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Table 2 The breadth (range & types) of work involved in the implementation of the Healthy Children Initiative and how it is recorded in PHIMS

From: Can an electronic monitoring system capture implementation of health promotion programs? A focussed ethnographic exploration of the story behind program monitoring data

The range and types of activities involved in the daily implementation of HCIPHIMS functionality for capturing this workaVariability in approaches by PHIMS usersa
1. Work involved in implementing HCI programs and practices
Development of HCI resources and materials: The resources produced and distributed by practitioners to support the delivery of HCI programs (e.g. factsheets, newsletters, Facebook and social media accounts, questionnaires)No specific function to record work involved in resource development and distribution in PHIMS.Some practitioners choose to enter notes about materials distributeda. No observed instances of users using PHIMS to document resource development.
HCI Pre-work: Work that builds the foundation for implementation of program practices (e.g. onboarding new sites, action planning, getting sign-off, data agreements and consent from sites to collect implementation data)Site details are loaded into PHIMS by central management either through database updates, or upon request from users. PHIMS has ability to keep record of contacts details including contact information and training status of active sites and staff.aMost work about practitioners’ process to recruit and onboard sites prior to becoming ‘active’ in PHIMS is recorded in alternate systems.
Site visits: Work involved in preparing for and conducting a site visit, including scheduled follow-ups.Free-text boxes in PHIMS allow users to enter notes about site visits. PHIMS does not have functionality to quantify the work involved, including the time it takes to complete the site visit. PHIMS has “alert” functions for scheduled follow-ups with sites at 1, 6- and 12-month intervals. If a site visit is not documented in PHIMS within a specified time window, the practitioner and their supervisor are notified.All teams enter data to record practice achievement; some teams have a dedicated PHIMS ‘champion’ to record this data, whereas in others, each practitioner is responsible for entering data on their sites. The amount of detail entered about the site visit varies depending on individual practitioners.
Team work: How HCI teams work together to conduct the work and achieve implementation targets (E.g. collaboration and team work within HCI teams, or with other districts)Site details and notes can be shared among team members at the supervisor’s discretion.Some practitioners keep detailed notes in PHIMS to provide their team with a full overview of the site and to keep a record for other practitionersb.
Workshops (in-services): Work involved in organising, and hosting in-services (training workshops with teachers in order to teach them and meet the training requirements for certain practices)PHIMS allows user to schedule ‘training’, to mark invitations sent and to mark training completed. Workshop attendees are entered into PHIMS individually, and each recorded as trained. PHIMS also has a function to update training status of multiple users or sites in-bulk. There is no function to record other types of workshops, e.g. hosted to support general program delivery.As above, and practitioners use PHIMS to record training status. Some practitioners also include qualitative notes about how the workshop went, and how much progress they madea.
Organisational work: Basic work tasks required to support and keep track of HCI work (E.g. keeping notes on scheduled follow ups, saving emails, cancellations and reorganising site visits)Scheduled follow-ups are specifically designed to facilitate organisational work by providing a record of due dates and reminders. PHIMS has rudimentary functionality to send/save emails.Some practitioners cut and paste emails with contacts into PHIMS’ ‘additional contact notes’ – a free form note taking data fielda.
Networking, communication and relationship building with sites: The extent of networking, communication and building relationships required with sites in order to satisfy a tick (E.g. how practitioners interact with sites (emails, phone calls), build relationships with contacts and work in partnership with sites)As above. PHIMS has ability to keep record of “contacts” (e.g. phone calls, emails) with site contacts.b PHIMS has functionality to do bulk updates for multiple sites at once, which can be used to record the distribution of resources (newsletters) to all services or when an practitioner has phoned/emailed all their services to provide information or invite them to a training/information session.Practitioners use the contact details for sites contacts. Some practitioners also record details about their interactions with sites.
Network meetings: Work involved in coordinating and running network meetings. Network meetings are used to engage and have more contact with site staff, offer a support network and may provide them with training that helps meet implementation targetsPractitioners can input training dates, invitations sent and whether sites attended trainings, which are often held in conjunction with meetings. It cannot track sites' registration.Network meetings are used by some practitioners to collect information on practice adoption and update quantitative implementation data in PHIMS.
Strategic work: Work done to achieve implementation targets or implement practices in a strategic manner. (E.g. how the team makes decisions, weighs options, plan and uses resources to achieve targets)PHIMS reports (including customizable reports) are available to assist with strategic work.Use of PHIMS reports varies dependent on skill of users and teams. Some teams with superusers generate bespoke, detailed reports while others use this function sparingly, if at all.
Flexible work to support HCI work and practice implementation: Work involved in the development of new materials that assist in achieving HCI practices. (E.g. an app to help teach fundamental movement skills, an informational handout, school veggie gardens)No specific functionSome practitioners may document this work in notesa
Self-directed work of HCI Team members: Work tasks/activities that practitioners choose to do or have special interest in that may or may not align with HCI program goalsNo specific functionSome practitioners may document this work in notes a
Work that addresses a site’s self-identified needs: This work may or may not align with achieving a particular practice, and may be responding to a sites’ need or request that differ from the aims of HCINo specific functionSome practitioners may document this work in notesa
2. Performance monitoring work required to convert the work done into PHIMS data
Interpreting what program adoption looks like: Collaborative or deductive work to interpret practices to know what practitioners must report onPHIMS lists each practice that must be reported against (see Additional file 2 for the practices). It does not provide interpretative guidance, but a monitoring guide is available to assist with interpretation.Some teams have internal discussions to interpret implementation targets and determine a consistent minimum standard for ticking a practice. We didn’t observe these conversations being documented using PHIMS.
Collecting implementation data in sites: How practitioners go about collecting information on practice achievementPractice achievement status is recorded in PHIMS via a multiple-choice survey. PHIMS provides a printable template for data collectionPHIMS is not available via mobile devices and is difficult to access from non-team computers, so data entry is usually done in the team office.
Data entry in PHIMS: Inputting information from site visits, and other HCI activities into PHIMS to record progress and achieve a tick (i.e., target practice adopted in the site)PHIMS has “alert” functions for scheduled follow-ups with sites at 1, 6 and 12 month intervals. So, if this data is not recorded already, the practitioner is advised.We did not observe that PHIMS records information about user behaviour (e.g. active time spent on PHIMS, number of log-in or date of last log-in).
  1. PHIMS Population Health Information Management System, HCI Healthy Children Initiative
  2. aPHIMS contains a ‘notes’ function with a limited character allowance that users may use at their discretion. Practitioners may use this functionality to record information about the types of activities in implementing HCI. We have noted instances where we observed this function being used to record tasks or instances where we expect it might be used. However, the notes function lacks search and retrieval functions to be able to thoroughly assess content
  3. bNote that the ability to record this information and the ability to later retrieve it in a useful and meaningful way is an important distinction