Judith M. Ottoson

After the Applause: Exploring Multiple Influences on Application Following an Adult Education Program

This study explores barriers and facilitators to the application of learning following a continuing education program. Telephone interviews were conducted with 27 multidisciplinary participants four months after a five-day Institute. The interviews sought to assess whether and how participants had applied a health education planning and evaluation model taught during the Institute. A model, the Application Process Framework, guided interviews and data analysis in five areas of potential influence on application: educational program, innovation to be applied, predisposition of the learner, enabling skills of the learner and characteristics of the context of application, and social support. Although respondents primarily looked to the context to explain whether and how application occurred, the conceptual framework helped illuminate other influences, most notably, respondent predisposition. Implications for adult education practice and research are discussed.

Linking reasons for continuing professional education participation with postprogram application

&NA; This study explores links between the reasons health professionals give for participation in continuing professional education (CPE) and postprogram application of learning. Data collected by pre‐, post‐, and 2‐month follow‐up questionnaires were analyzed for 247 health professionals, including nurses, physicians, mental health counselors, and rehabilitation specialists. Of the five reasons for participation studied, bivariate correlational analyses revealed a link between three reasons and postprogram application: “need to do your job differently,” “confirm what you are already doing is okay,” and “chance to network with others.” These reasons have a voluntary nature, intrinsic motivation, and specificity, and are comparatively more active than passive in orientation. Two other reasons for participation, “required to attend” and “general interest,” were not significantly associated with outcome measures. The results of this exploratory study provide discussion and suggestions for program planners and educators in influencing posteducational application.

Salud America! Developing a National Latino Childhood Obesity Research Agenda

U.S. childhood obesity has reached epidemic proportions, with one third of children overweight or obese. Latino children have some of the highest obesity rates, a concern because they are part of the youngest and fastest-growing U.S. minority group. Unfortunately, scarce research data on Latinos hinders the development and implementation of evidence-based, culturally appropriate childhood obesity interventions. In response, the Salud America! network conducted a national Delphi survey among researchers and stakeholders to identify research priorities to address Latino childhood obesity and compare differences by occupation and race or ethnicity. The resulting first-ever National Latino Childhood Obesity Research Agenda provides a framework to stimulate research and collaboration among investigators, providers, and communities, and inform policy makers about the epidemic’s seriousness and specific needs for priority funding. The agenda ranks family as the main ecological level to prevent Latino childhood obesity—followed by community, school, society, and individual—and ranks top research priorities in each level.

When a Bottom-Up Innovation Meets Itself as a Top-Down Policy The AVID Untracking Program

While practitioner-based research holds potential for closing the theory and practice gap, it is unclear how such research contributes to the policy and practice gap. This case study traces an educational innovation from its practice-based creation to its mandated implementation as public policy. Findings indicate that these bottom-up innovations face the same kind of implementation challenges as their top-down cousins. The authors take the position that practice-based innovations can engage in multiple contexts if knowledge creation (research) continues into knowledge utilization (policy and practice). The authors argue that this happens when knowledge utilization, like implementation, is understood as mutual adaptation. If innovations are frozen as knowledge creations in time and context, they cannot mutually adapt elsewhere. The result is that the good innovations of one practitioner will remain just that.

Reclaiiming the Concept of Application: From Social to Technological Process and Back Again

Application-to put a thing into practical contact with another-is treated variously in adult education as a central concept, vague understanding, or anathema. These mixed responses are tied to the practical roots of application and its tension with science and theory. Technical rationality coopted application to reduce this tension by putting value on outcomes and technology, not on the processes that surround them. By reclaiming application from positivism, new opportunity arises for adult educators to contribute to the applied turn in contemporary theory and practice. In this reconstruction, means connect not only to ends, but to intent; knowledge creation occurs throughout process, not just before it; control surrenders to feasibility and negotiation; individual action interacts with context; and disciplines release control of application to all learners. The complex, multi-dimensional process of application takes more than a good idea. It takes knowledge, skill, endurance, and artistry. To reclaim application is to reclaim the value of process.

Contextual Influences on Learning Application in Practice An Extended Role for Process Evaluation

Although process evaluation usually ends with the program, process itself does not end. This study analyzed process or contextual influences health professionals face when returning from continuing professional education (CPE) and attempting to apply learning. Follow-up survey data were analyzed for a sample (N = 549) of physicians, nurses, counselors, and rehabilitation specialists. Contextual influences studied include resources, encouragement, support, opportunity, and authority. Logistic regression analysis found support for changes to apply training ideas was a predictor of application for the sample as a whole and for all professional groups except one. Encouragement from others was a predictor of application for rehabilitation specialists, and opportunity to apply learning was a second predictor for nurses. Sufficient resources was not a predictor in any models tested. Results indicate that the practice context can affect educational outcomes and an extended vision of process evaluation is needed to incorporate such variables in the evaluation of CPE.

Diffusion theory and knowledge dissemination, utilization and integration.

Part of the Community Health and Preventive Medicine Commons, Health and Medical Administration Commons, Health Policy Commons, Health Services Administration Commons, Health Services Research Commons, and the Public Health Education and Promotion Commons. Many accomplishments of public health have been distributed unevenly among populations. This article reviews the concepts of applying evidence-based practice in public health in the face of the varied cultures and circumstances of practice in these varied populations. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community and practitioners in decision making, conducting sound evaluation, and disseminating what is learned. The usual application of these principles has overemphasized the scientific evidence as the starting point, whereas this review suggests engaging the community and practitioners as an equally important starting point to assess their needs, assets and circumstances, which can be facilitated with program planning frameworks and use of local assessment and surveillance data.

Implementation link between clinical practice guidelines and continuing medical education

&NA; Clinical practice guidelines (CPGs) are statements designed to assist practitioners and patients in making decisions about health care in specific clinical circumstances. The purpose of practice guidelines is to improve patient outcomes by changing physician behavior. Continuing medical education (CME) has a similar purpose. Many strategies facilitate implementation of practice guidelines, some of which are also strategies used in CME. By systematically examining the factors that influence implementation of practice guidelines and the factors that influence the effectiveness of CME, many similarities between the two types of interventions are found. Factors considered include those related to the expected change in behavior itself, the method of implementation, the implementing organization, the actors involved in implementation, and the environment or context of implementation. Based on these similarities and other common features, including development and evaluation strategies, we propose that CME programs may provide an existing framework to facilitate implementation of CPGs. In addition, we propose that development, implementation, and evaluation of CPGs may be considered CME activities in their own right.

Consideration of an applied model of public health program infrastructure.

Systemic infrastructure is key to public health achievements. Individual public health program infrastructure feeds into this larger system. Although program infrastructure is rarely defined, it needs to be operationalized for effective implementation and evaluation. The Ecological Model of Infrastructure (EMI) is one approach to defining program infrastructure. The EMI consists of 5 core (Leadership, Partnerships, State Plans, Engaged Data, and Managed Resources) and 2 supporting (Strategic Understanding and Tactical Action) elements that are enveloped in a programs context. We conducted a literature search across public health programs to determine support for the EMI. Four of the core elements were consistently addressed, and the other EMI elements were intermittently addressed. The EMI provides an initial and partial model for understanding program infrastructure, but additional work is needed to identify evidence-based indicators of infrastructure elements that can be used to measure success and link infrastructure to public health outcomes, capacity, and sustainability.

Did They Use It

In the last 300 years the greatest advances in public health have been achieved by population health initiatives that have reduced or eliminated major threats or scourges to whole populations. Likewise, the future health of communities will depend on a similar population perspective that has come to be described as public health. As past successes achieved by public health practitioners depended largely on surveillance systems based on in-patient and disease registries, recording of vital events, laboratory and sentinel reporting, administrative systems, and population surveys, so too will future health status and outcomes. Information technology may change the way in which public health surveillance is conducted and information is gathered, processed, and accessed, but the fundamental concept of population surveillance will remain.