Dr. Karen Liller wants to empower injury prevention workers

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I believe it is absolutely critical  for the injury prevention field to continue our success in decreasing injuries and deaths,” said Dr. Karen Liller of the USF College of Public Health.

Liller, a professor in the Department of Community and Family Health says decreasing injuries and deaths often includes effective policy making skills of those working on the frontlines.

Her research, “An Examination of the Perceived Importance and Skills Related to Policies and Policy Making Among State Public Health Injury Prevention Staff,” published in the Journal of Public Health Management and Practice used the Public Health Workforce Interest and Needs Survey (PH WINS)— the first nationally representative survey of state health agency workers—to assess state injury prevention staff perceptions of policy development, as well as their awareness and perceptions of Health in All Policies (HiAP).

Karen Liller, PhD. (Photo by Caitlin Keough)

HiAP is collaborative approach that integrates and articulates health considerations into policymaking across sectors to improve the health of all communities and people, according to the CDC.

“The HiAP approach is very important to know as it focuses on the consequences of broad-ranging public policies on health determinants and strives to improve the accountability of policy makers for health impacts at all levels of policy making,” Liller said.

Injury prevention benefits from this approach, according to Liller, because most of the injury-related policies need to be addressed not only by public health officials but by those outside of public health’s immediate control.

“For example, transportation officials are critical to our work within motor vehicle injury prevention and keeping streets safe,” she said.

Liller said PH WINS gauged public health practitioners’ perspectives on workplace environment, job satisfaction, national trends, and training needs, and gathered demographics on the workforce. It was fielded in 2014 and has three frames: a nationally-representative frame of state health agency staff, staff from a group of large, urban local health departments, and staff from other, smaller local health departments.

PH WINS  was developed by the Association of State and Territorial Health Officials, the de Beaumont Foundation, a panel of experts from CDC, HRSA, the National Network of Public Health Institutes, the Public Health Foundation, NACCHO, the Public Health Accreditation Board, in addition to experts in survey design and public health workforce development.

“Dr. Theresa Chappel-McGruder, senior research and evaluation officer of the de Beaumont Foundation sent out an email in 2016 asking if individuals wanted to be part of writing groups focused on the data results pertaining PH WINS,” Liller said.

Liller joined the maternal and child health (MCH) national writing group. The participants are co-authors on each other’s papers.  There are also several other writing groups focused on different topics, according to Liller.

Liller said she was particularly interested in reviewing data related to state injury prevention workers. She focused on data from the state health agency frame only, focusing on permanently employed, central office staff in injury prevention.

PH WINS respondents are from five paired U.S. Dept. of Health and Human Services regions, according to Liller.

Her study included a weighted population of 365 injury prevention workers measuring demographics and responses to understanding policy development and perceptions of the HiAP public health trend.

(Photo courtesy of Pixabay)

Overall, she found that injury prevention workers reported lower policy-making skills, but had an overall appreciation of the importance of policies.

“The majority of the injury prevention workers had heard of HiAP and believed there should be more emphasis on it,” she said. “Also, the majority believed HiAP to be somewhat or very important to public health.”

However, Liller also found that only about one-third of the injury prevention workers reported that HiAP would have a fair amount or a great deal of impact on their daily work.

“This is concerning because the principles of HiAP are very critical to the success of many injury prevention efforts,” she said.

Injury prevention workers perceptions of their skills in policy making were much lower than she would like to have seen.

“This could be due to the worker’s lacking confidence in their ability to be change agents and not on their perception of the importance of these skills which rated much higher,” she said. “It could also mean that more training and skill development needs to be done for injury prevention workers.”

According to Liller, the field of injury prevention has long-held the importance of policies related to their efforts.

“It has been shown that legislation and regulation, especially in reference to unintentional injuries (those done without harmful intent), are the most effective interventions,” she said. “Therefore, addressing these skills among state workers is important.”

Dr. Karen Liller helped to drive the state’s bicycle helmet law in the late 1990s. (Photo courtesy of ThinkStock)

Liller said she hopes to help develop policy-making training opportunities for state injury prevention staff to build their skills and determine the efficacy of those skills in decreasing injury and mortality.

“These workers can be very strong advocates and role models for their local counterparts. Efforts are needed to fill these gaps perhaps through education from CDC’s National Center for Injury Prevention and Control, state injury prevention programs, schools and colleges of public health, and other educational groups,” she said. “Advocacy is critical and efforts need to be put forth to make sure not only injury prevention professionals, but all public health professionals have these skills.”


Liller, K.D., Chapple-McGruder, T., Castrucci, B., Wingate, M.S., Hilson, R., Mendez, D., Cilenti, D., & Raskind, I. (2017).  An examination of the perceived importance and skills related to policies and policy making among state public health injury prevention staff.  Journal of Public Health Management and Practice, doi 10.1097/PHH.0000000000000672


Story by Anna Mayor, USF College of Public Health

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