142nd APHA Annual Meeting and Exposition

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Research location and research reach: The My Own Health Report (MOHR) study

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 5:30 PM - 5:45 PM

Suzanne Heurtin-Roberts, PhD, MSW , Implementation Science Team, NCI/NIH, Rockville, MD
Sherri Sheinfeld Gorin, PhD , New York Physicians against Cancer (NYPAC), New York, NY
Bijal Balasubramanian, MBBS, PhD , Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center Houston School of Public Health, Dallas, TX
Kayla Fair, RN, BSN, MPH , Texas A&M School of Rural Public Health, College Station, TX
Sarah Krasny, BA, BS , Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX
Catherine Rohweder, DrPH , UNC Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Kurt Stange, MD, PhD , Family Medicine and Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH
Background:  Beyond geographic location, “Healthography” can be interpreted as health research sites’ locations in organizational, financial and cultural systems.   Research location influences a study’s reach, validity, and outcomes.  The aims of this study are to: (1) describe variation in research location; and (2) discuss how location influenced reach in the My Own Health Report (MOHR) study.  MOHR is an evidence-based patient-reported behavioral health assessment tool that includes physician-led counseling and goal-setting.

Methods:  MOHR was federally funded as a cluster-randomized pragmatic implementation trial.  Nine pairs of diverse primary care practices (either FQHC or PBRN sites) were randomized to field MOHR in 6 states across the U.S.  Reach, % of eligible patients that were offered and completed the MOHR tool, was computed for each practice.  Location was measured qualitatively at three time points, via practice-based observation and key informant interviews.  Data were coded by four independent coders using qualitative analysis software. Content analysis was performed to identify salient practice characteristics by which each location differed.

Results: Overall reach for the nine practices was 40.0%, ranging from 27.0%-89.5% across sites.  Variation in reach can be explained by five practice characteristics that differed by location:  (1) clinician and staff attitudes and motivations towards MOHR, (2) mode of MOHR administration (3) impact of the research process on the practice, (4) patient populations and (5) staffing constraints.  The motivation of practice leaders and autonomy of MOHR champions aided efforts to administer MOHR.  Mode of administration (e.g., via web, paper and pencil, or telephone) based upon patient/practice preference and capacity resulted in significant differences in reach.  Practice resources such as staff time and access to technology, and patient literacy differed by location and influenced reach. Although clinicians found MOHR valuable to initiate health behavior discussions, aspects of location limited MOHR's sustainability in routine practice.

Conclusion.  Understanding how and why implementation trials reach their target population requires knowledge of location, since implementation happens in diverse, real-world settings.  Implementation success of evidence-based interventions depends largely on the location of research sites.

Learning Areas:

Implementation of health education strategies, interventions and programs
Provision of health care to the public
Public health or related research

Learning Objectives:
Explain how location can mean place in organizational, financial and sociocultural systems and hierarchies, beyond geographic location. Explain how knowledge of implementation trials' locations help us understand outcomes such as reach.

Keyword(s): Preventive Medicine, Health Assessment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a medical anthropologist and implementation scientist who has published in both health services research and implementation science. Among my scentific interests are the different contexts/locations of health and healthcare and their influence on health outcomes. I served as the government lead on the project from which the presentation data was drawn.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.