Upload
others
View
0
Download
0
Embed Size (px)
Citation preview
The Meaning of “Evidence” and Strategies for Incorporating Evidence into Practice
Using Concept Mapping
“Both/And” Research Conference
University of Victoria, May 10, 2013
Bernie Pauly and Marjorie MacDonald
Overview of RePHS
Principal Investigators: Marjorie MacDonald, Trevor Hancock and Bernie Pauly, University of Victoria
ON Academic Lead: Ruta Valaitis, McMaster University
ON Decision-maker Lead: Heather Manson, PHO
Funder: CIHR
Time Frame: January 2009 – January 2014
Purpose: To examine the implementation and impact of public health renewal processes using two public health programs as exemplar cases - chronic disease prevention/healthy living and sexually transmitted infection prevention across the two provinces.
Authors – on behalf of the REPHS Team
University of Victoria
• Marjorie MacDonald
• Bernie Pauly
• Diane Allan
• Laura Tomm Bonde
• Trevor Hancock
McMaster University
• Ruta Valaitis
• Danielle Hunter
BC Ministry of Health
• Warren O’Briain
Public Health Ontario
• Heather Manson
Concept Mapping
• Concept mapping is a structured conceptualization process used to develop a framework of participants’ understanding of a particular concept and the processes related to the concept
• Done in 3 phases:
– brainstorming
– sorting and rating
– interpretation
Phase 1: Brainstorming
• Prompt: Effective strategies to support the integration of evidence into public health practice and/or decision making are: …….
• 18 people from BC and 55 people from ON responded to the brainstorming survey
– BC: all roles and 4 of 6 HAs + Ministry represented
– ON: all roles and 6 of 6 HUs + Ministry + PHO represented
• Brainstorming statements were synthesized resulting in 27 statements
Phase 2: Sorting and Rating
• 14 BC and 21 ON respondents
• All roles (FLS, Managers, Executives) represented in 35 respondents
• BC: 5 of 6 HAs + Ministry + Other represented
• ON: 5 of 6 HUs + Ministry + PHO represented
Multi-Dimensional Scaling and Cluster Analysis
• Sorting data entered into analysis program for concept mapping (Ariadne)
• First, data are entered into similarity matrices and then analyzed using multidimensional scaling
• Then the program conducts a cluster analysis to group the statements into related clusters as reflected in a point
Concept Map
Cluster 1: Fostering innovation, learning and an evidence-informed public health culture
1: Involve all levels of public health practitioners in the process of creating, gathering, and integrating evidence into practice
4: Ensure support and/or commitment in place from leadership to integrate evidence
6: Ensure formal processes and structures for integration of evidence are consistent across the health unit/health authority
7: Have flexibility and be willing to challenge standard practice and change practice as needed
11: Foster an evidence-informed organizational culture
16: Incorporate evidence into program planning and evaluation in an iterative fashion
Cluster 1 continued
18: Value all forms of research as evidence
22: Promote external partnerships/collaborations in the development and use of evidence
23: Promote reflexivity in public health practice
25: Promote greater visibility of public health
26: Ensure that innovation can still happen within evidence-based practice
Cluster 2: Building staff capacity
2: Provide education, professional development, staff training, and/or skill building specific to research skills for staff
14: Ensure accessibility of knowledge brokers or content experts
19: Ensure staff has time to seek out and integrate evidence into practice and decision-making
27: Integrate research skills into all public health practitioners’ role/practice/scope
Cluster 3: Structural supports for developing, accessing and using evidence
3: Create government funded evidence-informed resources specific to public health
9: Provide access to librarian support
12: Provide examples of how evidence can be integrated into and impact practice
13: Provide access to relevant literature, resources, and/or databases
15: Ensure some staff members are equipped with advanced skills in research
17: Establish internal forums or networks to enable staff to share and review evidence
20: Make evidence understandable
24: Provide financial resources for research
Cluster 4: Supporting relevant, public health specific evidence
5: Utilize standard models/frameworks/tools for gathering and/or integrating evidence
8: Review, appraise, and incorporate multiple sources of evidence
10: Generate research that guides public health practice
21: Create or establish context specific evidence
Pattern Matching: Importance and Feasibility
Importance
Rank Mean
1 Cluster 2 4.19
2 Cluster 1 4.16
3 Cluster 3 4.09
4 Cluster 4 4.01
Feasibility
Rank Mean
1 Cluster 3 3.38
2 Cluster 1 3.09
3 Cluster 4 3.07
4 Cluster 2 2.95
Importance and Feasibility: BC and Ontario
Cluster 1 Go-Zone
Cluster 2 Go-Zone
Cluster 3 Go-Zone
Cluster 4 Go-Zone
CONCLUSIONS
• This study, grounded in the experiences of both practitioners and decision makers, provides some concrete direction about possible actions to support evidence-informed practice that are identified as both feasible and important
Next Steps
• Analyze interview and focus group data from front line public health practitioners, mid-level managers, and senior executives about:
– understandings of the meaning of evidence,
– barriers and facilitators to implementation of strategies to support evidence use
– What strategies are being used and how
– Explanations for differences between BC and Ontario, and between importance and feasibility ratings