1. Mixed methods needs assessments: using social research methods to understand and compliment the numbers Rich Tyler, Robert Whitehead Public Health Analyst, Research Officer 16/06/2016

2. Outline Public health research methods (very brief outline) – Brief outline of quantitative and qualitative methods and how they fit together (in public health practice) – Mixed methods Overview of WSCC Research Unit Work examples

3. Public Health and qualitative methods ‘the ongoing challenge of finding more effective strategies of disease prevention and health promotion, requires more individually based and contextualized knowledge; qualitative methods could be a way of achieving this' – Faltermaier (1997) Dominance of sophisticated quantification, giving way to more nuanced methods/analyses of human experience – Padgett (2012)

4. Public Health (applied methods) How do we understand the health of our residents Focus on populations but ultimately to reach/speak to/help individuals – Often try to identify which areas within the county are better or worse than others. – Identifying spatial variation is not the end point Classic PH methods focus on epidemiology and quantification of health behaviours/experiences in local areas.

5. Qualitative data as part of JSNA work ‘A range of quantitative and qualitative evidence should be used in JSNAs. There are a number of data sources and tools that health and wellbeing boards may find useful for obtaining quantitative data. Qualitative information can be gained via a number of avenues, including but not limited to views collected by the local Healthwatch organisation or by local voluntary sector organisations, feedback given to local providers by service users; and views fed in as part of community participation within the JSNA and JHWS process.’ Statutory Guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies – Department of Health (2013)

6. Qualitative approach Roberta Goldman, PH.D., Brown University and HSPH, 2012 Attempts to “make sense of” the social world in terms of the meanings people bring to it Focus is on understanding meaning of a phenomenon and not to understand the frequency of its occurrence – Bryman 1988 To uncover ideas, insights, or ways of thinking of and explaining phenomena; – For things we know little about (exploration) – For things we know something or a lot about (confirmation/triangulation) Qualitative methods emphasise inductive over deductive enquiries

7. What is qualitative data analysis not Quickly done by a computer programme Not specialist automated text searching and grouping – NUD*IST, Nvivo, Atlas.ti are software which can assist in qualitative data analysis, but they cannot do the analysis for you, they are data/document storage and retrieval systems. – Automated text search functions chunk up the data to show patterns but meaning must come from the researcher.

8. Barriers to using qualitative methods Qualitative research, case studies and interviews in particular marred with a stigma of not being robust. – Small unrepresentative n Saturation of a phenomena a goal rather than representativeness of the population – Mason 2010 Qualitative methods require an unparalleled immersion of the researcher/analyst as an instrument (as opposed to the instrument being SPSS, Excel, R etc) to analyse the data Qualitative methods are not ostensibly better than quantitative methods (and vice versa) – Be pragmatic about which approach best answers the specific questions or objectives within a piece of work

9. Public Health and Social Research Unit (PHSRU) Support to CCGs and increasing access to & use of NHS Data Providing PH support to the three West Sussex CCGs. Maintaining and analysing health data (including data relating to births and deaths, child health data, and via the CCGs working with primary and secondary care datasets). Joining up health and social care data. JSNA & Evidence Team Delivering work programme agreed by HWB Work on specific needs assessments agreed by the HWB each year. Undertaking evidence reviews Drafting cost benefit models and economic evaluations Population and demand forecasting (used across health and social care) Social Research and Evaluation Service evaluation Quality assurance and supporting research across the council Staff hold regular “research surgeries” to support frontline practitioners undertaking research (in the main this is support to staff engaged in social work). Supporting engagement with national research programmes and opportunities in social care.

10. WSCC PHSRU structure Principal Manager PHSRU Jacqueline Clay JSNA & Evidence Review Manager Rachel Jevons Health Economist Matthew Dorey JSNA Research & Information Officer Ryan Walkley JSNA Analyst and Project Officer Clare Toon Evidence Review Specialist Aloisia Katsande Epidemiologist Thye S Leow Principal Research Officers Pat Rouse Tim Martin PH Research Officers Sue D'Authreau Robert Whitehead Healthcare PH Intelligence Manager Lesley Wilkes PH Analyst – Later Life Richard Tyler PH Analyst – Start of Life Verity Pinkney

11. WSCC examples Mental Health Needs Assessment (Children and Young People) What are the characteristics of the population aged 0‐24 years in West Sussex? What are the risk factors and protective factors affecting the mental health and emotional wellbeing of the population? What are the mental health, emotional and behavioural conditions and needs requiring commissioned services? What services are currently provided to meet those needs? How well are services currently provided to meet those needs? What gaps/barriers, if any, need to be addressed?

12. Mixed methods approaches

13. Qualitative questions to think about first experiences of services and how parents’ and young people’s worries and concerns were dealt with; how referral processes worked; what services were provided and what difference they made; what happened if further help was required; how did professionals work together; and more generally what worked well, what could have been improved, or what was missing.

14. Sample 19 Focus groups 8 with young people 5 with parents 6 with professionals 6 Interviews 2 with parents 4 with professionals 3 Online surveys 67 children and young people 137 parents (whose children had involvement with CAMHS) 334 professionals from a range of CYP settings

15. Final Products

16. Black, Asian and Minority Ethnic Communities in West Sussex Describe the makeup of the West Sussex BAME population and its attributes; Ascertain how characteristics specific to a minority community may affect health or wellbeing; Describe current service provision and known barriers to access; Produce actionable recommendations to improve the health and wellbeing of members of these communities.

17. Research cycle A literature review of evidence, including BAME needs assessment from similar local authorities Share existing knowledge with partners and community organisations and conduct a call for evidence Commission a community engagement, conducted by local peer researchers Further quantitative analysis and deep-dive into major issues Formation of recommendations and dissemination to partners and communities

18. Engagement process Use findings and recommendations to inform on the full needs assessment Feedback and discuss findings and recommendations to stakeholders/partners Work with the foundation to interpret findings into a concise report with recommendations 120 interviews carried out with additional focus groups Recruit and train researchers Advertise project amongst the public Devise interview schedule around key topics Commission third party

19. Collated findings Language barriers are not solving themselves Public-facing workforces often do not reflect local communities in terms of ethnicity and religion Cultures which do not match Western practices do not match western practices Data-recording is generally poor and can be improved Many recommendations and examples of best practice exist

20. Final Products

21. So what? Mixed methods key to the success of answering complex questions about our populations Qualitative research methods compliment the numbers and enhances needs assessment activity Talk to us about qualitative and mixed methods research activities.