scholarly journals Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy

2017 ◽  
Vol 5 ◽  
Author(s):  
Chia-Ching Chen ◽  
Tetsuji Yamada ◽  
Taeko Nakashima ◽  
I-Ming Chiu
2019 ◽  
Author(s):  
Alison Brown ◽  
Courtney Barnes ◽  
Judith Byaruhanga ◽  
Matthew McLaughlin ◽  
Rebecca K Hodder ◽  
...  

BACKGROUND Knowledge translation (KT) aims to facilitate the use of research evidence in decision making. Changes in technology have provided considerable opportunities for KT strategies to improve access and use of evidence in decision making by public health policy makers and practitioners. Despite this opportunity, there have been no reviews that have assessed the effects of digital technology-enabled KT (TEKT) in the field of public health. OBJECTIVE This study aims to examine the effectiveness of digital TEKT strategies in (1) improving the capacity for evidence-based decision making by public health policy makers and practitioners, (2) changing public health policy or practice, and (3) changes in individual or population health outcomes. METHODS A search strategy was developed to identify randomized trials assessing the effectiveness of digital TEKT strategies in public health. Any primary research study with a randomized trial design was eligible. Searches for eligible studies were undertaken in multiple electronic bibliographic databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and Scopus) and the reference lists of included studies. A hand search of 2 journals (Implementation Science and Journal of Medical Internet Research) and a gray literature search were also conducted. Pairs of independent review authors screened studies, assessed the risk of bias, and extracted data from relevant studies. RESULTS Of the 6819 citations screened, 8 eligible randomized trials were included in the review. The studies examined the impact of digital TEKT strategies on health professionals, including nurses, child care health consultants, physiotherapists, primary health care workers, and public health practitioners. Overall, 5 of the interventions were web-training programs. The remaining 3 interventions included simulation games, access to digital resource materials and the use of tailored messaging, and a web-based registry. The findings suggest that digital TEKT interventions may be effective in improving the knowledge of public health professionals, relative to control, and may be as effective as a face-to-face KT approach. The effectiveness of digital TEKT strategies relative to a control or other digital KT interventions on measures of health professional self-efficacy to use evidence to enhance practice behavior or behavioral intention outcomes was mixed. The evidence regarding the effects on changes to health policy or practice following exposure to digital TEKT was mixed. No trials assessed the effects on individual or population-level health outcomes. CONCLUSIONS This review is the first to synthesize the effectiveness of digital TEKT interventions in a public health setting. Despite its potential, relatively few trials have been undertaken to investigate the impacts of digital TEKT interventions. The findings suggest that although a digital TEKT intervention may improve knowledge, the effects of such interventions on other outcomes are equivocal.


10.2196/17274 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e17274
Author(s):  
Alison Brown ◽  
Courtney Barnes ◽  
Judith Byaruhanga ◽  
Matthew McLaughlin ◽  
Rebecca K Hodder ◽  
...  

Background Knowledge translation (KT) aims to facilitate the use of research evidence in decision making. Changes in technology have provided considerable opportunities for KT strategies to improve access and use of evidence in decision making by public health policy makers and practitioners. Despite this opportunity, there have been no reviews that have assessed the effects of digital technology-enabled KT (TEKT) in the field of public health. Objective This study aims to examine the effectiveness of digital TEKT strategies in (1) improving the capacity for evidence-based decision making by public health policy makers and practitioners, (2) changing public health policy or practice, and (3) changes in individual or population health outcomes. Methods A search strategy was developed to identify randomized trials assessing the effectiveness of digital TEKT strategies in public health. Any primary research study with a randomized trial design was eligible. Searches for eligible studies were undertaken in multiple electronic bibliographic databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and Scopus) and the reference lists of included studies. A hand search of 2 journals (Implementation Science and Journal of Medical Internet Research) and a gray literature search were also conducted. Pairs of independent review authors screened studies, assessed the risk of bias, and extracted data from relevant studies. Results Of the 6819 citations screened, 8 eligible randomized trials were included in the review. The studies examined the impact of digital TEKT strategies on health professionals, including nurses, child care health consultants, physiotherapists, primary health care workers, and public health practitioners. Overall, 5 of the interventions were web-training programs. The remaining 3 interventions included simulation games, access to digital resource materials and the use of tailored messaging, and a web-based registry. The findings suggest that digital TEKT interventions may be effective in improving the knowledge of public health professionals, relative to control, and may be as effective as a face-to-face KT approach. The effectiveness of digital TEKT strategies relative to a control or other digital KT interventions on measures of health professional self-efficacy to use evidence to enhance practice behavior or behavioral intention outcomes was mixed. The evidence regarding the effects on changes to health policy or practice following exposure to digital TEKT was mixed. No trials assessed the effects on individual or population-level health outcomes. Conclusions This review is the first to synthesize the effectiveness of digital TEKT interventions in a public health setting. Despite its potential, relatively few trials have been undertaken to investigate the impacts of digital TEKT interventions. The findings suggest that although a digital TEKT intervention may improve knowledge, the effects of such interventions on other outcomes are equivocal.


2021 ◽  
pp. medethics-2020-107134
Author(s):  
Thana Cristina de Campos-Rudinsky ◽  
Eduardo Undurraga

Although empirical evidence may provide a much desired sense of certainty amidst a pandemic characterised by uncertainty, the vast gamut of available COVID-19 data, including misinformation, has instead increased confusion and distrust in authorities’ decisions. One key lesson we have been gradually learning from the COVID-19 pandemic is that the availability of empirical data and scientific evidence alone do not automatically lead to good decisions. Good decision-making in public health policy, this paper argues, does depend on the availability of reliable data and rigorous analyses, but depends above all on sound ethical reasoning that ascribes value and normative judgement to empirical facts.


Author(s):  
Said Shahtahmasebi

Information is considered the currency within health systems. Numerous reorganisations and restructuring, coupled with many buzz words (e.g. evidence-based practice) and the various advancements in ICT (information and communication technology) are apparently designed to improve the utilisation of this currency. However, what constitutes information appears to vary between health professionals. For some, only the data derived from RCTs (randomized control trials) is considered evidence, for others it is the conclusions drawn from focus groups, whilst for others, finding information goes well beyond subjectivity and experimental design and comes from understanding human behaviour and other processes.Although advancements in ICT have greatly improved access to information (currency), the data often disguised as information appears only as small change. Restructuring and reorganizing have been used to inflate the value of this currency (information) leading to the replacement of information departments by the Public Health Intelligence Units or Observatories. However, a change in behaviour is difficult to bring about and manage, while it is easier to change the tools with which the tasks are carried out. It is all too easy to fall into the trap of reproducing what has been produced before by information departments only under a different guise, as well as using different configurations, software or updated hardware and ICT (e.g. the Internet). These units hardly concern themselves with exploring the underlying message of the data. A quick trawl of the web pages of these entities can be testimony to this fact. The process so far has been, in effect, one of test-tubing health outcomes and then extracting the data from the test tubes. Although we have been eager to embrace technological advancements and change, we have failed to monitor the impact and consequences of change on our behaviour and thus on health outcomes. This chapter will delve into the current availability of information for public health policy purposes and will argue its ineffectiveness as information/evidence in the context of human behaviour and social processes. Behaviour and processes are by nature dynamic. Specifically, the feedback effect, a feature of dynamic process, can have a profound attenuating effect on data that was once important, thereby affecting not only the shelf life of a policy but also its intended outcomes. Examples from published reports by public health intelligence units/observatories in New Zealand and the UK, plus references to teenage smoking and suicide, will be used to illustrate these concepts and issues. A conceptual but pragmatic model of data collection based on current health care data management systems will be argued as a way forward for translating data into information and tangible evidence with a view to informing the process of public health policy formation. This chapter discusses a holistic approach to identifying data needed as evidence to inform the process of policy formation/decision making as a conceptual model.


2020 ◽  
Vol 41 (1) ◽  
pp. 381-396
Author(s):  
James R. Dunn

Housing is often described as an important determinant of health, but less commonly of child health. Despite acknowledgment of the importance of housing to health, however, there are relatively few studies of the effects of housing interventions on health, and again even fewer on child health. This article argues that a broad focus on healthy child development—as opposed to just physical health—coupled with a conceptual framework outlining specific attributes of housing with the potential to influence child health, should be adopted to guide a comprehensive approach to public health policy for healthy child development. Most housing interventions address direct pathways linking in-home hazard exposures to child health outcomes, with promising but mixed results. But few housing interventions address the broader aspects of healthy child development. This review addresses potential housing interventions that could impact the broader determinants of healthy child development and accompanying methodological challenges.


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