Getting evidence into policy and practice: a framework for KT

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Getting evidence into policy and practice a
framework for KTE

• Rebecca Armstrong
• Cochrane Health Promotion Public Health Field

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Co-authors

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

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Evidence influencing policy and practice
decision making
Experience Expertise
Pragmatics Contingencies
Judgement
Research Evidence
Lobbyists Pressure Groups
Resources
Values and Policy Context
Habits Tradition
www.gsr.gov.uk
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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

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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
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Social model of health/lifecourse
Lynch 2000
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Project aims

• 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 MHW
  of adults who have families.
• Identify evidence for interventions in the three
  topic areas
• Develop recommendations for Queensland Heaths
  policy and practice in the three topic areas

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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

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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 _at_ health-evidence.ca
• Included only high/moderate quality reviews

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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

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Phase 3. Combining evidence with context-related
information

• This stage was iterative challengingbut 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 11 level e.g. mental health promotion
  in early childhood

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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

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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

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Contact details

• Rebecca Armstrong
• Cochrane HPPH Group
• VicHealth
• rarmstrong_at_vichealth.vic.gov.au
• 61 3 9667 1336
• www.ph.cochrane.org