the role of ‘champions’ in€¦ · why didn’t i know this back ... because how you raise your...

J. Abelson; D. Myers; L. Szymecko (presenting author); M. Danis; Z. Rowe; C. Salman; S. Goold

The role of ‘champions’ in

deliberations for priority setting:

Results from the DECIDERS project

Lisa A. Szymecko, JD, PhD Research Associate

szymecko@umich.edu

Priorities Conference University of Birmingham September 6-9 2016

Acknowledgements

Community Co-Director Zachary Rowe, Executive Director, Friends of Parkside

Research team and Steering Committee

Funding provided by National Institutes of Health (NIA) 1RO1AG040138-01

3

Steering committee members (15)

Steve Barnett McKenzie Health System

Lynnette LaHahnn Public Health Practitioner

James Bridgforth Michigan Center for Urban African American Aging Research

Margaret Brown Allegan General Hospital

Karen Calhoun City Connect Detroit & Michigan Institute for Clinical and Health Research

Terrance Campbell YOUR Center

Adnan Hammad Arab Community Center for Economic & Social Services

Jeffrey Halter University of Michigan

LaNeice Jones Neighborhood Service Organization

Charo Ledón Acción Buenos Vecinos

Peter Lichtenberg Wayne State University

Esther Onaga Coalition for Healthy Communities and MSU

Rene Rosenbaum Michigan State University

Lori Schultz Lake/Newago County Department of Human Services

Beth Waitrovich Michigan State University Extension

Research Team

Julia Abelson

McMaster University

Lawrence An University of Michigan

Nancy Baum Center for Healthcare Research & Transformation

Eric Campbell Harvard Medical School

Marion Danis National Institutes of Health Clinical Center

Hyungjin Myra Kim University of Michigan

Kathryn Moseley University of Michigan

Stephanie Solomon St. Louis University

Adreanne Waller Washtenaw County Public Health Department

Matthew Wynia American Medical Association

Background & Objectives

Priorities set through deliberative processes are informed by the values of deliberators and the discussions that precede them

Few systematic attempts to explore the roles and mechanisms through which deliberative discussions inform priorities

Guiding research question: What role do champions who advocate for particular priorities play in deliberative processes?

Study Context

The DECIDERS study (Deliberative Engaging Communities in Decisions about Research Spending)

CHAT (Choosing All Together) simulation exercise to research priority setting for minority and underserved communities

CHAT

CHAT – a serious

game

Played in 4 rounds

1. Choose for yourself or family

2. Team

3. Whole community

4. Individual (yourself or family)

8

CHAT

Study Context

47 groups (n=519) deliberated about health research priorities

October 2014 to November 2015

39 locations across Michigan

pre- and post-deliberation surveys captured participants’ individual and group priorities for health research

Study Demographics Age 18-85, 20% over 65 67% women 1/3 rural residents Race/Ethnicity

Non Hispanic White 45% Black/AA 30% Hispanic/Latino 8% Native American 6% Arab-American, Arab, or Chaldean 4%

63% income <$35,000 32.6% under the federal poverty level

Health status 17% fair/poor 35% good 48% very good/excellent.

Group Priorities (N=47) Priority Not

Selected Selected Level

N 1 2 3

What Causes Disease? 5 9 17 16

Promote Health 9 9 18 11 Communication 20 12 9 6

What works better? 29 5 7 6

Health disparities 21 10 10 6

Families and caregivers 11 13 16 7

Access 8 12 14 13 Improve research 34 5 3 5

Health care quality 20 15 8 4

Aging 6 9 18 14

Child health 3 1 19 24 Health policy 29 8 9 1

Healthy environment 5 9 16 17

Culture and beliefs 30 9 3 5

Mental health 2 0 13 32

Multiple conditions 13 13 14 7

Quotes on Mental Health

Because it's such a, it causes so much of our social problems and there are neglected people out there, wandering, without any health care.”

Marquette, UP

Guiding research question

What role do champions who advocate for particular priorities play in deliberative processes?

Methods

Qualitative analysis of group discussion component of selected transcripts (n=12)

Selection criteria: Transcripts

minimum of 7 participants identifiable speakers

Passages within transcripts Mental health and child health (overall top ranked

funding category) Health environments (range of responses that may be

more/less prevalent based on location) Culture & beliefs (often not selected)

Group Priorities (N=47) Priority Not

Selected Selected Level

N 1 2 3

What Causes Disease? 5 9 17 16

Promote Health 9 9 18 11 Communication 20 12 9 6

What works better? 29 5 7 6

Health disparities 21 10 10 6

Families and caregivers 11 13 16 7

Access 8 12 14 13 Improve research 34 5 3 5

Health care quality 20 15 8 4

Aging 6 9 18 14

Child health 3 1 19 24 Health policy 29 8 9 1

Healthy environment 5 9 16 17

Culture and beliefs 30 9 3 5

Mental health 2 0 13 32

Multiple conditions 13 13 14 7

Development of analytical

framework and coding scheme

Inductively derived through open coding of 3-4 full transcripts at a time by 4 team members to identify the presence and characteristics of a champion (2 rounds)

application of trial coding scheme to 3 additional transcripts for 4 categories of interest

discussion of trial coding results to identify areas of convergence and disagreement and to further refine the coding scheme

application of refined coding scheme to 12 transcripts

Coding scheme

Two principal elements of a champion role

Ownership (introduces the issue, offers initial case, dominates conversation…)

Advocacy (language arguing for or against a funding level, speaks to advance arguments…)

Both elements must be present but how and to what degree may vary (?)

Coding scheme Ownership Advocacy

- introduces the issue - offers an initial case for why it is

important to talk about - dominates conversation - Personalizes their interest in the

topic - Pushes to close conversation and

reach agreement about funding level to assign

- Uses language that clearly argues for a particular level of funding

- Advances arguments in support of this stance

- Makes a case for why the category should be prioritized

- Responds to counter-arguments or disagreements with additional counter arguments rather than as ideas that should be considered

- Offers a clear framing of the issues that has implications for funding level to be assigned

- Uses discussion of other categories to push their own favored view forward

Results

What does our data tell us about the presence or absence champions

overall?

within and across different categories?

How does the champion role exert itself in deliberations about priority setting?

Results – were champions

present?

Yes – but a limited champion presence in the data analyzed so far

Combined ownership + advocate of a category

Varying degrees (minor, major, co-champion and anti-champions)

Results champions in 12 focus

groups

Mental Health: 5/12 (3 minor)

Child Health: maybe 1/12 (1 minor)

Healthy Environment: 2/12 (3 minor)

Culture and Beliefs: 2 minor champions; 2 anti-champions

1 focus group had same champion in child health and in Environmental health

Results– how was the champion

role exerted – Mental Health?

most likely to garner quick and broad agreement from the group

despite this, some championing evident by taking ownership of the category and advocating for high level of funding on behalf of the group

Champion for MH X introduces and makes a case for starting

with this category on behalf of the group and for assigning a high priority for funding

Mental health’ because it seems like we are all—a lot of us are in agreement on

that. How important it is

To me, it’s a priority. I put 3 both times

because…I was happily surprised that so many

people in this room seem to feel the same

way… I just, personally,

I think it is something that’s been lacking in…

CHATrs provided many reasons for

funding, often personal

Safe place for discussion; shared personal stories; gave examples current and historical

My brother also had a stroke and he lives with me and I can see that he has a slight mental problem because we will play certain music and he will just bust out crying. And nobody knows why he’s crying

…After all these years, the psychiatrist said, “Yeah, you’re bipolar. You have a mood disorder, split personality. Well, where did that come from? Why am I finding out about this now? Why didn’t I know this back then?

Results– how was the champion

role exerted – Child health?

championing isn’t needed as there is broad support for this category

Champion here pushed for Child Health when discussing other categories

Because how you raise your child will dictate how they live their life. Like if

you teach your child certain fundamentals about nutrition,

exercise, and all that, then that will stem problems with aging

So that’s why I feel it’s really

important

Results– how was the champion

role - healthy environment

strong and compelling introduction to the topic and case for healthy environment being linked to all of the other categories; jumps right into advocating for a funding level

The environment affects all categories. That’s why I'm

really 3 on this one S for President

quick agreement from others

Results– how was the champion

role exerted – culture and beliefs?

An Anti-Champion - Offers strong counter-frame, strongly advocates for not funding research in the area

I just don’t think it’s very necessary. I think

that it’s too much research going on on

language and stuff and background and not

enough getting at the main core of the issue.

…as long as somebody can come in and get the care that they need. So, if their

feelings get hurt in the process, then they

should get over themselves a little bit,

Bing-Bing-Bing-Bing-Bing

Connecting Champions with

Outcomes FG MH CH EH CB

A 3 3 3 1

B 0 3 1 1

C 3 2 2 1

D 3 3 3 0

E 3 2 2 0

F 3 0 3 0

G 3 1 1 1

H 3 3 3 3

I 3 3 3 0

J 3 2 2 2

K 2 2 3 1

L 2 2 2 0

M 2 3 2 0

Champion in YELLOW

Anti- Champion in GREEN

Early reflections on the champion

role in deliberations for priority

setting Sometimes a champion may not be

needed

general agreement about the importance of certain topic areas

Our interest was in exploring when a champion is needed and how this role is carried out

Caveats

Order in which category is discussed can influence the presence of a champion

early discussions of research categories offer more opportunity for champion role

categories discussed later may be rushed or perceived to have a lower stake as most of the funding allocations have been assigned by this point

Next Steps

Feed back on Champion definition and application

Does both advocacy and ownership have to be present?

Consider looking at other transcripts and other categories

Consider game modifications/events to help with education

Compare champion v. dominant talker

Comments?

Discussion

Thank you

Lisa Szymecko

szymecko@umich.edu