McGill Elizabeth, Egan Matt, Petticrew Mark, Mountford Lesley, Milton Sarah, Whitehead Margaret, Lock Karen
Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK.
Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK.
BMJ Open. 2015 Apr 2;5(4):e007053. doi: 10.1136/bmjopen-2014-007053.
Local government services and policies affect health determinants across many sectors such as planning, transportation, housing and leisure. Researchers and policymakers have argued that decisions affecting wider determinants of health, well-being and inequalities should be informed by evidence. This study explores how information and evidence are defined, assessed and utilised by local professionals situated beyond the health sector, but whose decisions potentially affect health: in this case, practitioners working in design, planning and maintenance of the built environment.
A qualitative study using three focus groups. A thematic analysis was undertaken.
The focus groups were held in UK localities and involved local practitioners working in two UK regions, as well as in Brazil, USA and Canada.
UK and international practitioners working in the design and management of the built environment at a local government level.
Participants described a range of data and information that constitutes evidence, of which academic research is only one part. Built environment decision-makers value empirical evidence, but also emphasise the legitimacy and relevance of less empirical ways of thinking through narratives that associate their work to art and philosophy. Participants prioritised evidence on the acceptability, deliverability and sustainability of interventions over evidence of longer term outcomes (including many health outcomes). Participants generally privileged local information, including personal experiences and local data, but were less willing to accept evidence from contexts perceived to be different from their own.
Local-level built environment practitioners utilise evidence to make decisions, but their view of 'best evidence' appears to prioritise local relevance over academic rigour. Academics can facilitate evidence-informed local decisions affecting social determinants of health by working with relevant practitioners to improve the quality of local data and evaluations, and by advancing approaches to improve the external validity of academic research.
地方政府的服务和政策会影响规划、交通、住房和休闲等多个领域的健康决定因素。研究人员和政策制定者认为，影响健康、福祉和不平等的更广泛决定因素的决策应以证据为依据。本研究探讨了卫生部门以外的地方专业人员如何定义、评估和利用信息与证据，但其决策可能会影响健康：在本案例中，是指从事建筑环境设计、规划和维护工作的从业者。
采用三个焦点小组的定性研究。进行了主题分析。
焦点小组在英国各地举行，参与者包括在英国两个地区以及巴西、美国和加拿大工作的当地从业者。
在地方政府层面从事建筑环境设计和管理工作的英国及国际从业者。
参与者描述了一系列构成证据的数据和信息，其中学术研究只是其中一部分。建筑环境决策者重视实证证据，但也强调通过将其工作与艺术和哲学联系起来的叙述方式进行较少实证性思考的合法性和相关性。参与者将干预措施的可接受性、可交付性和可持续性方面的证据置于长期结果（包括许多健康结果）的证据之上。参与者通常更看重本地信息，包括个人经验和本地数据，但不太愿意接受来自与其自身情况不同的背景的证据。
地方层面的建筑环境从业者利用证据来做出决策，但他们对“最佳证据”的看法似乎更优先考虑本地相关性而非学术严谨性。学者可以通过与相关从业者合作提高本地数据和评估的质量，以及推进提高学术研究外部有效性的方法，来促进基于证据的地方决策，这些决策会影响健康的社会决定因素。
