Dr Becky White and Rebecca Zosel, members of the Australian Public Health Consultant’s Network, discuss innovation in health promotion in the latest edition of Around the Traps, an occasional column provided by members of the Network.
Becky White and Rebecca Zosel write:
The concept of innovation carries associations with ‘silver bullets’, new ideas and solving difficult problems. It promises much to the health promotion sector where wicked health problems like obesity, gender inequality and health inequity are complex and intertwined. Innovation roles and teams are popping up everywhere. Perhaps because innovation is hyped in business and health, it can feel like a fad that promises much, but will be discarded once the next big thing comes along. But we believe that innovative practice in health promotion is enduring and more than just a fad.
So what do we mean by the term ‘innovation’? Business defines innovation as changing processes to create more value, products or ideas. WHO defines health innovation as creating new ways of thinking and working, and identifying new or improved health policies, systems, products and technologies, and services and delivery methods that improve people’s health and wellbeing.
Health promoters have always innovated, albeit perhaps under a different banner. At times, innovative practice results in wholesale change; at other times, it involves small, incremental changes and gradual transformation. Changing messages, searching for new ways to reach populations and challenging the norms have always been core health promotion business. Increasingly, the term innovation is applied to the use of innovative technology and new media, for example increasing physical activity involvement through the use of social media. However, there are important challenges such as the faster rate of technological change compared with the evidence-base, and how we balance this to reach populations effectively.
There are a range of innovation tools currently favoured by health promotion innovators.
Drawing on the notion of user-centred design from the commercial design world is the current interest in citizen engagement, also known as consumer or patient involvement, participatory methods and co-design. These methods offer the opportunity to create interventions that receive better take-up than other interventions because, in effect, they have been ‘road tested’ by the end-user prior to dissemination.
While co-design is a newish concept, involving community (end-users) in the design, implementation and evaluation of programs has long been a key component of health promotion work. It is critical to ensure that users have a meaningful level of involvement that is related to the stage and goals of the program. Some user-centred design has been criticised for being tokenistic, particularly when working with children and young people. Checking where your intervention is against the iap2 continuum helps to assess the appropriate level of involvement of end users and address concerns about tokenism.
Ways to strengthen this are ensuring that the voice of end-users is included in a data-focused report, ensuring that end users are involved in all levels of resource design and dissemination, and member-checking your interpretation of the findings. The type of user involvement will depend heavily on the finances, personnel and time available to meet deadlines, as well as the level of experience working with user-centred design.
Dr Victoria Kearney talked about the benefits of innovation design thinking at the NZ Health Promotion Conference in April 2019 and argued that health promoters may often incorrectly perceive the problem and apply out-dated linear responses to solution creation. Traditional models involve strategies like starting with an environmental scan, examining the data and developing project objectives based on these activities. Dr Kearney encourages health promotion practitioners to utilise human-centred design and systems thinking to approach problems differently, but does acknowledge that this takes courage. For example, in designing better kinship care service delivery models, she asks first whether ‘we have even got the problem right?’ She looks for ‘pain points’ – these are the problems that health promoters are engaged to solve – and then encourages people to approach them from another perspective. This can free up thinking and deliver more effective messages.
Kristy Schirmer agrees. Kristy works in social media and really likes the content in this approach https://vimeo.com/114603939 developed by the New Zealand Transport Authority. As a government agency, their ‘pain point’ was people switching off to government authorised health promoting messages. The Tinnyvision campaign got through to hard-to-reach young people by getting endorsement from trusted editors of their preferred platforms, using Snapchat to reduce risks associated with being identified, and utilising funny content developed by relatable people.
Behavioural insights is another valuable tool in the innovator’s toolbox because it incorporates innovative thinking with evidence-based methods. This is a powerful combination which can be critical for risk-averse environments. Behavioural insights draws on our understanding of human behaviour from cognitive science and behavioural psychology to guide interventions, then uses rigorous testing methods to demonstrate effectiveness.
Innovation is core health promotion practice
Health promotion has always involved innovation, and this is reflected in contemporary workforce competencies from peak professional associations, including the Australian Health Promotion Association and the International Union for Health Promotion and Education. From John Snow’s innovative use of mapping cholera, to the days of radical policy reform advocated in the early years of tobacco control, the sector has looked for new ways to improve health. Innovation is steeped in good scientific knowledge and encourages practitioners to utilise expert knowledge with design methods to come up with novel responses. New methods and technology present us with new opportunities, which may involve taking risks, using an existing idea in a new context or time, or working more closely with end-users.
It is important to note that at times a tension exists between innovative and evidence-based practice. Innovation is critical to the continued evolution of the field and improving health and wellbeing outcomes, and health promoters need the skills and supportive systems in place to manage and mitigate risk to ensure innovative practice isn’t stifled, particularly within risk adverse organisations. Critically, innovation draws on deep knowledge and adds to the evidence base for others to learn from. These are qualities that are not going to be replaced in health promotion any time soon.
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