Table 1 Results of small group discussion on "Q5: what are the next steps to build capacity for regional/local area surveillance?", by themes (7 themes) and by groups (12 groups), think tank forum, Toronto, Canada, 2008

1. Strategy

1.1. Marketing strategy

• Promote risk factor awareness and knowledge to policy makers, public (groups 1 and 10).

• Market local surveillance to local and regional decision makers (group 1).

• Create a business case including a marketing plan - where do we need to go? (5 and 11).

• Elevate the importance of chronic disease surveillance and raise profile of the work (5).

1.2. Legislation

• Develop legislation to mandate local risk factor surveillance at a minimum level, to be similar across the board (1 and 5).

• Look at altering legislation regarding information held by Statistics Canada to increase ready availability of data (10).

1.3. National leadership

• Federal government (e.g. PHAC) leads, coordinates and facilitates, but not control (1).

• Strong national leadership and mandate required from federal level to set the vision, set quality assurance standards, conduct validity research, provide national clearing house or resource centre for queries, and maintain consistency across provinces (2, 3, 6 and 9).

• Provide flexible leadership to reflect changing needs of the provinces and territories (6).

• At the national level, one must recognize the importance of local/small area data, provide technical support, mitigate redundancy and duplication, provide grants to help build capacity for some areas to create parity, and create a transparent format for application for funding (8).

• Support at the national level for multi-modes, assessment, analysis and tools (9).

• Make creation of the collaborative local area surveillance system a priority for PHAC (10).

• PHAC coordinates in early stages but then this leads to a self-organization system (12).

1.4. Provincial/territorial leadership

• Strong provincial and territorial leadership and mandate required to coordinate local/regional groups, ensure balanced regional stakeholder representation, ensure equity of resources and capacity across the regions, enforce quality standards, tie together databases, and mediate relationships between database holders and research at universities (2, 3 and 6).

• Province must work on resolving comparability issues and coordinate regional needs (8).

• Provincial leadership in local area surveillance (e.g. provide common analysis resources, ensure consistent regular reports across local areas, roll out existing surveys to all health units and ensure methodology is appropriate for all local areas (9 and 10).

1.5. Regional/local leadership

• Regional and local leadership to define information needs, including core and additional data (3).

• Need to gain understanding of local needs in order to avoid a "one size fits all" solution (4 and 8).

• Establish local networks of surveillance (4).

• Regional and local leadership to provide resources to implement the local system, engage policy makers (6).

1.6. Funding strategy

• Strategy to share human resources, expertise and funding between all federal/provincial/territorial and local levels (2 and 10).

• Sustainable funding (7).

• Identify tools for funding, find any potential pools of resources (8).

1.7. Clear vision

• Clear vision of the health goals and ultimate functions (3 and 5).

• Clearly defined roles and responsibilities of national, provincial and local systems (3, 4 and 8).

• Create a business plan and roadmap for surveillance activities (5 and 8).

• Define common vision, including a common glossary of terms (11).

1.8. Network of networks

• Establish a country-wide network of local area surveillance networks across Canada (12).

• Establish connections and deal with confidentiality and workflow issues (12).

2. Collaboration

2.1. Identification of stakeholders

• Identify the stakeholders and ensure that the right people are at the table (1, 5 and 7).

• Ensure that non-public health organizations (education, wellness, etc.) are brought to the table (3 and 9).

• Engage policy makers, decision makers, clinical experts, members of other sectors and stakeholders (6).

• Inclusiveness needs to be ensured including representation from all provinces and territories, and non-government groups (11).

2.2. Collaboration at federal, provincial/territorial, regional/local levels

• Support meetings of stakeholders at all levels (1).

• Infrastructure (7).

2.3. Inter-sectoral working grops

• Create inter-sectoral working groups (1).

• Support regional working groups including communities, programs, experts, education, health, NGOs, etc. (1).

• Ensure inclusive and balanced representation in working groups (s 1, 5, 6 and 7)

3. Information

3.1. Data sharing agreements

• Implement data sharing agreements (local data collection and ownership, but shared data for centralized analysis) (1 and 3).

• Improve access to CCHS data and statistical expertise (4).

• Augment CCHS, with age standardized rates and logistic regression (5).

• Expand CCHS to build on what is happening nationally (e.g. oversample in certain health regions to collect local data) (8).

• Explore existing non-health sources of health data (e.g. drivers’ licenses, taxes, census, passports, health cards, etc.) and remove barriers to accessing these data (10).

3.2. Data sharing practices

• Centralized repository (secure) with mapping and comparability features (2).

• Sharing of GIS mapping to expand into local area data (3).

• Data to be collected locally in all areas, to roll up to provincial estimates (4).

• Create network architecture (mapping diagram and data pieces) (5).

• Create and manage clearinghouse of what’s being done, and support information sharing (8).

3.3. Data standard

• Coordinate the creation of data standards (2).

• Work must be mandated and funded to a minimum level for parity across the country (3 and 11).

• Network should feature central analytic capacity and address inequities in localities and regions (4).

• Centralized support (e.g. public health observatory) would help greatly with capacity and contribute to methods, core content, analysis and standard core content, and data sharing (5).

• Conduct international benchmarking (7 and 11).

3.4. Standard questions

• Set up validated standard questions that meet local needs but allow national perspective (2).

• Need a clear list of indicators with clear identification of key risk factors (5).

• Consistent definitions of risk factors (7).

• Establish a resource library which includes questionnaires and methods (10).

• Identify what questions really need to be asked (12).

3.5. Reporting standard

• Provide standard templates for reporting (2).

3.6. Information dissemination

• Help disseminate results (2).

• Interface for knowledge sharing (7).

• All survey information is readily available and easily accessed (9).

3.7. Capacity mapping/information gap

• Perform capacity mapping for databases and competencies (3 and 6).

• Conduct an inventory of what is currently being done, what the complementary network components are, and a gap analysis with focused consideration of special groups (e.g. children, First Nations, etc.) (5).

• Conduct system inventory (6).

• Conduct environmental scan of existing tools, systems and datasets (7 and 12).

• Stay conscious of the needs of unique populations (7).

• Perform a capacity assessment and environmental scan, and a gap analysis (11).

4. Education

4.1. Training workshops

• Provide workshops and ongoing training (2 and 7).

• Build capacity in data analysis (4).

• Capitalize on existing resources including data and knowledge (12).

4.2. Newsletter

• Electronic newsletter to disseminate knowledge on new techniques and tools (9).

4.3. Public education

• Educate public that participation in surveys helps in local area planning, and which surveys are currently being done (10).

• Link to and have presence at conference to build appetite and spread the word (10).

5. Novelty

5.1. New methodology

• Foster research and development (R&D) to develop new surveillance methodologies, and a better understanding of what is feasible in different geographic areas (4).

• Need for small area data means a need for high quality geographic identifiers and new methodology (9).

• Develop tools for reaching "missing populations" (11).

5.2. Technology

• Look at technology required to support such a system and in particular non-proprietary formats (6).

5.3. Observatory/repository

• Think beyond conventional surveys and consider different modes, e.g. a public health observatory or population health repository, to use existing data (9).

5.4. Emerging issues

• Deal with privacy issues (11).

• Deal with confidentiality issues (12).

6. Communication

6.1. Internal communication

• Create an internet-based communication platform which is a professional (secure) site (1).

• Create an online forum to share experiences about surveys, data, program, and new developments in surveillance (2).

• Establish library and information exchange forum (12).

6.2. External communication

• Create a web portal for public use (1).

• Need to use dissemination as a public health strategy (4).

7. Evaluation

7.1. Demonstration of benefit

• Identify particular issues and areas of greatest surveillance need and pilot surveillance systems to demonstrate its ability to function at all levels (6).

• Conduct a smaller-scale pilot to demonstrate value and gain buy-in (7).

• Build business case, with models showing benefits to decision makers and funders (8).