authors from the PubMed database were included on
  the initial list).
• From the list of 1,027, 180 verified their MCH
  researcher status,
• 687 did not respond (66.9)
• 160 responded that they were not a MCH researcher
  (15.6)
• 180 responded they were a MCH researcher (17.5).
  
• Of the 180 persons identified as MCH researchers,
  130 of them completed the survey, for a 72.2
  response rate.

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The Participants Demographics

• Job titles
• Professors (64.6)
• Specialists (2.3)
• Epidemiologists (5.7)
• Physicians (5.4)
• Other (20.0)
• Employer Type
• University (75)
• Hospital (12.3)
• State of Local Public Health Agency (6.2)
• Other health venue (e.g., MCH Coalition,
  Missouri Family Health Council) (6.2)
• Employer Location
• Major or minor metropolitan area (95.4)
• Micropolitan area (3.2)
• Non-metropolitan area of the state (1.5)

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Results Priorities

1. Evaluate disparities in terms of age, race,
   ethnicity, and gender, regarding sexually
   transmitted diseases, chronic disease, birth
   outcomes, prenatal care, access to care,
   child-hood exposure to lead, immunizations and
   vaccinations, mental health, substance abuse, and
   oral health 54.6
2. Identify barriers to health care access (e.g.,
   geographical, ethnic/racial, economic, school-
   based clinics, etc.) 52.3,
3. Construct research ecologically (e.g.,
   understanding the relationship between humans and
   physical and social environments and the impact
   of individual, organizational, and community
   level variables on health phenomena) 50.0
4. Increase access to oral health for rural
   children, low SES families 43.1,
5. Reduce the prevalence of children who are or are
   at-risk for overweight 42.3

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Results Areas of Expertise

• Areas of expertise were determined by topical
  area, rather than specific research issue,
  designed to reflect broader MCH public health
  goals and objectives.
• 83.1 of respondents reported at least one
  specific topic of expertise, with a mean of 7.4
  areas of expertise per respondent (range 0-41 SD
  7.8).

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Results Areas of Expertise
Topics Number of Experts Percent of all respondents who were experts
Health Care Access 52 40.0
School Health 50 38.5
Community Development 47 36.2
Family Support 39 30.0
Pre/Post Natal Care 37 28.5
Environment 37 28.5
Community Education 35 26.9
Chronic Conditions 30 23.1
CSHCN 27 20.1
Mental Health 23 17.7
Disparities 23 17.7
Immunizations 20 15.4
Substance Abuse 20 15.4
Injury/Violence 19 14.6
Oral Health 17 13.1
Tobacco/Alcohol 15 11.5
Nutrition/ Physical 14 10.8
Create Your Own 13 10.8
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Results Write Ins

• Sixty-one respondents added 153 specific research
  items to the agenda, with 97 identified as a
  priority for the state.
• Of those 97 priorities for the state,
• 25 items were allocated to the infrastructure
  division,
• 42 items were allocated to the prevention
  division
• 8 items were allocated to the disease/treatment
  division
• 3 items were added to the disparities division
• 19 items were added to a create your own
  division.
• In sum, 46.9 of respondents added at least one
  specific research item to the agenda, with the
  majority of those items (80.4) added to the
  already designated divisions within the survey,
  that is, infrastructure, prevention,
  disease/treatment, and disparities.

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Conclusions Priorities

• This survey identified disparities as the top
  priority for the state, followed by health care
  access, community development, oral health, and
  nutrition/physical activity, respectively.
• Over 83 of respondents reported at least one
  area of expertise, another important finding if
  the agenda is to be implemented by the community
  it is meant to serve.
• In addition, every specific item on the initial
  survey was identified by at least one respondent
  as a priority for the state.

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Conclusions Experts

• 54.6 identified disparities as a priority, with
  only 17.7 of the respondents reporting
  disparities as their area of expertise.
• 52.3 identified health care access as a
  priority, with only 40 of the respondents
  reported being as an expert in that area.
• 50.0 identified a community development issue as
  a research priority, with only 36.2 of all
  respondents indicating expertise in community
  development.
• 42 of the respondents voted for oral health
  and/ or nutrition/physical activity issues as MCH
  research priorities for the state, only slightly
  more than 10 of the respondents were experts in
  those areas.

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Weaknesses

• A clear weakness of this study is in regards to
  the sample.
• The link between the establishment of a research
  agenda and the effect of its implementation on
  population level MCH indicators.
• This project did not assign specific research
  projects to specific researchers, and in fact,
  153 additional specific research issues were
  added to the agenda.

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Next Steps

• Identifying MCH researchers and practitioners
  throughout the state to develop practical plans
  and commit to researching these important social
  problems.
• Additionally, MCH researchers might need support
  and training to enhance or expand their expertise
  to address MCH issues of concern.

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Public Health Implications

• The goal of moving efficacious innovations
  towards changes in practice can only happen when
  researchers, practitioners, and local leaders
  work collectively to lead an agenda more quickly
  to implementation and subsequently improve the
  health of women and children.