Participatory systems mapping for localised evidence and decision-making: helminth control, SSA

Abstract Background Evidence-informed decision-making to assist public health practitioners in local-level programme implementation requires adaptive approaches to research, policy and practice. To address these needs there is focus on using participatory methods. Adopting such methods, this research asks: what are the evidence needs of local public health practitioners? How do evidence and decision-making processes interact? We reflect on the process of using Participatory Systems Mapping (PSM) and implications for localising evidence-informed decision-making. Methods We conducted workshops with district and national-level MoH personnel in Uganda and Malawi using PSM to elicit insights into local modes of schistosomiasis transmission and control, and group discussions on evidence needs and use in implementing control programmes. PSM maps are analysed, triangulated with thematic analysis of group discussion transcripts. Results Analysing PSM outputs alongside discussions on evidence provides critical methodological and policy insights with implications for localised evidence and decision-making. Further insights into the local dynamics of public health decision-making are gained by triangulating PSM with discussions on the meanings and importance of 'factors' identified. Information which is accessible and useful for local practitioner's decision-making in implementing disease control measures does not always align with academic production and dissemination of evidence, nor across levels where policy is produced or implemented. Conclusions An array of factors influence local decision-making with implications for global health policies and practices such as for schistosomiasis control. Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners. Key messages Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.

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Acceptability and utilization of evidence for decision-making: helminth control, sub-Saharan Africa

European Journal of Public Health ◽

10.1093/eurpub/ckz186.111 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

G Pearson ◽

B D’Souza ◽

C Fergus

Keyword(s):

Public Health ◽

Decision Making ◽

Global Health ◽

Disease Control ◽

Local Level ◽

Health Interventions ◽

Local Public Health ◽

Health Practitioners ◽

Decision Making Processes ◽

Public Health Practitioners

Abstract Background Public health practitioners are part of a larger global health system, responsible for the implementation of disease-specific health interventions, largely financed by external actors through a variety of mechanisms. Emphasis on the need for evidence-informed decision-making often includes rhetoric for the localization of this approach to assist practitioners in resource allocation. In practice its realisation is challenging. This research addresses the following: what are the evidence needs of local public health practitioners? How acceptable are, for example, modeled disease estimates? What decision-making processes occur for implementation? How do evidence and decision-making processes interact? Methods Examining mass drug administration (MDA) for schistosomiasis and soil-transmitted helminths (STH) in the African Great Lakes region (Kenya, Malawi, Tanzania and Uganda), we use qualitative approaches to collect data, including a series of 4 workshops with district- and national-level MoH personnel, key informant interviews and e-survey questionnaires from a sample of relevant local and global organisations including NGOs. Coded data are analysed thematically. Results Preliminary results provide important insights into the sources, types and format of evidence which local public health practitioners find acceptable and useful for decision-making when implementing disease control measures. Conclusions A variety of factors influence local level decision-making with implications for policy aimed at disease control, such as MDA for schistosomiasis and STH, and global health policy and practice more broadly. First, processes of decision-making at different localities are heterogenous and evidence needs of local practitioners are not well understood. Second, evidence development and knowledge synthesis on health interventions are rarely linked in ways that feedback and respond to local implementation, decision-making practices and public health practitioners. Key messages Evidence needs of local public health practitioners need to be accounted for when producing and synthesising evidence. Multiple factors influence local level decision-making with implications for public health disease control policy.

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

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1258 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J Stratil ◽

K Oliver ◽

P von Philipsborn ◽

A Movsisyan ◽

E A Rehfuess

Keyword(s):

Public Health ◽

Decision Making ◽

Adverse Effects ◽

Adverse Events ◽

Informed Decision ◽

Health Interventions ◽

Decision Makers ◽

Informed Decision Making ◽

Public Health Interventions ◽

Integrate Framework

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.

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Public Health Ethics

Public Bioethics ◽

10.1093/med/9780199798483.003.0011 ◽

2020 ◽

pp. 233-251

Author(s):

James F. Childress ◽

Ruth R. Faden ◽

Ruth D. Gaare [Bernheim] ◽

Lawrence O. Gostin ◽

Jeffrey Kahn ◽

...

Keyword(s):

Public Health ◽

Public Health Policy ◽

Public Health Ethics ◽

Health Interventions ◽

Individual Liberty ◽

Policy And Practice ◽

Health Ethics ◽

Health Practitioners ◽

Health Policy And Practice ◽

Public Health Practitioners

This chapter, which grew out of a Greenwall Foundation–funded working group of a dozen or so ethicists, lawyers, and public health practitioners, provides a rough conceptual map of the terrain of public health ethics. It examines the nature of public health and public health interventions, and it identifies a number of general moral considerations (principles) relevant to public health policy and practice and often, especially as articulated in basic human rights, promotive of public health. Because these moral considerations are general and broad, they require specification and weighting. In cases of conflict, five “justificatory conditions” need to be met: effectiveness, proportionality, necessity, least infringement, and public justification. These conditions help to determine whether protecting or promoting public health warrants overriding individual liberty in particular situations.

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Harm Perceptions of the JUUL E-Cigarette in a Sample of Ever Users

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17134755 ◽

2020 ◽

Vol 17 (13) ◽

pp. 4755 ◽

Cited By ~ 2

Author(s):

Elise M. Stevens ◽

Emily T. Hébert ◽

Alayna P. Tackett ◽

Eleanor L. S. Leavens ◽

Theodore L. Wagener

Keyword(s):

Public Health ◽

Electronic Cigarettes ◽

Health Interventions ◽

Mechanical Turk ◽

Public Health Interventions ◽

Tobacco Products ◽

Health Practitioners ◽

The Absolute ◽

Amazon's Mechanical Turk ◽

Public Health Practitioners

Background: Monitoring trends and perceptions of new nicotine salt-based electronic cigarettes (ECs), like JUUL, is important to identify associations with product experimentation and use. Understanding harm perceptions of these new devices will inform prevention and intervention efforts. The current study assesses perceptions of the absolute harmfulness of JUUL use in addition to comparing it to other tobacco products. Methods: Participants (N = 839, 52% male) reporting ever use of JUUL were recruited from Amazon’s Mechanical Turk from January to March 2018. Respondents completed questionnaire items assessing demographics, co-use of non-JUUL products, JUUL use status (i.e., daily users (10.8%), non-daily users (29.4%), and triers (59.9%)), and JUUL and other tobacco products absolute harm perceptions. Results: Overall, participants rated JUUL as significantly less harmful than all other tobacco products (p < 0.001), except other ECs. Daily JUUL users rated JUUL as less harmful compared to non-daily JUUL users and JUUL triers (p < 0.05). JUUL was rated as more harmful by women compared to men (p < 0.05). Conclusions: Increased frequency of JUUL use was associated with decreased harm perceptions. JUUL was associated with reduced perceptions of absolute harm compared to most other tobacco products, except other ECs. Public health practitioners should develop public health interventions that increase harm perceptions of ECs.

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Applying precaution to environmental health issues at the local level: A proposed guide based on the research and experiences of Toronto Public Health

Environmental Health Review ◽

10.5864/d2011-001 ◽

2012 ◽

Vol 55 (01) ◽

pp. 11-18 ◽

Cited By ~ 1

Author(s):

Loren Vanderlinden ◽

Donald C. Cole ◽

Monica Hau ◽

Monica Campbell ◽

Ronald Macfarlane ◽

...

Keyword(s):

Public Health ◽

Decision Making ◽

Environmental Health ◽

Local Level ◽

Health Issues ◽

Support Tool ◽

Case Examples ◽

Trade Offs ◽

Health Practitioners ◽

Public Health Practitioners

While the Precautionary Principle (PP) is an important policy innovation relevant to public health, practitioners do not agree on how or when it should be applied. Action on environmental health issues at Toronto Public Health (TPH) has clearly been informed by the PP. We have recently developed a guide to applying precaution that can be used to assist local public health practitioners in decision making to address environmental health hazards in the community. We applied the Guide retrospectively to TPH case examples involving education, program, policy, legislative, and advocacy interventions to manage exposures to environmental hazards. This exercise served to refine the Guide and increase our understanding of how and when TPH has applied precaution in the past. Our Guide promises to be a useful decision making support tool that will help users (1) assess what degree of precaution is appropriate for a given context; (2) systematically document evidence about harms and exposures (including uncertainties) while making the assumptions about evidence more explicit and transparent; (3) highlight potential trade-offs (including consideration of both risks and benefits), explore alternatives, and assess feasibility of interventions; (4) plan adequate communication and stakeholder engagement; and (5) institute monitoring and evaluation so as to ensure interventions still meet users’ needs. We see the Guide as a tool that deepens the process of learning and enquiry on issue management in environmental health practice. We urge others to share their applications of the PP using our Guide to promote mutual learning.

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A Framework for Training Public Health Practitioners in Crisis Decision-Making

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2015.149 ◽

2015 ◽

Vol 10 (1) ◽

pp. 165-173 ◽

Cited By ~ 2

Author(s):

Harvey Kayman ◽

Tea Logar

Keyword(s):

Public Health ◽

Decision Making ◽

Emergency Preparedness ◽

Public Health Emergency ◽

Public Health Emergencies ◽

Health Practitioners ◽

Emergency Preparedness And Response ◽

Public Health Emergency Preparedness ◽

Public Health Practitioners ◽

And Training

AbstractThree sets of issues tend to be overlooked in public health emergency preparedness and response, which can be addressed with new training protocols. The first issue is procedural and concerns the often intuitive (as opposed to deliberative) nature of effective crisis decision-making. The second issue is substantive and pertains to the incorporation and prioritization of ethical, political, and logistical concerns in public health emergency guidelines. The third issue is affective and concerns human feelings and human frailty, which can derail the most well designed and best practiced procedural and substantive approaches to emergency response. This article offers an outline for a decision-making framework for public health emergencies that addresses and incorporates these issues within relevant guidelines and training. (Disaster Med Public Health Preparedness. 2016;10:165–173)

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A new tool to assess community-level evidence to inform public health decision making

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.183 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Clark ◽

S Snelling ◽

J Beyers ◽

C Howarth ◽

S Neil-Sztramko ◽

...

Keyword(s):

Public Health ◽

Decision Making ◽

Quality Assessment ◽

Community Level ◽

Public Health Decision ◽

Political Preferences ◽

Health Practitioners ◽

Health Decision ◽

Public Health Practitioners

Abstract Background As public health responds to evolving challenges around the globe, it is critical to draw on community-level evidence to inform decisions on emerging needs. There are existing tools for assessing the quality of research evidence, but none that explicitly focus on quality assessment of evidence from community sources, including local health status and ever-changing community and political preferences and actions. Methods The National Collaborating Centre for Methods and Tools (NCCMT) in Canada has developed new tools, called Quality Assessment of Community Evidence (QACE), to help public health decision makers assess the quality of community evidence. The QACE tools were drafted through extensive review of existing frameworks, tools and measures for appraising population health and community evidence, and diverse key informants. We identified three consistent themes that became the core dimensions in these tools. By using the QACE tools, practitioners can answer the question: “Is the quality of this evidence about local context, community needs and political preferences good enough to influence decision making?” Results The QACE tools provide probing questions for each of three dimensions: relevant, trustworthy and equity-informed. Supplementary resources help users delve more deeply into different aspects of quality assessment. The QACE tools are intended for public health practitioners who provide and use evidence to support or make decisions about public health practice and policy, including public health practitioners, senior leaders, policy makers and funders. Conclusions The QACE tool is a new addition to the public health toolbox for evidence-informed decision making, providing questions to ask about evidence from community sources. By using the tool as part of a decision-making process, public health practitioners can be assured that their decisions are based on the best-available evidence for their communities. Key messages The new Quality Assessment of Community Evidence (QACE) tools fill the gap in assessing quality of community-level evidence for public health decision-makers. Community evidence, including local health status and needs and community and political preferences and actions, should be assessed for quality in three critical domains.

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Decision-making for active living infrastructure in new communities: a qualitative study in England

Journal of Public Health ◽

10.1093/pubmed/fdz105 ◽

2019 ◽

Vol 42 (3) ◽

pp. e249-e258 ◽

Cited By ~ 2

Author(s):

A Le Gouais ◽

L Foley ◽

D Ogilvie ◽

C Guell

Keyword(s):

Public Health ◽

Decision Making ◽

Local Government ◽

Qualitative Study ◽

Local Level ◽

Active Living ◽

Structured Interviews ◽

Health Practitioners ◽

Post Hoc ◽

Public Health Practitioners

ABSTRACT Background Urban design can influence population levels of physical activity and subsequent health impacts. This qualitative study investigates local level decision-making for ‘active living’ infrastructure (ALI)—walking and cycling infrastructure and open spaces in new communities. Methods Thirty-five semi-structured interviews with stakeholders, and limited ethnographic observations, were conducted with local government and private sector stakeholders including urban and transport planners, public health practitioners, elected councillors and developers. Interview transcripts were coded and analysed thematically. Results Public health practitioners in local government could act as knowledge brokers and leaders to motivate non-health stakeholders such as urban and transport planners to consider health when designing and building new communities. They needed to engage at the earliest stages and be adequately resourced to build relationships across sectors, supporting non-health outcomes such as tackling congestion, which often had greater political traction. ‘Evidence’ for decision-making identified problems (going beyond health), informed solutions, and also justified decisions post hoc, although case study examples were not always convincing if not considered contextually relevant. Conclusion We have developed a conceptual model with three factors needed to bridge the gap between evidence and ALI being built: influential public health practitioners; supportive policies in non-health sectors; and adequate resources.

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