Translating evidence into practice: a shared priority in public health? Helen McAneney Centre for Public Health School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast Submitted Soc. Sci. Med.

Outline Background – Context & setting Public Health CoE – Aims & Objectives – Launch Networks within Public Health – Network Measures, – Trans-sectoral network, – RMSS Conclusions

Context The NI health care system has gone under major reforms in the last few years. In November 2005, the Secretary of State for Northern Ireland announced a radical restructure of public administration structures within the province. The number of public bodies have been reduced significantly to make the public sector more streamlined and economically efficient. The impact on health and social care has been significant [1]. The details given below were correct at the time of the launch of the CoE for Public Health in 2008, prior to the further reforms initiated on 1st April [1] Jordan et al., Health Systems in Transition: Northern Ireland. WHO Regional Office for Europe.

Context Chart 1: Organizational structure of the Northern Ireland Health Service [1].

Background: The NI Health Care System Table 1: Population sizes of the four Health and Social Services Boards, 2002 [1]. Figure 1: The four Health and Social Services Boards [1].

Background: The NI Health Care System Figure 2: The five Health and Social Care Trusts within NI. Source

BHSCT Belfast Health and Social Care Trust largest Health Care Trust in the UK [2]. 22,000 staff provide services to more than 340,000 people in Belfast and regional service to NI. From 1 April 2007, BHSCT responsible for services provided by Belfast City Hospital, The Royal Hospitals, The Mater Hospital, Greenpark Healthcare Trust, North and West Belfast and South and East Belfast HSS Trusts. [2]

Abbreviations Table 2: Abbreviations of organisational names

UKCRC Public Health Research Centres of Excellence. In 2006, the major funders of public health research in the UK came together under the auspices of the UKCRC to develop a coordinated approach to improving the UK public health research environment. Consortium of eight funding partners to create five UKCRC Public Health Research Centres of Excellence. The successful Centres, announced in January 2008, are based in –Newcastle, Cardiff, Belfast, Cambridge and Nottingham.

CoE for Public Health: Aims and Objectives Build academic capacity Increase infra-structure Multi-disciplinary working Sustain partnerships with practitioners, policy makers and the public, through leadership, networking and collaboration Promote excellence Increase evidence base Tackle challenging methodology, exploit and share datasets Complement other Research Council initiatives

CoE Network in Public Health Launch of UKCRC CoE in Public Health (NI) June 2008 Questionnaire to provide baseline data Create a map of PH community in NI 98 participants from 44 organisations & research clusters 193 nodes (organisations) nominated Table 3: Profile of participants

Table 3: How academic and non-academics personal goals related to those of CoE.

Table 4: Expectations at launch of CoE for Public Health (NI)

CoE Network in Public Health 193 organisations and research clusters Figure 3: Complete network

Network Measures Centrality measures Elevated position of the RDO in eigenvector and betweenness centrality. Table 5: Top 6 nodes by degree, eigenvector and betweenness centrality measures of Figure 3. See Table 2 for meaning of abbreviations.

Network Measures Centralisation Eigenvector centralisation, indicates a cluster of a few dominate organisations, central in the network structure. Other values indicate a robust network. Table 6: Centralisation measures of the network.

Network Measures Table 7: Core organisations within Figure 3 as ranked by the four centrality measures investigated. All organisations are regional to Northern Ireland with the exception of academics who are international.

Trans-sectoral Network A trans-sectoral network is calculated by grouping the individual actors according to some pre-described attribute and then aggregating the number of ties directed towards each group [3,4]. In mathematical terms, the adjacency matrix is rearranged to form a specified number of groups, wherein each group contains nodes with the same attribute. The 193 organisations depicted in Figure 3 organised according to their work sector, as listed in Table 3. [3] Norman and Huerta, 2006, Implementation Science 1, 20. [4] Lewis et al., 2008, Soc. Sci. Med. 67, 280–291.

Trans-sectoral Network Figure 4: Trans-sectoral network where nodes have been partitioned into equivalent groups according to work setting.

Quantifying Connections To quantify the connections, participants indicated the –impact (x) –strength (y) of the collaboration. Likert scale of 1 (strong) – 3 (weak) Correlation of parameters? Consider one or both? How?

Correlation of Parameters Figure 5: A bubble chart of values attributed to impact and strength of collaboration. Both measures were rated from strong (1) to weak (3). A bubble chart is a two- dimensional scatter plot where a third variable is represented by the size of the points, in this case the frequency of choice. The coefficient of correlation between impact and strength is r = Therefore both are duly considered in Table 7.

Root Mean Sum of Squares (RMSS) RMSS of impact (x) and strength (y) of collaboration allows for greater distinguishability of the given values. For example, given two samples –(x 1,y 1 ;x 2,y 2 )=(1,1;2,3) and (X 1,Y 1 ;X 2,Y 2 )=(1,2;2,2) –RMSS equates to  7.5 and  6.5 respectively, –arithmetic mean is 7 in both cases.

RMSS of Trans-sectoral Network Table 8: RMSS of impact (x) and strength (y), Entry (i; j) from row i and column j, gives the RMSS from group i to group j. Strongest if  2, weakest if 3  2

Conclusions Identified difference in attitudes/goals of academics & non- academics. Core organisations Influential organisation –good or bad? Sectors with little or no interaction. Network robust to removal of Academics ‘Value’ of trans-disciplinary interaction (RMSS).

Questions for the future CoE’s translational message, –improving cross collaboration –improving effectiveness for clinical or PH outcomes Future structure of NI PH Community Health reforms in NI (1 st April 2009) –new PH Agency, –One HSCB

Acknowledgements Centre for Health Improvement - QUB “The work was undertaken by the Centre of Excellence for Public Health (Northern Ireland), a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, Research and Development Office for the Northern Ireland Health and Social Services and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration is gratefully acknowledged ”.

Acknowledgements Dr Jim McCann –School of Mathematics and Physics, QUB Prof. Lindsay Prior –School of Sociology, Social Policy and Social Work, QUB Jane Wilde CBE –The Institute of Public Health in Ireland Prof. Frank Kee –Director UKCRC Centre of Excellence for Public Health (NI) –