Rebecca E. Johnson

It’s hard to play ball: A qualitative study of knowledge exchange and silo effects in public health

BackgroundPartnerships in public health form an important component of commissioning and implementing services, in England and internationally. In this research, we examine the views of staff involved in a City-wide health improvement programme which ran from 2009 to 2013 in England. We examine the practicalities of partnership work in community settings, and we describe some of barriers faced when implementing a large, multi-organisation health improvement programme.MethodsQualitative, semi-structured interviews were performed. Purposive sampling was used to identify potential participants in the programme: programme board of directors, programme and project managers and intervention managers. Interviews were conducted one-to-one. We conducted a thematic analysis using the ‘one sheet of paper’ technique. This involved analysing data deductively, moving from initial to axial coding, developing categories and then identifying emerging themes.ResultsFifteen interviews were completed. Three themes were identified. The first theme reflects how poor communication approaches hindered the ability of partnerships to deliver their aims and objectives in a range of ways and for a range of reasons. Our second theme reflects how a lack of appropriate knowledge exchange hindered decision-making, affected trust and contributed to protectionist approaches to working. This lack of shared, and communicated, understanding of what type of knowledge is most appropriate and in which circumstance made meaningful knowledge exchange challenging for decision-making and partnership-working in the City-wide health improvement programme. Theme three demonstrates how perceptions about silos in partnership-working could be problematic, but silos themselves were at times beneficial to partnerships. This revealed a mismatch between rhetoric and a realistic understanding of what components of the programme were functional and which were more hindrance than help.DiscussionThere were high expectations placed on the concept of what partnership work was, or how it should be done. We found our themes to be interdependent, and reflective of the ‘dynamic fluid process’ discussed within the knowledge mobilisation literature. We contend that reframing normal and embedded processes of silos and silo-working already in use might ease resistance to some knowledge exchange processes and contribute to better long-term functioning of public health partnerships.

Pillar Integration Process: A Joint Display Technique to Integrate Data in Mixed Methods Research

Despite an emphasis on integration in mixed methods research, there remain relatively few well-articulated integration techniques for use by researchers. We developed the Pillar Integration Process, a transparent and rigorous four-stage technique for integrating and presenting qualitative and quantitative findings in a joint display. The purpose of this article is to describe the technique and illustrate how it was developed and applied using via two examples from health sciences. The first is an evaluation of a health improvement program, the second is a mixed methods systematic review to identify interacting factors which influenced decision making in orthopedics. Future research can provide additional evidence on the value of the Pillar Integration Process technique within a mixed method approach.

OP24 Eliciting children’s perceptions and experiences of health, diet, physical activity and weight through the draw, write and tell technique

Background Existing research exploring determinants of childhood obesity tends to overlook the experiential, contextual and cultural basis of such determinants, and lacks methodological features that support children’s own framing of issues around obesity. This study aimed to explore children’s perceptions and experiences of health, diet, physical activity and weight, with a focus on culture-specific contextual factors that may give rise to childhood obesity, in an ethnically diverse sample. Methods Children aged 9–10 years were recruited from primary schools in Coventry, UK, with purposive sampling of schools to ensure an ethnically diverse sample. Data were collected through a ‘draw, write and tell technique’ using semi-structured one-to-one interviews at school. Images, text and transcripts were analysed using a thematic framework approach, with themes reviewed and mapped against existing ecological models of health behaviours. Results To date, six of fifteen invited schools agreed to participate, with 27 children (girls n=16) successfully recruited from three schools, all of which lived in areas of high deprivation, with 81% from minority ethnic groups. Recruitment is on-going to allow for data collection with children from ethnic groups currently under-represented in the sample. Preliminary analysis has identified seven over-arching themes: knowledge, understanding, beliefs, values, motivations, intentions and group-specific experiences. Children had a grasp of the fundamental elements of a healthy diet, physical activity and maintaining a healthy weight but understandings were simplistic and often contradictory. Children viewed health as a personal responsibility, attributed to will-power, but often described external factors affecting their own ability to be healthy e.g. social pressures to indulge and permissive parenting. Positive and negative personal characteristics were assigned to others on the basis of healthfulness and weight. Key motivations for health behaviours were avoidance of the negative social consequences of being overweight, personal success and happiness. Boys and girls differed in their perception of a healthy aesthetic, but culture-specific experiences were largely absent from the data. Conclusion The findings suggest that childhood obesity interventions could focus on the existing assets that children describe, such as friendships and supportive family environments; emphasising health benefits framed by child-based motivations e.g. personal success and happiness. The lack of culture-specific experiences in children’s accounts is inconsistent with other research in ethnically diverse child populations, which may be attributable to the methods used or lack of representation of some ethnic groups. Use of the draw, write and tell technique allowed the research to be child-led, supporting children’s own framing of issues.

P63 An exploration of childhood obesity across ethnic groups in Coventry

Background Research suggests that there is variation in childhood obesity across ethnic groups in the UK, although findings are inconsistent. The influence of other individual, school and neighbourhood characteristics is not well understood. In addition, patterns may differ geographically. The objectives were to explore the variation in childhood overweight and obesity and BMI across ethnic groups in Coventry, how this compares to other areas, and the influence of additional individual, school and neighbourhood factors. Methods National Child Measurement Programme data (measuring BMI-for-age against a reference population for reception year and year 6) was combined for 2007/8 to 2014/15 (n = 56,049). Multiple linear regression was conducted in Stata v13 to explore associations between BMI z-score (zBMI) and individual, school and neighbourhood characteristics using local data, with White British as the reference group. Models were fitted with likelihood ratio tests and sensitivity analyses explored the impact of missing data. Neighbourhood was fitted as a random effect in the multi-level model. Prevalence of overweight and obesity by ethnic group for Coventry was compared to local authorities with similar demographics using a Dunnett-type test to adjust for multiple testing. Results White British children had a mean zBMI of 0.41 (95% CI: 0.39, 0.43) for reception year and 0.51 (0.49, 0.53) for year 6. zBMI for Indian and Chinese children was significantly lower than the reference group for both reception year at −0.09 (−0.14, −0.05) and −0.03 (−0.23, 0.16) and year 6 at 0.37 (0.32, 0.43) and 0.16 (−0.14, 0.46) respectively. Black African children had a higher mean zBMI across both years at 0.58 (0.54, 0.63) and 0.71 (0.68, 0.78) for reception and year 6 respectively. For other ethnic groups, the findings differed by school year. For Bangladeshi children, mean zBMI was significantly lower than the reference group in reception year at 0.24 (0.14, 0.34) yet significantly higher in year 6 at 0.73 (0.61, 0.84). Preliminary results indicate ethnic group differences remain after adjustment for individual, school and neighbourhood factors. The results of multi-level modelling will be presented. Coventry had a similar prevalence of overweight and obese children to Bolton, Derby and Kirklees for all ethnic groups with the exception of Asian children, where Coventry had a significantly higher prevalence. Conclusion Variation in childhood overweight and obesity and BMI exists across ethnic groups in Coventry, and patterns differ geographically, although analysis is limited by the available data. There is a need for further exploration of the factors driving this variation.

P20 Transatlantic knowledge mobilisation in public health: A case study

Background Knowledge mobilisation (KMb) can be defined as the movement of available knowledge (research) into active use. In the health sciences, there is a need to identify and describe knowledge mobilisation activities from a range of different ‘producers’ and ‘users’ of knowledge. A recent review of reviews of knowledge mobilisation highlighted the need for the evaluation of KMb activities and approaches, as well as mapping knowledge mobilisation archetypes. This case study details a knowledge mobilisation activity between a UK and US university (knowledge producers), and a US state public health department (knowledge users). There were 3 objectives: First, exchange knowledge of the persistent challenges and best practices identified by UK and US settings for conducting research embedded in public health practice. Second, identify the methods that worked best and in what context, for moving knowledge into active use in public health practice. Third, map knowledge mobilisation activities. The exchange took place over 1 week in 2016. Methods Qualitative case study. We used participant observation, document analysis and interview to record knowledge mobilisation activities. We used thematic analysis (using the OSOP technique) to draw out themes. Results We discussed the challenges and opportunities that the UK and US institutions face in achieving high-quality ‘real-world’ public health research that has been or could be used in practice. Thematic findings centred on: Exemplars of practice: Knowledge mobilisation that worked well was usually dependent on secure, long-standing relationships between key individuals (but not necessarily the most powerful individuals). Mobilisation methods: A range of methods were reported to move knowledge into active use, from social and relational to traditional linear processes of knowledge production and (assumed) implementation in practice. Mobilisation activities: archetypes identified in a knowledge mobilisation review of reviews were compared to current practice from this exchange. Archetypes of knowledge mobilisation in practice were ‘evidence advocacy’ and ‘knowledge production’ and those ‘brokering research’ and ‘fostering networks’. Details of each theme will be presented. Conclusion This knowledge mobilisation exchange helped to identify the most useful knowledge mobilisation activities occurring in these UK and US institutions. The exchange was itself an example of knowledge mobilisation. It has provided a benchmark for identifying what types of knowledge mobilisation activities are best suited, and in what context, for moving knowledge into active use in each country. A study limitation is the case study method, as the findings cannot be widely generalised without external replication.

OP41 Practising Partnership: A Qualitative Analysis of Public Health and Local Authority Co-Implementation of Health and Mental Wellbeing Improvement Interventions

Background The 2010 NHS White Paper Equity and Excellence: Liberating the NHS proposed major changes to how public health services are delivered from 2013. The imminent transition of public health into local authorities will have implications for how services are planned, commissioned and implemented, particularly for wellbeing initiatives. Anticipating this transition, a city-wide initiative brought together Local Authority and NHS Public Health partners to plan, manage and implement a health and mental wellbeing improvement programme over three years (2009-2012). This qualitative study examines the attitudes and views of stakeholders on their involvement in this programme and their experiences of ‘practising partnership’. Methods Qualitative thematic analysis (as part of a mix-methods study). Purposive sampling was used to identify potential participants from three groups (programme stakeholders): directorate, programme managers and intervention managers. One-to-one semi-structured interviews were conducted. We used Schutz’s theory of social phenomenology to support the analytical method and the One Sheet of Paper technique was used to identify emerging themes. Creswell’s (2009) strategies for qualitative validity were used to enhance the accuracy of our findings. Results Fifteen one-on-one interviews were completed, out of seventeen requests for interview, with five participants from each stakeholder group. Interview times ranged from 45 minutes to 2 hours and were conducted after participants gave informed consent. Three main themes emerged. The first theme, ‘defining, designing and adapting’ represents stakeholders’ challenges using language with culturally different organisational meaning, introducing new concepts (such as mental wellbeing) and designing a programme with implementation and evaluation structures that were both rigid and flexible. The ‘practice of partnership’ theme reflected how partnership was more of a ‘façade’ at the programmes’ commencement and how, by working through stages of conflict and confusion, stakeholders developed an understanding of what the practice of partnership meant and achieved clarity on how it could be done. The third theme ‘knowledge, learning and understanding’ describes how knowledge was created, diffused and utilised. For example ‘evidence’ was used for different strategic ends depending on the stakeholder perspective -- to promote new ideas or interventions or to bolster an existing intervention to prove its merit. Conclusion This study demonstrates the challenges and opportunities for partnership working that are likely to be encountered in the transition of Public Health into local authorities. It offers insight into understanding and practising partnership and has implications for planning, managing and implementing public health and wellbeing improvement interventions post-transition.