Getting evidence into policy and practice: a framework for KT&E

Rebecca Armstrong

Cochrane Health Promotion & Public Health Field

Co-authors

Professor Elizabeth Waters Dr Elise Davis Catherine Harper (Queensland Health) Naomi Priest

Evidence influencing policy and practice decision making

Research Evidence

Experience & Expertise

Judgement

Resources

Values and Policy

Context

Habits & Tradition

Lobbyists & Pressure Groups

Pragmatics & Contingencies

www.gsr.gov.uk

Context of global evidence-based decision-making initiatives

Very limited work establishing processes of knowledge translation and exchange

Evidence into policy/practice; policy/practice into evidence

Lack of clarity around how to incorporate local knowledge into policy and practice

Recommendations need to have user involvement

Complex, methodological, political process

Knowledge translation framework Building a case for action Identifying contributing factors and points of

intervention Defining opportunities for action Evaluating potential interventions Selecting a portfolio of specific policies,

programs and actions

Swinburn et al 2005

Social model of health/lifecourse

Social and Economic Policy Environment

Culture

Distal Social Environments

Family

Macro Environ-mental Factors

Proximal Social Environments

Neighborhood Community

Organizational Connections

Friends

Individual Characteristics

Lifecourse

Conception Adulthood

Health & Development:Physical health, mental

health, social functioning, cognitive functioning

School

Socioeconomic

BehaviouralPsychosocial

GeneticCharacteristics

Pathobiology

Genetics Human Biology

Pathological Biomarkers

Lynch 2000

Project aims

1. Develop an understanding of the context within which decisions are made for policy and practice for the three topic areas (falls prevention, mental health and wellbeing of children and MH&W of adults who have families.

2. Identify evidence for interventions in the three topic areas

3. Develop recommendations for Queensland Heath’s policy and practice in the three topic areas

Phase 1. Establishing context

Key informants list and questions generated by steering group

Semi-structured interviews Questions focussed on use of evidence,

decision-making processes Questions informed by policy documents

Phase 2. Establishing the evidence-base

Review of systematic reviews Searched Cochrane Library, DARE,

health-evidence.ca, NICE, CDC, Medline,

Appraised reviews using tool developed by Dobbins et al @ health-evidence.ca

Included only high/moderate quality reviews

Phase 3. Combining evidence with context-related information

Made statements about where the evidence is at

Developed recommendations which sought to support the implementation of evidence into action in Queensland

These were then workshopped with policymakers, practitioners and researchers at a series of workshops

Phase 3. Combining evidence with context-related information

This stage was iterative & challenging…but this is the reality of EIPH

Used a deliberative process model The need for recommendations to be directive The incorporation of context-specific recommendations

which are actionable vs those which are egs of good PH practice

Common language Difficulty where evidence is limited or only exists at 1:1

level e.g. mental health promotion in early childhood

Limitations of the evidence-base/our approach

Focus only on reviews Context often hard to glean from reviews

Recommendations based on context reflect good PH practice rather than content specific (e.g. capacity building)

Limited cost effectiveness data Limited evidence of effectiveness in some areas

Absence of evidence is not the same as evidence of absence

Strengths of our approach

High level governance of project Development of a framework for developing evidence-

informed recommendations within tight timeframe and limited budget

Two way knowledge transfer Strong collaboration - Workshops and relationships with

project steering group and participants Objective views about evidence and context Empowering and capacity building

Contact details

Rebecca Armstrong

Cochrane HPPH Group

VicHealth

rarmstrong@vichealth.vic.gov.au

61 3 9667 1336

www.ph.cochrane.org