Rebecca Armstrong

‘Scoping the scope’ of a cochrane review

Systematic reviews use a transparent and systematic process to define a research question, search for studies, assess their quality and synthesize findings qualitatively or quantitatively. A crucial step in the systematic review process is to thoroughly define the scope of the research question. This requires an understanding of existing literature, including gaps and uncertainties, clarification of definitions related to the research question and an understanding of the way in which these are conceptualized within existing literature. This information is often acquired in an ad hoc fashion, however a useful and increasingly popular way to collect and organize important background information and develop a picture of the existing evidence base is to conduct a scoping review. Such reviews may be published as a research outcome in their own right and are appealing since they produce a broad map of the evidence that, if sufficiently transparent and widely available via publication, can be used by many and for applications beyond the authors originally intended purpose. Scoping reviews can inform a systematic review, particularly one with a very broad topic scope, such as those edited by the Cochrane Public Health Group.

Improving the reporting of public health intervention research: advancing TREND and CONSORT

BACKGROUND Evidence-based public health decision-making depends on high quality and transparent accounts of what interventions are effective, for whom, how and at what cost. Improving the quality of reporting of randomized and non-randomized study designs through the CONSORT and TREND statements has had a marked impact on the quality of study designs. However, public health users of systematic reviews have been concerned with the paucity of synthesized information on context, development and rationale, implementation processes and sustainability factors. METHODS This paper examines the existing reporting frameworks for research against information sought by users of systematic reviews of public health interventions and suggests additional items that should be considered in future recommendations on the reporting of public health interventions. RESULTS Intervention model, theoretical and ethical considerations, study design choice, integrity of intervention/process evaluation, context, differential effects and inequalities and sustainability are often overlooked in reports of public health interventions. CONCLUSION Population health policy makers need synthesized, detailed and high quality a priori accounts of effective interventions in order to make better progress in tackling population morbidities and inequalities. Adding simple criteria to reporting standards will significantly improve the quality and usefulness of published evidence and increase its impact on public health program planning.

Essential components of public health evidence reviews: capturing intervention complexity, implementation, economics and equity

Carefully developed recommendations for conducting studies of programme effectiveness have provided an extremely useful framework for researchers and articulated the different components required to answer not only the question of effectiveness (does it work?), but also the equally important questions of how, why and for whom was the programme effective. However, the continued emphasis on the use of the term ‘complex’ in describing the intervention itself or the system within which it is contextualized can detract from our ability to focus on the strategies required to better understand the strengths or limitations of the evidence base for decision-making. Social and public health interventions operate in a context that demands explicit recognition of politics, service systems, funding flows and shortages, staff competencies and multi-strategic approaches. For those immersed in the complicated political and scientific acrobatics of coordinating studies of programme implementation and evaluation, any real or perceived misalignment in the connection between research effectiveness trials versus policy relevant implementation knowledge must be overcome. Devising relatively simple approaches to understand complexity can assist in making complexity more manageable so that meaningful answers to important policy and practice questions can emerge. In this paper we argue that if reviews of intervention evidence are to be useful to decision-makers at all, contextual and implementation information is an essential, nonnegotiable component of the review process. We highlight steps evidence review authors can take to capture and interpret this information. With relatively small changes or additions to the evidence review process, practical, meaningful and rigorous public health evidence can be generated. Practical steps for embracing complexity and ensuring policy relevance

Health equity: evidence synthesis and knowledge translation methods

BackgroundAt the Rio Summit in 2011 on Social Determinants of Health, the global community recognized a pressing need to take action on reducing health inequities. This requires an improved evidence base on the effects of national and international policies on health inequities. Although systematic reviews are recognized as an important source for evidence-informed policy, they have been criticized for failing to assess effects on health equity.MethodsThis article summarizes guidance on both conducting systematic reviews with a focus on health equity and on methods to translate their findings to different audiences. This guidance was developed based on a series of methodology meetings, previous guidance, a recently developed reporting guideline for equity-focused systematic reviews (PRISMA-Equity 2012) and a systematic review of methods to assess health equity in systematic reviews.ResultsWe make ten recommendations for conducting equity-focused systematic reviews; and five considerations for knowledge translation. Illustrative examples of equity-focused reviews are provided where these methods have been used.ConclusionsImplementation of the recommendations in this article is one step toward monitoring the impact of national and international policies and programs on health equity, as recommended by the 2011 World Conference on Social Determinants of Health.

Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan

BackgroundKnowledge translation strategies are an approach to increase the use of evidence within policy and practice decision-making contexts. In clinical and health service contexts, knowledge translation strategies have focused on individual behavior change, however the multi-system context of public health requires a multi-level, multi-strategy approach. This paper describes the design of and implementation plan for a knowledge translation intervention for public health decision making in local government.MethodsFour preliminary research studies contributed findings to the design of the intervention: a systematic review of knowledge translation intervention effectiveness research, a scoping study of knowledge translation perspectives and relevant theory literature, a survey of the local government public health workforce, and a study of the use of evidence-informed decision-making for public health in local government. A logic model was then developed to represent the putative pathways between intervention inputs, processes, and outcomes operating between individual-, organizational-, and system-level strategies. This formed the basis of the intervention plan.ResultsThe systematic and scoping reviews identified that effective and promising strategies to increase access to research evidence require an integrated intervention of skill development, access to a knowledge broker, resources and tools for evidence-informed decision making, and networking for information sharing. Interviews and survey analysis suggested that the intervention needs to operate at individual and organizational levels, comprising workforce development, access to evidence, and regular contact with a knowledge broker to increase access to intervention evidence; develop skills in appraisal and integration of evidence; strengthen networks; and explore organizational factors to build organizational cultures receptive to embedding evidence in practice. The logic model incorporated these inputs and strategies with a set of outcomes to measure the intervention’s effectiveness based on the theoretical frameworks, evaluation studies, and decision-maker experiences.ConclusionDocumenting the design of and implementation plan for this knowledge translation intervention provides a transparent, theoretical, and practical approach to a complex intervention. It provides significant insights into how practitioners might engage with evidence in public health decision making. While this intervention model was designed for the local government context, it is likely to be applicable and generalizable across sectors and settings.Trial registrationAustralia New Zealand Clinical Trials Register ACTRN12609000953235.

Better evidence about wicked issues in tackling health inequities

Mark Petticrew1, Peter Tugwell2, Vivian Welch2, Erin Ueffing2, Elizabeth Kristjansson2,3, Rebecca Armstrong4, Jodie Doyle4, Elizabeth Waters4 Public and Environmental Health Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK Institute of Population Health, University of Ottawa, Ottawa, ON, Canada K1N 6N5 School of Psychology, University of Ottawa, Ottawa, ON, Canada K1N 6N5 McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Melbourne 3153, Australia Address correspondence to Rebecca Armstrong, E-mail: rarmstrong@vichealth.vic.gov.au

An exploratory cluster randomised controlled trial of knowledge translation strategies to support evidence-informed decision-making in local governments (The KT4LG study)

BackgroundChildhood overweight and obesity is the most prevalent and, arguably, politically complex child health problem internationally. Governments, communities and industry have important roles to play, and are increasingly expected to deliver an evidence-informed system-wide prevention program. However, efforts are impeded by a lack of organisational access to and use of research evidence. This study aims to identify feasible, acceptable and ideally, effective knowledge translation (KT) strategies to increase evidence-informed decision-making in local governments, within the context of childhood obesity prevention as a national policy priority.Methods/DesignThis paper describes the methods for KT4LG, a cluster randomised controlled trial which is exploratory in nature, given the limited evidence base and methodological advances. KT4LG aims to examine a program of KT strategies to increase the use of research evidence in informing public health decisions in local governments. KT4LG will also assess the feasibility and acceptability of the intervention. The intervention program comprises a facilitated program of evidence awareness, access to tailored research evidence, critical appraisal skills development, networking and evidence summaries and will be compared to provision of evidence summaries alone in the control program. 28 local governments were randomised to intervention or control, using computer generated numbers, stratified by budget tertile (high, medium or low). Questionnaires will be used to measure impact, costs, and outcomes, and key informant interviews will be used to examine processes, feasibility, and experiences. Policy tracer studies will be included to examine impact of intervention on policies within relevant government policy documents.DiscussionKnowledge translation intervention studies with a focus on public health and prevention are very few in number. Thus, this study will provide essential data on the experience of program implementation and evaluation of a system-integrated intervention program employed within the local government public health context. Standardised programs of system, organisational and individual KT strategies have not been described or rigorously evaluated. As such, the findings will make a significant contribution to understanding whether a facilitated program of KT strategies hold promise for facilitating evidence-informed public health decision making within complex multisectoral government organisations.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000953235

The development of a network for community-based obesity prevention: the CO-OPS Collaboration

BackgroundCommunity-based interventions are a promising approach and an important component of a comprehensive response to obesity. In this paper we describe the Collaboration of COmmunity-based Obesity Prevention Sites (CO-OPS Collaboration) in Australia as an example of a collaborative network to enhance the quality and quantity of obesity prevention action at the community level. The core aims of the CO-OPS Collaboration are to: identify and analyse the lessons learned from a range of community-based initiatives aimed at tackling obesity, and; to identify the elements that make community-based obesity prevention initiatives successful and share the knowledge gained with other communities.MethodsKey activities of the collaboration to date have included the development of a set of Best Practice Principles and knowledge translation and exchange activities to promote the application (or use) of evidence, evaluation and analysis in practice.ResultsThe establishment of the CO-OPS Collaboration is a significant step toward strengthening action in this area, by bringing together research, practice and policy expertise to promote best practice, high quality evaluation and knowledge translation and exchange. Future development of the network should include facilitation of further evidence generation and translation drawing from process, impact and outcome evaluation of existing community-based interventions.ConclusionsThe lessons presented in this paper may help other networks like CO-OPS as they emerge around the globe. It is important that networks integrate with each other and share the experience of creating these networks.

Strengthening evaluation to capture the breadth of public health practice: ideal vs. real.

Tahna L. Pettman2, Rebecca Armstrong1,2, Jodie Doyle1,2, Belinda Burford1,2, Laurie M. Anderson2, Tessa Hillgrove3, Nikki Honey3, Elizabeth Waters1,2 Jack Brockhoff Child Health and Wellbeing Program, McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia Cochrane Public Health Group, McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia Knowledge and Environments for Health Unit, The Victorian Health Promotion Foundation (VicHealth), Carlton, Victoria, Australia Address correspondence to Tahna Pettman, E-mail: tpettman@unimelb.edu.au

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting

BackgroundThe value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions.MethodsThe study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health.ResultsIn total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making.ConclusionsThis study makes an important contribution to understanding how evidence is used within the public health LG context.Trial registrationACTRN12609000953235.