Lane Cassandra, Nathan Nicole, Wiggers John, Hall Alix, Shoesmith Adam, Bauman Adrian, Groombridge Daniel, Sutherland Rachel, Wolfenden Luke
School of Medicine and Public Health, The University of Newcastle, 1 University Drive Callaghan, Newcastle, NSW, Australia.
Hunter New England Population Health, Hunter New England Area Health Service, Newcastle , NSW, Australia.
Implement Sci Commun. 2024 Jul 31;5(1):85. doi: 10.1186/s43058-024-00619-3.
Learning Health Systems (LHS) - characterised by cycles of evidence generation and application - are increasingly recognised for their potential to improve public health interventions and optimise health impacts; however there is little evidence of their application in the context of public health practice. Here, we describe how an Australian public health unit applied a LHS approach to successfully improve a model of support for implementation of a school-based physical activity policy.
This body of work was undertaken in the context of a strong research-practice partnership. Core LHS capabilities included: i) partnerships and stakeholder engagement; ii) workforce development and learning health communities; iii) multi-disciplinary scientific expertise; iv) practice data collection and management system; v) evidence surveillance and synthesis; and vi) governance and organisational processes of decision making. Three cycles of data generation and application were used. Within each cycle, randomised controlled trials conducted in NSW primary schools were used to generate data on the support model's effectiveness for improving schools' implementation of a government physical activity policy, its delivery costs, and process measures such as adoption and acceptability. Each type of data were analysed independently, synthesised, and then presented to a multi-disciplinary team of researchers and practitioners, in consult with stakeholders, leading to collaborative decisions for incremental improvements to the support model.
Cycle 1 tested the first version of the support model (composed of five implementation strategies targeting identified barriers of policy implementation) and showed the model's feasibility and efficacy for improving schools' policy implementation. Data-informed changes were made to enhance impact, including the addition of three implementation strategies to address outstanding barriers. Cycle 2 (now, testing a package of eight implementation strategies) established the model's effectiveness and cost-effectiveness for improving school's policy implementation. Data-informed changes were made to reduce delivery costs, specifically adapting the costliest strategies to reduce in-person contact from external support personnel. Cycle 3 showed that the adaptations minimised the relative cost of delivery without adversely impacting on the effect.
Through this process, we identified an effective, cost-effective, acceptable and scalable policy implementation support model for service delivery. This provides important information to inform or support LHS approaches for other agencies seeking to optimise the health impact of evidence-based interventions.
学习型卫生系统（LHS）——其特点是证据生成与应用循环——因其改善公共卫生干预措施及优化健康影响的潜力而日益受到认可；然而，几乎没有证据表明其在公共卫生实践背景下的应用情况。在此，我们描述了澳大利亚一个公共卫生单位如何应用学习型卫生系统方法成功改进了一种支持实施基于学校的体育活动政策的模式。
这项工作是在强大的研究 - 实践伙伴关系背景下开展的。学习型卫生系统的核心能力包括：i）伙伴关系和利益相关者参与；ii）劳动力发展和学习型卫生社区；iii）多学科科学专业知识；iv）实践数据收集和管理系统；v）证据监测与综合；以及vi）决策的治理和组织流程。使用了三个数据生成与应用循环。在每个循环中，在新南威尔士州小学进行的随机对照试验用于生成关于支持模式在改善学校实施政府体育活动政策方面效果、实施成本以及诸如采用率和可接受性等过程指标的数据。每种类型的数据都进行独立分析、综合，然后在与利益相关者协商后提交给一个由研究人员和从业者组成的多学科团队，从而做出协作决策以逐步改进支持模式。
第1个循环测试了支持模式的第一个版本（由针对已确定的政策实施障碍的五项实施策略组成），并显示了该模式在改善学校政策实施方面的可行性和有效性。根据数据进行了改进以增强影响，包括增加了三项实施策略以解决突出障碍。第2个循环（现在测试一套八项实施策略）确定了该模式在改善学校政策实施方面的有效性和成本效益。根据数据进行了改进以降低实施成本，特别是调整成本最高的策略以减少外部支持人员的面对面接触。第3个循环表明这些调整在不负面影响效果的情况下将实施的相对成本降至最低。
通过这个过程，我们确定了一种有效、具有成本效益、可接受且可扩展用于服务提供的政策实施支持模式。这为其他寻求优化基于证据的干预措施的健康影响的机构提供了重要信息，以指导或支持其学习型卫生系统方法。
