'A system that is struggling': understanding health protection resilience in England during the COVID-19 pandemic through the experiences of local health protection responders.

BACKGROUND: Local health protection systems play a crucial role in infectious disease prevention and control and were critical to COVID-19 pandemic responses. Despite this vital function, few studies have explored the lived experience of health protection responders managing COVID-19. We provide new insights by examining how COVID-19 shaped infectious disease prevention and control in local health protection systems in England. METHODS: Semi-structured interviews were conducted with twenty local health protection responders from three contrasting local authority areas, and Public Health England (PHE) health protection teams, in England between June 2021 - March 2022. Participants were from: PHE health protection teams (n=6); local authority public health teams (n=5); local authority Public Protection Services (n=7); and local authority commissioned Infection Prevention and Control Teams (n=2). Data were analysed using reflexive thematic analysis. RESULTS: First, participants acknowledged the pandemic caused an unprecedented workload and disruption to local health protection service delivery. There was not enough capacity within existing local health protection systems to manage the increased workload. PHE health protection teams therefore transferred some COVID-19 related health protection tasks to other staff, mainly those employed by local authorities. Second, health protection responders highlighted how COVID-19 drew attention to the weaknesses in local health protection systems already stressed by reduced funding in the years leading up to the pandemic. Injecting money into the COVID-19 response did not completely overcome former losses in specialist health protection workforce. Third, health protection responders described how pandemic management raised the profile of public health, especially infectious disease prevention and control. Managing COVID-19 strengthened collaborative working, resulting in enhanced capacity of local health protection systems at the time. CONCLUSION: The COVID-19 pandemic challenged the public health preparedness of all countries. Health protection responders in this study also expressed many challenges. There was insufficient resilience in these local health protection systems and an inability to scale up the specialist health protection workforce, as required in a pandemic situation. The UK needs to learn from the pandemic experience by acknowledging and addressing the challenges faced by local health protection responders so that it can more effectively respond to future threats.

User engagement by user-centred design in e-Health.

This paper describes the application of user-centred design (UCD) methods and a user engagement (UE) approach to a case study development of a visualization tool (ADVISES) to support epidemiological research. The combined UCD/UE approach consisted of scenario-based design, and analysis of the users' tasks and mental model of the domain. Prototyping and storyboarding techniques were used to explore design options with users as well as specifying functionality for two versions of the software to meet the needs of novice and expert users. An evaluation of the prototype was carried out to assess the extent to which the expert model would support public health professionals in their analysis activities. The results of the design exploration requirements analysis study are reported. The implications of scenario-based design exploration, participatory design and user engagement are discussed.