Pregnant and recently pregnant women's perceptions about influenza a pandemic (H1N1) 2009: implications for public health and provider communication.

The objective of this study was to explore pregnant and recently pregnant women's perceptions of influenza vaccine and antivirals during the 2009 H1N1 pandemic. We conducted 18 focus groups with pregnant and recently pregnant women in three US cities in September 2009. Participants were segmented into groups by insurance status (no or public insurance vs. private insurance), vaccine attitudes (higher vs. lower likelihood of acceptance of any vaccines, not only influenza vaccines), and parity (first child vs. other children in the home) based on information they provided on the screening questionnaire at the time of recruitment. We found that women are not well informed about influenza vaccinations and antiviral medicine and have significant concerns about taking them during pregnancy. An interest in their infant's well-being, however, can be strong motivation to adopt preventive recommendations, including vaccination. A woman's health care provider is a highly trusted source of information about the 2009 H1N1. Pregnant women have unique communication needs for influenza. Messages directing pregnant women to adopt public health recommendations, particularly for vaccination or prophylactic medication should include a detailed description of the benefits or lack of risk to the fetus and the safety of breastfeeding. Additionally, messages should recognize that pregnant women are taught to be selective about taking medication and provide a clear rationale for why the medicine or vaccine is necessary.

Prenatal care providers and influenza prevention and treatment: lessons from the field.

To better understand the knowledge, attitudes, and behaviors of providers regarding influenza infection and vaccination in pregnancy, fourteen focus groups were conducted among 92 providers in Atlanta, GA; Dallas, TX; and Portland, OR in late 2009. NVivo 8.0 was used for analysis. Most providers had no experience with pregnant women severely affected by influenza. Many perceived the 2009 H1N1 pandemic to be limited and mild. Providers knew that pregnant women should receive the 2009 H1N1 vaccine and reported plans to vaccinate more patients than the previous season. Most knew CDC guidelines for antiviral treatment and prophylaxis, but some reported hesitancy with presumptive treatment. Although awareness of influenza's potential to cause severe illness in pregnant women was observed, providers' experience and comfort with influenza prevention and treatment was suboptimal. Sustained efforts to educate prenatal care providers about influenza in pregnancy through trusted channels are critical.

Cross-site evaluation of a comprehensive pediatric asthma project: the Merck Childhood Asthma Network, Inc. (MCAN).

The Merck Childhood Asthma Network, Inc. (MCAN) initiative selected five sites that had high asthma burden and established asthma programs but were ready for greater program integration across schools, health care systems, and communities. MCAN supported a community-based approach that was tailored to the needs of each program site. As a result, each site was unique in its combination of interventions, but all sites served common goals of integration of care, incorporation of evidence-based programs, and improvement in knowledge, self-management, health, and quality of life. This case study of the MCAN cross-site evaluation discusses the challenges associated with evaluating interventions involving multiple stakeholders that have been adjusted to fit the unique needs of specific communities. The evaluation triangulates data from site-specific monitoring and evaluation data; site documents, site visits, and cross-site meetings; qualitative assessments of families, organizational partners, and other stakeholders; and quantitative data from a common instrument on health indicators before and after the intervention. The evaluation employs the RE-AIM framework--reach, effectiveness, adoption, implementation, and maintenance--to assess the barriers and facilitators of translation from theory into practice. Our experience suggests trade-offs between rigor of evaluation and burden of assessment that have applicability for other community-based translational efforts.

Balancing "fidelity" and community context in the adaptation of asthma evidence-based interventions in the "real world".

The Merck Childhood Asthma Network (MCAN) initiative selected five sites (New York City, Puerto Rico, Chicago, Los Angeles, and Philadelphia) to engage in translational research to adapt evidence-based interventions (EBIs) to improve childhood asthma outcomes. The authors summarize the sites' experience by describing criteria defining the fidelity of translation, community contextual factors serving as barriers or enablers to fidelity, types of adaptation conducted, and strategies used to balance contextual factors and fidelity in developing a "best fit" for EBIs in the community. A conceptual model captures important structural and process-related factors and helps frame lessons learned. Site implementers and intervention developers reached consensus on qualitative rankings of the levels of fidelity of implementation for each of the EBI core components: low fidelity, adaptation (major vs. minor), or high fidelity. MCAN sites were successful in adapting core EBI components based on their understanding of structural and other contextual barriers and enhancers in their communities. Although the sites varied regarding both the EBI components they implemented and their respective levels of fidelity, all sites observed improvement in asthma outcomes. Our collective experiences of adapting and implementing asthma EBIs highlight many of the factors affecting translation of evidenced-based approaches to chronic disease management in real community settings.

The role of partnerships in addressing childhood asthma: the experiences of the Merck Childhood Asthma Network, Inc. (MCAN) initiative.

Partnerships have taken on added importance in recent years because of their critical role in addressing complex public health problems and translating evidence-based practices to real-world settings. The Merck Childhood Asthma Network, Inc. initiative recognized the importance of partnerships in achieving the program's goals. In this article, case studies of the five Merck Childhood Asthma Network program sites describe the role of partnerships in the development and evolution of the program and its interventions. Three key factors contributed to the success of the partnerships: having common organizational goals, considering context in the selection and engagement of partners, and ensuring that each partnership benefited from the alliance. Over the 4-year program period, all five partnerships evolved, matured, and had an established goal to maintain collaboration.

Translating evidence-based interventions into practice: the design and development of the Merck Childhood Asthma Network, Inc. (MCAN).

Pediatric asthma is a multifactorial disease, requiring complex, interrelated interventions addressing children, families, schools, and communities. The Merck Childhood Asthma Network, Inc. (MCAN) is a nonprofit organization that provides support to translate evidence-based interventions from research to practice. MCAN developed the rationale and vision for the program through a phased approach, including an extensive literature review, stakeholder engagement, and evaluation of funding gaps. The analysis pointed to the need to identify pediatric asthma interventions implemented in urban U.S. settings that have demonstrated efficacy and materials for replication and to translate the interventions into wider practice. In addition to this overall MCAN objective, specific goals included service and system integration through linkages among health care providers, schools, community-based organizations, patients, parents, and other caregivers. MCAN selected sites based on demonstrated ability to implement effective interventions and to address multiple contexts of pediatric asthma prevention and management. Selected MCAN program sites were mature institutions or organizations with significant infrastructure, existing funding, and the ability to provide services without requiring a lengthy planning period. Program sites were located in communities with high asthma morbidity and intended to integrate new elements into existing programs to create comprehensive care approaches.

Public health efforts to build a surveillance system for child maltreatment mortality: lessons learned for stakeholder engagement.

CONTEXT: Reducing the number of largely preventable and tragic deaths due to child maltreatment (CM) requires an understanding of the magnitude of and risk factors for fatal CM and targeted research, policy, and prevention efforts. Public health surveillance offers an opportunity to improve our understanding of the problem of CM. In 2006, the Centers for Disease Control and Prevention (CDC) funded state public health agencies in California, Michigan, and Oregon to implement a model approach for routine and sustainable CM surveillance and evaluated the experience of those efforts. OBJECTIVE: We describe the experiences of 3 state health agencies in building collaborations and partnerships with multiple stakeholders for CM surveillance. DESIGN: Qualitative, structured key informant interviews were carried out during site visits as part of an evaluation of a CDC-funded project to implement a model approach to CM surveillance. PARTICIPANTS: Key informants included system stakeholders from state health agencies, law enforcement, child protective services, the medical community, and child welfare advocacy groups in the 3 funded states. RESULTS: Factors that facilitated stakeholder engagement for CM surveillance included the following: streamlining and coordinating the work of Child Death Review Teams (CDRTs); demonstrating the value of surveillance to non-public health partners; codifying relationships with participating agencies; and securing the commitment of decision-makers. Legislative mandates were helpful in bringing key stakeholders together, but it was not sufficient to ensure sustained engagement. CONCLUSIONS: The engagement process yielded multiple benefits for the stakeholders including a deeper appreciation of the complexity of defining CM; a greater understanding of risk factors for CM; and enhanced guidance for prevention and control efforts. States considering or currently undertaking CM surveillance can glean useful insights from the experiences of these 3 states and apply them to their own efforts to engage stakeholders.