More harm than good? Building a framework to identify adverse effects of public health interventions

Abstract Background While the importance of adverse events of medical interventions is widely recognized, adverse effects of public health interventions remain a neglected topic. This project aims to develop a framework to guide researchers and decision-makers to systematically reflect on and identify potential adverse effects of public health interventions. Methods We conducted a mixed-method systematic review of theoretical and conceptual publications on adverse events of public health interventions to develop a preliminary framework employing best-fit framework synthesis. We used the WHO-INTEGRATE framework as a starting point for the synthesis, a multidimensional evidence-to-decision framework developed for complex interventions in complex systems. Results The framework includes two interlinked parts: The first maps domains in which potential adverse events might arise. Drawing on the WHO-INTEGRATE framework, these domains include aspects related to health, but also domains related to societal, economic, and environmental implications. The second part maps general mechanisms through which public health interventions can lead to adverse effects (e.g. reactive behaviour change, increase of labelling and stigmatization, and exposure to environmental risk-factors). Conclusions The framework will be advanced in the second phase of the project through empirical studies of harmful effects in public health interventions, which we will identify through an overview of systematic reviews. Adverse effects of public health interventions are currently not sufficiently considered in research and practice. Taking them into account is essential for informed decision-making and establishing appropriate countermeasures. Our framework could be a valuable asset for researchers and policy makers in developing, implementing and evaluating public health interventions. Key messages Awareness of the adverse effects of public health interventions is essential for informed decision-making and establishing countermeasures. This framework supports researchers and decision-makers in systematically reflecting on and identifying adverse events when developing, piloting, implementing or evaluating public health interventions.

Download Full-text

Essential skills for using research evidence in public health policy: a systematic review

Evidence & Policy A Journal of Research Debate and Practice ◽

10.1332/174426421x16250726996691 ◽

2021 ◽

Author(s):

Saliha Ziam ◽

Pierre Gignac ◽

Élodie Courant ◽

Esther Mc Sween-Cadieux

Keyword(s):

Public Health ◽

Systematic Review ◽

Decision Making ◽

Research Evidence ◽

Informed Decision ◽

Decision Makers ◽

Informed Decision Making ◽

Evidence Use ◽

Public Health Decision ◽

Health Decision

Background: Decisions related to the development and implementation of public health programmes or policies can benefit from more effective use of the best available knowledge. However, decision makers do not always feel sufficiently equipped or may lack the capacity to use evidence. This can lead them to overlook or set aside research results that could be relevant to their practice area.Aims and objectives: The objective of this systematic review was to synthesise the essential skills that facilitate the use of research evidence by public health decision makers.Methods: Thirty-nine articles that met our inclusion criteria were included. An inductive approach was used to extract data on evidence-informed decision-making-related skills and data were synthesised as a narrative review.Findings: The analysis revealed three categories of skills that are essential for evidence-informed decision-making process: interpersonal, cognitive, and leadership and influencing skills. Such cross-sectoral skills are essential for identifying, obtaining, synthesising, and integrating sound research results into the decision-making process.Discussion and conclusions: The results of this systematic review will help direct capacity-building efforts towards enhancing research evidence use by public health decision makers, such as developing different types of training that would be relevant to their needs. Also, when considering the evidence-informed decision-making skills development, there are several useful and complementary approaches to link research most effectively to action. On one hand, it is important not only to support decision makers at the individual level through skills development, but also to provide them with a day-to-day environment that is conducive to evidence use. Key messages <ul><li>Public health programmes or policies can benefit from more effective use of the best available knowledge;</li> <li>This review identified 39 studies on skills related to evidence-informed decision making;</li> <li>Three categories of skills are proposed: cognitive, interpersonal and leadership and influencing skills;</li> <li>It will help direct capacity-building efforts towards enhancing evidence use by decision makers.</li></ul>

Download Full-text

The National Collaborating Centre for Methods and Tools (NCCMT): Supporting evidence-informed decision-making in public health in Canada

Canada Communicable Disease Report ◽

10.14745/ccdr.v47i56a08 ◽

2021 ◽

Vol 47 (56) ◽

pp. 292-296

Author(s):

Heather Husson ◽

Claire Howarth ◽

Sarah Neil-Sztramko ◽

Maureen Dobbins

Keyword(s):

Public Health ◽

Decision Making ◽

Informed Decision ◽

Decision Makers ◽

Supporting Evidence ◽

Informed Decision Making ◽

Public Health Response ◽

The Public ◽

Public Health Infrastructure ◽

Health Response

The National Collaborating Centre for Methods and Tools (NCCMT) is part of a network of six National Collaborating Centres for Public Health (NCC) created in 2005 by the federal government following the severe acute respiratory syndrome (SARS) epidemic to strengthen public health infrastructure in Canada. The work of the NCCMT, to support evidence-informed decision-making (EIDM) in public health in Canada, is accomplished by curating trustworthy evidence, building competence to use evidence and accelerating change in EIDM. Ongoing engagement with its target audiences ensures NCCMT’s relevance and ability to respond to evolving public health needs. This has been particularly critical during the coronavirus disease 2019 (COVID-19) pandemic, which saw NCCMT pivot its activities to support the public health response by conducting rapid reviews on priority questions identified by decision-makers from federal to local levels as well as create and maintain a national repository of in-progress or completed syntheses. These efforts, along with partnering with the COVID-19 Evidence Network to support Decision-Making (COVID-END), sought to reduce duplication, increase coordination of synthesis efforts and support decision-makers to use the best available evidence in decision-making. Data from website statistics illustrate the successful uptake of these initiatives across Canada and internationally.

Download Full-text

Research use at the Ministry of Health in Burkina Faso: the decision-makers’ perspective

Implementation Science Communications ◽

10.1186/s43058-021-00126-9 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Christian Dagenais

Keyword(s):

Decision Making ◽

Knowledge Transfer ◽

Burkina Faso ◽

Informed Decision ◽

Communication Strategy ◽

Decision Makers ◽

Research Use ◽

Informed Decision Making ◽

Ministry Of Health ◽

Policy Makers

Abstract Background Despite the increased emphasis placed on the use of evidence for policy development, relatively few initiatives have been developed to support evidence-informed decision-making, especially in West Africa. Moreover, studies examining the conditions under which policy-makers use research-based evidence are still scarce, but they show that their attitudes and opinions about research are one of the main determinants of such use. In February 2017, Burkina Faso’s Minister of Health planned to create a unit to promote evidence-informed decision-making within the ministry. Before the unit was set up, documenting the attitudes towards research at the highest levels of his Ministry appeared profitable to the unit’s planning. Method Individual interviews were conducted by the author with 14 actors positioned to consider evidence during decision-making from the Burkina Faso’s Minister of health cabinet. An interview grid was used to explore several themes such as attitudes towards research, obstacles and facilitators to research use, example of research use in decision-making and finally, ways to increase decision-makers’ participation in knowledge transfer activities. Interviews were partially transcribed and analysed by the author. Results The results show a mixed attitude towards research and relatively little indication of research use reported by respondents. Important obstacles were identified: evidence inaccessibility, lack of implementation guidelines, absence of clear communication strategy and studies’ lack of relevance for decision-making. Many suggestions were proposed such as raising awareness, improving access and research communication and prioritizing interactions with researchers. Respondents agree with the low participation of decision-makers in knowledge transfer activities: more leadership from the senior officials was suggested and greater awareness of the importance of their presence. Conclusions The conclusion presents avenues for reflection and action to increase the potential impact of the knowledge transfer unit planned within the Ministry of Health of Burkina Faso. This innovative initiative will be impactful if the obstacles identified in this study and policy-makers’ preferences and needs are taken into account during its development and implementation.

Download Full-text

Enhancing evidence-informed decision making: strategies for engagement between public health faculty and policymakers in Kenya

Evidence & Policy A Journal of Research Debate and Practice ◽

10.1332/174426416x14595114153349 ◽

2017 ◽

Vol 13 (2) ◽

pp. 225-253 ◽

Cited By ~ 5

Author(s):

Nasreen Jessani ◽

Caitlin Kennedy ◽

Sara Bennett

Keyword(s):

Public Health ◽

Decision Making ◽

Informed Decision ◽

Informed Decision Making

Download Full-text

Public Health Interventions with Harms and Benefits: A Graphical Framework for Evaluating Tradeoffs

Medical Decision Making ◽

10.1177/0272989x20960458 ◽

2020 ◽

Vol 40 (8) ◽

pp. 978-989

Author(s):

Allison L. Pitt ◽

Jeremy D. Goldhaber-Fiebert ◽

Margaret L. Brandeau

Keyword(s):

Public Health ◽

Black Males ◽

Health Interventions ◽

Decision Makers ◽

Net Benefit ◽

Public Health Interventions ◽

Meat Price ◽

Life Years ◽

Equity And Efficiency ◽

Decision Alternative

Background Evaluations of public health interventions typically report benefits and harms aggregated over the population. However, benefits and harms are not always evenly distributed. Examining disaggregated outcomes enables decision makers to consider health benefits and harms accruing to both intended intervention recipients and others in the population. Methods We provide a graphical framework for categorizing and comparing public health interventions that examines the distribution of benefit and harm between and within population subgroups for a single intervention and compares distributions of harm and benefit for multiple interventions. We demonstrate the framework through a case study of a hypothetical increase in the price of meat (5%, 10%, 25%, or 50%) that, via elasticity of demand, reduces consumption and consequently reduces body mass index. We examine how inequalities in benefits and harms (measured by quality-adjusted life-years) are distributed across a population of white and black males and females. Results A 50% meat price increase would yield the greatest net benefit to the population. However, because of reduced consumption among low-weight individuals, black males would bear disproportionate harm relative to the benefit they receive. With increasing meat price, the distribution of harm relative to benefit becomes less “internal” to those receiving benefit and more “distributed” to those not receiving commensurate benefit. When we segment the population by sex only, this result does not hold. Conclusions Disaggregating harms and benefits to understand their differential impact on subgroups can strongly affect which decision alternative is deemed optimal, as can the approach to segmenting the population. Our framework provides a useful tool for illuminating key tradeoffs relevant to harm-averse decision makers and those concerned with both equity and efficiency.

Download Full-text