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      The Use of Research Evidence in Public Health Decision Making Processes: Systematic Review

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          Abstract

          Background

          The use of research evidence to underpin public health policy is strongly promoted. However, its implementation has not been straightforward. The objectives of this systematic review were to synthesise empirical evidence on the use of research evidence by public health decision makers in settings with universal health care systems.

          Methods

          To locate eligible studies, 13 bibliographic databases were screened, organisational websites were scanned, key informants were contacted and bibliographies of included studies were scrutinised. Two reviewers independently assessed studies for inclusion, extracted data and assessed methodological quality. Data were synthesised as a narrative review.

          Findings

          18 studies were included: 15 qualitative studies, and three surveys. Their methodological quality was mixed. They were set in a range of country and decision making settings. Study participants included 1063 public health decision makers, 72 researchers, and 174 with overlapping roles. Decision making processes varied widely between settings, and were viewed differently by key players. A range of research evidence was accessed. However, there was no reliable evidence on the extent of its use. Its impact was often indirect, competing with other influences. Barriers to the use of research evidence included: decision makers' perceptions of research evidence; the gulf between researchers and decision makers; the culture of decision making; competing influences on decision making; and practical constraints. Suggested (but largely untested) ways of overcoming these barriers included: research targeted at the needs of decision makers; research clearly highlighting key messages; and capacity building. There was little evidence on the role of research evidence in decision making to reduce inequalities.

          Conclusions

          To more effectively implement research informed public health policy, action is required by decision makers and researchers to address the barriers identified in this systematic review. There is an urgent need for evidence to support the use of research evidence to inform public health decision making to reduce inequalities.

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          Most cited references49

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          Pathways to “Evidence-Informed” Policy and Practice: A Framework for Action

          Bowen and Zwi propose a new framework that can help researchers and policy makers to navigate the use of evidence.
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            Evidence-based health policy: context and utilisation.

            Evidence-based decision-making is centred on the justification of decisions. In the shift from an individual-clinical to a population-policy level, the decision-making context becomes more uncertain, variable and complex. To address this we have developed a conceptual framework for evidence-based decision-making, focusing on how context impacts on what constitutes evidence and how that evidence is utilised. We present two distinct orientations towards what constitutes evidence, representing different relationships between evidence and context. We also categorise the decision-making context based on the ways in which context impacts on evidence-based decision-making. Furthermore, we invoke the concept of axes of evidence-based decision-making to describe the relationship between evidence and context as we move from evidence-based medicine to evidence-based health policy. From this, we suggest that it may be more important how evidence is utilised than how it is defined. Based on the research and knowledge utilisation literature, we present a process model of evidence utilisation, which forms the basis for the conceptual framework for context-based evidence-based decision-making. The conceptual framework attempts to capture the role that context plays in the introduction, interpretation and application of evidence. We illustrate this framework with examples from policy development for colorectal cancer screening.
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              Applying clinical epidemiological methods to health equity: the equity effectiveness loop.

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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2011
                26 July 2011
                : 6
                : 7
                Affiliations
                [1]Public Health and Policy, University of Liverpool, Liverpool, Merseyside, United Kingdom
                Yale University, United States of America
                Author notes

                Conceived and designed the experiments: LO FL-W DT-R MOF SC. Performed the experiments: LO FL-W DT-R. Analyzed the data: LO. Wrote the paper: LO FL-W DT-R MOF SC.

                Article
                PONE-D-11-05641
                10.1371/journal.pone.0021704
                3144216
                21818262
                bea0ffa2-a22e-40bb-9903-853e19a16bf8
                Orton et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                Page count
                Pages: 10
                Categories
                Research Article
                Medicine
                Clinical Research Design
                Qualitative Studies
                Survey Research
                Systematic Reviews
                Epidemiology
                Non-Clinical Medicine
                Evidence-Based Medicine
                Health Care Policy
                Health Services Research
                Public Health
                Social and Behavioral Sciences
                Anthropology
                Economics
                Operations Research
                Decision Analysis
                Information Science
                Political Science
                Public Policy

                Uncategorized
                Uncategorized

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