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      A mixed methods evaluation of capturing and sharing practitioner experience for improving local tobacco control strategies

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          Abstract

          Objective

          Practitioner experience is one type of evidence that is used in public health planning and action. Yet, methods for capturing and sharing experience are under-developed. We evaluated the reach, uptake and use of an example of capturing and sharing practitioner experience from tobacco control known as documentation of practice (DoP) reports.

          Methods

          The participatory, mixed methods approach included the following: a document review to capture data related to the extent and how DoP reports reached the target population; an online survey to assess awareness, use and perceptions about DoP reports; and semi-structured interviews to identify and explore examples of instrumental, conceptual and symbolic use of DoP reports. The samples for the survey and interviews included tobacco control practitioners from public health units in Ontario, Canada.

          Results

          Seventy-three individuals participated in the survey and 10 were interviewed. Awareness of at least one DoP report was high. The most common way of learning about DoP reports was email. DoP reports focused on policy issues had highest use; these reports were used in conceptual (helped raise awareness), instrumental (directly informed local policy development) and symbolic (confirmed a choice already made) ways. DoP reports may be improved with key messages, shorter development timelines, more relevant topic selection and dissemination to audiences beyond public health.

          Conclusion

          DoP reports are useful to public health practitioners working in tobacco control within Ontario; refinements to development and dissemination processes will enhance use. Future studies and adaptations of DoP reports could help improve use of practitioner experience as one source of evidence informing public health practice.

          Electronic supplementary material

          The online version of this article (10.17269/s41997-018-0153-3) contains supplementary material, which is available to authorized users.

          Résumé

          Objectif

          L’expérience des praticiens est un type d’indice utilisé pour la planification et l’action en santé publique. Cependant, les méthodes pour saisir et partager l’expérience sont sous-développées. Nous avons évalué la portée, la prise et l’utilisation d’un exemple de saisir et partager l’expérience de praticiens en contrôle du tabagisme : des rapports connu sous le nom de la documentation des pratiques (DdP).

          Méthodes

          L’approche participative et d’une méthodologie mixte comprend une analyse documentaire, un sondage en ligne et des entretiens semi-structurés. L’échantillon comprend des praticiens en contrôle du tabagisme des bureaux de santé publique en Ontario, Canada.

          Résultats

          Soixante-treize individus ont participé au sondage et 10 ont été interviewés. La connaissance d’au moins un rapport DdP était élevé. La méthode la plus fréquente d’apprendre sur des rapports DdP était par courriel. Les rapports DdP se concentrant sur des problèmes de politiques ont était utilisés le plus; ces rapports ont été utilisé dans des manières conceptuelles (en aidant à sensibiliser), instrumentales (en informant directement le développement des politiques locales) et symboliques (en confirmant un choix déjà pris). Les rapports DdP peuvent être améliorer avec des messages clés; des chronologies de développement plus courtes; une sélection de sujet plus pertinente; et une diffusion aux gens au-delà de la santé publique.

          Conclusion

          Les rapports DdP sont utiles aux praticiens de la santé publique travaillant en contrôle du tabagisme en Ontario, et le raffinement des processus de développement et de diffusion améliorera leur usage. Des études à venir et des adaptations des rapports DdP pourrait aider à améliorer l’usage de l’expérience des praticiens en tant que source de connaissance scientifique qui informe la pratique en santé publique.

          Related collections

          Most cited references 13

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          Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966-1998.

          To determine effectiveness and costs of different guideline dissemination and implementation strategies. MEDLINE (1966 to 1998), HEALTHSTAR (1975 to 1998), Cochrane Controlled Trial Register (4th edn 1998), EMBASE (1980 to 1998), SIGLE (1980 to 1988), and the specialized register of the Cochrane Effective Practice and Organisation of Care group. Randomized-controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series evaluating guideline dissemination and implementation strategies targeting medically qualified health care professionals that reported objective measures of provider behavior and/or patient outcome. Two reviewers independently abstracted data on the methodologic quality of the studies, characteristics of study setting, participants, targeted behaviors, and interventions. We derived single estimates of dichotomous process variables (e.g., proportion of patients receiving appropriate treatment) for each study comparison and reported the median and range of effect sizes observed by study group and other quality criteria. We included 309 comparisons derived from 235 studies. The overall quality of the studies was poor. Seventy-three percent of comparisons evaluated multifaceted interventions. Overall, the majority of comparisons (86.6%) observed improvements in care; for example, the median absolute improvement in performance across interventions ranged from 14.1% in 14 cluster-randomized comparisons of reminders, 8.1% in 4 cluster-randomized comparisons of dissemination of educational materials, 7.0% in 5 cluster-randomized comparisons of audit and feedback, and 6.0% in 13 cluster-randomized comparisons of multifaceted interventions involving educational outreach. We found no relationship between the number of components and the effects of multifaceted interventions. Only 29.4% of comparisons reported any economic data. Current guideline dissemination and implementation strategies can lead to improvements in care within the context of rigorous evaluative studies. However, there is an imperfect evidence base to support decisions about which guideline dissemination and implementation strategies are likely to be efficient under different circumstances. Decision makers need to use considerable judgment about how best to use the limited resources they have for quality improvement activities.
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            A randomized controlled trial evaluating the impact of knowledge translation and exchange strategies

            Context Significant resources and time are invested in the production of research knowledge. The primary objective of this randomized controlled trial was to evaluate the effectiveness of three knowledge translation and exchange strategies in the incorporation of research evidence into public health policies and programs. Methods This trial was conducted with a national sample of public health departments in Canada from 2004 to 2006. The three interventions, implemented over one year in 2005, included access to an online registry of research evidence; tailored messaging; and a knowledge broker. The primary outcome assessed the extent to which research evidence was used in a recent program decision, and the secondary outcome measured the change in the sum of evidence-informed healthy body weight promotion policies or programs being delivered at health departments. Mixed-effects models were used to test the hypotheses. Findings One hundred and eight of 141 (77%) health departments participated in this study. No significant effect of the intervention was observed for primary outcome (p < 0.45). However, for public health policies and programs (HPPs), a significant effect of the intervention was observed only for tailored, targeted messages (p < 0.01). The treatment effect was moderated by organizational research culture (e.g., value placed on research evidence in decision making). Conclusion The results of this study suggest that under certain conditions tailored, targeted messages are more effective than knowledge brokering and access to an online registry of research evidence. Greater emphasis on the identification of organizational factors is needed in order to implement strategies that best meet the needs of individual organizations. Trial Registration The trial registration number and title are as follows: ISRCTN35240937 -- Is a knowledge broker more effective than other strategies in promoting evidence-based physical activity and healthy body weight programming?
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              Public health asks of systems science: to advance our evidence-based practice, can you help us get more practice-based evidence?

              Public health asks of systems science, as it did of sociology 40 years ago, that it help us unravel the complexity of causal forces in our varied populations and the ecologically layered community and societal circumstances of public health practice. We seek a more evidence-based public health practice, but too much of our evidence comes from artificially controlled research that does not fit the realities of practice. What can we learn from our experience with sociology in the past that might guide us in drawing effectively on systems science?
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                Author and article information

                Contributors
                (519) 888-4567 , j3boyko@uwaterloo.ca
                Journal
                Can J Public Health
                Can J Public Health
                Canadian Journal of Public Health
                Springer International Publishing (Cham )
                0008-4263
                1920-7476
                19 November 2018
                19 November 2018
                2019
                : 110
                : 1
                : 103-113
                Affiliations
                [1 ]ISNI 0000 0000 8644 1405, GRID grid.46078.3d, Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, , University of Waterloo, ; 200 University Avenue West, Waterloo, N2L3G1 Canada
                [2 ]ISNI 0000 0000 8644 1405, GRID grid.46078.3d, School of Public Health and Health Systems, Faculty of Applied Health Sciences, , University of Waterloo, ; Waterloo, Canada
                [3 ]Program Training and Consultation Centre, Toronto, Canada
                [4 ]ISNI 0000 0001 1457 1558, GRID grid.484022.8, Canadian Partnership Against Cancer, ; Toronto, Canada
                Article
                153
                10.17269/s41997-018-0153-3
                6335370
                30456744
                © The Author(s) 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Funding
                Funded by: Cancer Care Ontario (CA)
                Funded by: FundRef http://dx.doi.org/10.13039/501100000015, Canadian Cancer Society Research Institute;
                Award ID: 2011-701019
                Categories
                Mixed Research
                Custom metadata
                © The Canadian Public Health Association 2019

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