DISPARITIES RANK HIGH IN PRIORITIZED MCH RESEARCH AGENDA IN MISSOURI Pamela K. Xaverius 1, Sherri Homan 2, Paula Nickelson 2, & Leigh Tenkku 1 1 St. Louis University, School of Medicine, Department of Community and Family Medicine; 2 Missouri Department of Health and Senior Services

Background Maternal and child health (MCH) has long been a focus of public health programs. Identifying and investigating health problems is at the core of essential public health services. A general plan for research can provide the overarching framework necessary for identifying interventions that can ameliorate health problems.

Essential Public Health Services 1.Monitor health status 2.Diagnose and investigate health problems 3.Inform, educate and empower people about health 4.Mobilize community to solve health problems 5.Develop policies and plans that support health efforts 6.Enforce laws and regulations that protect health 7.(a) Link people to needed personal health services (b) Assure the provision of health care 8.Assure a competent public health workforce 9.Evaluate effectiveness of health services 10.Research new innovative solutions to health problems Source: Essential Public Health Services Work Group of the Public Health Functions Steering Committee

Essential Public Health Services Linked to the core functions Cyclical and continuous processes Managed at the systems level Enhanced through active research

Research Agendas: Previous Methods 1. Documentation of the gaps in the literature is required to establish innovative ideas for a research agenda. 2. Prioritization of agenda items, accomplished by a small group of experts prioritizing gaps in the literature review, is required to move an agenda to action. 3. Prioritization of agenda items should be contingent upon prevalence and incidence of morbidities and mortalities in communities

Moving Research Agendas to Action Strategies towards this should: 1.Enlist the support of local leaders 2.Assess available resources 3.Ensure community readiness 4.Identify practical & acceptable innovations These strategies combat issues that could move an agenda away from the needs of the population it is meant to serve, such as: 1.Funding sources 2.Vested researcher interests 3.Publication bias 4.Consumer pressure

Consideration of Community Readiness A research agenda must consider not only consider the gaps in the literature, expert reviews, and burden on society but also how receptive and ready the community is to implement efficacious innovations.

Study Question This study aimed to identify a MCH research agenda, geared towards identifying research priorities as well as experts within the community to carry out those priorities.

The Initial Agenda Eleven MCH researchers identified and researched 17 different topics, regarding potential MCH innovations: 1.Gaps in the literature 2.Burden on society 3.Burden of disease 130 specific research items were identified within one of 17 topics: 1.Community development 2.School health 3.Health care access 4.Family support 5.Immunizations 6.Community education 7.Pre/post natal care 8.Environment 9.Nutrition/physical activity 10.Tobacco/alcohol 11.Injury/violence 12.Substance abuse 13.Oral health 14.Children w/ special health care needs 15.Chronic conditions 16.Mental health 17.Disparities

The Survey In 2005, a survey was ed maternal and child health (MCH) researchers through out the state. Participants were asked to: 1.Select research priorities 2.Identify personal areas of expertise 3.Identify new research items for the agenda

The Participant: The MCH Researcher 1,027 potential participants were identified: 1.Identified epidemiology specialists at local public health agencies 2.Identified presenters at the Missouri Association of Local Public Health Agencies (MoALPHA); 3.Identified Missourians funded to conduct MCH research by the National Institutes of Health, CDC, and March of Dimes; 4.Identified Missourians who authored recent ( ) MCH research articles in peer-reviewed journals (names of first three authors from the PubMed database were included on the initial list). From the list of 1,027, 180 verified their MCH researcher status, 687 did not respond (66.9%); 160 responded that they were not a MCH researcher (15.6%); 180 responded they were a MCH researcher (17.5%). Of the 180 persons identified as MCH researchers, 130 of them completed the survey, for a 72.2% response rate.

The Participants: Demographics Job titles: Professors (64.6%) Specialists (2.3%) Epidemiologists (5.7%) Physicians (5.4%) Other (20.0%) Employer Type University (75%) Hospital (12.3%) State of Local Public Health Agency (6.2%) “Other” health venue (e.g., MCH Coalition, Missouri Family Health Council) (6.2%) Employer Location: Major or minor metropolitan area (95.4%) Micropolitan area (3.2%) Non-metropolitan area of the state (1.5%)

Results: Priorities 1.Evaluate disparities in terms of age, race, ethnicity, and gender, regarding sexually transmitted diseases, chronic disease, birth outcomes, prenatal care, access to care, child-hood exposure to lead, immunizations and vaccinations, mental health, substance abuse, and oral health: 54.6% 2.Identify barriers to health care access (e.g., geographical, ethnic/racial, economic, school- based clinics, etc.): 52.3%, 3.Construct research ecologically (e.g., understanding the relationship between humans and physical and social environments and the impact of individual, organizational, and community level variables on health phenomena): 50.0% 4.Increase access to oral health for rural children, low SES families: 43.1%, 5.Reduce the prevalence of children who are or are at-risk for overweight: 42.3%

Results: Areas of Expertise Areas of expertise were determined by topical area, rather than specific research issue, designed to reflect broader MCH public health goals and objectives. 83.1% of respondents reported at least one specific topic of expertise, with a mean of 7.4 areas of expertise per respondent (range 0-41; SD 7.8).

Results: Areas of Expertise Topics Number of Experts Percent of all respondents who were experts Health Care Access % School Health % Community Development % Family Support % Pre/Post Natal Care % Environment % Community Education % Chronic Conditions % CSHCN % Mental Health % Disparities % Immunizations % Substance Abuse % Injury/Violence % Oral Health % Tobacco/Alcohol % Nutrition/ Physical % Create Your Own %

Results: Write Ins Sixty-one respondents added 153 specific research items to the agenda, with 97 identified as a priority for the state. Of those 97 priorities for the state, 25 items were allocated to the infrastructure division, 42 items were allocated to the prevention division 8 items were allocated to the disease/treatment division 3 items were added to the disparities division 19 items were added to a “create your own division.” In sum, 46.9% of respondents added at least one specific research item to the agenda, with the majority of those items (80.4%) added to the already designated divisions within the survey, that is, infrastructure, prevention, disease/treatment, and disparities.

Conclusions: Priorities This survey identified disparities as the top priority for the state, followed by health care access, community development, oral health, and nutrition/physical activity, respectively. Over 83% of respondents reported at least one area of expertise, another important finding if the agenda is to be implemented by the community it is meant to serve. In addition, every specific item on the initial survey was identified by at least one respondent as a priority for the state.

Conclusions: Experts 54.6% identified disparities as a priority, with only 17.7% of the respondents reporting disparities as their area of expertise. 52.3% identified health care access as a priority, with only 40% of the respondents reported being as an expert in that area. 50.0% identified a community development issue as a research priority, with only 36.2% of all respondents indicating expertise in community development. 42% of the respondents voted for oral health and/ or nutrition/physical activity issues as MCH research priorities for the state, only slightly more than 10% of the respondents were experts in those areas.

Weaknesses A clear weakness of this study is in regards to the sample. The link between the establishment of a research agenda and the effect of its implementation on population level MCH indicators. This project did not assign specific research projects to specific researchers, and in fact, 153 additional specific research issues were added to the agenda.

Next Steps Identifying MCH researchers and practitioners throughout the state to develop practical plans and commit to researching these important social problems. Additionally, MCH researchers might need support and training to enhance or expand their expertise to address MCH issues of concern.

Public Health Implications The goal of moving efficacious innovations towards changes in practice can only happen when researchers, practitioners, and local leaders work collectively to lead an agenda more quickly to implementation and subsequently improve the health of women and children.