Guest Blog: Challenges for health promotion practice in the digital age

Working in health promotion is tough. With so many skilled practitioners, job hunting is competitive and job security is increasingly hard to find. Have you seen a permanent health promotion job advertised lately?

Health promoters need to be skilled at working with multiple stakeholders, keep up to date with best practice, and continually chip away to improve policy and environments. It can take decades to see population health changes. Of course there are lots of rewards, from seeing communities thrive, achieving positive and meaningful engagement and making huge differences to the world that negate the need for ‘miracle cures’ and expensive treatments that consume government health budgets.

The challenges and rewards of working in health promotion have not really changed over time. But as we move more and more into a digital age, what are the emerging challenges for health promotion practice?

As a reader of the Research Connect blog, there’s a good chance you are a researcher rather than practitioner. If so, as you read on keep in mind what role you think researchers can play to generate the evidence that supports practitioners in relation to the outlined issues.

I believe the challenges for health promotion practitioners in the digital age are as follows:

Professional development and competencies. Understanding how to apply social media to health promotion practice can require a new set of skills. When it comes to use in health promotion, social media expertise is often borrowed from, or outsourced to disciplines such as communications, public relations or marketing rather than from practitioners themselves. Whilst the current health promotion competencies touch upon technology, they do not incorporate the seismic shift in communication that web 2.0 technologies and social media have introduced.

Comparison paralysis. When you consider that Coca-Cola has more likes on Facebook than Harry Potter, Justin Bieber and Lady Gaga, and that there is a tweet a second made directly to McDonalds, it’s easy for health promotion programs to get sucked into believing that they need to compete with the private sector. It is unrealistic to think that small scale health promotion programs can compete with the resources of the private sector. That said, health promotion programs should choose social media strategies that are consistent with their populations/target groups and in line with their overall program objectives.

Finding evidence. Social media platforms and their nuances change frequently, much faster than traditional research cycles. How are practitioners meant to know how and what they should be doing health promotion work using social media if evidence can’t keep up? The answer may lie in social media! It’s really important that practitioners who are using social media work together to share their experiences, lessons and findings. The Australian Health Promotion Association in several jurisdictions offer online groups via LinkedIn or Facebook which create a great opportunity for professionals to exchange advice and ask questions.

Lure of social media as a tool for behaviour change. One of my key messages is that social media is another tool in a health promotion practitioner’s toolbox. Remember, a tool is just that and it should not be a case of ‘the tail wagging the dog’. With shareables, images and quotes being popular content on social media, it’s tempting to piggy-back on this trend and use social media purely as an intervention tool for behaviour change and promotion of social marketing messages. It’s important to think about how social media could be used for broader health promotion objectives, including creating new cultural norms. Organisations like GetUp and Obesity Policy Coalition are experts at this. Similarly there are some fantastic examples of promoting positive mental health and reducing mental illness stigma on social media.

Despite these new challenges, health promoters are a resilient and resourceful lot. With the support of research institutes and knowledge brokers, I am confident that there will be a growing baseline of technology literacy and competency in the health promotion workforce.

Given the range of challenges, how do you think researchers can generate evidence and support practitioners? Share your thoughts in the comments below.

 

Written by Kristy Schirmer

Kristy Schirmer worked as health promotion practitioner for more than a decade prior to starting Zockmelon, a consultancy that focuses on health promotion and social media strategy.

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Hidden agendas – do researchers and participants bring bias to studies?

The recent publication of our research on child health in same-sex families has gained a little media attention this week following my piece in the Conversation. I have had some wonderful feedback from members of the community who feel that this research provides valuable insights into the many diverse ways in which same-sex attracted people are raising children. But in the background the usual group of critics have set about trying to undermine our work.

One issue that has been raised is that of bias. There are many types of bias that can have an impact on research and this is one key area that academics like myself make every effort to account for. In clinical sciences the randomised control trial is the gold standard for eliminating bias, but in many population studies this is not always an achievable methodology. You can’t take a group of children, for example, and randomly allocate them to being raised by same-sex attracted parents or heterosexual parents. When bias cannot be completely omitted it is important to acknowledge its potential influence and this is something authors will highlight when considering the limitations of their work.

When researching child health in same-sex families the first problem is identifying, and then recruiting, such families. In Australia there is only one way that this can be achieved: through convenience sampling. Overseas, attempts have been made to draw representative samples from population surveys. While perhaps removing the volunteer nature of the sample these studies do suffer from small sample sizes, as the same-sex parent population within any population sample will be very small. This strategy is not an option in Australia where there are no population datasets that capture parent sexual orientation. Thus the volunteer sample is the only option. This is where the first criticisms of our study have been leveled.

It is argued that only parents with a vested interest in promoting positive health outcomes will volunteer. While this cannot be discounted as a possibility there is no evidence to suggest that this is the case. The underlying aim of the study was to characterise health and wellbeing and to understand the influence of stigma on child health in this context. As any parent will tell you what is paramount is ensuring that your children have the best health opportunities available. To intentionally corrupt research so that it cannot identify where problems may lie is doing yourself, and your children, a disservice. Only by providing an accurate picture of your child’s health will you know what can be done if there are issues. And in a context where stigma might be having a negative impact this is important to identify.

Further to this is the fact that significantly positive outcomes were only identified on a handful of scales. Overall 29 different measures of health and wellbeing were included in our study. Almost all showed no difference to the general population. Only 3 measures showed a significant difference, albeit a positive one for same-sex families. If same-sex attracted parents were systematically working to ensure an outcome that shows their children in the best light would there not be a more consistent skewing across all the scales? What is more likely is that there truly is something within same-sex families that shows a benefit on those three measures.

While the criticism has touched on the methodology, the limitations of which are clearly outlined in the published paper, there has also been an unfortunate focus on more personal aspects of the research. Some groups have highlighted the fact that I, the lead author on the paper, am a gay man raising children, suggesting that this is a conflict of interest and introduces inappropriate bias.

Family photo

The research team for this study is based within the Jack Brockhoff Child Health and Wellbeing Program at the University of Melbourne. This Program is led by Professor Elizabeth Waters, an internationally renowned child health researcher who leads work on many aspects of child health including obesity, oral health, disability and disaster recovery, to name a few. She is also a heterosexual parent and second author on the paper. The rest of the research team bring a range of research experiences and family backgrounds. But is there any relevance to their personal situations? All published papers go through a rigorous peer review process that is blind to such things, assessing work on its methodological merits alone. To suggest that my family situation is of relevance implies that no heterosexual researcher can produce unbiased work on heterosexual families. Or that any non-Caucasian researcher would be able to objectively conduct research on racial discrimination and child health.

Increasingly, across all areas of research, there is a move towards the publication of protocols. This establishes the theoretical underpinnings and methodological basis of studies and allows a continued process of transparency to be engaged from the outset. Our recently published findings on same-sex families took this approach and a protocol was published in the early phases of the project. By being up front and transparent at all times about the research we are allowing the work to be continually interrogated.

Research on same-sex families always draws critics. There is a small but vocal minority who do not accept family forms that fall outside the traditional mother-father construct. It is interesting to note that at the same time as criticising methodologies such as ours these same groups would baulk at including questions around sexual orientation on national surveys such as the Census. It is up to the scientific community to consider the merits of our work and place it in its appropriate context in terms of future health interventions and policy work.

It will never be possible to exclude bias completely from all research. But in the mean time it is up to us, the researchers, to maintain objectivity, be open about limitations, and be true to the evidence that our work provides.

Dr Simon R Crouch
Lead Investigator, the Australian Study of Child Health in Same-Sex Families (ACHESS)

Parent-reported measures of child health and wellbeing in same-sex parent families: a cross-sectional survey

Kids from same-sex families fare as well as peers – or better