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Building the evidence and changing practice in the wider public health workforce

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Recently the Centre for Workforce Intelligence and Royal Society for Public Health published reports highlighting the importance of engaging the wider public health workforce to support improvement in population health.

They identified several workforces such as the allied health professions (AHPs), fire and rescue services, midwifery, community pharmacy and housing sector staff as they not only have the opportunity, but also the skills and enthusiasm, to take a greater role.

The wider public health workforce consists of professions that have the opportunity or ability to positively impact the health and wellbeing of the public through their work, but are not employed directly in a public health role.

One of the struggles we face is to try and increase the limited amount of data and evidence to demonstrate the impact these workforces have on improving population health.

Common sense tells us that these professions can make an impact. Who could deny that a workforce of 80,000 allied health professionals across England, using the making every contact count (MECC) approach in their 2 million contacts per week can improve population health; or that the 167,000 safe and well visits carried out by fire and rescue services every year could reduce the number of falls. However we need hard evidence.

So which comes first, the mobilisation of an enthusiastic and committed workforce or the research to understand the impact of their interventions? In practice both need to be developed in tandem.

As part of Public Health England’s work to support the 12 allied health professionals become recognised as an integral part of the public health workforce, we have instigated and contributed to research into the impact of AHP's on population health.

A piece of work we commissioned from Sheffield Hallam University, which is due to be published later this year, mapped where there is current evidence of impact and where there are gaps in the research.

One of the key messages from this work is that AHP research is primarily focused on individual level outcomes which is hardly surprising given the historic way that AHP interventions have developed and been commissioned.

We have a role to support clinical researchers to expand their focus to include improving population health outcomes where possible.

Similarly to AHP’s the work of fire and rescue services involves case finding, early interventions and signposting and supporting the individual as part of an integrated approach. The evaluation of these pathways is notoriously difficult.

Therefore PHE is working with the Chief Fire Officers Association to develop evidence that demonstrates the potential impact and return on investment for these pathways.

Recently PHE partnered with the Council for Allied Health Professional Research to run the first ever public health research awards for allied health professionals. We had a high calibre of entry and I am delighted to announce the winners of this award for 2015 at the end of this this blog.  The winners will be presenting their posters at the PHE annual conference in September.

And finally, the message to the wider public health workforce is to consider how you could adapt your current work to have an impact on population health, then test it, evaluate the impact and share your results so that others can build on them.

And the call to action for clinical researchers is to consider the potential to add a population health component to your research.

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Winner - Niina Kolehmainen, Newcastle University;  Jill Francis, City University London; Christine Owen, NHS Lothian; Craig Ramsay and Loran McKee, University of Aberdeen; and Cheryl Missiuna, McMaster University in Ontario

Enabling health and well-being by promoting participation in physical activity:  a mixed method, multisite study of children with motor impairments.
This study identified the modifiable bio-social factors related to participation in physical activity in children between the ages of six and eight years old with motor impairments; and reviewed interventions used by therapists to increase participation. The researchers found that family participation in physical activity was the strongest factor explaining variation in children's participation yet therapist interventions tended to focus on the child’s impairment. This work has highlighted the opportunities and potential benefits for therapists to explore the wider social aspects of physical activity in children with motor impairment as part of their interventions, particularly family participation.

Winner - Dr Lisa Farndon and Vicki Robinson from Sheffield Teaching Hospitals (STH) NHS Foundation Trust

If the shoe fits: enabling patient centred podiatry through a social science methodology.
The researchers highlighted that two thirds of people with diabetes wear inappropriate footwear which increases the risk of diabetic foot complications.  Podiatrists may advise on the most appropriate footwear, however most people will choose a shoe based on factors such as its appearance, price and availability. The researchers took a more holistic view about’ fit’ and identified barriers linked to selecting appropriate footwear under 4 themes: practicalities, personal, purpose and pressures. As a result they have developed a tool kit to support conversations about suitable footwear intended to increase the likelihood that positive sustainable footwear changes are made. This work has the potential to be developed further with the shoe manufacturing industry.

Highly Commended as a service evaluation was Dr Deborah Gibbard from Solent NHS Trust

Evaluation of a trans agency approach to enabling access to parent based interventions for language delay in young children in areas of social disadvantage.
This evaluation compared an enhanced parent based service to standard care.  The results showed the enhanced intervention increased engagement from parents which increased language gains for children. Such interventions have potential to impact on a child’s future educational attainment and life chances

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  1. Comment by Niina Kolehmainen posted on

    A huge thank you for this prestigious award! We are thrilled as a team, and confident that this recognition will help us to move the work forward.

    Interestingly, our project showed that sometimes the things that by common sense seem as obviously true are not always so. That is where research can help: through collaborative projects it can help us identify new ways of doing things, and can improve the existing practices.

    AHP community is really embracing research at the moment; it's very exciting days. In the award letter to us, he award panel asked us how collaborative AHP public health research could be further advanced, and if there were learnings from our project. My top tip to all the readers of this blog would be: just get in touch with your potential partners. Just do it. You may need to knock on a few doors to find the right person, but ultimately it's just about us individuals making those contacts to build partnerships and collective projects. It's about speaking to others and being open to new relationships.

    I am certainly looking forward to hearing from any colleagues interested in public health and health promotion in children! =)

    A big thank you again to CAHPR for the award!