Salaried and Community Primary Care Dental Services, NHS Lanarkshire, Buchanan Centre, 1st Floor, Main Street, Coatbridge, ML5 3BJ, Scotland, UK.
Soc Sci Med. 2013 Nov;96:1-8. doi: 10.1016/j.socscimed.2013.07.001. Epub 2013 Jul 13.
Increased political enthusiasm for evidence-based policy and action has re-ignited interest in the use of evidence within political and practitioner networks. Theories of evidence-based policy making and practice are being re-considered in an attempt to better understand the processes through which knowledge translation occurs. Understanding how policy develops, and practice results, has the potential to facilitate effective evidence use. Further knowledge of the factors which shape healthcare delivery and their influence in different contexts is needed. This paper explores the processes involved in the development of a complex intervention in Scotland's National Health Service (NHS). It uses a national oral health programme for children (Childsmile) as a case study, drawing upon key actors' perceptions of the influence of different drivers (research evidence, practitioner knowledge and values, policy, and political and local context) to programme development. Framework analysis is used to analyse stakeholder accounts from in-depth interviews. Documentary review is also undertaken. Findings suggest that Childsmile can be described as an 'evidence-informed' intervention, blending available research evidence with knowledge from practitioner experience and continual learning through evaluation, to plan delivery. The importance of context was underscored, in terms of the need to align with prevailing political ideology and in the facilitative strength of networks within the relatively small public health community in Scotland. Respondents' perceptions support several existing theoretical models of translation, however no single theory offered a comprehensive framework covering all aspects of the complex processes reported. Childsmile's use of best available evidence and on-going contribution to knowledge suggest that the programme is an example of intelligent policy making with international relevance.
对基于证据的政策和行动的政治热情的增加重新点燃了人们对政治和从业者网络内部使用证据的兴趣。基于证据的政策制定和实践理论正在重新考虑，试图更好地理解知识转化发生的过程。了解政策制定和实践结果的过程有可能促进有效的证据使用。进一步了解塑造医疗保健提供的因素及其在不同背景下的影响是必要的。本文探讨了苏格兰国家卫生服务（NHS）中一项复杂干预措施的发展过程。它使用了一个针对儿童的全国口腔健康计划（Childsmile）作为案例研究，利用主要参与者对不同驱动因素（研究证据、从业者知识和价值观、政策以及政治和地方背景）对项目发展的影响的看法。使用框架分析对深入访谈的利益相关者进行分析。还进行了文献综述。研究结果表明，Childsmile 可以被描述为一种“基于证据的”干预措施，将现有的研究证据与从业者经验的知识以及通过评估进行的持续学习相结合，以规划交付。背景的重要性得到了强调，需要与当时的政治意识形态保持一致，并且在苏格兰相对较小的公共卫生界的网络中具有促进作用。受访者的看法支持现有的几种翻译理论模型，但没有一种理论提供了一个全面的框架，涵盖了所报告的复杂过程的所有方面。Childsmile 对最佳现有证据的利用和对知识的持续贡献表明，该计划是具有国际相关性的明智政策制定的一个例子。
