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Returning Home

New ideas are blossoming

New ideas are blossoming

 

After more than four weeks of travel, conferences and events it is good to return home. CENSEMaking’s sabbatical is over and over the next few weeks I’ll be sharing the insights gained from a brief, but deep immersion into of the biggest design cultures in the world (Italy and Finland) and spending time exploring the latest in evaluation research and practice from around the world at the Canadian Evaluation Society‘s annual conference as well as time spent at PAHO in Washington DC working with the eSAC team looking at how to develop engaged communities of practitioners, innovators and policy makers in public eHealth and equity.

Stay tuned and enjoy the start of summer wherever you are.

Cameron

behaviour changecomplexityeHealthinnovationknowledge translation

The Face-to-Face Complexity of eHealth & Knowledge Exchange

The Public Health Agency of Canada‘s 2010 Knowledge Forum on Chronic Disease was held last night today in Ottawa with the focus on social media. The invitation-only affair was designed to bring together a diverse array of researchers, practitioners, policy developers, consultants and administrators who work with social media in some capacity. There were experts and non-experts alike gathered to learn about what the state of the art of social media is and how it can support public health. By state of the art, I refer not to the technological side of things, but rather the true art of public health, much like that discussed earlier this year at the University of Toronto.

Last night began with a presentation from Leanne Labelle that got us all thinking about how social media is radically different in the speed of its adoption and breadth of its social impact drawing inspiration from this video from Eric Qualman’s Socialnomics website.

Today we got down to business and started working through some of the issues that we face as a field when adopting social media. I would probably consider myself among the most experienced users in the audience, yet still gained so much from the day. Although I learned some things about how to use social media in new ways, what I learned most was how others use it and what struggles they have. This is always a useful reminder.

What stuck out was a presentation and related discussion from Christopher Wilson from the University of Ottawa’s Centre on Governance and a consultant on governance issues. In speaking about the challenges of doing collaboration, Christopher pointed to the problems of a ‘one-size fits all’ strategy using a diagram illustrating the fundamental differences between engagement at a small scale (under 25 people) and what is the mass collaboration that folks like Clay Shirky, Don Tapscott, and others write about. His diagram looks like this:

Technology Spectrum of Social Collaboration by Christopher Wilson

What Wilson stressed to the audience was the role that complexity plays in all of this. Specifically, he stated:

The more complex and interdependent things become, the more people need to be aware of the changing context and the changes in shared understanding.

As part of this, groups are required to engage in ways that enable them to deal with this complexity. In his experience, this can’t be done exclusively online. He further stated:

As complexity increases, the need for offline engagement increases.

I couldn’t agree more. In my work with community organizing and eHealth promotion, I’ve found the most effective means of fostering collaboration is to blend the two forms of knowledge generation and exchange together. The model that my research team and I developed is called the CoNEKTR (Complexity, Networks, EHealth, and Knowledge Translation Research Model).

This model combines both face-to-face methods of organizing and ideation, with a social media strategy that connects people together between events. The CoNEKTR model has been applied in many forms, but in each case the need to have ways to use the power of social media and rich media together with in-person dialogue has been front and centre. Using complexity science principles to guide the process and powered by social media and face-to-face engagement, the power to take what we know, contextualize it, and transform it into something we can act on seems to me the best way forward in dealing with problems of chronic disease that are so knotted and pervasive, yet demand rapid responses from public health.

education & learningeHealthsocial media

Amazing Stuff: The Film and Video Edition

 

Last week my class on Health Behaviour Change was on the topic of eHealth. So to make the point about how information technologies can play a role in supporting change I decided to create a series of YouTube-sized bits of content for my students rather than give a lecture. The ‘lecture’ became a series of short videos starring some of my teammates at the Youth Voices Research Group and brilliantly shot and edited (with next to no time) by our uber-talented  resident health promotion videographer, Andrea Yip. This experience, plus exposure to a number of serendipitous videos over the past week had me thinking that a special film and video edition of Amazing Stuff was warranted. So to welcome the month of December, the darkest month of the year for us here in the North, I thought I’d share some sites to visit when you’re huddled inside looking for knowledge, inspiration or amusement:

1. TED. This is fast becoming THE site to waste time on and learn about amazing things from. Originally started as a meeting of artistic and creative types in Monterrey California in 1984, this annual meeting (now spawned into many international meetings) features some of the leading thinkers in such diverse areas as design, science, the arts, politics and public life. You’ll come for one talk and stay for a dozen. This is must-see Web TV.

2. Fora.tv. This newish web channel is another feed for the soul of those interested in science, the economy, technology and other issues that are particularly nerd friendly to us academics. There are some high-quality videos here and some insightful lectures.

3. Current.com is Al Gore’s digital cable channel. There are some interesting things on it, but nothing and I mean nothing beats Infomania; my favourite show on TV, or the Web, or both . Sadly, Infomania is taking a break this week, but the witty satire of the entertainment biz will return in early December.

4. The National Film Board of Canada is one of this country’s gems. It is a treasure-trove of high-quality material and insightful documentaries on a wide range of topics. Perhaps the one that has my interest most piqued is the Filmmaker in Residence program that Kat Cizek has held for the past few years. Kat and her colleagues have done some amazing work at highlighting the perils of homelessness, inner-city health, and the plight of new mothers living in poverty. This is really health promotion video at work and something that I’d like to see a lot more of.

5. And lastly, I came across Publicvoice.tv this past week as I attended the Ivey Centre for Health Innovation and Leadership’s first annual Global Health Innovation conference in Toronto. Publicvoice has a great set of speakers and interviews with people out to change the world and influence Canadian and international public policy. The entire conference and interviews with the key leaders are available at Publicvoice.tv or will be available at the conference’s ongoing Ning community of practice site.

Now if anyone can help me find the time to watch all of this…

behaviour changecomplexitydesign thinkingeHealthpublic health

Benchmarking Success in Times of Change

 

Successful evaluators know the power of benchmark. The Oxford English Dictionary describes the act ‘to benchmark’ as “evaluate or check (something) by comparison with a standard. The Wikipedia definition of Benchmarking is:

Benchmarking is the process of comparing the business processes and performance metrics including cost, cycle time, productivity, or quality to another that is widely considered to be an industry standard benchmark or best practice. Essentially, benchmarking provides a snapshot of the performance of your business and helps you understand where you are in relation to a particular standard.”

From an evaluation standpoint, a benchmark provides us with a comparator to help assess how well (or poorly) a particular program is doing. From corporate leaders to university presidents to healthcare administrators benchmarking serves as the referent and focus for programming activities and the foundation for ‘best practice’. But what if best practice isn’t good enough? Or put another way, what if following the leader means going the wrong way?

In the world of consumer or behavioural eHealth much of what we use as our benchmarks are derived from a type of healthcare model that is institution and often technology-centred rather than patient-centred. It is more often something tied to medical treatment of specific problems and technology focused using a highly linear approach to treatment.

Yet in the age of Google Wave, these linear models don’t look to fare well. The future of healthcare, as Frog Design recently opined, is social. What are the benchmarks when your eHealth intervention is not a single technology, but a suite of interacting tools that are online, collaborative and mobile in different measures at different times within a diverse context of treatment and preventive behaviour? How do we measure success? What happens when the ‘effect’ of an intervention is social in nature and supported by multiple tools working in different combinations each time?

In evaluation, we often look for the most likely cause of a particular effect. Yet, what is the effect of any one wave in an ocean of influence? While it is impossible to deconstruct the influence of that wave, it is possible to anticipate what a wave might do under certain conditions and, if the timing is right, it might be possible to get on top of that wave and surf it to shore.

What if we took a wave model and, like surfers, read the seas to determine the appropriate time to dive in, acknowledging that the break will occur differently, the velocity might vary, the height of can’t be predicted, but through activity and practice we can enhance our anticipatory guidance systems to better select waves that might lead to some fine surfing? My research team at the University of Toronto has begun working on these models and methods because as anyone in public health can tell you, the tide is high and with complex problems like chronic disease, the waves are getting big. Twitter, Facebook, blogs, iPhone apps big and small are all collectively influencing people’s behaviour in subtle ways and through acknowledging that these collective tools are the cause and consequence of change can we begin to develop evaluation models to make sense of their impact on the world around us.

behaviour changeeducation & learningeHealthhealth promotionpublic health

eHealth Deja Vu All Over Again

"This social media stuff is like eHealth deja vu all over again"

"This social media stuff is like eHealth deja vu all over again"

Yesterday I had the privilege of speaking to Cancer Care Ontario‘s LEARN community of practice meeting in Toronto about social media and how it could be used to support their health promotion (specifically tobacco control) work with youth and young adults. This group does a lot of work with young adults so information technologies are not alien to them (indeed, many had blogs, Facebook pages and other social media tools), yet they were still uncertain about how best to use these tools and why they might want to in the first place. In preparing for the presentation and in the subsequent discussion afterwards I had this overwhelming sense of having been here (and there) before. It was, as Yogi Berra famously said: deja vu all over again.

My first study on the Internet was conducted in 1995, a time when the World Wide Web was just becoming known outside of academia and the best option for social support was UseNet groups. With a friend of mine, we did the first (to my knowledge) global survey on the use of the Internet for social support (note: this is why its important to publish your results as soon as you get them, otherwise it will never happen 😦 . I did, however, present findings at the Prairie Undergraduate Research Conference at the University of Winnipeg, perhaps the most remarkable event in support of student scholarship in psychology (or any other discipline) I’ve witnessed. But I digress…)

As I moved along in my career, I continued to work with the Internet as a tool — from discussion boards to interactive smoking cessation support tools and using qualitative methods and design principles to large randomized trials. All along I would hear (and still do) comments like “isn’t that (technology) stuff just for fun?” or “why would anyone want to use that?” .

The same pattern keeps repeating. 20 years ago if you were to describe using email as a serious means of communicating – something that one should devote work time to – most employers would scoff. Now, email is integrated deeply into the very fabric of nearly every knowledge-based enterprise to the point that the corporate market for mobile services to deliver email to its workforce is in likely in the billions. 10 years ago if you were found in your office searching the World Wide Web for content of a serious (i.e., work-related) nature, a similar scoff might come. Now? Open access journals are becoming top publishing venues in their field (see the Journal of Medical Internet Research in the Health Services Research area as one example) and tools like Google Scholar are invaluable resources for scientists and practitioners alike.  The LEARN group gets this. They are the ones who are trying things out and trying to push the boundaries of their organizations, changing mindsets and considering whether or not social media is for them or not and in what measure.

A few months ago I spoke to another, similar group of health practitioners about eHealth and asked the audience about their experience using social media. Many of these settings — particularly public health units — didn’t allow Facebook or YouTube to be accessed.  Presumably, it was to avoid people doing things that weren’t serious work. This all reflects a mindset pattern that repeats in many organizations — public health or otherwise: people don’t see how the new technology can help because it is not obvious (or they haven’t even tried it), therefore it is dismissed as irrelevant or even banned outright.

The challenge here — and one that I take up — is about lowering these barriers through education. I think it is imperative that those of us (perhaps you, dear reader) who work in social media and eHealth help others to support their efforts to change the culture of their organizations. The LEARN folk are doing this, just as I did so with them. No matter how much we as ‘experts’ like to showcase new tools, we are the early adopters and massive social change will not happen until we inspire the next wave of people to take it up.  One forum for this is at the eHealth Promotion social network, a Ning group formed out of the experiences at this year’s Health Promotion Summer School in Toronto, that was on the very topic of teaching people about eHealth in public health. Best of all, when we get these new adopters joining into the discussion and familiar with the tools, they can also help us determine what doesn’t work with these tools, what their limits are, and even what risks they bring in a manner that is informed, constructive and not dismissive.

If public health is going to be innovative, that is doing things that haven’t been done or in new ways to address emerging problems, then it needs to understand social media. What and how much it adopts it is really a matter of need and circumstance, but as I pointed out in my talk yesterday, we cannot wait for the evidence to come in to make that leap. Last year, the research on Web-Assisted Tobacco Interventions (perhaps the leading domain of public eHealth research) finally reached a point where we could say with some confidence that the principal of using the Web to support smoking cessation and prevention is evidence-based. That was more than 15 years after the birth of WWW.

Are we going to have to wait another 15 years before public health widely adopts tools like microblogging (e.g. Twitter) or considers the use of mobile messaging and video or social networks in its work? By then the evidence might be in and if that is what it takes to get this adopted or accepted it will be deja vu all over again, and that’s not a good thing.