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