Public Health Information Masterclass Scenario 3: A mix and match approach to health information

1. 1 Public Health Information MasterclassScenario 3: A mix and match approach to health information Rupert Suckling

2. 2 Acknowledgements Ann Richardson Peter Hannon Caroline Pickstone Debbie Crofts Jo Weinberger Linda Fox

3. 3 Workshop outline Context setting Task generation Health information Validation Hypothesis testing Skills required Thoughts on team working Welcome Get people to say who they are, where they work and what they would like to get out of the workshop? Record on flipchart Welcome Get people to say who they are, where they work and what they would like to get out of the workshop? Record on flipchart

4. 4 Context Setting Foxhill & Parson Cross Sure Start Sheffield 3% of budget on evaluation Research culture (led by School of Education, Sheffield University) Many service evaluations Increasing interest in �reach� Preschool intervention, in addition to normal services Eg. Health Visiting Head Start 1965 Even Start 1990 1990s UK Family Literacy programmes PEEP (Peers Early Education Partnership) & REAL Education Sure Start launched 1998. Government initiative to support families with children aged 3 years and under (and also before a baby is born) Targeted in defined geographical areas described as �in need� Community plan which must �make a difference� by achieving better outcomes for children to prepare them for school Must be extra and additional and add value to existing services Must be based on what families say they need through consultation Must be able to demonstrate its achievements through action research and evaluation Must work with others to improve and reshape services To work with parents to be, parents and children to promote the physical, intellectual and social development of babies and children � particularly those who are disadvantaged � so that they can flourish at home and when they get to school, and thereby break the cycle of disadvantage for the current generation of young childrenPreschool intervention, in addition to normal services Eg. Health Visiting Head Start 1965 Even Start 1990 1990s UK Family Literacy programmes PEEP (Peers Early Education Partnership) & REAL Education Sure Start launched 1998. Government initiative to support families with children aged 3 years and under (and also before a baby is born) Targeted in defined geographical areas described as �in need� Community plan which must �make a difference� by achieving better outcomes for children to prepare them for school Must be extra and additional and add value to existing services Must be based on what families say they need through consultation Must be able to demonstrate its achievements through action research and evaluation Must work with others to improve and reshape services To work with parents to be, parents and children to promote the physical, intellectual and social development of babies and children � particularly those who are disadvantaged � so that they can flourish at home and when they get to school, and thereby break the cycle of disadvantage for the current generation of young children

5. 5 Concern about reach Frank Field, MP for Birkenhead �Sure Start offers excellent services across the country, but this is irrelevant if, as is the case in a neighbouring local Sure Start programme, only one in five of eligible families are being reached.� Letter to Guardian newspaper, July 2005

6. 6 Why reach matters Participation in Sure Start is voluntary No guarantee that families will choose to participate If reach is low, people cannot benefit from the programme no matter how good it is Low reach could be a sign that a programme is not right for families Programme may reach families who need it least

7. 7 What do we mean by reach? Conceptually fuzzy Difficult to measure Observable and measurableConceptually fuzzy Difficult to measure Observable and measurable

8. 8 The two aspects of reach CONTACT Programme responsibility Identifying families Personal invitation Providing information Awareness raising USE Families� choice Services actually used Varies across families Varies across services

9. 9 Measuring reach How? simple proportion Reach = Number �reached� Target group Problems with denominators Problems with numerators Characteristics of users/ non-users Both Geographical boundary, no of children, mobility, inclusion of children out with the target group, inflated size not removing children. Postcodes didn�t correlateNumber of children HIS 550 0-4, 2001 Census 900 own database 12009-18% of council tax payers moved in anyone year. � �Both Geographical boundary, no of children, mobility, inclusion of children out with the target group, inflated size not removing children. Postcodes didn�t correlateNumber of children HIS 550 0-4, 2001 Census 900 own database 12009-18% of council tax payers moved in anyone year. � �

10. 10 Task Generation How it all came about What�s the task? Scoping the issue Previous work Task redefined Validation Hypothesis testing

11. 11 Sure Start Data Database(s) Reach (April 03 � March 04) Use of service upto 2 per month Maternal variables including postcode, maternal age, ethnicity, lone parent Child variables including gender, gestation, birth weight, ethnicity

12. 12 Validation Validating the number & location of children on the database Health Informatics Re-establish links E-mail, face to face meetings Use previous informatics work GIS reconciliation & data extraction

13. 13 Outcomes Sure Start database 1200 individuals over a 12 month period Compared actual vs predicted from population snapshots (1200 vs 924) No consistent pattern for variation Issues highly mobile population, fuzzy service boundaries

14. 14 Hypothesis testing Individual level data �missing� NHS no? Attribution of population level data to individuals Construction of expanded database postcode

15. 15 How? Unique id ? postcode ? census output area List of 70 Census output areas Generated a list of variables of interest Locally produced Nationally produced ONS � neighbourhood Constructed de novo

16. 16 Variables (1) Local � Sure Start use data Households on income support Households with children 0-4 on income support Distance from Sure start facility (km)

17. 17 Variables (2) ONS Census neighbourhood using OAs Education, health, tenure, economic activity, employment Constructed Townsend (unemployed, no car, not owner occupied, overcrowding). Raw score standardised by z-score technique (http://www.avon.nhs.uk/phnet/Methods/Townsend_Scores.xls)

18. 18 Analysis Ranked 2 ways: high �low and quintiles Used Chi square Problems with excel so constructed chi-square analysis

19. 19 Skills required �Can-do� attitude Ability to self define the task Project management skills Relationship building skills Ability to work across organisational and cultural boundaries Good enough informatics knowledge Computer skills/ONS/Excel skills (stats) Knowing what you want Persitence Knowing what you want Persitence

20. 20 Team working Another person to talk to! Two heads are better than one You have different skills and different understanding

21. 21 Discussion Any comments on the approach used? How can you build and foster good relationships with health informatics? What are your core information skills?