A population health approach uses evidence to assess health, identify priorities, and develop strategies to improve health.
What is evidence-based decision making?
Evidence-based decision-making refers to an approach in which a body of information is put through a broad critical review process. This means that every decision should be justified by reference to the best available evidence and reasoning. Evidence, when used with good reasoning and principles of appraisal, answers the question “Why did you decide that?”
- What evidence will be used?
- What evidence-based interventions fit both the health issues and the context?
- Who will the knowledge exchange strategy reach and how will it reach them?
A) What evidence will be used?
There are differences in opinion about what represents effectiveness and what evidence is. Politicians, economists and budget managers, the target population, academic researchers, and practitioners often disagree on the way in which effectiveness is concluded. These different perspectives are reflected in the current wide range of methods and measures used to establish effectiveness.
Randomized control trials, systematic reviews or single evaluations can be considered evidence of effectiveness, depending on the definition of ‘effective’. Cost-benefit analysis, considered by some to be the ‘gold standard’ in health promotion effectiveness evidence, are rarely conducted or available; there are, however, a growing number of synthesis reports available (e.g., The Evidence of Health Promotion Effectiveness by the International Union for Health Promotion and Education) which demonstrate that these investments in health do pay dividends and have clear relevance in health, social, economic and political terms.
An ongoing challenge is to develop ever more reliable and valid measures of health intervention success and to improve the quality and range of evidence available to guide decision making.
B) What evidence-based interventions fit both the health issues and the context?
There are a number of collections of recommended interventions, based on various review methodologies. The Canadian Best Practices Portal Intervention database is one source that incorporates the interventions of many other collections.
Resources to Increase Understanding:
What are evidence-based approaches and interventions?
- Best Practices Selection Process – Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention
- Research Tested Intervention Programs Review Criteria – National Cancer Institute (U.S.)
- Evidence- based Information Package Creation Process – Canadian Cancer Society, Manitoba Division
- Program Assessment Tools – Towards Evidence Informed Practice Project, Ontario Heart Health Resource Centre
C) How long will the knowledge exchange strategy reach and how will it reach them?
A knowledge exchange strategy is a system for tracking and reporting evidence and its implications to policy makers, health practitioners and the public, to ensure that evidence informs decision-making. To do this effectively, the strategy must identify who needs what information by when, for what purpose. This information can help to make good decisions about how to engage decision-makers.
How will evidence-based decision-making be accomplished?
3.1 Use best evidence available at all stages of policy and program development
To make sure the best evidence available will be used:
- Consider all types of evidence, formal and informal, quantitative and qualitative.
- Use the expertise of analysts, decision makers, community organizations and others who gather or work with research and other types of evidence.
- Use evidence that is current.
- Consider the best evidence at all stages of decision-making.
- Select data systematically and transparently, in order to minimize biases. A population health approach clearly explains its methods for including or excluding specific evidence from decision-making.
3.2 Explain criteria for including or excluding specific evidence
Acknowledge the limitations of data. For example, outcome data may be incomplete because, in many cases, ten or more years are required to realize the benefits of some investments in health promotion and disease prevention. Policies and programs should be developed on the basis of logic and common sense, but in some cases, it is necessary to admit that the evidence is lacking and that the recommendations might not have the desired effects. In these cases, it is important to avoid the temptation to make decisions based solely on what evidence is easiest to collect.
3.3 Draw on a variety of data
A population health approach draws on the full range of data types — both qualitative and quantitative.
Data types include:
- environmental data
- lifestyle data
- vital statistics data
- social and economic data
- epidemiological data
- health systems data
- consumer information
A population health approach also relies on diverse data sources, including:
- census records
- vital events registries
- regulatory or quasi-regulatory systems.
A population health approach supports research that covers the full spectrum of issues that affect health and well-being.
Evidence to Support Decision-Making:
What data is available on evidence-based health promotion approaches?
- The Evidence of Health Promotion Effectiveness – International Union for Health Promotion and Education
- Developing a Canadian Economic Case for Financing the Social Determinants of Health – Canadian Policy Research Network
3.4 Generate data through mixed research methods
In situations of insufficient evidence, it may be necessary to resort to other approaches to justify the use of resources for population health; these approaches can include expert opinion, trial programs with mid-term evaluations, and risk-based assessments.
Specific methods for generating evidence include:
- randomized trial studies
- case studies
- risk/benefit analysis
- population polls
- forecast modeling
- economic methods, such as cost-benefit and cost effectiveness analyses.
3.5 Identify and assess effective interventions
There are a number of online inventories of effective interventions. Make sure that the effectiveness criteria used for the inventory matches up with the standards in the planning process underway.
Prioritize possible interventions using the decision-making process outlined in Key Element One, and the knowledge of health issues, context, and determinants gained in Key Elements one and two.
Evidence to Support Decision-Making:
What sources of evidence-based interventions are available?
- Best Practice Interventions Database – Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention, Public Health Agency of Canada
Resources that Build Capacity:
What decision-making frameworks or guides can help facilitate decisions about which interventions to support or implement?
- Intervention Selection and Adaptation Checklist – The Health Communication Unit
- Can I use this Evidence in my Program Decision? Assessing Applicability and Transferability of Evidence – National Collaborating Centre for Methods and Tools
- Improving Population Health: The Uses of Systematic Reviews – Milbank Memorial Fund, in collaboration with the Centres for Disease Control and Prevention
3.6 Spread the research findings and make them easier to use
As with all communication activity, it is important to identify and understand the audience, the goals and objectives, the ways and means to reach them, and the key messages before developing, testing and finally spreading the information. Building in the opportunity for feedback and strategy refinement is important.
Important decision-makers to engage include:
- Government departments emphasizing health and social services, which are potential collaborators
- Policy organizations conducting similar research, which have established communication and networks with decision makers
- International organizations, which add credibility and prestige
- Professional organizations (particularly in the health field), which provide access to new audiences
- The general public, who can serve as advocates to the decision makers
- Community organizations, which can provide community support and assist in spreading information
- The business community, which is concerned with broad social and economic issues
- Regional health authorities and health care providers, who allocate health care services and can identify relevant targets for information and service delivery.
Methods that may help meet decision-makers’ needs for certain types of information at specific times include:
- using web sites effectively
- building a research transfer strategy into each project
- establishing formal links and partnerships with policy- and decision-makers
- employing specialists in research transfer
- sponsoring investigations into the transfer of research findings.
Resources that Build Capacity:
What decision-making frameworks or guides can help develop an effective knowledge transfer strategy?
- An Environmental Scan of Research Transfer Strategies – Canadian Institute for Health Information
- Knowledge Transfer and Exchange resources – Canadian Foundation for Healthcare Improvement
- Knowledge exchange in Health Promotion: Theoretical Models and Examples – Chronic Disease Prevention Alliance of Canada
What do you have at the end of Key Element 3?
- A statement of principles related to the accepted and required evidence for decision-making.
- A list of potential interventions to consider.
- A well-considered Knowledge Exchange strategy.
How does this relate to the other Key Elements?
- It identifies multiple choices for action (Key Elements 1 and 2).
- Supplements existing information by means of additional evidence-gathering (Key Elements 1 and 2).
Why is this Key Element important?
- It provides a measure of accountability, which is important in an environment increasingly pressured to base decisions on evidence.
- It can invalidate previously accepted ways of assessing and intervening, and replace them with new ones that are more powerful, more accurate, more beneficial, and safer.
- It supports the development of new models and tools, such as “best practices” guidelines, that help critically review data on an ongoing basis.
Examples Illustrating Application:
What is an example of a group, organization or government that has supported the adoption of evidence-based approaches and interventions?