Assessing the Public Health System in Delaware
Assessment Results
Essential Public Health Service #3:
Inform, Educate, and Empower People about Health Issues
On July 19, 2006, an Assessment Team including representatives from the Division of Public Health, Department of Education, Delaware Academy of Medicine, University of Delaware, and private entities including the media and consultants listened to public testimony from Blue Cross Blue Shield of DE, Department of Education (DOE), Westside Health, CAMP Rehoboth, Comcast Spotlight, American Diabetes Association, DE Academy of Medicine, Nylex Educational & Counseling Services, Aloysius Butler & Clark, and Cape Henlopen Wellness Center. The Assessment Team then examined how the public health system in Delaware performs Essential Service #3: Inform, Educate, and Empower People about Health Issues. This essential service includes:
- health communication on health issues for all Delawareans;
- health education assistance and resources to all areas of Delaware;
- effective and appropriate health communications and health promotions; and
- resources to assure people are informed, educated, and empowered about health issues.
The Assessment Team examined four indicator categories:
- planning and implementation;
- technical assistance and support;
- evaluation and quality improvement; and
- resources.
The Team identified both strengths and gaps in the public health system performance of this essential service in Delaware. A consensus agreed that the statewide public health system is currently performing in the bottom quartile of the model standard for Essential Service #3.
The Assessment Team rated the Delaware public health system as having partially met the model standard in the areas of planning/implementation and in technical assistance/support. Under planning/implementation, Delaware public health system partners are fairly strong at using multiple media including print, radio, television, and the internet to provide current health information, education and promotion. Public health partners also provide some technical assistance and consultation to communities and each other.
The Team identified noticeable gaps in the areas of evaluation/quality improvement and resources. Gaps included a lack of clarity and consistency in health education/information messages; a lack of grass root social marketing and getting the proper message to target groups (cultural competency needs); a lack of organized collaboration; and a lack of sharing system wide resources.
Evaluation of the Assessment Process:
Members of the Assessment Team felt the public hearing information was very helpful and they appreciated the interaction and openness throughout the session. The process and the format of the assessment were well received, but the topics were quite broad and it was difficult to stay focused especially since some of the questions were difficult to understand and were open to interpretation.
Sharing of Final Thoughts
This session helped participants to recognize how large the public health system is in Delaware and how perspectives vary among the partners. Consumers and family members look at things differently than agencies, and participants acknowledged the difficulty in focusing on comprehensive planning when dealing with immediate needs. Partners mentioned that there is a good of collaboration that goes on; however, it is evident that silos still occur. Several participants mentioned that the health messages that partners put out are sometimes inconsistent. Some struggled with the assessment questions, and some weren’t sure that they fully understood all the parts of the Essential Service model standard.
Priority List
Each member of the Assessment Team was asked to vote on a scale of 1 - 10 on the importance and priority of each of the four activity categories with 10 being the highest priority. Below are the indicator areas with the priority scores and a summary of strengths (in italic) and gaps (in bold ) that were identified during the public testimony. There was a lot of information that was shared and hopefully we captured the critical points.
3.1 Planning and Implementation (priority rank: 8)
- Many community partnerships
- Health communication plans are in place for some agencies
- Accessible health information is available
- DPH promotes optimal health and reduction of health risks
- Community education is ongoing through various agencies, and partners seek to develop more programs
- Traditional Public Health focus of individual service is now moving to a community focus
- Lack plans to address specific health problems such as obesity
- Crafting messages is very labor intensive – we don’t always have the time or expertise so inconsistent messages may get out.
- We tend to broadcast messages rather than targeting specific groups.
- Some areas of the state are harder to reach because of broader media accessibility
- Hospitals and major businesses were not at the table
- Lack of computerized planning
- Lack of community resources
- Lack of follow-up – results from task forces, Healthy People 2010, etc.
- Need more grassroots – social marketing efforts
- DPH expertise not used well
- Lack of messages to Sussex Co & low-income people
- Poor health education training for partners such as police, fire, etc
- Partners don’t always use the expertise of affected people in planning & developing health issues
- There is a lack of culturally and linguistically appropriate health education and health promotion materials available
- There is a lot that we don’t do for specific populations
3.2 Technical Assistance/Support (priority rank: 8)
- DPH website
- Community groups
- Partners support local organizations
- Public health system partners act as a resource and provide educational information and material
- Web-bases tools are available
- Spanish educational materials are becoming more readily available
- Media variety
- Effective methods used in providing assistance
- Subcontracts from DPH have benefited many programs.
- DE has a lot of resources to provide technical support, although they may be hard to locate
- No training or lack of training to provide technical support
- Silos restrict assistance
- Poor infrastructure system
3.3 Quality Improvement/Evaluation (priority rank: 9)
- Individual systems do well – hospitals, DPH
- Some partners monitor and evaluate programs – (DPH programs submit monthly or quarterly reports)
- Collaborative activities are ongoing
- Social marketing campaigns involve affected persons
- Public surveys are ongoing through a number of programs
- Data for specific programs and disease conditions is reviewed periodically
- Silos limit possible collaboration and partnerships
- The people who are affected by health issues aren’t involved in the review of health information/education materials
- Some programs and coalitions struggle with outcomes – did we make a difference?
- Changes in the public health system are slow-moving
- Some health information/messages conflict
- What happens to the information – once surveyed – we never see it.
- Who is assuring coordination – participants with providers
- In collaboration sometimes it is difficult to agree on a specific set of measures for various programs
3.4 Resources (priority rank: 10)
- Much accessible health information
- Lots of interest in cultural competency
- Many community partnerships
- Much data gathering
- Good disease surveillance
- Social Marketing used by some partners
- Focus groups used by some partners
- DPH website exists
- Delaware Academy of Medicine librarian located at a public library in both Kent and Sussex Counties – NCC in fall
- Spanish educational materials are more available
- Web-base tools available - internet
- Multiple media outlets such as brochures, billboards, radio, and television
- Health educators with a number of agencies provide public outreach
- Public is not utilizing public resources
- System-wide sharing of resources is weak
- Silos keep us from being flexible with money
- People with issues other than priority issues have difficulty finding help
- Lack of cultural and linguistic variety in health messages – location of billboards
- Don’t use workforce expertise as effectively as possible
- Resources are not allocated readily to address severe mental health crises
Next Steps:
Once the discussion and reports from this meeting are shared with the group, several participants mentioned considering setting up town meetings with health organizations to bring the outcomes of the assessment to the communities. One participant expressed the need to share contact information of all assessment team and the testimonies, which will be done. The Division of Public Health anticipates convening a meeting in the first quarter of 2007 with all of the participants in each of the essential service assessments. Participants will be asked to prioritize the services and gaps, develop an implementation plan, and draft action steps with assigned responsibilities.
