UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, St. Lucia, QLD 4072, Australia.
Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia.
Int J Environ Res Public Health. 2022 Nov 18;19(22):15285. doi: 10.3390/ijerph192215285.
Noncommunicable diseases (NCDs), including obesity, remain a significant global public health challenge. Prevention and public health innovation are needed to effectively address NCDs; however, understanding of how healthcare organisations make prevention decisions is immature. This study aimed to (1) explore how healthcare organisations make decisions for NCD prevention in Queensland, Australia (2) develop a contemporary decision-making framework to guide NCD prevention in healthcare organisations. Cross-sectional and qualitative design, comprising individual semi-structured interviews. Participants ( = 14) were recruited from two organisations: the state public health care system (CareQ) and health promotion/disease prevention agency (PrevQ). Participants held executive, director/manager or project/clinical lead roles. Data were analysed in two phases (1) automated content analysis using machine learning (Leximancer v4.5) (2) researcher-led interpretation of the text analytics. Final themes were consolidated into a proposed decision-making framework for NCD prevention in healthcare organisations. Decision-making was driven by four themes: Data, Evidence, Ethics and Health, i.e., data, its quality and the story it tells; traditional and non-traditional sources of evidence; ethical grounding in fairness and equity; and long-term value generated across multiple determinants of health. The strength of evidence was directly proportional to confidence in the ethics of a decision. can be adapted by public health practitioners and policymakers to guide real-world policy, practice and investment decisions for obesity prevention and with further validation, other NCDs and priority settings (e.g., healthcare).
非传染性疾病（NCDs），包括肥胖症，仍是全球重大公共卫生挑战。需要预防和公共卫生创新，以有效应对 NCDs；然而，对医疗保健组织如何做出预防决策的理解还不成熟。本研究旨在：（1）探讨澳大利亚昆士兰州的医疗保健组织如何做出 NCD 预防决策；（2）制定一个当代决策框架，以指导医疗保健组织的 NCD 预防。采用横断面和定性设计，包括个人半结构化访谈。参与者（=14）从两个组织中招募：州公共医疗保健系统（CareQ）和健康促进/疾病预防机构（PrevQ）。参与者担任执行、主任/经理或项目/临床负责人的角色。数据分两个阶段进行分析：（1）使用机器学习（Leximancer v4.5）的自动化内容分析；（2）研究人员对文本分析的解释。最终主题被整合到一个医疗保健组织中预防 NCD 的决策框架中。决策由四个主题驱动：数据、证据、伦理和健康，即数据、其质量及其讲述的故事；传统和非传统证据来源；公平和公平的伦理基础；以及跨多个健康决定因素产生的长期价值。证据的强度与对决策伦理的信心成正比。该框架可以为公共卫生从业人员和政策制定者提供指导，以指导肥胖症预防的实际政策、实践和投资决策，并在进一步验证后，适用于其他 NCD 和重点领域（例如医疗保健）。
