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

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 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 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