Sally Redman

Increasing the use of evidence in health policy: practice and views of policy makers and researchers

BackgroundBetter communication is often suggested as fundamental to increasing the use of research evidence in policy, but little is known about how researchers and policy makers work together or about barriers to exchange. This study explored the views and practice of policy makers and researchers regarding the use of evidence in policy, including: (i) current use of research to inform policy; (ii) dissemination of and access to research findings for policy; (iii) communication and exchange between researchers and policy makers; and (iv) incentives for increasing the use of research in policy.MethodsSeparate but similar interview schedules were developed for policy makers and researchers. Senior policy makers from NSW Health and senior researchers from public health and health service research groups in NSW were invited to participate. Consenting participants were interviewed by an independent research company.ResultsThirty eight policy makers (79% response rate) and 41 researchers (82% response rate) completed interviews. Policy makers reported rarely using research to inform policy agendas or to evaluate the impact of policy; research was used more commonly to inform policy content. Most researchers reported that their research had informed local policy, mainly by increasing awareness of an issue. Policy makers reported difficulty in accessing useful research syntheses, and only a third of researchers reported developing targeted strategies to inform policy makers of their findings. Both policy makers and researchers wanted more exchange and saw this as important for increasing the use of research evidence in policy; however, both groups reported a high level of involvement by policy makers in research.ConclusionPolicy makers and researchers recognise the potential of research to contribute to policy and are making significant attempts to integrate research into the policy process. These findings suggest four strategies to assist in increasing the use of research in policy: making research findings more accessible to policy makers; increasing opportunities for interaction between policy makers and researchers; addressing structural barriers such as research receptivity in policy agencies and a lack of incentives for academics to link with policy; and increasing the relevance of research to policy.

Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study

Background Despite the widespread use of accreditation in many countries, and prevailing beliefs that accreditation is associated with variables contributing to clinical care and organisational outcomes, little systematic research has been conducted to examine its validity as a predictor of healthcare performance. Objective To determine whether accreditation performance is associated with self-reported clinical performance and independent ratings of four aspects of organisational performance. Design Independent blinded assessment of these variables in a random, stratified sample of health service organisations. Settings Acute care: large, medium and small health-service organisations in Australia. Study participants Nineteen health service organisations employing 16 448 staff treating 321 289 inpatients and 1 971 087 non-inpatient services annually, representing approximately 5% of the Australian acute care health system. Main measures Correlations of accreditation performance with organisational culture, organisational climate, consumer involvement, leadership and clinical performance. Results Accreditation performance was significantly positively correlated with organisational culture (rho=0.618, p=0.005) and leadership (rho=0.616, p=0.005). There was a trend between accreditation and clinical performance (rho=0.450, p=0.080). Accreditation was unrelated to organisational climate (rho=0.378, p=0.110) and consumer involvement (rho=0.215, p=0.377). Conclusions Accreditation results predict leadership behaviours and cultural characteristics of healthcare organisations but not organisational climate or consumer participation, and a positive trend between accreditation and clinical performance is noted.

A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737]

BackgroundAccreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted.Methods/designTo understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation.DiscussionThe accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it.

Measuring the quality of public open space using Google Earth.

BACKGROUND Proximity to public open space, such as parks and other green spaces, has considerable health benefits, and people have been shown to be more likely to use such space for physical activity if it is of high quality. This paper describes a new remote-assessment approach that makes use of Google Earth Pro (the free version of this program is Google Earth) to provide rapid and inexpensive measurement of the quality of public open space. PURPOSE The aim of the study was to assess the correlation between assessments of the quality of public open space using (1) the remote method (making use of Google Earth Pro) and (2) direct observation with a well-established measure of quality, the Public Open Space Tool (POST). METHODS Fifty parks selected from the southwest part of Sydney, Australia, were assessed in 2009 with the remote method (using Google Earth Pro), and scores were compared with those obtained from direct observation of the same parks using POST. The time taken to conduct the assessments using each method was also recorded. Raters for each method were blind to scores obtained from using the other method. Analyses were conducted in 2009. RESULTS The Spearman correlation coefficient between the quality scores obtained for the 50 parks using the remote method and direct observation was 0.9 (p<0.0001). The remote method took 4 hours, whereas direct observation took 42 hours, showing the remote method to be much faster and more resource efficient for the measurement of the quality of physical activity-related environments. CONCLUSIONS The remote-assessment method provides, for the first time, the capacity to assess the quality of large numbers of parks and other green spaces without the need for in-person visits, dramatically reducing the time required for environmental audits of public open space.

‘Well, have I got cancer or haven't I?’ The psycho‐social issues for women diagnosed with ductal carcinoma in situ

Objectives  To explore womens experience of being diagnosed with ductal carcinoma in situ (DCIS) in relation to the following: response to the diagnosis; understanding about the diagnosis; satisfaction with information; satisfaction with the level of involvement in treatment decision‐making and satisfaction with support services.

What works to increase the use of research in population health policy and programmes: a review

Policy agencies are implementing strategies to increase the use of research in policy decisions. This paper examines the evidence about the effectiveness of these strategies. We conducted an extensive search focused on population health policy and programmes. We classified 106 papers meeting study criteria into research type (conceptual, descriptive and intervention). We examined the descriptive studies to identify commonly nominated potential intervention strategies. We examined the intervention studies to evaluate the impact of the tested strategies in increasing the use of research in policy decisions. There is little evidence about which strategies increase the use of evidence in population health policy and programmes.

A narrative review of research impact assessment models and methods

BackgroundResearch funding agencies continue to grapple with assessing research impact. Theoretical frameworks are useful tools for describing and understanding research impact. The purpose of this narrative literature review was to synthesize evidence that describes processes and conceptual models for assessing policy and practice impacts of public health research.MethodsThe review involved keyword searches of electronic databases, including MEDLINE, CINAHL, PsycINFO, EBM Reviews, and Google Scholar in July/August 2013. Review search terms included ‘research impact’, ‘policy and practice’, ‘intervention research’, ‘translational research’, ‘health promotion’, and ‘public health’. The review included theoretical and opinion pieces, case studies, descriptive studies, frameworks and systematic reviews describing processes, and conceptual models for assessing research impact. The review was conducted in two phases: initially, abstracts were retrieved and assessed against the review criteria followed by the retrieval and assessment of full papers against review criteria.ResultsThirty one primary studies and one systematic review met the review criteria, with 88% of studies published since 2006. Studies comprised assessments of the impacts of a wide range of health-related research, including basic and biomedical research, clinical trials, health service research, as well as public health research. Six studies had an explicit focus on assessing impacts of health promotion or public health research and one had a specific focus on intervention research impact assessment. A total of 16 different impact assessment models were identified, with the ‘payback model’ the most frequently used conceptual framework. Typically, impacts were assessed across multiple dimensions using mixed methodologies, including publication and citation analysis, interviews with principal investigators, peer assessment, case studies, and document analysis. The vast majority of studies relied on principal investigator interviews and/or peer review to assess impacts, instead of interviewing policymakers and end-users of research.ConclusionsResearch impact assessment is a new field of scientific endeavour and there are a growing number of conceptual frameworks applied to assess the impacts of research.

Assessing the practical and psychosocial needs of rural women with early breast cancer in Australia.

Abstract The purpose of the current study was to assess the practical and psychosocial needs of rural women with early breast cancer in Australia and recommend strategies to ensure equity in availability and access to cancer treatment for all women. A random sample of 204 rural women diagnosed with early breast cancer was recruited to participate in a telephone survey via state and territory cancer registries. Although the majority of women were satisfied with their provision of information overall, less than a third of participants were provided with specific information on assistance for rural women. Findings also revealed that only 47% of the women who had to travel for treatment received financial assistance, and 13% of these women had difficulty organizing or claiming financial assistance. Furthermore, only 10% of women found social workers to be a source of support.

Medical tests: women's reported and preferred decision-making roles and preferences for information on benefits, side-effects and false results

Objective  To determine womens preferences for and reported experience with medical test decision‐making.

Women's preferences for and views on decision-making for diagnostic tests.

It is unclear whether the Control Preferences Scale (CPS) provides a suitable framework for eliciting womens preferences for involvement in decision-making about diagnostic tests. The aims of this study were to assess the appropriateness of the role label approach for eliciting preferences for decision-making about diagnostic tests and to elicit womens preferences for, and views about, decision-making for diagnostic tests. In-depth, face-to-face, semi-structured interviews were conducted with 37 women who had previously participated in a population-based telephone survey. Analysis of the interview transcripts revealed that qualitative questions may be a more sensitive methodology for eliciting preferences than the role label approach as exemplified by the CPS. The analysis identified a number of issues associated with decision-making for diagnostic tests, including defining what a decision is, the rationale for the preference and factors that influence the preferred role such as the perceived seriousness of the test and potential outcomes. The role label approach used to elicit preferences for involvement in decision-making may be too simplistic. It may not fully capture the complexity of womens thoughts about test decision-making, including how they define a decision and what factors affect their preference.