Evidence for Policy and Practice Information and Coordinating Centre, UCL Institute of Education, University College London, 20 Bedford Way, London, WC1H 0AL, United Kingdom.
NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom.
Health Res Policy Syst. 2019 Jun 28;17(1):61. doi: 10.1186/s12961-019-0446-x.
Local public health service delivery and policy-setting in England was overhauled in 2013, with local government now responsible for the complex tasks involved in protecting and improving population health and addressing health inequalities. Since 2013, public health funding per person has declined, adding to the challenge of public health decision-making. In a climate of austerity, research evidence could help to guide the more effective use of resources, although there are concerns that the reorganisation of public health decision-making structures has disrupted traditional evidence use patterns. This study aimed to explore local public health evidence use and needs in this new decision-making climate.
Semi-structured interviews with Public Health Practitioners across three Local Authorities were conducted, with sites purposefully selected to represent urban, suburban and county Local Authorities, and to reflect a range of public health issues that might be encountered. A topic guide was developed that allowed participants to reflect on their experience and involvement in providing evidence for, or making a decision around, commissioning a public health service. Data were transcribed and template analysis was employed to understand the findings, which involved developing a coding template based on an initial transcript and applying this to subsequent transcripts.
Increased political involvement in local public health decision-making, while welcomed by some participants as a form of democratising public health, has influenced evidence preferences in a number of ways. Political and individual ideologies of locally elected officials meant that certain forms of evidence could be overlooked in favour of evidence that corresponded to decision-makers' preferences. Political involvement at the local level has increased the appetite for local knowledge and evidence. Research evidence needs to demonstrate its local salience if it is to contribute to decision-making alongside competing sources, particularly anecdotal information.
To better meet decision-making needs of politicians and practitioners, a shift in the scope of public health evidence is required. At a systematic review level, this could involve moving away from producing evidence that reflects broad global generalisations about narrow and simple questions, and instead towards producing forms of evidence that have local applicability and can support complex policy-focussed decisions.
2013 年，英国对地方公共卫生服务提供和政策制定进行了全面改革，地方政府现在负责保护和改善人口健康以及解决健康不平等问题所涉及的复杂任务。自 2013 年以来，人均公共卫生资金有所减少，这给公共卫生决策增加了挑战。在紧缩的环境下，研究证据可以帮助指导更有效地利用资源，尽管人们担心公共卫生决策结构的重组扰乱了传统的证据使用模式。本研究旨在探索新决策环境下地方公共卫生证据的使用和需求。
对三个地方当局的公共卫生从业人员进行了半结构化访谈，选择了具有代表性的地点，代表城市、郊区和县城地方当局，并反映了可能遇到的各种公共卫生问题。制定了一个主题指南，允许参与者反思他们在提供证据或围绕公共卫生服务的委托做出决策方面的经验和参与情况。对数据进行了转录，并采用模板分析来理解研究结果，包括根据初始转录本开发编码模板，并将其应用于后续转录本。
一些参与者欢迎政治更多地参与地方公共卫生决策，认为这是民主化公共卫生的一种形式，但这在很多方面影响了证据偏好。地方民选官员的政治和个人意识形态意味着某些形式的证据可能被忽视，而偏向于符合决策者偏好的证据。地方一级的政治参与增加了对本地知识和证据的需求。如果要与竞争来源（特别是传闻证据）一起为决策做出贡献，研究证据需要证明其在当地的相关性。
为了更好地满足政治家和从业人员的决策需求，需要转变公共卫生证据的范围。在系统评价层面，这可能涉及从制作反映关于狭隘和简单问题的广泛全球概括的证据，转变为制作具有本地适用性并能支持复杂政策重点决策的证据。
