Tahna Pettman

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

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.

Cochrane update : Predicting sustainability of intervention effects in public health evidence: identifying key elements to provide guidance

Jillian Whelan1, Penelope Love1, Tahna Pettman1,2, Jodie Doyle2, Sue Booth1,3, Erin Smith1, Elizabeth Waters1,2 The CO-OPS Collaboration, WHO Collaborating Centre for Obesity Prevention, Population Health SRC, Deakin University, Geelong, Australia Cochrane Public Health Group, Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia Department of Public Health, Flinders University, Bedford Park, Australia Address correspondence to Jillian Whelan, E-mail: jill.whelan@deakin.edu.au

Exploring the pragmatic and explanatory study design on outcomes of systematic reviews of public health interventions: a case study on obesity prevention trials.

Sze Lin Yoong1,2, Luke Wolfenden1,2,3, Tara Clinton-McHarg3, Elizabeth Waters4, Tahna L. Pettman4, Emily Steele4, John Wiggers1,2,3 School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, NSW 2308, Australia Hunter New England Population Health, NSW Health, Wallsend, NSW 2287, Australia Cochrane Public Health Group, Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC 3053, Australia Address correspondence to Sze Lin Yoong, E-mail: serene.yoong@hnehealth.nsw.gov.au

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.

Tracking and understanding the utility of Cochrane reviews for public health decision-making

Cochrane reviews aim to support policy and practice decisions. Developing systematic strategies to understand the pathway from their production to actually making a difference in practice is difficult but extremely valuable. Such an exercise can help to determine meaningfulness of the reviews, identify their use in highlighting the spectrum of the primary evidence, flag opportunities to update and stimulate research gap analyses. This paper briefly describes our emerging approach to tracking and understanding the use, and usefulness, of published Cochrane Public Health Group (CPHG) reviews to date.

Assessing evidence in public health: the added value of GRADE

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Knowledge Translation for researchers: developing training to support public health researchers KTE efforts

Kirsty Jones1, Rebecca Armstrong1, Tahna Pettman1, Elizabeth Waters1,2 Public Health Insight, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia Address correspondence to Rebecca Armstrong, E-mail: armr@unimelb.edu.au

Changes in Primary School Children's Behaviour, Knowledge, Attitudes, and Environments Related to Nutrition and Physical Activity

Rigorous evaluation of large-scale community-based obesity interventions can provide important guidance to policy and decision makers. The eat well be active (ewba) Community Programs, a five-year multilevel, multistrategy community-based obesity intervention targeting children in a range of settings, was delivered in two communities. A comprehensive mixed-methods evaluation using a quasiexperimental design with nonmatched comparison communities was undertaken. This paper describes the changes in primary school childrens attitudes, behaviours, knowledge, and environments associated with healthy eating and physical activity, based on data from six questionnaires completed pre- and postintervention by students, parents, and school representatives. As self-reported by students in years from five to seven there were few significant improvements over time in healthy eating and physical activity behaviours, attitudes, knowledge, and perceived environments, and there were few changes in the home environment (parent report). Overall there were considerably more improvements in intervention compared with comparison schools affecting all environmental areas, namely, policy, physical, financial, and sociocultural, in addition to improvements in teacher skill and knowledge. These improvements in childrens learning environments are important and likely to be sustainable as they reflect a change of school culture. More sensitive evaluation tools may detect behaviour changes.