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Presented at the Canadian Public Health Association Centenary Conference Public Health in Canada: Shaping the Future Together, June 16, 2010
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Outline
• About the partners• Project background• Objectives • Methods• Results• Learning
Project Partners
Region of Peel Public Health• West of Toronto• 2nd largest public health unit in
Ontario
Health Evidence• Based at McMaster University• Dedicated to a Canadian public
health system informed by the best-available evidence
Peel Public Health
• Cities of Mississauga, Brampton and Town of Caledon – population >1.25 million
• Higher proportion of children, young families and immigrants than rest of Ontario
Baby-friendly Designation
• Baby Friendly Community Health Service - in June 2009:
– seven Point Plan outcome criteria were met; 5 years to achieve
–awarded by the Breastfeeding Committee for Canada, the national authority for WHO/UNICEF
–Baby-friendly Initiative
Health Evidence Funders
Health Evidence
Provide and promote access to the best available evidence–Registry– Literature searches & summaries–Facilitated evidence reviews
Provide knowledge‐brokering services –Customized EIDM training–Mentoring and Knowledge Broker
Health Evidence
• online registry –1900 reviews
• evaluated interventions
• updated quarterly
• quality-assessed
• searchable by commonly-used public health terms
• two page summaries
FormulaNOthanks.ca
Next Step?
Key Message Development
Goal: To provide the best available evidence about the health consequences of formula feeding and to support informed decision-making with a comprehensive website to build efficacy and confidence to breastfeed
EIDM Model
National Collaborating Centre for Methods and ToolsHaynes B, DiCenso, A., Ciliska D., & Guyatt, G. 2005
EIDM Process
Define the question
Search for evidence
Appraise the quality
Interpret
Assess applicability
Objective
• Determine if the available research literature supported a claim of improved cognitive development due to breastfeeding.
Methods
• Define the question• Search the literature• Relevance & quality assessment • Critical appraisal• Interpretation• Decision-making
The Question
Is breastfeeding exclusively for 6 months associated with enhanced cognitive development outcomes in children when compared with formula feeding?
The Search
• Database searches of Medline, Embase, CINAHL (2005-2009), searches run June 10, 2009
• Search terms were limited to results relating to humans, and English language
Findings
1261 articles
40 retrieved
10 included
30 excluded (quality)
1221 excluded (design,
relevance)
Findings
4 studies moderate quality6 had serious methodological flaws
Good quality evidence suggested:- No relationship between
breastfeeding and cognitive development when you control for maternal characteristics including IQ, socio-environmental factors
Decision Factors
• Research evidence
• Public health experience, beliefs
• Public health credibility
• Audience assessmentEvidence-informed decision
apply
search &
appraise
define question
context
Decision
- Concept for the ‘IQ’ poster was deferred- Continued with infection, weight
Learning and Next Steps
• Crafting messaging to explain these findings
• Continue to mine the literature• For Clients: create web pages with
information about findings in language that is suitable to all literacy levels and add to the FormulaNOthanks.ca website
• For Staff: Ongoing EIDM training, organizational supports and opportunities
Thank you!
Peel HealthBeverley Bryant,Manager of Education and [email protected]
Angela Garrison, Family Health Supervisor [email protected]
Health Evidence
Maureen DobbinsDirector
Lori Greco
Knowledge Broker,
