Smith Marissa J, Katikireddi Srinivasa Vittal, Skivington Kathryn, Hilton Shona
University of Glasgow, Glasgow, UK.
Evid Policy. 2023 Aug;19(3):400-422. doi: 10.1332/174426421X16711062023280.
E-cigarette policy has varied across jurisdictions, contrasting with the previous coordinated approach of international tobacco control communities.
A multi-method case study approach was used to understand the role of evidence and external and internal contextual factors in the development of public health recommendations across four purposively selected jurisdictions (WHO, UK, Australia and USA).
Informed by Dobrow et al.'s (2004) conceptual framework for context-based evidencebased decision-making, four data sources were drawn upon: 1) 15 public health bodies' e-cigarette recommendation documents, 2) seven development documents produced by the public health bodies, 3) sources of evidence cited in the public health bodies' recommendation documents and 4) 15 qualitative interviews with experts. Thematic analysis and citation analysis were conducted to aid triangulation of evidence.
We found a complex interplay between internal and external factors which influence the role and use of evidence in the development of e-cigarette recommendations. For example, recommendation documents' remit (internal factor) was influenced by various external factors such as epidemiology and policy history, with decisions made over time having reshaped the external context. Considering the findings with respect to evidence utilisation, we propose a modified version of Dobrow et al.'s (2004) framework, highlighting the important interplay between internal and external contextual factors.
This research suggest internal and external contextual factors mutually interact and influence how evidence is incorporated into recommendations. This dynamic interplay of contextual factors may help explain the why different policy approaches are pursued concerning public health topics, particularly e-cigarettes.
电子烟政策在不同司法管辖区各不相同，这与国际烟草控制界此前的协调方法形成对比。
采用多方法案例研究方法，以了解证据以及外部和内部背景因素在四个有目的地选定的司法管辖区（世界卫生组织、英国、澳大利亚和美国）制定公共卫生建议过程中的作用。
以多布罗等人（2004年）基于背景的循证决策概念框架为指导，利用了四个数据源：1）15个公共卫生机构的电子烟建议文件，2）公共卫生机构编制的七份制定文件，3）公共卫生机构建议文件中引用的证据来源，4）对专家进行的15次定性访谈。进行了主题分析和引文分析，以辅助证据的三角互证。
我们发现内部和外部因素之间存在复杂的相互作用，这些因素影响着证据在电子烟建议制定过程中的作用和使用。例如，建议文件的职权范围（内部因素）受到各种外部因素的影响，如流行病学和政策历史，随着时间的推移所做出的决策重塑了外部环境。考虑到关于证据利用的研究结果，我们提出了多布罗等人（2004年）框架的修改版本，突出了内部和外部背景因素之间的重要相互作用。
本研究表明，内部和外部背景因素相互作用，并影响证据如何纳入建议。背景因素的这种动态相互作用可能有助于解释为什么在公共卫生主题，特别是电子烟方面会采取不同的政策方法。
