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

1. Getting evidence into policy and practice: a framework for KT&E Rebecca Armstrong Cochrane Health Promotion & Public Health Field

2. Co-authors • Professor Elizabeth Waters • Dr Elise Davis • Catherine Harper (Queensland Health) • Naomi Priest

3. 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

4. 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

5. 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

6. Social model of health/lifecourse Lynch 2000

7. 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 MH&W of adults who have families. • Identify evidence for interventions in the three topic areas • Develop recommendations for Queensland Heath’s policy and practice in the three topic areas

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Contact details Rebecca Armstrong Cochrane HPPH Group VicHealth rarmstrong@vichealth.vic.gov.au 61 3 9667 1336 www.ph.cochrane.org