scholarly journals Advancing the WHO-INTEGRATE Framework as a Tool for Evidence-Informed, Deliberative Decision-Making Processes: Exploring the Views of Developers and Users of WHO Guidelines

2020 ◽  
Author(s):  
Jan M. Stratil ◽  
Deepak Paudel ◽  
Karen E. Setty ◽  
Carlos E. Menezes de Rezende ◽  
Aline A. Monroe ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Health Policy ◽  
Real World ◽  
Guideline Development ◽  
Decision Makers ◽  
Societal Implications ◽  
Who Guidelines ◽  
Health Decision ◽  
Integrate Framework

Background: Decision-making on matters of public health and health policy is a deeply value-laden process. The World Health Organization (WHO)-INTEGRATE framework was proposed as a new evidence-to-decision (EtD) framework to support guideline development from a complexity perspective, notably in relation to public health and health system interventions, and with a foundation in WHO norms and values. This study was conducted as part of the development of the framework to assess its comprehensiveness and usefulness for public health and health policy decision-making. Methods: We conducted a qualitative study comprising nine key informant interviews (KIIs) with experts involved in WHO guideline development and four focus group discussions (FGDs) with a total of forty health decision-makers from Brazil, Germany, Nepal and Uganda. Transcripts were analyzed using MAXQDA12 and qualitative content analysis. Results: Most key informants and participants in the FGDs appreciated the framework for its relevance to real-world decision-making on four widely differing health topics. They praised its broad perspective and comprehensiveness with respect to new or expanded criteria, notably regarding societal implications, equity considerations, and acceptability. Some guideline developers questioned the value of the framework beyond current practice and were concerned with the complexity of applying such a broad range of criteria in guideline development processes. Participants made concrete suggestions for improving the wording and definitions of criteria as well as their grouping, for covering missing aspects, and for addressing overlap between criteria. Conclusion: The framework was well-received by health decision-makers as well as the developers of WHO guidelines and appears to capture all relevant considerations discussed in four distinct real-world decision processes that took place on four different continents. Guidance is needed on how to apply the framework in guideline processes that are both transparent and participatory. A set of suggestions for improvement provides a valuable starting point for advancing the framework towards version 2.0.

scholarly journals The NCCMT’s dynamic model for evidence-informed public health

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Clark ◽  
S Neil-Sztramko ◽  
M Dobbins
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Research Evidence ◽  
Decision Makers ◽  
Local Data ◽  
Public Health Decision ◽  
Health Decision Making ◽  
Political Preferences ◽  
Health Decision ◽  
Structured Approach

Abstract Issue It is well accepted that public health decision makers should use the best available research evidence in their decision-making process. However, research evidence alone is insufficient to inform public health decision making. Description of the problem As new challenges to public health emerge, there can be a paucity of high quality research evidence to inform decisions on new topics. Public health decision makers must combine various sources of evidence with their public health expertise to make evidence-informed decisions. The National Collaborating Centre for Methods and Tools (NCCMT) has developed a model which combines research evidence with other critical sources of evidence that can help guide decision makers in evidence-informed decision making. Results The NCCMT's model for evidence-informed public health combines findings from research evidence with local data and context, community and political preferences and actions and evidence on available resources. The model has been widely used across Canada and worldwide, and has been integrated into many public health organizations' decision-making processes. The model is also used for teaching an evidence-informed public health approach in Masters of Public Health programs around the globe. The model provides a structured approach to integrating evidence from several critical sources into public health decision making. Use of the model helps ensure that important research, contextual and preference information is sought and incorporated. Lessons Next steps for the model include development of a tool to facilitate synthesis of evidence across all four domains. Although Indigenous knowledges are relevant for public health decision making and should be considered as part of a complete assessment the current model does not capture Indigenous knowledges. Key messages Decision making in public health requires integrating the best available evidence, including research findings, local data and context, community and political preferences and available resources. The NCCMT’s model for evidence-informed public health provides a structured approach to integrating evidence from several critical sources into public health decision making.

scholarly journals The WHO-INTEGRATE evidence to decision framework version 1.0: integrating WHO norms and values and a complexity perspective

2019 ◽  
Vol 4 (Suppl 1) ◽  
pp. e000844 ◽  
Author(s):  
Eva A Rehfuess ◽  
Jan M Stratil ◽  
Inger B Scheel ◽  
Anayda Portela ◽  
Susan L Norris ◽  
...  
Keyword(s):  
Decision Making ◽  
Guideline Development ◽  
Evidence Synthesis ◽  
Societal Implications ◽  
Synthesis Methods ◽  
Quality Of Evidence ◽  
Health Decision Making ◽  
Norms And Values ◽  
Health Decision

IntroductionEvidence-to-decision (EtD) frameworks intend to ensure that all criteria of relevance to a health decision are systematically considered. This paper, part of a series commissioned by the WHO, reports on the development of an EtD framework that is rooted in WHO norms and values, reflective of the changing global health landscape, and suitable for a range of interventions and complexity features. We also sought to assess the value of this framework to decision-makers at global and national levels, and to facilitate uptake through suggestions on how to prioritise criteria and methods to collect evidence.MethodsIn an iterative, principles-based approach, we developed the framework structure from WHO norms and values. Preliminary criteria were derived from key documents and supplemented with comprehensive subcriteria obtained through an overview of systematic reviews of criteria employed in health decision-making. We assessed to what extent the framework can accommodate features of complexity, and conducted key informant interviews among WHO guideline developers. Suggestions on methods were drawn from the literature and expert consultation.ResultsThe new WHO-INTEGRATE (INTEGRATe Evidence) framework comprises six substantive criteria—balance of health benefits and harms, human rights and sociocultural acceptability, health equity, equality and non-discrimination, societal implications, financial and economic considerations, and feasibility and health system considerations—and the meta-criterion quality of evidence. It is intended to facilitate a structured process of reflection and discussion in a problem-specific and context-specific manner from the start of a guideline development or other health decision-making process. For each criterion, the framework offers a definition, subcriteria and example questions; it also suggests relevant primary research and evidence synthesis methods and approaches to assessing quality of evidence.ConclusionThe framework is deliberately labelled version 1.0. We expect further modifications based on focus group discussions in four countries, example applications and input across concerned disciplines.

scholarly journals Health economics methods for public health resource allocation: a qualitative interview study of decision makers from an English local authority

2019 ◽  
Vol 15 (1) ◽  
pp. 128-140 ◽  
Author(s):  
Emma Frew ◽  
Katie Breheny
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Health Economics ◽  
Local Authority ◽  
Decision Makers ◽  
Natural Experiments ◽  
Public Health Decision ◽  
Health Decision Making ◽  
Qualitative Interview Study ◽  
Health Decision

AbstractLocal authorities in England have responsibility for public health, however, in recent years, budgets have been drastically reduced placing decision makers under unprecedented financial pressure. Although health economics can offer support for decision making, there is limited evidence of it being used in practice. The aim of this study was to undertake in-depth qualitative research within one local authority to better understand the context for public health decision making; what, and how economics evidence is being used; and invite suggestions for how methods could be improved to better support local public health decision making. The study included both observational methods and in-depth interviews. Key meetings were observed and semi-structured interviews conducted with participants who had a decision-making role to explore views on economics, to understand the barriers to using evidence and to invite suggestions for improvements to methods. Despite all informants valuing the use of health economics, many barriers were cited: including a perception of a narrow focus on the health sector; lack of consideration of population impact; and problems with translating long timescales to short term impact. Methodological suggestions included the broadening of frameworks; increased use of natural experiments; and capturing wider non-health outcomes that resonate with the priorities of multiple stakeholders.

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

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.<br />Key messages<br /><ul><li>Public health programmes or policies can benefit from more effective use of the best available knowledge;</li><br /><li>This review identified 39 studies on skills related to evidence-informed decision making;</li><br /><li>Three categories of skills are proposed: cognitive, interpersonal and leadership and influencing skills;</li><br /><li>It will help direct capacity-building efforts towards enhancing evidence use by decision makers.</li></ul>

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

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.

scholarly journals Methods to support evidence-informed decision-making in the midst of COVID-19: creation and evolution of a rapid review service from the National Collaborating Centre for Methods and Tools

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah E. Neil-Sztramko ◽  
Emily Belita ◽  
Robyn L. Traynor ◽  
Emily Clark ◽  
Leah Hagerman ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Lessons Learned ◽  
Decision Makers ◽  
Rapid Review ◽  
Final Report ◽  
Health Crisis ◽  
Public Health Decision ◽  
Public Health Crisis ◽  
Health Decision

Abstract Background The COVID-19 public health crisis has produced an immense and quickly evolving body of evidence. This research speed and volume, along with variability in quality, could overwhelm public health decision-makers striving to make timely decisions based on the best available evidence. In response to this challenge, the National Collaborating Centre for Methods and Tools developed a Rapid Evidence Service, building on internationally accepted rapid review methodologies, to address priority COVID-19 public health questions. Results Each week, the Rapid Evidence Service team receives requests from public health decision-makers, prioritizes questions received, and frames the prioritized topics into searchable questions. We develop and conduct a comprehensive search strategy and critically appraise all relevant evidence using validated tools. We synthesize the findings into a final report that includes key messages, with a rating of the certainty of the evidence using GRADE, as well as an overview of evidence and remaining knowledge gaps. Rapid reviews are typically completed and disseminated within two weeks. From May 2020 to July 21, 2021, we have answered more than 31 distinct questions and completed 32 updates as new evidence emerged. Reviews receive an average of 213 downloads per week, with some reaching over 7700. To date reviews have been accessed and cited around the world, and a more fulsome evaluation of impact on decision-making is planned. Conclusions The development, evolution, and lessons learned from our process, presented here, provides a real-world example of how review-level evidence can be made available – rapidly and rigorously, and in response to decision-makers’ needs – during an unprecedented public health crisis.

scholarly journals Methods to support evidence-informed decision-making in the midst of COVID- 19: Creation and evolution of a rapid review service from the National Collaborating Centre for Methods and Tools

2021 ◽  
Author(s):  
Sarah Neil-Sztramko ◽  
Emily Belita ◽  
Robyn L. Traynor ◽  
Emily Clark ◽  
Leah Hagerman ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Lessons Learned ◽  
Decision Makers ◽  
Rapid Review ◽  
Final Report ◽  
Health Crisis ◽  
Public Health Decision ◽  
Public Health Crisis ◽  
Health Decision

Abstract Background The COVID-19 public health crisis has produced an immense and quickly evolving body of evidence. This research speed and volume, along with variability in quality, could overwhelm public health decision-makers striving to make timely decisions based on the best available evidence. In response to this challenge, the National Collaborating Centre for Methods and Tools developed a Rapid Evidence Service, building on internationally accepted rapid review methodologies, to address priority COVID-19 public health questions. Methods Each week, we receive requests from public health decision-makers and frame the prioritized topics into searchable questions. We develop and conduct a comprehensive search strategy and critically appraise all relevant evidence using validated tools. We synthesize the findings into a final report that includes key messages, with a rating of the certainty of the evidence using GRADE, as well as an overview of evidence and remaining knowledge gaps. Rapid reviews are typically completed and disseminated within two weeks. Results As of May 12, 2021, we have answered more than 29 distinct questions and completed 28 updates as new evidence emerged. Reviews receive an average of 200 downloads per week, with some reaching up to 5000. To date reviews have been accessed and cited around the world, and a more fulsome evaluation of impact on decision making is planned. Conclusions The development, evolution, and lessons learned from our process, presented here, provides a real-world example of how review-level evidence can be made available – rapidly and rigorously, and in response to decision-makers’ needs – during an unprecedented public health crisis.

scholarly journals Coronavirus disease (COVID-19) outbreak: can HTA improve preparedness and response in emergencies with a high degree of uncertainty?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Timen ◽  
A Miglietta
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Scientific Evidence ◽  
Decision Makers ◽  
Public Health Decision ◽  
Public Health Emergencies ◽  
Health Decision Making ◽  
Health Decision ◽  
High Degree ◽  
The Impact

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 irrefutable evidence may be lacking. The Coronavirus disease (COVID-19) outbreak is determining a scenario of uncertainty for public health decision-making with fragmented and different responses also within countries (i.e. regional level), which are implemented quickly, sometimes not fully supported by the necessary body of scientific evidence. In such a situation, following a common line and having a shared tool that would allow to include evidence in public health decision-making, would be strategic to strengthen the impact of interventions, enabling stakeholders and decision makers taking actions based on the best available evidence through a process which is systematic and transparent. The objective of this presentation is to use the example of the COVID-19 outbreak, in order to explore how HTA can improve preparedness and response in emergencies with a high degree of uncertainty, representing the mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies, addressing the link between scientific evidence and decision-making in public health emergencies, overcoming the key challenges faced by public health experts when advising decision makers, including strengthening and accelerating knowledge transfer through rapid HTA, improving networking between actors and disciplines.

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