Methodological and Practical Considerations in Rapid Qualitative Research: Lessons Learned From a Team-Based Global Study During COVID-19 Pandemic

Rapid qualitative research (RQR) studies are increasingly employed to inform decision-making in public health emergencies. Despite this trend, there remains a lack of clarity around what these studies actually involve in terms of methodological processes and practical considerations or challenges. Our team conducted a global RQR study during the COVID-19 pandemic. In this article, we provide a detailed account of our methodological processes and decisions taken related to ethics, study design, and analysis. We describe how we navigated limitations on time and resources. We draw attention to several elements that operated as facilitators to the rapid launch and completion of this study. Rendering methodological considerations and rationales for specific RQR studies explicit and available for consideration by others can contribute to the validity of RQR, support further discussion and development of RQR methods, and make findings for particular studies more credible.

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Building Evidence for Legal Decision Making in Real Time: Legal Triage in Public Health Emergencies

Disaster Medicine and Public Health Preparedness ◽

10.1001/dmp.2011.57 ◽

2011 ◽

Vol 5 (S2) ◽

pp. S242-S251 ◽

Cited By ~ 4

Author(s):

James G. Hodge ◽

Timothy Lant ◽

Jalayne Arias ◽

Megan Jehn

Keyword(s):

Public Health ◽

Decision Making ◽

Real Time ◽

H1n1 Influenza ◽

Lessons Learned ◽

Influenza Outbreak ◽

Public Health Emergencies ◽

Ethical Decisions ◽

Law And Ethics ◽

Critical Public Health

ABSTRACTSimilar to the triaging of patients by health care workers, legal and public health professionals must prioritize and respond to issues of law and ethics in declared public health emergencies. As revealed by the 2009-2010 H1N1 influenza outbreak and other events, there are considerable inconsistencies among professionals regarding how to best approach these issues during a public health emergency. Our project explores these inconsistencies by attempting to assess how practitioners make legal and ethical decisions in real-time emergencies to further critical public health objectives. Using a fictitious scenario and interactive visualization environment, we observed real-time decision-making processes among knowledgeable participants. Although participants' decisions and perspectives varied, the exercise demonstrated an increase in the perception of the relevance of legal preparedness in multiple aspects of the decision-making process and some key lessons learned for consideration in future repetitions of the exercise and actual, real-time emergency events.(Disaster Med Public Health Preparedness. 2011;5:S242-S251)

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18.H. Workshop: Bringing evidence during public health emergencies: addressing the challenge through HTA

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.941 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

◽

Keyword(s):

Public Health ◽

Decision Making ◽

Emergency Preparedness ◽

Public Health Emergency ◽

Decision Makers ◽

Evidence Based ◽

Public Health Emergencies ◽

Response Planning ◽

Emergency Preparedness And Response ◽

Public Health Emergency Preparedness

Abstract Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and irrefutable evidence may be lacking. The process of including evidence in public health decision-making and for evidence-informed policy, in preparation, and during public health emergencies, is not systematic and is complicated by many barriers as the absences of shared tools and approaches for evidence-based preparedness and response planning. Many of today's public health crises are also cross-border, and countries need to collaborate in a systematic and standardized way in order to enhance interoperability and to implement coordinated evidence-based response plans. To strengthen the impact of scientific evidence on decision-making for public health emergency preparedness and response, it is necessary to better define mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies and the context in which these mechanisms operate. As a multidisciplinary, standardized and evidence-based decision-making tool, Health Technology Assessment (HTA) represents and approach that can inform public health emergency preparedness and response planning processes; it can also provide meaningful insights on existing preparedness structures, working as bridge between scientists and decision-makers, easing knowledge transition and translation to ensure that evidence is effectively integrated into decision-making contexts. HTA can address the link between scientific evidence and decision-making in public health emergencies, and overcome the key challenges faced by public health experts when advising decision makers, including strengthening and accelerating knowledge transfer through rapid HTA, improving networking between actors and disciplines. It may allow a 360° perspective, providing a comprehensive view to decision-making in preparation and during public health emergencies. The objective of the workshop is to explore and present how HTA can be used as a shared and systematic evidence-based tool for Public Health Emergency Preparedness and Response, in order to enable stakeholders and decision makers taking actions based on the best available evidence through a process which is systematic and transparent. Key messages There are many barriers and no shared mechanisms to bring evidence in decision-making during public health emergencies. HTA can represent the tool to bring evidence-informed actions in public health emergency preparedness and response.

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The challenge of bringing evidence in decision-making for public health emergencies: can preparedness reach out to HTA?

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.942 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C E Chronaki ◽

A Miglietta

Keyword(s):

Public Health ◽

Decision Making ◽

Policy Development ◽

Digital Health ◽

Resource Planning ◽

Public Health Emergency ◽

Evidence Based ◽

Public Health Emergencies ◽

The Impact ◽

Evidence Based Decision Making

Abstract Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and reliable data is typically lacking. The process of including data for preparedness and training for evidence-based decision making in public health emergencies is not systematic and is complicated by many barriers as the absence of common digital tools and approaches for resource planning and update of response plans. Health Technology Assessment (HTA) is used with the aim to improve the quality and efficiency of public health interventions and to make healthcare systems more sustainable. Many of today's public health crises are also cross-border, and countries need to collaborate in a systematic and standardized way in order to enhance interoperability to share data and to plan coordinated response. Digital health tools have an important role to play in this setting, facilitating use of knowledge about the population that can potentially affected by the crisis within and across regional and national borders. To strengthen the impact of scientific evidence on decision-making for public health emergency preparedness and response, it is necessary to better define and align mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies and the context in which these mechanisms operate. Activities and policy development in the HTA network could inform this process. The objective of this presentation is to identify barriers for evidence-based decision making during public health emergencies and discuss how standardization in digital health and HTA processes may help overcome these barriers leading to more effective coordinated and evidence-based public health emergency response.

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Biodefense and Emergency Use Authorization: Different Originations, Purposes, and Evolutionary Paths of Institutions in the United States and South Korea

10.21203/rs.3.rs-1214856/v1 ◽

2022 ◽

Author(s):

HyunJung Kim

Keyword(s):

Public Health ◽

United States ◽

South Korea ◽

Driving Forces ◽

The United States ◽

Lessons Learned ◽

Post Exposure Prophylaxis ◽

Meso Level ◽

Public Health Emergencies ◽

Level Analysis

Abstract Background: Historical institutionalism (HI) determines that institutions have been transformed by a pattern of punctuated evolution due to exogenous shocks. Although scholars frequently emphasize the role of agency - endogenous factors – when it comes to institutional changes, but the HI analytic narratives still remain in the meso-level analysis in the context of structure and agency. This article provides domestic and policy-level accounts of where biodefense institutions of the United States and South Korea come from, seeing through emergency-use-authorization (EUA) policy, and how the EUA policies have evolved by employing the policy-learning concepts through the Event-related Policy Change Model. Results: By employing the Birkland’s model, this article complements the limitation of the meso-level analysis in addressing that the 2001 Amerithrax and the 2015 Middle East Respiratory Syndrome (MERS) outbreak rooted originations and purposes of the biodefense respectively. Since the crisis, a new post-crisis agenda in society contributed to establishing new domestic coalition, which begin to act as endogenous driving forces that institutionalize new biodefense institutions and even reinforce them through path dependent way when the institutions evolved. Therefore, EUA policy cores (Post-Exposure Prophylaxis (PEP) in the United States and Non-Pharmaceutical Intervention (NPI) in South Korea keep strengthened during the policy revisions. Conclusions: The United States and South Korea have different originations and purposes of biodefense, which are institutions evolving through self-reinforce dependent way based on the lessons learned from past crises. In sum, under the homeland security biodefense institution, the US EUA focuses on the development of specialized, unlicensed PEP in response to public health emergencies; on the other hand, under the disease containment-centric biodefense institution, the Korean EUA is specialized to conduct NPI missions in response to public health emergencies.

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Legitimising a ‘Zombie idea’: childhood vaccines and autism

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.807 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Rizzi ◽

K Attwell ◽

V Casigliani ◽

J Taylor ◽

F Quattrone ◽

...

Keyword(s):

Public Health ◽

Decision Making ◽

Media Coverage ◽

Economic Benefits ◽

Lessons Learned ◽

Strategic Decision ◽

Childhood Vaccination ◽

Vaccine Hesitancy ◽

Scientific Authority ◽

Immunization Rates

Abstract Background In June 2017 the Italian government made childhood vaccination mandatory following a drop in immunization rates. In the years preceding, two court judgments affirmed a causal link between vaccines and autism. Studies have linked these decisions to internet searches about vaccine-autism, the popularity of 'no-vax' theories, and drops in immunization rates. This paper provides an in-depth case study of both decisions and their impact. Methods We use a synthetic research design reliant on: (i) a systematic collection of primary sources (publicly available and obtained via official access to information requests); (ii) interviews with key actors prominently involved in the two cases or privy to the Italian vaccine-injury compensation regime (iii) a systematic analysis of media coverage. Results Circumstantial and systemic flaws enabled these decisions. Poor trial strategies, insufficient resources and laborious communication practices between arms of government were facilitators. Lack of awareness of the social sensitivity of vaccine issues, underestimation of the phenomenon of vaccine hesitancy, and a tendency to 'think in silos' informed the lack of attention dedicated to the cases. The decisions created false expectations of economic benefits and vindication for families with autistic children, resulting in increased litigation. Systemic flaws exist in the process of appointment of expert consultants acting for the court leading to judicial reliance on false data. Conclusions Lessons learned include greater levels of attention to vaccine cases by the administration and a matured attitude of adjudicating bodies. Two issues remain: (i) the inability of government lawyers to disseminate positive results to counteract unfounded narratives; (ii) flaws in the process of appointing expert consultants advising courts, which remains focused on the fiduciary nature of the relationship, rather than scientific authority. Key messages The Milan and Rimini decisions that directly affected vaccine governance stemmed from a combination of circumstantial decision-making and systemic flaws that still lurk in public health governance. Strategic decision-making that overlooks lower levels of the adjudicative system can lead to significant public health consequences as courts of law and courts of public opinion obey different logics.

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(P1-21) Medical Disaster Relief after the 2009 American Samoan Tsunami: Lessons Learned

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11003530 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s105-s106

Author(s):

R. Partridge ◽

D.B. Bouslough ◽

L. Proano ◽

S. Soliai-lemusu ◽

F. Avegalio ◽

...

Keyword(s):

Public Health ◽

Disaster Response ◽

American Samoa ◽

Flood Damage ◽

Lessons Learned ◽

Capital City ◽

Public Health Emergencies ◽

The Pacific ◽

American Samoan ◽

Post Disaster

BackgroundTsunamis most commonly occur in the “Ring of fire” in the Pacific due to frequency of earthquakes and volcanic activity. Damaging tsunamis occur 1–2 times yearly. On September 29, 2009, an earthquake on the Pacific floor caused a tsunami that struck American Samoa, Samoa and Tonga, with only 20 minutes warning.ObjectiveTo evaluate the disaster response in American Samoa by emergency medical services (EMS), the territorial hospital, and the Department of Health.MethodsA retrospective review of EMS logs, public health records, hospital emergency department charts, and key-informant interviews over a 2-week period. Descriptive statistics were used to evaluate data.ResultsThree 5-meter waves struck the American Samoan islands, with land inundation as far as 700 meters. Many low- lying villages, including the capital city Pago Pago were affected. A total of 33 people (8 male, 23 female, including 3 children) were killed by the water, with approximately 150 significantly injured. EMS runs increased 250% from normal daily averages, with island-wide responses significantly delayed by flood damage. The hospital in Pago Pago, situated near the shore and only 10 meters above sea level, utilized 75 staff to evacuate 68 in-patients to high ground as soon as tremors were felt. This process was completed in 20 minutes with no associated morbidity or mortality. Patient injury patterns for the event are similar to recent literature reports. Mobile clinics and alternate care sites established at outlying dispensaries were used to decentralize healthcare from the hospital. DMAT/DMORT teams from Oregon and Hawaii supported local healthcare initiatives. Post-disaster public health surveillance focused on identifying and limiting food/water-borne illnesses, dengue fever, and influenza-like-illness outbreaks, as well as disaster related PTSD.ConclusionThe disaster response to the tsunami in American Samoa was effective. Disaster planning was appropriate and rapidly implemented. Post-disaster public health emergencies were minimized.

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Building Qualitative Research Capacity Among Interdisciplinary Teams to Investigate Girls’ Challenges With Menstruation: Process and Lessons Learned From a 14-Country E-Course

Pedagogy in Health Promotion ◽

10.1177/2373379918811983 ◽

2018 ◽

Vol 5 (4) ◽

pp. 283-292

Author(s):

Bethany A. Caruso ◽

Anna Ellis ◽

Gloria Sclar ◽

Candace Girod ◽

Gauthami Penakalapati ◽

...

Keyword(s):

Public Health ◽

Qualitative Research ◽

Research Capacity ◽

Interdisciplinary Teams ◽

Lessons Learned ◽

Middle Income ◽

Health Training ◽

Positive Effects ◽

Public Health Training ◽

Evidenced Based

Public health–related decisions are influenced by a variety of actors operating on local to global levels, including community leaders, educators, nongovernment organizations, government officials, donors, and researchers, many of whom may lack formal public health training. The provision of public health instruction to interdisciplinary professionals has the potential to strengthen the capacity of all stakeholders to make informed, evidenced-based decisions about health policies and programs. The use of online learning is emerging as a promising means of providing public health training, particularly among those living in geographically disparate areas and from multidisciplinary backgrounds. This article describes an online course created to teach participants in stakeholder teams from 14 low- and middle-income countries how to design and conduct qualitative research to understand girls’ challenges managing menstruation at school. The goal of the course was to strengthen each country team’s ability to conduct research by building the capacity of the members. Thus, completion of the course by all team members was an objective, but less of a focus than assuring that each team as a collective was gaining public health insights and working together to make informed decisions about their research goals. This course led to benefits beyond capacity strengthening, including the formation of a broader community of learning and practice that extended beyond country boundaries. We recommend embedding training opportunities for multidisciplinary stakeholders into research endeavors given the potential for positive effects on individual participants and overall policy decisions to improve community health and provide lessons learned for doing so.

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Who does Bolsonaro listen to under emergency conditions? Building a framework for analyzing informal presidential advisory networks during the Covid-19 pandemic in Brazil

Revista Chilena de Derecho y Ciencia Política ◽

10.7770/rchdcp-v12n1-art2362 ◽

2021 ◽

Vol 12 (1) ◽

pp. 219-253

Author(s):

Aglaé Tumelero

Keyword(s):

Public Health ◽

Decision Making ◽

Latin America ◽

Daily Diary ◽

Governance Structure ◽

Information Channel ◽

Methodological Framework ◽

Informational Support ◽

Public Health Emergencies

Despite evidence about the informal advisors of the presidents in Latin America, literature on this topic is still incipient. This article investigates the informational scenario that surrounded the Brazilian president, Jair Bolsonaro, from January to April 2020, a period of presidential decision-making on the measures to face the Covid-19 pandemic. In-depth case study of interactions established by the Brazilian president is developed based on data from the Brazilian President’s Daily Diary. Social Network Analysis (SNA) tools are used to analyze this evidence. The findings suggest that the Ministry of Health (MOH) was not the main information channel for the president at the beginning of the pandemic despite its central role in the national governance structure of public health emergencies. In addition, the analysis shows the president's choice to use the structures of the Presidency as main informational support, including strengthening them through unilateral administrative measures. Finally, the results indicate that there is no evidence that the president combined formal and informal advisory as a strategy to access alternative information to the MOH. The findings should be pondered regarding the partly reliable nature of the President’s Daily Diary as a source of relational data. The study provides a conceptual and methodological framework to identify and measure the presidential informal advisory strategy, contributing to the advance of research on presidential advising in Latin America.

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Methods to support evidence-informed decision-making in the midst of COVID-19: creation and evolution of a rapid review service from the National Collaborating Centre for Methods and Tools

BMC Medical Research Methodology ◽

10.1186/s12874-021-01436-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sarah E. Neil-Sztramko ◽

Emily Belita ◽

Robyn L. Traynor ◽

Emily Clark ◽

Leah Hagerman ◽

...

Keyword(s):

Public Health ◽

Decision Making ◽

Lessons Learned ◽

Decision Makers ◽

Rapid Review ◽

Final Report ◽

Health Crisis ◽

Public Health Decision ◽

Public Health Crisis ◽

Health Decision

Abstract Background The COVID-19 public health crisis has produced an immense and quickly evolving body of evidence. This research speed and volume, along with variability in quality, could overwhelm public health decision-makers striving to make timely decisions based on the best available evidence. In response to this challenge, the National Collaborating Centre for Methods and Tools developed a Rapid Evidence Service, building on internationally accepted rapid review methodologies, to address priority COVID-19 public health questions. Results Each week, the Rapid Evidence Service team receives requests from public health decision-makers, prioritizes questions received, and frames the prioritized topics into searchable questions. We develop and conduct a comprehensive search strategy and critically appraise all relevant evidence using validated tools. We synthesize the findings into a final report that includes key messages, with a rating of the certainty of the evidence using GRADE, as well as an overview of evidence and remaining knowledge gaps. Rapid reviews are typically completed and disseminated within two weeks. From May 2020 to July 21, 2021, we have answered more than 31 distinct questions and completed 32 updates as new evidence emerged. Reviews receive an average of 213 downloads per week, with some reaching over 7700. To date reviews have been accessed and cited around the world, and a more fulsome evaluation of impact on decision-making is planned. Conclusions The development, evolution, and lessons learned from our process, presented here, provides a real-world example of how review-level evidence can be made available – rapidly and rigorously, and in response to decision-makers’ needs – during an unprecedented public health crisis.

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Measuring crisis decision making for public health emergencies

PsycEXTRA Dataset ◽

10.1037/e660202010-001 ◽

2009 ◽

Cited By ~ 4

Author(s):

Andrew M. Parker ◽

Christopher Nelson ◽

Shoshana R. Shelton ◽

David J. Dausey ◽

Matthew W. Lewis ◽

...

Keyword(s):

Public Health ◽

Decision Making ◽

Public Health Emergencies

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