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Table 3 Functions that informal technologies perform in practice, themes, and exemplars from ethnographic field notes

From: Capturing implementation knowledge: applying focused ethnography to study how implementers generate and manage knowledge in the scale-up of obesity prevention programs

Function Excerpt from ethnographic field notes
Relationship management
 Keeping detailed records of interaction with contacts [Name] shows me that she keeps a list of all staff and their mail addresses and she will print that out and bring it along, so she can update it if there has been any changes. There is so much turnover in this industry, that she needs to keep track of the changes. – LHD L
PHIMS also does not track individuals/teachers as they move around within the LHD – so when they move to a different school or day care setting. This is important to them because these educators have training and relationships with the HP staff, relationships that have taken a long time and work to build. However, PHIMS does not allow you to “move” an educator from site to site within the system. Essentially, you have delete the educator and create a new record for them at a different school… - LHD M
 Keeping historical record of relationships with sites and contacts [Name] also has been responsible for updating their school database. They keep a database separate from PHIMS, with all the data they need for their various projects, it goes back more than 10 years. –LHD D
 Capturing subjective impressions and details of relationships with contacts [Name] says that if she is doing a phone follow-up she will get out the paper file because it is good to know what they are like if she is going to be having a phone conversation. That way she will know if they are “friendly” or whether they are “open” – so if someone is not open to changing the milk KPI, [name] will put that in the paper file and then if she goes to call them. – LHD E
Some of the additional information in the spreadsheet is not in PHIMS – for example when recess and lunch is because that is the best time to contact schools, but that is nowhere to record that in PHIMS. – LHD F
 Processing experiences with contacts [Name] says, “you cannot really track things in terms of comments on PHIMS. You can track the numbers” which is why on paper “it’s like a venting thing, I think, writing it on there. That’s where I feel like it’s safe to write if they were rude or something like that. Not that it benefits anything at all… it’s probably the most personal part.” – LHD E
 Recording implementation strategies used across multiple sites PHIMS cannot capture what they do across a whole set of schools because it’s focused on each individual site. – LHD M
Monitoring progress towards target achievement
 Track program adoption and implementation progress in each site [Name] shows me the Excel spreadsheet that she’s been working on from the PHIMS drill down report she downloaded yesterday. She still has to do a lot of work preparing the Excel spreadsheet to give her the information that she wants. She is trying to find out how the sites are doing on two specific practices so they can figure out who to target in the next round of incentive grants. Last time, they only targeted schools that were not meeting 80% of [implementation targets] – so as to help get the LHD over their [implementation] targets. – LHD I
I ask if I can take a photo of her ‘colourful’ excel spreadsheet, which she has filtered. [She] explains her colour-coding system in the excel spreadsheet – where it is easy for her to see which sites are sitting above 80% for ‘program adoption’ so she colour codes them green. Whilst you can see that information in PHIMS, it’s just easier for her to see it this way. She can also see the sites that are under and who “need a bit more support.” – LHD F
 Collect contextual information about sites progress towards targets In [a] spreadsheet, [name] enters some info on the service she just visited, such as “have a great healthy eating program” – this is so she has “a bit more context” when she calls them next time “we would not put this kind of information into PHIMS all the time”. –LHD E
 Tracking LHD-level targets in addition to state-level targets She opens a huge master spreadsheet of all of the schools. Here they record detail including the same scoring that goes into PHIMS. The reason they keep the scores in two places is that PHIMS does not allow them to drill down into the details of the low-performing schools. This LHD has an equity framework that they use to prioritize the sites. -LHD N
Guiding and troubleshooting PHIMS use
 Tips and guides to facilitate accuracy and consistency of data entered into PHIMS One of the monitors has a small printed list physically attached to the bottom of the screen. The list, she tells me, is a set of bullet points to guide what she should note in PHIMS following a site visit. –LHD F
 Planning for deadlines in PHIMS She keeps track of due dates of her sites in her own excel file because she will start working on contacting them about a month before the scheduled follow-up date [in PHIMS]. – LHD I
 Critical information is kept available at a glance or close at hand He keeps his own colour coding excel spreadsheet open while he calls, it is made so he can see the information he need for all his sites on one page... He also has prints on the wall with an overview of the sites and his contacts. – LHD L
She’s got 3 spreadsheets taped to her wall. Each represents a different team members way of organizing the work. They are all different with different columns, colours, and level of detail. In addition, she has folders for each school where she keeps hard copies of correspondence, checklists, etc. - LHD N
 Copies of data is kept to safeguard against PHIMS going offline or losing data “I do not think PHIMS is going to open, which is a bit inconvenient. I can show you the last month’s report but I cannot show you exactly how I extracted it…it’s literally because the limitations of PHIMS mean that we still need to maintain some other information off of PHIMS so I still do not really know the best way of doing it. I think each Health Promotion Officer does it differently.”
Informal interview in LHD G
Supporting team work
 Histories of interactions with sites is kept to safeguard against turnover of staff [Name] says she prefers to use her handwritten notes from today, a spreadsheet of all her sites which she records notes on, and the email as her record. The spreadsheet is saved on a shared drive so this is shared with her colleagues who can access it should she be unavailable or leave for a new position. – LHD H
They keep a database separate from PHIMS, with all the data they need for their various projects, it goes back more than 10 years. [Name] will train the officer who will take over from her this afternoon. [Name] is in general informing them about what they need to be aware of while she is away. – LHD D
 Team work: strategizing, planning, coordinating activities and providing support They have their own systems that they keep independent of PHIMs. This includes “a lot of excel spreadsheets.” They save emails exchanged between the HCI team and the schools in a shared folder. If one practitioner is having no progress with a school, they swap schools among the team. They do planning/strategize together as a team. – LHD M
The database contains the teachers’ names, when they have attended, and the certificates they have received for attending. It has nothing to do with the HCI program practices, it is just to keep track of the workshop. … The database has got all the information she needs to email them, so she can send invitations and information out directly from here. [Name’s] office staff needs to be able to access this because she asks them to do it for her. – LHD J
Conducting evaluation
 Formative evaluation [The team hosted] student interns for a few weeks who did a survey monkey with the sites about their general needs and barriers to implementation… As a result of the survey monkey and practice experience, the Health Promotion team identified that a handout/poster with key messages … would be beneficial. – LHD H
 Process evaluation Following the two rounds of workshops, [Name] said they have been able to do “a bit of an evaluation” based on pre and post in terms of the “confidence levels” of cooks and directors. She showed me a print out of the results and said that overall confidence levels have increased. – LHD B
She is entering data into survey monkey – these are feedback forms they collected at the end of the workshop…This is a separate system from PHIMS. – LHD M
Recording work that does not count towards HCI implementation
 Documenting interactions with non-program sites or community organizations As an example of what PHIMS does not do, she tells me that the HP department here is working on some sort of IT system to help track their work with community organisations. It sounds like this would be a database of interactions so that when tobacco goes into a community org, they know if the HCI team has already worked with them, in what capacity, who it was, etc. so they can better coordinate their work. – LHD M
The HP officers often see new childcare centres opening in the area. When HP staff notice them, they add them to an “off-record” list at the office, then stop by with [program] information and incentives. However, they do not add the site to the PHIMS system until they agree to come on board. – LHD H
  1. Note: Unless otherwise noted, excerpts are from qualitative field notes, written in the first person by the researchers. Quotation marks denote verbatim quotes from participants
  2. HP health promotion, LHD local health district, PHIMS Population Health Information Management System, HCI Healthy Children Initiative