A survey tool for measuring evidence-based decision making capacity in public health agencies

Abstract Background Mis-implementation, the inappropriate continuation of programs or policies that are not evidence-based or the inappropriate termination of evidence-based programs and policies, can lead to the inefficient use of scarce resources in public health agencies and decrease the ability of these agencies to deliver effective programs and improve population health. Little is known about why mis-implementation occurs, which is needed to understand how to address it. This study sought to understand the state health department practitioners’ perspectives about what makes programs ineffective and the reasons why ineffective programs continue. Methods Eight state health departments (SHDs) were selected to participate in telephone-administered qualitative interviews about decision-making around ending or continuing programs. States were selected based on geographic representation and on their level of mis-implementation (low and high) categorized from our previous national survey. Forty-four SHD chronic disease staff participated in interviews, which were audio-recorded and transcribed verbatim. Transcripts were consensus coded, and themes were identified and summarized. This paper presents two sets of themes, related to (1) what makes a program ineffective and (2) why ineffective programs continue to be implemented according to SHD staff. Results Participants considered programs ineffective if they were not evidence-based or if they did not fit well within the population; could not be implemented well due to program restraints or a lack of staff time and resources; did not reach those who could most benefit from the program; or did not show the expected program outcomes through evaluation. Practitioners described several reasons why ineffective programs continued to be implemented, including concerns about damaging the relationships with partner organizations, the presence of program champions, agency capacity, and funding restrictions. Conclusions The continued implementation of ineffective programs occurs due to a number of interrelated organizational, relational, human resources, and economic factors. Efforts should focus on preventing mis-implementation since it limits public health agencies’ ability to conduct evidence-based public health, implement evidence-based programs effectively, and reduce the high burden of chronic diseases. The use of evidence-based decision-making in public health agencies and supporting adaptation of programs to improve their fit may prevent mis-implementation. Future work should identify effective strategies to reduce mis-implementation, which can optimize public health practice and improve population health.

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Training needs and supports for evidence-based decision making among the public health workforce in the United States

BMC Health Services Research ◽

10.1186/s12913-014-0564-7 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 30

Author(s):

Rebekah R Jacob ◽

Elizabeth A Baker ◽

Peg Allen ◽

Elizabeth A Dodson ◽

Kathleen Duggan ◽

...

Keyword(s):

Public Health ◽

United States ◽

Decision Making ◽

Health Workforce ◽

The United States ◽

Training Needs ◽

Public Health Workforce ◽

Evidence Based ◽

The Public ◽

Evidence Based Decision Making

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Evidence-Based Decision-Making (Part 1): Origins and Evolution in the Health Sciences

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00007019 ◽

2009 ◽

Vol 24 (4) ◽

pp. 298-305 ◽

Cited By ~ 14

Author(s):

David A. Bradt

Keyword(s):

Public Health ◽

Decision Making ◽

Evidence Based Medicine ◽

Strategic Decision ◽

Systematic Research ◽

Evidence Based ◽

Clinical Expertise ◽

Strength Of Evidence ◽

Based Medicine ◽

Evidence Based Decision Making

AbstractEvidence is defined as data on which a judgment or conclusion may be based. In the early 1990s, medical clinicians pioneered evidence-based decision-making. The discipline emerged as the use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine required the integration of individual clinical expertise with the best available, external clinical evidence from systematic research and the patient's unique values and circumstances. In this context, evidence acquired a hierarchy of strength based upon the method of data acquisition.Subsequently, evidence-based decision-making expanded throughout the allied health field. In public health, and particularly for populations in crisis, three major data-gathering tools now dominate: (1) rapid health assessments; (2) population based surveys; and (3) disease surveillance. Unfortunately, the strength of evidence obtained by these tools is not easily measured by the grading scales of evidence-based medicine. This is complicated by the many purposes for which evidence can be applied in public health—strategic decision-making, program implementation, monitoring, and evaluation. Different applications have different requirements for strength of evidence as well as different time frames for decision-making. Given the challenges of integrating data from multiple sources that are collected by different methods, public health experts have defined best available evidence as the use of all available sources used to provide relevant inputs for decision-making.

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The challenge of bringing evidence in decision-making for public health emergencies: can preparedness reach out to HTA?

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.942 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C E Chronaki ◽

A Miglietta

Keyword(s):

Public Health ◽

Decision Making ◽

Policy Development ◽

Digital Health ◽

Resource Planning ◽

Public Health Emergency ◽

Evidence Based ◽

Public Health Emergencies ◽

The Impact ◽

Evidence Based Decision Making

Abstract Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and reliable data is typically lacking. The process of including data for preparedness and training for evidence-based decision making in public health emergencies is not systematic and is complicated by many barriers as the absence of common digital tools and approaches for resource planning and update of response plans. Health Technology Assessment (HTA) is used with the aim to improve the quality and efficiency of public health interventions and to make healthcare systems more sustainable. Many of today's public health crises are also cross-border, and countries need to collaborate in a systematic and standardized way in order to enhance interoperability to share data and to plan coordinated response. Digital health tools have an important role to play in this setting, facilitating use of knowledge about the population that can potentially affected by the crisis within and across regional and national borders. To strengthen the impact of scientific evidence on decision-making for public health emergency preparedness and response, it is necessary to better define and align mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies and the context in which these mechanisms operate. Activities and policy development in the HTA network could inform this process. The objective of this presentation is to identify barriers for evidence-based decision making during public health emergencies and discuss how standardization in digital health and HTA processes may help overcome these barriers leading to more effective coordinated and evidence-based public health emergency response.

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Assessing Organizational Supports for Evidence-Based Decision Making in Local Public Health Departments in the United States

Journal of Public Health Management and Practice ◽

10.1097/phh.0000000000000952 ◽

2019 ◽

Vol 25 (5) ◽

pp. 454-463 ◽

Cited By ~ 2

Author(s):

Stephanie Mazzucca ◽

Renee G. Parks ◽

Rachel G. Tabak ◽

Peg Allen ◽

Maureen Dobbins ◽

...

Keyword(s):

Public Health ◽

Decision Making ◽

The United States ◽

Evidence Based ◽

Health Departments ◽

Local Public Health ◽

Public Health Departments ◽

Organizational Supports ◽

Local Public Health Departments ◽

Evidence Based Decision Making

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Evidence-Based Decision Making in Public Health

Journal of Public Health Management and Practice ◽

10.1097/00124784-199909000-00012 ◽

1999 ◽

Vol 5 (5) ◽

pp. 86-97 ◽

Cited By ~ 127

Author(s):

Ross C. Brownson ◽

James G. Gurney ◽

Garland H. Land

Keyword(s):

Public Health ◽

Decision Making ◽

Evidence Based ◽

Evidence Based Decision Making

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Rugged landscapes: complexity and implementation science

Implementation Science ◽

10.1186/s13012-020-01028-5 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Joseph T. Ornstein ◽

Ross A. Hammond ◽

Margaret Padek ◽

Stephanie Mazzucca ◽

Ross C. Brownson

Keyword(s):

Public Health ◽

Decision Making ◽

Quality Improvement ◽

Evolutionary Biology ◽

Public Health Practice ◽

Evidence Based ◽

Health Practice ◽

Context Specific ◽

Evidence Based Programs ◽

Evidence Based Decision Making

Abstract Background Mis-implementation—defined as failure to successfully implement and continue evidence-based programs—is widespread in public health practice. Yet the causes of this phenomenon are poorly understood. Methods We develop an agent-based computational model to explore how complexity hinders effective implementation. The model is adapted from the evolutionary biology literature and incorporates three distinct complexities faced in public health practice: dimensionality, ruggedness, and context-specificity. Agents in the model attempt to solve problems using one of three approaches—Plan-Do-Study-Act (PDSA), evidence-based interventions (EBIs), and evidence-based decision-making (EBDM). Results The model demonstrates that the most effective approach to implementation and quality improvement depends on the underlying nature of the problem. Rugged problems are best approached with a combination of PDSA and EBI. Context-specific problems are best approached with EBDM. Conclusions The model’s results emphasize the importance of adapting one’s approach to the characteristics of the problem at hand. Evidence-based decision-making (EBDM), which combines evidence from multiple independent sources with on-the-ground local knowledge, is a particularly potent strategy for implementation and quality improvement.

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Perceptions of Evidence-Based Decision-Making Among Full-Time Teachers and Senior Undergraduates in Public Health: A Nationwide Survey in Taiwan

Asia Pacific Journal of Public Health ◽

10.1177/1010539520921723 ◽

2020 ◽

Vol 32 (4) ◽

pp. 209-214

Author(s):

Yi-Hao Weng ◽

Chun-Yuh Yang ◽

Ya-Wen Chiu

Keyword(s):

Public Health ◽

Decision Making ◽

Scale Up ◽

Nationwide Survey ◽

School Curriculum ◽

Evidence Based ◽

Full Time ◽

Teachers And Students ◽

Evidence Based Decision Making ◽

Structured Questionnaire

Using current best evidence to make decisions can improve outcomes of public health. Thus, establishing the capacities of evidence-based public health (EBPH) has become one of the core competences. To better scale up EBPH movement, efforts should focus on introduction of EBPH into school curriculum. However, data indicating the extent to which EBPH is used in universities are scant. In the current study, we conducted a nationwide questionnaire survey to investigate the perceptions toward EBPH among full-time teachers and senior undergraduates at all universities with a Department of Public Health in Taiwan. A structured questionnaire was distributed by post to all potential participants of nine universities in 2017. Questions included items related to awareness, knowledge, skills, behaviors, and barriers of EBPH. Results showed teachers were more aware of EBPH than students. In addition, teachers more often had sufficient knowledge and skills of EBPH, and more often applied the findings to decision-making after critical appraisal than students. Furthermore, personal barriers toward EBPH were more common in students than teachers. In conclusion, there are differences in awareness, knowledge, skills, behaviors, and barriers of EBPH between teachers and students. The data suggest that an initiative of systematically teaching EBPH to undergraduates is important.

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