Jack Brockhoff Child and Wellbeing Program, Academic Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
Jack Brockhoff Child and Wellbeing Program, Academic Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
Public Health. 2014 Jun;128(6):525-32. doi: 10.1016/j.puhe.2014.03.013. Epub 2014 Jun 7.
Public health practitioners and policymakers value research evidence as one of many resources to use in evidence-informed decision making (EIDM) for public health. However, both researchers and decision-makers have described persistent barriers and facilitators involved in using research evidence for public health practice and policy. This is likely to affect the extent to which research evidence is influential or useful in decisions. Numerous taxonomies, typologies and frameworks are available to guide action in EIDM, but their application in practice is relatively unknown.
The Public Health Evidence group based in Australia, which incorporates The Cochrane Collaboration's Public Health Review Group, have adapted a number of conceptualizations of research use and types of evidence into a practical typology that defines and illustrates three main types of evidence used in evidence-informed public health: data (Type 1), intervention effectiveness (Type 2) and implementation evidence (Type 3). The authors have actively used this typology within our primary research, evidence synthesis, workforce development and stakeholder engagement strategies, which has enabled practical application of these concepts. To test the relevance of the typology in practice, relevant findings from our applied research and evaluation (including two exploratory studies of evidence use in decision-making and evaluations of the use and impact of systematic reviews among end-users) were triangulated.
The typology has been useful in stakeholder interactions when defining evidence, and identifying processes for EIDM. There was a preference for defining evidence as descriptive evidence (data) rather than impact evidence and implementation evidence. Practitioners were confident and competent at generating and using data and community views descriptively for priority setting (describing the problem). However, finding and using impact and implementation evidence appropriate for strategy development (effective solutions) was often described as a more daunting task. As a result, there was low awareness of, and competence with, Types 2 and 3 evidence. Organizational processes for using these types of evidence were almost non-existent.
Applying this typology with stakeholders has allowed us to observe that it; (1) has been useful in conceptualizing useful evidence for public health, which has guided our work (2) has been useful in stakeholder interactions to introduce evidence, its definition and what it means to be 'evidence-informed' and (3) has identified 'faults' in the EIDM approach. The typology includes examples of common questions in public health, and suggestions of the types of evidence that may be useful to answer those questions. Findings that test the use of the typology have been synthesized. These have demonstrated inconsistencies in defining and applying evidence, and low awareness about what types of evidence are crucial to ensure that interventions are effective and minimize harm. Based upon these findings, the authors would argue that current investment in type 1 evidence (e.g. data repositories) shifts to make way for KT strategies, which facilitate the uptake of type 2 and 3 evidence (interventions and implementation guidance).
Building a shared understanding of the types of evidence and their importance in public health decision-making is crucial if we wish to build a system that supports EIDM and results in effective interventions being delivered. There are a number of 'faults' in the system which the authors have illuminated through understanding the individual and organizational realities of evidence use. These faults could be addressed through KT strategies with the public health workforce, and development of organizational cultures and the broader system.
公共卫生从业人员和政策制定者将研究证据视为用于公共卫生循证决策（EIDM）的众多资源之一。然而，研究人员和决策者都描述了在将研究证据用于公共卫生实践和政策方面存在持续存在的障碍和促进因素。这可能会影响研究证据在决策中的影响力或有用性。有许多分类法、类型学和框架可用于指导 EIDM 中的行动，但它们在实践中的应用相对未知。
澳大利亚的公共卫生证据小组，其中包括考科蓝协作组织的公共卫生评论组，已经将研究使用和证据类型的多种概念改编为实用的类型学，该类型学定义并说明了用于循证公共卫生的三种主要证据类型：数据（类型 1）、干预效果（类型 2）和实施证据（类型 3）。作者在我们的主要研究、证据综合、劳动力发展和利益相关者参与策略中积极使用了这种类型学，这使得这些概念的实际应用成为可能。为了测试该类型学在实践中的相关性，我们对来自应用研究和评估的相关发现进行了三角分析（包括对决策中证据使用的两项探索性研究，以及对最终用户系统评价使用和影响的评估）。
该类型学在定义证据和确定 EIDM 流程时，在利益相关者互动中很有用。人们更倾向于将证据定义为描述性证据（数据），而不是影响证据和实施证据。从业者在生成和使用数据以及社区观点方面具有自信和能力，可用于优先事项设定（描述问题）。然而，寻找和使用适合策略制定的影响和实施证据（有效解决方案）通常被描述为一项更加艰巨的任务。因此，对类型 2 和 3 证据的认识和能力较低。用于使用这些类型证据的组织流程几乎不存在。
与利益相关者一起应用这种类型学使我们能够观察到：（1）它有助于我们对公共卫生有用的证据进行概念化，这指导了我们的工作；（2）在与利益相关者互动时，它有助于引入证据、其定义以及循证的含义；（3）它确定了 EIDM 方法中的“缺陷”。该类型学包括公共卫生中常见问题的示例，并提出了可能有助于回答这些问题的证据类型。对测试该类型学使用情况的研究结果进行了综合。这些结果表明，在定义和应用证据方面存在不一致，并且对确保干预措施有效和最大限度减少伤害至关重要的证据类型的认识不足。基于这些发现，作者认为，目前对第 1 类型证据（例如数据存储库）的投资应进行调整，以支持知识转化策略，从而促进第 2 类型和第 3 类型证据（干预措施和实施指南）的采用。
如果我们希望建立一个支持 EIDM 并导致有效干预措施实施的系统，就必须就证据的类型及其在公共卫生决策中的重要性建立共同的理解。在证据使用的个人和组织现实中，作者已经揭示了系统中的一些“缺陷”。通过对公共卫生劳动力的知识转化策略以及组织文化和更广泛系统的发展，可以解决这些缺陷。
