Rapid communication of scientific results—while maintaining academic rigor—is a challenge. The peer reviewed publication timeline is not conducive to in-the-moment communication. Studies can take months, or even years to conduct, and papers often then take months to be published. So how does public health respond to—and communicate to people about—public health problems as they emerge in real time?
The People, Place and Health Collective (PPHC) is a group of more than 40 faculty, postdoctoral fellows, staff members, and students in the School of Public Health, led by Brandon Marshall Ph.D. and Francesca Beaudoin MD, MS, Ph.D. PPHC intentionally pursues projects with a component of active dissemination. The last few years have been a busy time for the Collective, with an accelerating overdose crisis, the challenges of the COVID-19 pandemic, and now the epidemic of monkeypox.
Since helping to launch the state’s overdose prevention campaign and dashboard, PreventOverdoseRI, in 2015, the collective has taken on a variety of projects that involve communicating on the go. From early work with the Rhode Island Department of Health on their COVID-19 data dashboards, to the Long COVID Initiative—which aims to provide people, providers, and companies with resources and information to tackle the challenge of long COVID—the collective sees communications work as being just as important as the peer reviewed research they pursue.
There are a few principles that guide the work of the collective as they communicate to policymakers and the broader public. They seek to use data to drive action; providing data points with the relevant context for understanding and connecting them with concrete policy action people or policymakers can take. They create materials in as plain language as
possible, aiming for a 9th grade reading level or less. They adhere to CDC’s health communications guidelines, which outline best practices for plain language health communication to make work more accessible. They use social media and visual tools as much as possible, in addition to traditional media and print resources—allowing them to reach multiple audiences through many different mediums. Finally, PPHC recognizes the importance of prioritizing health equity, especially when it comes to tackling racial and ethnic inequities in healthcare. They do this by ensuring equity is taken into consideration when designing messaging and by partnering with affected communities to ensure their work has its intended impact.
The collective has been working on two projects recently that exemplify these principles: testRI and Project SIGNAL.
TestRI or (Toxicological and Ethnographic Drug Surveillance Testing RI) combines toxicology and ethnographic methods to communicate in real time what is in the drug supply in Rhode Island. The project, funded by the Foundation for Opioid Response Efforts, involves collecting drug samples from across the state and testing them at a toxicology lab at Rhode Island Hospital to find out what exactly they contain. Once supplies are tested, results are communicated back to the community (through infosheets and social media graphics) as well as to the person who donated the sample. This project is especially important due to the increasing presence of the opioid fentanyl in all sorts of drugs. For those who aren’t used to using fentanyl, its presence means an increased risk of overdose.
“The drug supply across the U.S. is continuing to change rapidly, and it has left a lot of unknowns,” said Alexandra Collins Ph.D., M.Sc., an assistant professor of epidemiology with the collective and co-principal investigator on the testRI project along with Rachel Wightman MD, assistant professor of emergency medicine. Those unknowns are often deadly. “While there are regional differences, supply contents remain very complex and comprised of a range of synthetic and novel psychoactive substances that can really increase overdose risk.”
The testRI project has a lot of moving parts. A sample might be collected in Newport in the morning and in the afternoon, samples may have to be picked up in Providence. The project also incorporates an ethnographic interview component to learn more about how people are navigating drug use in a time of a changing supply. These findings will be presented in formal academic papers in the months to come. Throughout the project, the team works with harm reduction organizations like Project WEBER/Renew to collect samples and disseminate their findings to ensure the information reaches those who need it the most.
While drug samples are diligently collected and tested in one part of the collective, another group of researchers on the team is hard at work with the Rhode Island Department of Health (RIDOH) trying to address the persistent challenge of health equity in the state’s COVID response. Project SIGNAL is a CDC-funded project led by assistant professor of epidemiology William Goedel Ph.D.’20. It uses data, mapping, and analytical tools to display disparities in COVID-related outcomes like testing, hospitalization, and vaccination in Rhode Island and lets stakeholders explore these differences at the intersections of race, ethnicity, and place.
The Project SIGNAL web tool is utilized by Rhode Island’s “health equity zones,” the 15 areas spread across the state and led by local community-based organizations that deliver services, conduct outreach, and help build the state’s public health infrastructure in a way that is grounded in and led by the community. The Project SIGNAL tool allows the health equity zone partners to see first-hand, in real time, where they need to target testing, vaccination, and other outreach efforts.
In order to create and maintain the Project SIGNAL data tool, a variety of team members with different skills are needed. Computer programmers, data analysts, students, and plain language reviewers worked with the Center for Computational Visualization at Brown and RIDOH to come up with prototypes of the tool before it launched. In weekly meetings, the PPHC team codes collaboratively, discusses bugs and fixes, and tries to put themselves in the shoes of those using the tool. Messaging is refined and color schemes and layouts debated, as members of the team ask themselves, How can we make this tool easy to use? How do we present the data in a way that leads to easy and logical action to address the gaps in response?
“While COVID-19 has impacted us all, it has not impacted us all in the same way,” said Goedel. “It’s important for data to be made readily available at the neighborhood level. This allows leaders in communities across our state to combine their rich understandings of what people in their community want and need with local public health data to make and implement plans to tackle this pressing public health problem.”
Both Project SIGNAL and testRI are academic projects that include dissemination as an ongoing, active component. The work does not wait for a peer reviewed publication to communicate its findings. The communication is the work itself; it is not an afterthought. At the same time, the work follows and is based in rigorous research processes and methods. The work of the People, Place and Health Collective demonstrates just what real time health communication can look like; researchers do not need to choose between the false dichotomy of good communication and good, rigorous research. They can do both.
Beyond College Hill
As part of the School of Public Health’s second phase of space planning, office space at 66 Pavilion Avenue in Providence has been leased to serve as a community research space for the People, Place and Health Collective (PPHC).
Located in a commercial area in lower South Providence, the new SPH space is on the second floor above the Providence Comprehensive Treatment Center and will serve as the new home for the PPHC beginning in early 2023. A group of approximately 25 staff members and researchers led by Professors of Epidemiology Brandon Marshall and Francesca Beaudoin, the PPHC conducts community-based research on overdose prevention and substance use, grounded in a harm-reduction framework.
After evaluating multiple options for leased office space in Providence, both near campus and in other neighborhoods, 66 Pavilion Avenue was chosen in consideration of the space, transportation, and facilities needs of those who will use the site, including study participants. To ready the space for use, it will be remodeled with a focus on improving accessibility for individuals with disabilities.
While participants in PPHC studies will still have the option of coming to 121 South Main Street, many organizations and teams have found that off-site research spaces successfully further study recruitment and retention goals, while encouraging closer community ties. Spaces situated nearer to participants’ communities are often more convenient and foster an environment that is more welcoming. The selection of the Pavilion Avenue site will allow the PPHC team to advance the positive impact of their work well beyond College Hill.