THE WONDERFUL WORLD OF DATA : BEYOND THE BASICS Anne Klein Barna, MA, Health Analyst Barry-Eaton District Health Department abarna@bedhd.org Outline Data Visualization Charts: Best Practices Using data in coalition and program evaluation. Social determinants and health equity data. Techniques for problem prioritization. New tools in data communication Qualitative analysis techniques Storytelling in prevention Visual communication Our eyes provide the greatest amount of information that is processed by our brains. Show, don’t tell! General Principles of Tufte http://www.youtube.com/watch?v=HfXSltlDfDw Grand Principles of Analytical Design (Edward Tufte) Show comparisons. Compared with what? Show causality. How did it happen? Multivariate analyses. To clarify, add detail. Choose the best mode. Integrate words and numbers. Don’t restrict yourself. Whatever it takes. Document everything and tell people about it. Integrity, quality, and credibility are important. Passion about the content. High quality and high integrity of the content. Books: Edward Tufte and Stephen Few Data Journalism Handbook (free) http://datajournalismhandbook.org/ Enhancing Visual Communications Attract attention in an aesthetically pleasing way Integrated into written and oral communications Relevant and tailored to the audience Gender, race, ethnicity, socioeconomics Simplicity! Note this section adapted from: Communicating Public Health Information Effectively, 2002, Nelson et.al. Forms of Visual Communication Kind Main Features Major Uses Table Numbers in columns and rows List specific numbers or text Line Graph Lines plotted on a grid over time Examine trends Bar Chart Vertical or horizontal columns plotted on a grid Highlight magnitude or comparison of numbers Pie Chart Divided circle that represents 100% Display proportions totaling to 100% Map Geographic regions Suggest geographic patterns or clusters Picture Actual or artistic representations Demonstrate sequences, enhance key features, evoke emotions, provide realism Typography Text Highlight words through layout design Table Great way to bore someone! OK for lists Must rapidly display a clear pattern Actual Causes of Death, 1990 Tobacco 400,000 Diet and Physical Activity 300,000 Alcohol 100,000 Firearms 35,000 Illicit Use of Drugs 20,000 But… a chart would still be better Charts and Graphs Misconceptions Handout Random Dots Humans make into patterns! Anatomy of a (bad) Chart http://www.excelcharts.com/blog/anatomy-of-abad-chart/ So, what’s a good chart? Bar Charts Display the magnitude of numbers Compare groups How many bars? Eaton Barry Smoking Healthy Weight Adequate Fruits & Veg BEWARE of messing with scales on bar charts! Stacked bar charts are hard to understand & decode Barry Eaton Category 1 Category 2 Category 3 Category 4 Line Graphs Very good at displaying trends over time Problems include too many lines (use 4 or less unless chart is big and ) and poor labeling Example: Past 30 day Use 40% 30% 20% 10% 0% 7th 9th 11th Alcohol Tobacco Marijuana Painkillers (no Rx) Data Visualization in Excel http://www.excelcharts.com/blog/datavisualization-excel-users/ This is an in-process online tutorial Origin Chart (number line) Bar chart version (separates values) Stack bars, then curve around… Fill in the doughnut hole… Add another dimension (Tree Map) Oh, the pie chart… Google returns 2.2 million pie charts in image search, 1.8 million bar charts and only 0.34 million line charts; Percentage of 3D pie charts in the first page: around 30%; Percentage of pie charts with exploded slices: around 15%; Bad pie charts (3D or exploded slices or legend or too many data points or no labels or unsorted slices): around 99%. Evolution of a pie HARD to compare: Area, Arc, and Angle Pie Chart Do’s and Don’ts Don’t use 3D Don’t explode your pies Don’t use a legend Don’t use too many chunks (groups of slices) Label the slices Sort the slices Don’t compare pie charts Maps Excellent when you have data sub-county Google maps www.michigantrafficcrashfacts.org Census/American Factfinder Most health departments and counties have GIS capability – but you must have geocoded data or addresses or rates for specific areas. Pictures Use as part of the design, not part of the chart. Typography & Good Design Proximity Alignment Repetition Contrast & White Space Fonts You know it when you see it…or do you? Data-to-ink ratio Examine your chart – what is the amount of ink used to display your data? What is the amount of ink used for other parts of the display? The more ink used for data, the better. Using Excel 2007 versus an earlier version will help do this for you. This is what the default chart looks like. 6 5 4 Series 1 Series 2 Series 3 3 2 1 0 Category 1 Category 2 Category 3 Category 4 A low data-to-ink ratio… 6 5 4 Series 1 Series 2 Series 3 3 2 1 0 Category 1 Category 2 Category 3 Category 4 Color and Shading Cost Warm colored objects set on cool backgrounds Cultural meanings of colors Shading can convey meaning, esp, maps Consider the color blind – can they still read it? Fill patterns Colors have meaning Gender Nationality Political Party Nature School Familiar Objects Colors have meaning Titles and Labels Convey meaning with your title if possible Label your axes unless it’s obvious or previously explained Thoughts on legends? Get rid of every other line that you can! Date Source Distortion Sometimes the same data can be plotted with different y-value axes, and it looks very different. Consider whether you are accurately displaying a trend if you “zoom in”. 3-D Charts Please don’t. This is not good. 100% 90% 80% 70% Series 3 Series 2 Series 1 60% 50% 40% 30% 20% 10% 0% Category 1 Category 2 Category 3 Category 4 Pictograms or Glyphs http://www.fao.org/docrep/006/t7838e/T7838E06 .htm Precise Representation of Distinct Individuals 50 The Beauty of Data Visualizations http://www.ted.com/talks/lang/eng/david_mccandle ss_the_beauty_of_data_visualization.html A fun example: http://www.babynamewizard.com/name-voyager# Many Eyes is a tool that you can use with your own data: http://www958.ibm.com/software/data/cognos/manyeyes/ Interactive Charts http://www.nytimes.com /interactive/2009/11 /06/business/econom y/unemploymentlines.html While many of us may not have the capacity to create interactive charts, they are highly effective at helping people draw insights in a web-based platform or presentation platform. Using Data in Evaluation Why use data in evaluation? Process Evaluation Measuring “Did we do what we said we were going to do” is incredibly important. What sort of data is necessary? What kinds of questions can you ask and answer? Did you provide pro-social interactions for at-risk youth? Did you talk to five city governments about adopting smoke-free parks policies? PROGRAM or COALITION ! Outcome Evaluation Measuring: “Did we have the impact that we predicted?” What sort of data is necessary? What kinds of questions can you ask and answer? Did the youth who participated have an improvement in their GPA compared to a control group? Has the smoking rate in youth decreased over time? Do youth today feel that it’s more risky than in the past? PROGRAM or COALITION ! Considering Determinants and Equity Data in your work What makes someone healthy..or not? How can we prevent you from being unhealthy? Prevention: Behaviors and Conditions affect health Behaviors Tobacco Use Substance Misuse Poor Nutrition Lack of Exercise Conditions Targeted sales Marketing/No taxation Food Deserts Poor infrastructure Where does Prevention Begin? Where do we Focus? Social Determinants of Health The economic and social conditions that influence the health of individuals, communities, and jurisdictions as a whole. They include, but are not limited to: Safe Affordable Housing Living Wage Quality Education Job Security Access to Transportation Social Connection & Safety Availability of Food Dennis Raphael, Social Determinants of Health; Toronto: Scholars Press, 2004 Root Causes Institutional Racism LABOR MARKETS HOUSING POLICY Safe Affordable Housing Living Wage Gender Discrimination and Exploitation Class Oppression TAX POLICY Power and Wealth Imbalance GLOBALIZATION & EDUCATION DEREGULATION SYSTEMS SOCIAL SAFETY NET SOCIAL NETWORKS Social Determinants of Health Quality Education Transportation Availability of Food Job Security Social Connection & Safety Psychosocial Stress / Unhealthy Behaviors Disparity in the Distribution of Disease, Illness, and Wellbeing Adapted from R. Hofrichter, Tackling Health Inequities Through Public Health Practice. Distinguishing Disparity from Inequity Health Disparity A disproportionate difference in health between groups of people. (By itself, disparity does not address the chain of events that produces it.) Health Inequity Differences in population health status and mortality rates that are systemic, patterned, unfair, unjust, and actionable, as opposed to random or caused by those who become ill.* *Margaret Whitehead Your QUESTION is so important! Healthy! Capital Counties visioning question. What would our community be like if everyone had an equal chance of living a healthy life? versus just… What are the community’s health needs? or How can we be healthy? Changing the Questions Instead of only asking: Perhaps we should also ask: Why do people smoke? What social conditions and economic policies predispose people to the stress that encourages smoking? Who lacks health care coverage and why? What policy changes would redistribute health care resources more equitably in our community? How do we connect isolated individuals to social supports? How can we create more green space, bike paths, and farmer’s markets in vulnerable neighborhoods? What institutional policies and practices maintain rather than counteract people’s isolation from social supports? What policies and practices by government and commerce discourage access to transportation, recreational resources, and nutritious food in neighborhoods where health is poorest? Weaving in the concept… “Some people have fewer opportunities than others to live in good health.” What indicators would you use to measure whether the community was getting healthier or not? Be creative! WATCH: Why is Jason in the Hospital? List, then sort List colorcoded: Our Model for How Health Happens: Opportunity Measures Evidence of power and wealth inequity resulting from historical legacy, laws & policies, and social programs. Social, Economic, and Environmental Factors (Social Determinants of Health) Factors that can constrain or support healthy living Behaviors, Stress, and Physical Condition Ways of living which protect from or contribute to health outcomes Health Outcomes Can be measured in terms of quality of life (illness/ morbidity), or quantity of life (deaths/mortality) Social determinant questions…purple alludes to inequity Do people have money to meet basic needs? What about enough to live a life of quality? Are kids in our community ready for school? Will every child go to a safe, well-resourced, high-performing school? Are people secure in their employment? Do we have clean air, clean water, in communities built to enhance health? Can all people get health care? Of high quality? Does everyone have a safe home at a reasonable price? Is the community empowered to improvement through civic action or grassroots action? Can people get where they need to go? Are we safe? Qualitative Data Analysis When you really need to know WHY… Consider the difference… 65% of Barry County High School Youth report that it’s sort of easy or very easy to get alcohol. (2010 MiPHY) “Kids were bringing to school. [We] would dump half a powerade out, put clear liquor in and put it in our backpacks to drink throughout the day. A lot of kids were doing it. If you hang out downtown long enough, someone will buy it [for you]. A local restaurant would provide alcohol with delivery of food for an extra $20. Kids thought this was cool.” – A Barry County Youth Offender, interviewed in 2009 Underage Use of Alcohol Problem? 81% yes, 19% no Of those who said no, what did they say? Kids will always drink I’m not sure Not really a problem in youth I’ve never seen it Conclusion based on qualitative data? Personal knowledge is a predictor of whether an individual perceives something as a problem in their community. Why use qualitative data? Provide insight into how people make sense of their experience Help to facilitate the dissemination of research findings Explains why someone did something or thinks something Two types to highlight… Interviews All sorts, most typically used is the “semi-structured interview” Focus on individuals thoughts and experiences Focus Groups Focus on attitudes and experiences, cultural context of knowledge and ideas, how opinions are constructed Writing Questions Questions should not lead the person to the “correct answer” or color their response to you. “Given all of the horrible things that underage drinking causes, what should we do to stop it?” Allow for the whole range of experience and views through prefacing the question: “Some parents have many rules about drinking and parties – others have only a few. What do you expect from your teen when it comes to drinking and parties?” “Some people learn through talking to a doctor or nurse – others prefer to read information on their own. What way would you prefer to get information about family planning choices? Writing Questions Open ended questions allow someone to have the opportunity to tell a story that’s meaningful to them. Probing This means that you follow up a general question with questions aimed to get the person to expand on what they first said. EXAMPLE: Participant: “I really like the parks in our town.” Interviewer: “What do you enjoy about the parks?” Participant: “I love taking my grandson there to run around and experience nature.” Recording You should strongly consider audio-recording the session, whether it’s an interview or a focus group. Consent. You should make up a consent form that states that they understand they are being recorded but that their name is not being used. IRB. Someone may ask you if you are getting IRB approval to conduct your focus group. Are you doing it for research, for surveillance, for program evaluation? If you are affiliated with a community, non-profit, or public health agency, it’s usually not necessary. However, academic institutions, hospitals, and similar entities may want you to submit for exemption. Qualitative Analysis Text (such as an interview transcript) Codes (descriptive tags) Themes (an interpretive sentence or two) Process of Analysis DESCRIPTION describe what people said "What?" PATTERNS CATEGORIES relationships and comparison between descriptions "Who? When? Where?" THEMES insights, concepts, conceptual models "Why?" ACTIVITY You have a copy of a focus group transcript and a copy of a focus group summary of an audio file. Read through the text. Read through the text again. Jot down notes on the side that try to summarize the topic of the quote in a few phrases (there are your descriptive codes) Compare your codes with your neighbor. Exercise Exercise was commonly discussed as a way to get and/or stay healthy. People with chronic diseases discussed the paradox that they know they need to exercise more, but now that they have a chronic disease it’s much more difficult to do so. Children were perceived as being less physically active than in the past. Many cited walking as an enjoyable exercise. Gyms were perceived as out of reach and expensive, however the YMCA and Alive! Center were discussed as having scholarships or free programs or facilities based on need. Many community attributes were seen as helping to encourage people to exercise, including walkable neighborhoods, living in the country, parks, walking to school, and walking hallways at schools. Ideas to encourage more people to exercise included more exercise facilities at worksites, places for families to go together to exercise, equipment loans, more lowcost fitness classes, and utilize the schools more to allow public to use gyms and pools. Healthcare Cost Most participants agreed that the cost of healthcare was a barrier in a number of ways. Many people without any extra income have to make difficult choices when it comes to paying for healthcare services. “The way the economy is right now, you have to choose between your health and paying your living expenses.” Also discussed was the lack of cost transparency of healthcare. Many participants were surprised and shocked at the high cost of care, and that they do not have the knowledge ahead of time of what the service will cost. “Healthcare is one of the only industries that you walk in blindly not knowing what to expect as it pertains to what you will be billed. I would like estimates or other options available.” What makes me healthy? What did these participants believe help to make their health better? taking vitamins eating healthy time, skills, and money to prepare not-processed food exercising access to primary care sidewalks and paths social and neighborhood connection What were suggestions for making the community healthier? (not ranked) Offer incentives to eat more healthy foods Help people cope better with stress and depression Make insurance affordable Increase access to specialty medical care, especially for children Improve transportation options for persons with disabilities More walkable neighborhoods Safe, well-lighted paths and trails Reduce violence Improve educational achievement Making a video! http://youtu.be/8-wq7ly22dI Using Powerpoint and Windows Live Movie Maker Make a Powerpoint or adapt one you already have (do not animate it) Save your Powerpoint presentation as a set of jpg files…in “Save As”. Open Windows Live Movie Maker, and Insert Picture…selecting each of your jpg pictures of your slides in turn. Make it look fancy by using one of the pre-made transition schemes. Record yourself speaking…or use public domain music files, and add sound. Or record yourself while the music is playing in the background. Publish on You Tube! Making a PREZI! http://prezi.com/_sto8qf_0vcs/the-how-tomake-a-great-prezi-prezi/ Moving from DATA to PLANNING -- Prioritization -- Dialogue Prioritization Matrices (traditional) Why use it? Narrow down options through a systemic approach of comparing choices by selecting, weighting, and applying criteria. What does it do? Quickly surfaces basic disagreements Best thing, not everthing Limits ‘hidden agendas’ by surfacing the selection criteria Increases chances of follow-though Reduces chances of selecting a “pet project” Agree on the ultimate goal to be achieved Choose the most important problem to fix in my house and yard Create the list of criteria Cost Everyday aesthetics Code Compliance (authority is complaining) You must AGREE on the criteria! Weight each criterion against the other criterions Use the worksheet from your packet. Comparing Criteria Cost Cost Everyday Aesthetics Everyday Aesthetics Code Row total Compliance Relative Decimal Value 5 1/10 5.1 .248 1/5 0.4 .020 15 .732 1/5 Code 10 Compliance 5 TOTALS: 20.5 1.00 Cost COST Fence (inexpensive) Paint Bathroom Build Family Room Row total Relative Decimal Value Fence 1/10 5 5.1 0.20 10 20 0.78 0.4 .016 Paint Bathroom 10 Build Family 1/5 Room 1/5 TOTALS: 25.5 1.0 Summary Cost (.248) Fence 0.2 x .248 = Paint Bathroom .78 x .248 = Build Family .016 x .248 = Room Everyday Aesthetics (.020) Code Compliance (.732) Row Total Dialogue is different from DEBATE Debate Dialogue Highlights competing factions Highlights commonality of purpose “Best” solution Multiple, complementary solutions Emphasis on persuading Emphasis on listening ‘Facilitated Dialogue’ is adapted from the Technology of Participation methods developed by the Institute of Cultural Affairs. http://www.ica-usa.org/ The Dialogue Process INFORMATION Senses Data REFLECTION Feelings Experience INTERPRETATION Meaning Insights DECISION Actions Strategies Slide courtesy Doak Bloss, ICHD, modified from Institute for Cultural Affairs TOPS The Dialogue Process INFORMATION Trigger for the entire dialogue; can take many forms: READING PRESENTATION OF DATA EXERCISE REFLECTION OPEN DIALOGUE Opportunity for participants to say anything they are thinking or feeling about the information presented, tracked on adhesive board INTERPRETATION DECISION Slide courtesy Doak Bloss, ICHD, modified from Institute for Cultural Affairs TOPS Open Dialogue “How do we encounter … in our lives?” At work Point Point Point At home Point Point Point Point Point Point Point In the Community Point Point Point Slide courtesy Doak Bloss, ICHD, modified from Institute for Cultural Affairs TOPS The Dialogue Process INFORMATION Trigger for the entire dialogue; can take many forms: READING PRESENTATION OF DATA REFLECTION OPEN DIALOGUE Opportunity for participants to say anything they are thinking or feeling about the information presented, tracked on adhesive board INTERPRETATION* SUMMARY QUESTIONS (Not Dialogue) Question sequence that summarizes what the group knows, collectively. (Mirrors the Information-ReflectionInterpretation sequence) DECISION Slide courtesy Doak Bloss, ICHD, modified from Institute for Cultural Affairs TOPS “MODEL” SUMMARY QUESTIONS* (Solicit short answers, no repeats) Of everything you seen and heard so far today, what stands out for you as particularly surprising or important? In what ways do we witness ...? What bothers you about the way we (or others) currently respond to …? What stands in the way of responding more effectively to …? If we were to respond more effectively, what would it look like? What strengths or assets will support us in making that happen? What are some ways to take advantage of those strengths or assets? *Sequence is adapted from the ICA Technologies of Participation ® training. The Dialogue Process INFORMATION Trigger for the entire dialogue; can take many forms: READING PRESENTATION OF DATA REFLECTION OPEN DIALOGUE Opportunity for participants to say anything they are thinking or feeling about the information presented, tracked on adhesive board INTERPRETATION SUMMARY QUESTIONS (Not Dialogue) DECISION Question sequence that summarizes what the group knows, collectively. (Mirrors the Information-ReflectionInterpretation sequence) STRUCTURED EXERCISE TO ANSWER THE FOCUS QUESTION Individual & group process generating between 25-40 answers. Slide courtesy Doak Bloss, ICHD, modified from Institute for Cultural Affairs TOPS FOCUS QUESTION* “What do we need to do to…?” Individual Brainstorm Group Decisions Answer Answer Slide courtesy Doak Bloss, ICHD, modified from Institute for Cultural Affairs TOPS Answer Answer Answer FOCUS QUESTION* “What do we need to do to…?” Answer Answer Answer Answer Answer Answer Answer Answer Answer Slide courtesy Doak Bloss, ICHD, modified from Institute for Cultural Affairs TOPS Answer FOCUS QUESTION* “What do we need to do to…?” Pairing Similar Answers Answer Answer Answer Answer Answer Answer Answer Answer Answer Slide courtesy Doak Bloss, ICHD, modified from Institute for Cultural Affairs TOPS Answer FOCUS QUESTION* “What do we need to do to…?” Clustering Naming the Clusters Finding Answer Answer Answer Answer Answer Answer Answer Answer Finding Answer Finding Slide courtesy Doak Bloss, ICHD, modified from Institute for Cultural Affairs TOPS Answer Focus Question “What do we need to do to…?” Finding Finding Finding Finding Finding Finding Findings are reviewed and refined at a follow up “validation” session. Slide courtesy Doak Bloss, ICHD, modified from Institute for Cultural Affairs TOPS Validation of Recommendations (Follow-up Session) Review each Recommendation & “Case” Made for it. Does this adequately express the will of the group? (Participants hold up one of 3 cards.) YES it Does Not Quite NO it Doesn’t Holders of Yellow and Red Cards explain their concerns / suggested changes. Capture suggested changes, and see if they meet with the group’s approval Slide courtesy Doak Bloss, ICHD, modified from Institute for Cultural Affairs TOPS Storytelling in Prevention www.preventionspeaks.org How can story help you? www.preventionspeaks.org/stories/speak-toinspire http:// Share knowledge Share Knowledge Story shows rather than tells. (example: one simple technique is highlighted here for teaching about improved pedestrian routes). What kinds of stories teach? Short, memorable stories that illustrate one surprising or unexpected fact. A story that shows human experience as authentic and credible, lending believability to science and research. (example: how a school changed its lunch menu) Build Commitment If you are working to change policy and systems, your group needs a strong and united commitment to persevere. Stories can help build, maintain and reinforce this commitment. What kinds of stories build commitment? Those that build trusted relationships—"why you do what you do" stories. People talk about: Why they care about the issue they're working on What happened in their life that led them to do this work Do this frequently, and do it when new people join, to: deepen their relationships with each other, bring out knowledge and skills, clarify and recommit to their own purpose, and strengthen the group collective story or purpose. (Here are examples) Influence Change Influence Change Story has the power to help people believe in new possibilities. (Here's how a school gotkids excited about eating vegetables.) What kinds of stories transform? Stories: with a sympathetic character who changes. The listener can imagine herself changing. that show achievement and motivation. of success and impact. Inspire Action Inspire Action You have to connect with emotions and values for people to make decisions and act on them, whether it is to join a coalition, visit a legislator, or support your idea. Stories build trust. The audience doesn't separate the speaker from the message; by telling a personal story you are more likeable, knowable, and easier to trust. What stories connect with emotions and values? Those that show a likeable, relatable "hero" who takes on a challenge or conflict and comes to a realization. "What if" or "imagine if" stories that show new possibilities and futures. Sharing a story is really sharing learning. Your audience will come to the same realization the lead character has, or at least understand a different point of view. From this shared base of understanding, you are now prepared to ask the audience to engage in some kind of action. http://www.preventionspeaks.org/stories/teenskick-tobacco-ads-out#families-deserve-safe-parks Debriefing What part did you like best? What part did you like least? What was working with your group like? What new skills did you learn? What did you already know? Is there anything you need more information or practice with before you feel you can do it yourself?