How to support professionals with evidence? Djoeke van Dale Senior advisor Centre for Healthy Living

Content Background Best Practice portal Implementation of BP New strategies Conclusions back

Centre For Healthy Living Evidence information To contribute to the health of all Dutch citizens by supporting health promotion professionals Website and an intervention database Assessment system for interventions (Recognition) Specific information/ support in settings: School Day childcare / preschool Municipality Workplace Loketgezondleven.nl information about planning and processes Centre and mission Our Centre is part of the sector Public Health and Health Services. We are supported by the Ministry of Health, Sports and Welfare of the Netherlands. The Centre aims to contribute to the health of all Dutch citizens by supporting health promotion professionals through a dedicated website (Loketgezondleven.nl) and best practice portal (with an assessment system for evaluating best practices), and we organise direct support (meetings, training and coaching).   We organize our information in settings. Together with health promotion professionals and partners, we developed four online manuals, each targeting a different setting: Healthy School, Healthy Neighborhood /Municipality, Healthy Childcare and Healthy Workplace. The manuals provide information, tips and practical examples for developing, implementing and evaluating public health policy at local and settings level. Furthermore the manuals provide options for an integrated approach with regard to eight health themes for example overweight but also alcohol, durgs depression etc) For each theme, the manual presents a list of formally recommended interventions. I will show some examples for overweight and obesity 3

Database (Loketgezondleven.nl) 350 good practices (governance function): Insight in quality and effectiveness CGL puts information/data in the database (assessment information) 994 interventions (collection and sharing): Insight in HP intervention supply in the Netherlands Professionals submit their intervention to the database. CGL verifies the content

The Recognition System Objectives to provide policy makers and professionals with sound information on the quality and effectiveness of available health promotion interventions to promote the quality of the interventions (research) Collaboration of 7 organisations One system for several sectors 5

Assesment system: The Recognition System Improving effectiveness in 2 directions Evidence-based practice Practice-based evidence

Assessment levels 994 interventions in database 350 best practices 61 effective 7 highest level 15

How? The submission form in a nutshell Description of the intervention (Required for all levels) target, targetgroup, planning of the intervention & methods Theoretical foundation (Required for ‘theoretically sound’ and ‘effective’) scientific epidemiological analyis, intervention methods, strategies and activities are appropriate for and tailored to the goals and target population, as indicated by published scientific evidence Preconditions for implementation and quality assurance (Required for all levels) Requirements for training, implementation, quality assurance ,costs Process Evaluation Evidence for effectiviness (Required for ‘effective) First indications: pre-post design (monitoring) Good indications: controlled study design (no follow up) Strong indications: controlled study design, including a 6 month follow up) 8

List of recommended interventions Interventies per gezondheidsthema Interventieoverzicht overgewicht Interventieoverzicht alcohol Interventieoverzicht drugs Interventieoverzicht roken Interventieoverzicht depressie Interventieoverzicht seksuele gezondheid Interventieoverzicht letsel

what about the professionals in the field?? For both? Information OK! What is used? Are the professionals satisfied We are satisfied with our sites (most of the time) but more important the professsionals are they using our databases what about the professionals in the field??

Why choosing a best practice? Professionals use a best practice if: Management supports the implementation of a best practice Incentive programs of the government encourage the adoption/ implementation Municipalities require the implementation of best practices Intervention has to be easy to implement for the professional There have been two evaluations (most recent one was last year). The respondents (600 from practice and less from policy) appreciated the system. Gives insigth in quality, effectiveness and feasibility of the interventions R

Why not choosing for a best practice? Not using best practices: Unfamiliarity with the database and different levels of evidence Best practices can not be adjusted to local context (according to the practitioners) Want to connect /align with the existing activities in the municipality or organisation Professionas want to develop own interventions…want to have information about common effective elements/ What works There have been two evaluations (most recent one was last year). The respondents (600 from practice and less from policy) appreciated the system. Gives insigth in quality, effectiveness and feasibility of the interventions X R

How can we improve the support of the health promotion practitioners and policy makers with information about evidence based information?

1. Adjusting a best practice to local context: keep the core elements Message: best practices can be adjusted to local context We provide information about the core elements of a best practice Core elements: Central to its theory and logic. Are thought to be responsible for the effectiveness of the intervention. Critical features of the intervention intent and design. Should be kept intact when program is implemented (centre.trt.org)

Example of core elements: A new Leaf Choices for healthy living Structured assessment and counseling tool that emphasizes practical strategies for making changes in dietary and physical activity behaviors. Risk perception (diet, physical activity, smoking) Goal setting as collaborative process and action planning Self-efficacy (to built self confidence ) Tip sheet (guidelines) to tackle barriers Tailored feedback and follow-up Social support (participants learn why, where, and how to generate and sustain a successful social support network)  (centre.trt.org) We add also information about the conditions of the feasability or applilcability. Condition of the context of the intervention are also very important.

2. Provide information about What works? An overview of ‘common elements’ of successful studies for one specific topic of a group of interventions Best practices are shown as an example of these common elements /active ingredients. Method of the What Works Review of literature Focus on common effective elements of interventions List of common effective elements Focus groups with professionals Practical document how to work on specific topic (alcohol prevention for elderly people) Online and offline…workshop

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3.Model intervention? Is it possible to develop a ‘ model’ intervention based on common effective elements which can be adapted to the local context? Not 20 interventions differing slightly but one generic intervention Professionals can adapt the model intervention to the needs of the local contexts. If there is an incentive best practices are implemented but if not it is very difficult to have the best practices implemented (unless a small program with

Concluding remarks From interventions only to also What works: improvement of quality of local work? From mainly online information to also offline (workshops, regional gatherings) Tailored advice to local communities (using practice based and evidence based information) Improving use of evidence based knowledge

Thank you

Centrum Gezond Leven | 31-10-2016

Focus on common effective elements of interventions What works Review of literature Focus on common effective elements of interventions List of common effective elements Focus groups with professionals Practical document how to work on specific topic (alcohol prevention for elderly people) Online and offline…workshop Centrum Gezond Leven | 31-10-2016