Informatics training for public health practitioners

We read with interest the article by Eldredge et al. [1], as we attempted to replicate their randomized controlled trial, which took place in 2005/06, with our study of 69 public health practitioners in central and southwestern Virginia from February 2007 to December 2007. As with Eldredge et al., the increase in the sophistication of questions obtained during our study did not reach statistical significance (P = 0.126). In addition, we did not find an increase in the number of questions posed by participants. In our study, the number of questions actually decreased by 35% after training. Preliminary results of our study were presented at the 2007 American Public Health Association Annual Meeting and Exposition [2].

Recruitment of participants in our study was hampered by the time and budget constraints of all the local health departments involved, whereas the Eldredge et al. study experienced the unusual problems of both a new email system at the statewide health department and personnel redeployments due to two hurricanes. Our more negative results might also have been due to the fact that many district health department directors in Virginia would not allow their employees to receive incentives (i.e., the “gift card”), which were offered and distributed to all of Eldredge's participants. Another difference between the studies was the makeup of the study population. In our study, we included those persons identified as “environmental health specialists,” a job category intentionally excluded from the Eldredge study. These specialists (a significant percentage of our population, n = 14) are required to do a large amount of searching for information to answer questions in their jobs but seem to need very localized and specific answers to their questions. In retrospect, after evaluating participant comments, it appeared that PubMed searching was not particularly relevant for this environmental health population.

We did not find the positive trend described by Eldredge et al. that training of public health practitioners would increase articulation of questions or stimulate participants to pose more sophisticated foreground questions. To fully understand the impact of such training on the public health workforce, we recommend further studies that not only quantify the impact of training on these practitioners but that can demonstrate that training in this way appropriately answers the needs of this diverse and complex population.