David L. Mowat

Building capacity for evidence informed decision making in public health: a case study of organizational change

BackgroundCore competencies for public health in Canada require proficiency in evidence informed decision making (EIDM). However, decision makers often lack access to information, many workers lack knowledge and skills to conduct systematic literature reviews, and public health settings typically lack infrastructure to support EIDM activities. This research was conducted to explore and describe critical factors and dynamics in the early implementation of one public health units strategic initiative to develop capacity to make EIDM standard practice.MethodsThis qualitative case study was conducted in one public health unit in Ontario, Canada between 2008 and 2010. In-depth information was gathered from two sets of semi-structured interviews and focus groups (n = 27) with 70 members of the health unit, and through a review of 137 documents. Thematic analysis was used to code the key informant and document data.ResultsThe critical factors and dynamics for building EIDM capacity at an organizational level included: clear vision and strong leadership, workforce and skills development, ability to access research (library services), fiscal investments, acquisition and development of technological resources, a knowledge management strategy, effective communication, a receptive organizational culture, and a focus on change management.ConclusionWith leadership, planning, commitment and substantial investments, a public health department has made significant progress, within the first two years of a 10-year initiative, towards achieving its goal of becoming an evidence informed decision making organization.

Canadian medical students' perceptions of public health education in the undergraduate medical curriculum.

Purpose To understand the perceptions and attitudes of Canadian medical students toward their undergraduate medical public health curriculum and to identify student suggestions and priorities for curriculum change. Method Five focus groups of 11 or 12 medical students from all years of medical school were recruited at McMaster University Faculty of Health Sciences, Université de Sherbrooke Faculty of Medicine and Health Sciences, University of Toronto Faculty of Medicine, University of Manitoba Faculty of Medicine, and University of British Columbia Faculty of Medicine between February and April 2006. A professional facilitator was hired to conduct the focus groups using a unique, computer-based facilitation system. Questions in both the focus group and an accompanying survey sought to determine medical students’ understanding and exposure to public health and how this impacted their attitudes and choices toward careers in the public health medical specialty of community medicine. The transcripts were independently reviewed and analyzed by each of the authors to identify themes. Results Four major themes related to students’ desired curriculum change were identified: (1) poor educational experiences in public health courses, (2) lack of positive role models, especially exposure to community medicine specialists, (3) emphasis on statistics and epidemiology, and (4) negative attitudes toward public health topics. Conclusions Students are disillusioned, disengaged, and disappointed with the public health curriculum currently being provided at the Canadian medical schools studied. Many medical students would prefer a public health curriculum that is more challenging and has more applied field experience and exposure to public health physician role models.

Creating an organizational culture for evidence-informed decision making.

A public health department in Ontario, Canada, seta 10-year strategic direction for evidence-informed decision making, defined as the systematic application of research evidence to program decisions. The multifaceted approach has identified eight key lessons for leadership, funding, infrastructure, staff development, partnerships, and change management. Results after 4 years include systematic and transparent application of research to >15 program decisions and, increasingly, evidence-informed decision making as a cultural norm.

Supporting collaborative use of the diabetes population risk tool (DPoRT) in health-related practice: a multiple case study research protocol

BackgroundHealth policy makers have stated that diabetes prevention is a priority; however, the type, intensity, and target of interventions or policy changes that will achieve the greatest impact remains uncertain. In response to this uncertainty, the Diabetes Population Risk Tool (DPoRT) was developed and validated to estimate future diabetes risk based on routinely collected population data. To facilitate use of DPoRT, we partnered with regional and provincial health-related decision makers in Ontario and Manitoba, Canada. Primary objectives include: i) evaluate the effectiveness of partnerships between the research team and DPoRT users; ii) explore strategies that facilitate uptake and overcome barriers to DPoRT use; and iii) implement and evaluate the knowledge translation approach.MethodsThis protocol reflects an integrated knowledge translation (IKT) approach and corresponds to the action phase of the Knowledge-to-Action (KtoA) framework. Our IKT approach includes: employing a knowledge brokering team to facilitate relationships with DPoRT users (objective 1); tailored training for DPoRT users; assessment of barriers and facilitators to DPoRT use; and customized dissemination strategies to present DPoRT outputs to decision maker audiences (objective 2). Finally, a utilization-focused evaluation will assess the effectiveness and impact of the proposed KtoA process for DPoRT application (objective 3). This research design utilizes a multiple case study approach. Units of analyses consist of two public health units, one provincial health organization, and one provincial knowledge dissemination team whereby we will connect with multiple regional health authorities. Evaluation will be based on analysis of both quantitative and qualitative data collected from passive (e.g., observer notes) and active (e.g., surveys and interviews) methods.DiscussionDPoRT offers an innovative way to make routinely collected population health data practical and meaningful for diabetes prevention planning and decision making. Importantly, we will evaluate the utility of the KtoA cycle for a novel purpose – the application of a tool. Additionally, we will evaluate this approach in multiple diverse settings, thus considering contextual factors. This research will offer insights into how knowledge translation strategies can support the use of population-based risk assessment tools to promote informed decision making in health-related settings.

Incorporating consideration of health impacts into land use development approval processes: Development of a Health Background Study Framework

RésuméObjectifsNotre projet impliquait l’élaboration d’un cadre d’étude de base sur la santé (ÉBS) qui permette de tenir compte des impacts sur la santé dans le processus d’approbation des plans d’aménagement du territoire des municipalités.ParticipantsLe Bureau de santé de la région de Peel et Santé publique Toronto ont dirigé le projet avec la participation de planificateurs, d’urbanistes, d’ingénieurs, de fonctionnaires en santé publique et de représentants du secteur de l’aménagement.LieuLa croissance historique dans la Région de Peel et en banlieue de Toronto a entraîné un aménagement à faible densité généralisé, créant ainsi des communautés tributaires de l’automobile avec des rues sans issue et des utilisations compartimentées des terrains.InterventionL’inclusion d’une ÉBS dans les demandes que les promoteurs présentent aux municipalités est une approche permettant d’établir des attentes sanitaires pour le milieu bâti dans le processus d’approbation. L’élaboration du cadre d’ÉBS a utilisé les six éléments fondamentaux du milieu bâti pour lesquels il existe les indications les plus solides d’impacts sur la santé et s’est fondée sur l’analyse des contextes des politiques provinciales et locales, sur les pratiques d’autres municipalités et sur des entrevues avec les acteurs. Le contenu du cadre a été peaufiné à la lumière de la rétroaction d’ateliers multipartenaires et multidisciplinaires.RésultatsLe cadre d’ÉBS définit des normes minimales pour les éléments fondamentaux du milieu bâti que les promoteurs doivent aborder dans leurs demandes. Ce cadre se veut un outil simple et instructif qui peut s’appliquer à un éventail de lieux et d’échelles d’aménagement et aux diverses étapes du processus d’approbation des plans d’aménagement. Le Bureau de santé de la région de Peel dirige plusieurs initiatives qui appuient l’utilisation de l’ÉBS dans le processus de demande des plans d’aménagement.ConclusionLe cadre d’ÉBS est un outil dont les fonctionnaires en santé publique et en planification peuvent se servir pour appuyer la prise en compte des impacts sur la santé dans les processus d’aménagement du territoire des municipalités.