Debra L. Scammon

Context Matters: The Experience of 14 Research Teams in Systematically Reporting Contextual Factors Important for Practice Change

PURPOSE We aimed to advance the internal and external validity of research by sharing our empirical experience and recommendations for systematically reporting contextual factors. METHODS Fourteen teams conducting research on primary care practice transformation retrospectively considered contextual factors important to interpreting their findings (internal validity) and transporting or reinventing their findings in other settings/situations (external validity). Each team provided a table or list of important contextual factors and interpretive text included as appendices to the articles in this supplement. Team members identified the most important contextual factors for their studies. We grouped the findings thematically and developed recommendations for reporting context. RESULTS The most important contextual factors sorted into 5 domains: (1) the practice setting, (2) the larger organization, (3) the external environment, (4) implementation pathway, and (5) the motivation for implementation. To understand context, investigators recommend (1) engaging diverse perspectives and data sources, (2) considering multiple levels, (3) evaluating history and evolution over time, (4) looking at formal and informal systems and culture, and (5) assessing the (often nonlinear) interactions between contextual factors and both the process and outcome of studies. We include a template with tabular and interpretive elements to help study teams engage research participants in reporting relevant context. CONCLUSIONS These findings demonstrate the feasibility and potential utility of identifying and reporting contextual factors. Involving diverse stakeholders in assessing context at multiple stages of the research process, examining their association with outcomes, and consistently reporting critical contextual factors are important challenges for a field interested in improving the internal and external validity and impact of health care research.

Weathering the Storm: A Social Marketing Perspective on Disaster Preparedness and Response with Lessons from Hurricane Katrina

The devastation of New Orleans as a result of Hurricane Katrina presents an opportunity and an obligation to examine the human and social factors that influenced the nations response to this disaster. Lessons from Katrina suggest that a social marketing approach to disaster management could increase the likelihood of positive outcomes for individuals and communities when a disaster strikes. The authors propose an integrated approach to effective risk communications that encourages self-protective behaviors.

Agency Review of Environmental Marketing Claims: Case-by-Case Decomposition of the Issues

Abstract Environmental claims in marketing are subject to review by a variety of government and self-regulatory bodies. Although some of these bodies have issued guidelines, the most important precedents have been set in case-by-case actions. We discuss cases brought by the state attorneys general and the New York City Division of Consumer Affairs, and examine in detail cases brought by the Federal Trade Commission and the National Advertising Division of the Council of Better Business Bureaus between 1990 and the end of 1994. Similarities and differences among the cases brought by these bodies are analyzed in relation to the goals and powers of the various review bodies. We conclude with observations about the adequacy with which issues involving environmental issues (e.g., degradability, recyclability, ozone impact, life cycle assessments) have been addressed in case-by-case action and provide some suggestions for future research.

Transforming Consumer Health

The 2010 Patient Protection and Affordable Care Act is intended to transform the U.S. health care system. Its success will require the transformation of consumers’ views about health and their willingness to participate in healthful behaviors. Focusing on three barriers to consumers’ engagement in healthful behaviors, the authors review the research literature and suggest opportunities for further research. Using a social marketing perspective, they suggest actions for health care providers, marketers, and policy makers to help overcome these barriers.

Principle-Based Stakeholder Marketing: Insights from Private Triple-Bottom-Line Firms

To expand scholarly understanding of stakeholder marketing, the authors report data from a study that explores the practices of private firms founded with a commitment to triple-bottom-line achievement. The findings suggest that these firms develop and offer value propositions based on the inherent interconnectedness of all stakeholders in the marketplace, particularly recognizing opportunities to improve conditions for the “weakest-link” stakeholders and the legitimacy of their practices in the eyes of an extended set of stakeholders. The authors offer a model of principle-based stakeholder marketing in which moral principles and organizational culture support marketing behaviors that offer value propositions for stakeholders rather than to stakeholders. This requires not only organizationwide but also channelwide intelligence gathering, dissemination, and responsiveness and entails unique marketing-mix practices. The authors discuss the challenges that large public firms face in attempting to practice this model and avenues by which such firms can address those challenges. The authors suggest ways that public policy can encourage more firms to adopt principle-based stakeholder marketing. Finally, the authors identify future research needs.

Health Claims and Disclaimers: Extended Boundaries and Research Opportunities in Consumer Interpretation

In Pearson v. Shalala, the court restricts FDA authority by allowing sellers of dietary supplements to make health claims based on less than “significant scientific agreement” when these claims are accompanied by a disclaimer. The authors raise issues regarding the lack of standards for substantiation and the effectiveness of disclaimers in light of the untested nature of some supplements and the vulnerabilities of some supplement consumers.

No Pet Left Behind: Accommodating Pets in Emergency Planning

New federal legislation requiring accommodation of pets and service animals in emergency planning has garnered broad, bipartisan support. The authors review changes in societal views of pets that may have contributed to the recent passage of the Pets Evacuation and Transportation Standards Act. The authors identify some areas in which interpretation of the provisions of the act will require further debate and definition. Finally, they offer suggestions on how marketing skills can be employed to make emergency planning more effective.

Quality, Satisfaction, and Financial Efficiency Associated With Elements of Primary Care Practice Transformation: Preliminary Findings

PURPOSE We examined quality, satisfaction, financial, and productivity outcomes associated with implementation of Care by Design (CBD), the University of Utah’s version of the patient-centered medical home. METHODS We measured the implementation of individual elements of CBD using a combination of observation, chart audit, and collection of data from operational reports. We assessed correlations between level of implementation of each element and measures of quality, patient and clinician satisfaction, financial performance, and efficiency. RESULTS Team function elements had positive correlations (P ≤.05) with 6 quality measures, 4 patient satisfaction measure, and 3 clinician satisfaction measures. Continuity elements had positive correlations with 2 satisfaction measures and 1 quality measure. Clinician continuity was the key driver in the composite element of appropriate access. Unexpected findings included the negative correlation of use of templated questionnaires with 3 patient satisfaction measures. Trade-offs were observed for performance of blood draws in the examination room and the efficiency of visits, with some positive and some negative correlations depending on the outcome. CONCLUSIONS Elements related to care teams and continuity appear to be key elements of CBD as they influence all 3 CBD organizing principles: appropriate access, care teams, and planned care. These relationships, as well as unexpected, unfavorable ones, require further study and refined analyses to identify causal associations.

Organizational Culture Associated With Provider Satisfaction

Background: Organizational culture is key to the successful implementation of major improvement strategies. Transformation to a patient-centered medical home (PCHM) is such an improvement strategy, requiring a shift from provider-centric care to team-based care. Because this shift may impact provider satisfaction, it is important to understand the relationship between provider satisfaction and organizational culture, specifically in the context of practices that have transformed to a PCMH model. Methods: This was a cross-sectional study of surveys conducted in 2011 among providers and staff in 10 primary care clinics implementing their version of a PCMH: Care by Design. Measures included the Organizational Culture Assessment Instrument and the American Medical Group Association provider satisfaction survey. Results: Providers were most satisfied with quality of care (mean, 4.14; scale of 1–5) and interactions with patients (mean, 4.12) and were least satisfied with time spent working (mean, 3.47), paperwork (mean, 3.45), and compensation (mean, 3.35). Culture profiles differed across clinics, with family/clan and hierarchical cultures the most common. Significant correlations (P ≤ .05) between provider satisfaction and clinic culture archetypes included family/clan culture negatively correlated with administrative work; entrepreneurial culture positively correlated with the Time Spent Working dimension; market/rational culture positively correlated with how practices were facing economic and strategic challenges; and hierarchical culture negatively correlated with the Relationships with Staff and Resource dimensions. Conclusions: Provider satisfaction is an important metric for assessing experiences with features of a PCMH model. Identification of clinic-specific culture archetypes and archetype associations with provider satisfaction can help inform practice redesign. Attention to effective methods for changing organizational culture is recommended.

Incidence of Online Health Information Search: A Useful Proxy for Public Health Risk Perception

Background Internet users use search engines to look for information online, including health information. Researchers in medical informatics have found a high correlation of the occurrence of certain search queries and the incidence of certain diseases. Consumers’ search for information about diseases is related to current health status with regard to a disease and to the social environments that shape the public’s attitudes and behaviors. Objective This study aimed to investigate the extent to which public health risk perception as demonstrated by online information searches related to a health risk can be explained by the incidence of the health risk and social components of a specific population’s environment. Using an ecological perspective, we suggest that a population’s general concern for a health risk is formed by the incidence of the risk and social (eg, media attention) factors related with the risk. Methods We constructed a dataset that included state-level data from 32 states on the incidence of the flu; a number of social factors, such as media attention to the flu; private resources, such as education and health insurance coverage; public resources, such as hospital beds and primary physicians; and utilization of these resources, including inpatient days and outpatient visits. We then explored whether online information searches about the flu (seasonal and pandemic flu) can be predicted using these variables. We used factor analysis to construct indexes for sets of social factors (private resources, public resources). We then applied panel data multiple regression analysis to exploit both time-series and cross-sectional variation in the data over a 7-year period. Results Overall, the results provide evidence that the main effects of independent variables—the incidence of the flu (P<.001); social factors, including media attention (P<.001); private resources, including life quality (P<.001) and health lifestyles (P=.009); and public resources, such as hospital care utilization (P=.008) and public health funds (P=.02)—have significant effects on Web searches for queries related to the flu. After controlling for the number of reported disease cases and Internet access rate by state, we estimate the contribution of social factors to the public health risk perception levels by state (R2=23.37%). The interaction effects between flu incidence and social factors for our search terms did not add to the explanatory power of our regression models (R2<1%). Conclusions Our study suggests a practical way to measure the public’s health risk perception for certain diseases using online information search volume by state. The social environment influences public risk perception regardless of disease incidence. Thus, monitoring the social variables can be very helpful in being ready to respond to the public’s behavior in dealing with public health threats.