Decision-Making in Environmental Health: From Evidence to Action
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Contents:
View All Previous Meetings. Phone: Fax: Email: clynx nas. For example: Obesity prevention decision-making and research occurs in diverse and dynamic social contexts. Determinants of obesity are embedded in and interventions are fielded in complex and multi-level systems. Acceptable levels of internal and external validity need to be achieved. Public and private vested interests in the status quo exist.
When asked, staff were able to recall the key messages of the campaign. ETI results showed that the campaign successfully increased staff understanding of and their perception of the value of ET.
There are barriers for staff to incorporate ET into their work, including high workloads and not understanding how it can apply to their role. This was a short four-week campaign, and continued effort will be needed to shift organizational culture, building toward a learning organization where EIDM is second nature. If you are interested in any of the campaign materials described, please contact Kristin Beaton at kbeaton huroncounty. Cornwall, Ontario, Canada. Health Research Policy and Systems , 15 , Evaluation Capacity Assessment Instrument.
Defining and teaching evaluative thinking: Insights from research on critical thinking. The Evaluative Thinking Inventory. WCC visits include all publicly-funded childhood immunizations as well as a number of health assessment, promotion and education activities.
Examples of some of these non-immunization activities include growth measurement, injury-prevention messaging and breastfeeding and nutrition support. The timing of the WCC visits is aligned with the provincial immunization schedule. Families attend clinic when their children are 2, 4, 6, 12 and 18 months of age, and before school entry at 4 to 6 years of age.
In addition to the health assessments and immunization, WCC visits offer parents the opportunity to ask questions and make connections to other health and community services. In Alberta, 56, babies were born in , 1 resulting in approximately , WCC visits in In recent years the province had increases in both the population and the number of immunizations provided during WCC visits, however the funding and time allocated for each visit has not increased.
This led to a decline in the time available for non-immunization, health promotion activities. Concurrently, it was identified that there were regional differences in the activities offered to families across the province. While AHS has been the single healthcare provider in the province since , there are still differences in the delivery of health services across the five regional zones. Each zone has geographical, cultural and demographic differences that influence their health service delivery.
Background
Representatives from each zone joined the provincial health promotion team, decision-makers and researchers to decide which non-immunization activities should be consistently offered across the province, including which should be prioritized and which ones potentially discontinued. This group was highly motivated to make fiscally responsible, evidence-informed decisions about WCC service delivery. The objective of this initiative was to examine and decide on the routine, non-immunization public health WCC activities to be completed across the province of Alberta. Stakeholders were engaged from the start to establish initiative goals and objectives.
These stakeholders included regional front-line public health managers and operational directors, researchers in maternal-child health and health promotion experts. These same stakeholders were engaged throughout the process. Prior to collecting evidence, decision-making criteria and a ranking system were identified to help prioritize WCC non-immunization activities.
Criteria considered important to decision-making included: literature-informed best practice, required organizational policies or directives for practice, potential for improving the health of the population, patient safety, parent priorities, evaluability, alignment with organizational priorities and feasibility. These criteria were further confirmed as being comprehensive after scanning other work within Alberta, other jurisdictions and the academic and grey literature. The decision-making criteria helped identify which types of evidence were needed to support decision-making and what project work needed to be undertaken.
An environmental scan was used to document current practices across the province. All WCC manuals and practice and support documents were requested and reviewed to identify current non-immunization activities and interventions across the regions zones.
The role of interface organizations in science communication and understanding. This model 74 per cent classification accuracy was used to assign all other meshblocks in the country to exposure categories, and the resulting meshblock populations summed for each category. Palgrave Communications , 3 1 , 30 , DOI: Addressing the issue of food and physical literacy, a team from British Columbia developed a strategy to support and promote healthy eating and physical activity in the early years. As a result, workers suffered from malnutrition, and the poor physical condition was made worse by the ill-ventilated factories and, textile mills, the high temperatures and humidity" Foskket,
Data were then validated through key informant interviews. It was essential to understand the details of each of the activities, in each region, in order to identify variations in practice and to collect adequate details about the intervention for the review of evidence that followed.
A Framework for Decision-Making for Obesity Prevention: Integrating Action with Evidence
An example of one identified activity that was common to all five zones was postpartum depression screening of new mothers using the Edinburgh Postpartum Depression Screening Tool. The scan identified variations in the cut-off scores used to identify mothers at risk as well as the well-child visit in which the screening occurred. In all, 19 different WCC activities were identified. A rapid review of the literature was conducted for each of the WCC activities to determine if there was evidence of effectiveness to support the current clinical practices.
Systematic reviews were primarily used, while clinical practice guidelines and individual research studies were used when systematic reviews were unavailable. Searches of the Cochrane Library were conducted first. No formal quality assessment was undertaken. The evidence review provided insight into which activities were effective and the details about best clinical practice. A review of internal organizational policies, provincial directives and priorities was conducted by searching internal websites for relevant policies and priorities.
Stakeholders were also asked to identify regional policies that determined practice requirements. The WCC activities that were dictated by policies and priorities were flagged. Four organizational policies were identified: postpartum depression screening, childhood growth measurement, safe infant sleep and tobacco and smoke-free environments. The potential for improving the health of the population was assessed by reviewing the WCC activity-related data from population-level health status assessments.
Evaluability was assessed by examining the capability of monitoring health outcomes of each WCC activity through existing data systems.
Alberta Health Services stakeholders weighed in on patient safety and operational feasibility. Each stakeholder independently applied a three-point scale to each criteria, for each activity. The scores of each of the criteria were summed, resulting in a total score for each WCC activity for each stakeholder. WCC activities were then ranked from top to bottom for each stakeholder, based on total scores.
Delphi analysis for consensus building based on the median of total aggregated score of each activity was used to determine the final ranking of activities. Success of the project was gauged by continuous stakeholder participation and satisfaction.
Grants | Evidence for Action
Consensus regarding which non-immunization activities should be consistently offered in public health WCC visits was achieved. The next steps will be the implementation and the evaluation of the standard activities across Alberta. Many factors influence public health decision-making. Evidence from a variety of sources must be considered due to the multitude of factors that are involved in designing public health interventions.
Additionally, the lack of certainty in public health literature and challenges in measuring health outcomes make decision-making both a science and an art. One of the facilitators of this work was that AHS was formed over 10 years ago and has remained relatively stable for this period of time. Presumably, consensus building would have been more challenging if this had been in the early days of the formation of a single healthcare system.
Due to this stability, the stakeholders were familiar with each other from work on other provincial policies and projects. A challenge of the project was bringing experts from different disciplines together to make decisions. The a priori creation of criteria for decision-making, continuous stakeholder engagement and collection of evidence from a variety of sources aided the group in coming to consensus. Interactive Health Data Application. Live Birth Data. Evidence-based healthcare and public health: How to make decisions about health services and public health 3 rd ed.
Toronto: Churchill Livingstone. The Delphi technique: making sense of consensus. Birth to the age of 5 years is a time of rapid growth in children. Patterns and behaviours develop that will last into adulthood, directly affecting lifelong health and resilience. The Canada Food Guide recommends four servings of fruits and vegetables per day for children aged 2 to 3 years of age, and five servings for children aged 4 to 8 years. Appetite to Play is a provincial intervention in British Columbia aimed at building the capacity of early years providers to promote and support healthy eating and physical activity in the early years birth—5 years old.
Specifically, the initiative focuses on building food literacy and physical literacy skills in the early years. Food literacy is the knowledge, attitude and skills that people have about food. The more children understand about food, the more likely they are to try new foods and eat a healthy diet. Physical literacy focuses on children having the fundamental movement skills and the motivation, confidence and competence to move for a lifetime. Skills such as hopping, running, jumping, throwing and catching are key building blocks for being physically active. Early years providers e. First, an extensive market research study was conducted with early years providers across British Columbia to understand current awareness and usage of healthy eating and physical activity resources; assess perceptions, attitudes and values regarding these resources; assess motivators and barriers to using the resources; and determine what information and resources are required by early years practitioners.
This information was used to design the components, tools and delivery of the Appetite to Play initiative across BC. Early years providers also had input into the name of the initiative, as well as the marketing and branding material used to promote the initiative.
Second, the partner organizations in the initiative Child Health BC, YMCA of Greater Vancouver, Childhood Obesity Foundation and Sport for Life brought together subject-matter experts, who were identified through the Ministry of Health and BC health authorities, to develop and implement the healthy eating and physical activity best practice recommendations. These best practice recommendations were developed based on current evidence that the subject-matter experts brought forward and according to BC childcare licensing regulations.
These subject-matter experts are also regularly contacted to provide feedback on website posts on physical activity and healthy eating in the early years to ensure that up-to-date and best practices are incorporated into the games, ideas, tips, recipes and other activities that are published on the website.
Third, a PhD trained evaluation coordinator was included as part of the project team to conduct an ongoing process evaluation that involved pre- and post-training surveys; qualitative interviews with early years providers, trainers and project stakeholders; web analytics; and training delivery feedback. The pre- and post-training surveys captured demographics, subject area knowledge and confidence, intention to change, assessment of resources and workshop satisfaction constructs, as well as facility policy and open-ended training experience questions.