Purpose: Considerable resources are spent on research to establish what works to improve public health. If these findings are used, better health outcomes can follow, but we know that they are not always used. In public health, the use of evidence is particularly difficult. The evidence is often patchy, or created in different settings, and may not ‘fit’, making it difficult to know what to do locally, when planning or commissioning services. Research suggests that evidence use is a social and dynamic process, not a simple application of research findings. Contextual pressures, including limited resources, political pressures, local traditions, can shape what is possible. We know little about the conditions which make the use of evidence likely. This research investigated these issues.
Design/Approach: We undertook two qualitative in-depth case studies in two sites, one in England and one in Scotland to explore how research evidence and other types of information are used to address alcohol-related harms. Fieldwork took place January 2012 to November 2013 against the backdrop of significant NHS reforms in England. We worked in co-creation with our case study partners in three ways: our partners picked the case study topic; they could take part in the research process; and participate in analysis of emergent findings through joint interpretation meetings, if they so wished. Our English partners picked ‘reducing maternal alcohol consumption; and our Scottish partners picked ‘alcohol licensing’ as the research topics. Through purposive sampling we interviewed key stakeholders (69 interviews); carried out 2 focus groups; observed 14 decision-making meetings and examined accompanying documentation. To share our findings and to explore how the findings applied elsewhere (transferability) a modified 2-stage Delphi process was issued. This was used to prompt discussion in a national seminar.
Findings: Research evidence, local data and statistics are pulled into organisational decision-making at different times. Strategic policy and planning documents (including the JSNA) are updated at regular intervals and pull in the latest research evidence. Local data highlights problematic issues, their prevalence and trends over time to set local priorities. In this important way, action within the organisation that falls out of these is evidence-informed. The evidence base provides a starting place, raises awareness but rarely directly influences action directly. The impact of research evidence may be more evolutionary than revolutionary. Beyond this, research evidence use is largely a person dependent system, where it is up to specific commissioners and their partners to decide what action to take. They take into account their own local knowledge, professional expertise, and local testimony – a wide variation in what counts as ‘valid knowledge’ to explore the acceptability, and feasibility of any actions proposed. Organisations have created roles to gather, collate and interpret external information sources, but there is not always a specific requirement to use this. Some public health research is seen as unduly complicated, dull, out of date with no actionable messages. We found if evidence is short, snappy, relates to local context, has saliency and immediacy, and is supported by local champions, it is more likely to be used. For example, people with power and credibility in an organisation who advocate evidence use.
Project award: £304,774
Project dates: From December 2011 to December 2013
Practical implications: It is difficult to directly attribute research efforts to specific outcomes. The following outcomes, reported by case study partners, may have resulted from their participation in the research. In the Scottish case study site, there are plans to address membership and operation of the local Licensing Forum to enable ‘more constructive conversations’ to take place. Increased partnership working was observed which partners felt ‘would not have happened as quickly if it had not been for this process’. There are plans to appoint a jointly funded post to support input of health evidence into the licensing process to address the gaps in the flow of evidence identified.
In the English case study site, the study confirmed the existence of gaps in local intelligence. Local providers undertook work to improve their data collection systems to enable better understanding of maternal alcohol consumption before, during and after pregnancy. Research was commissioned to explore the views of midwives and pregnant women to inform services. Some participants reflected that their involvement in the research prompted them to reflect differently, informing how they allocated roles and responsibilities in their team: ‘Not just in meetings, but outside meetings, it prompted a light-bulb moment for some’.
Findings from the study were shared, and their implications discussed, with case study partners at local workshops, and with other policy, practice and academic colleagues at national and international events: the second annual conference on knowledge exchange in public health in Holland (April 2013), the UKCRC Public Health Research Centres of Excellence Conference in Cardiff (July 2013), Teesside University Qualitative Researchers Forum (2013), the Scottish Public Health conference in Glasgow (November 2013), Fuse Knowledge Exchange seminar (December 2013), a Fuse Quarterly Research Meeting (January 2014), in Leeds (May 2014), and at the first International Conference on Realist Approaches to Evaluation and Synthesis: Successes, Challenges & the Road Ahead, 27-30 October 2014, Liverpool.
Project outputs: The full report will be available on the NIHR website: Rushmer et al (2014) Research utilisation and knowledge mobilisation in the commissioning and joint planning of public health services and interventions to reduce alcohol related harms - a study in the co-creation of knowledge through case studies. Final Report in Production Reference: 09/1002/37
Further details about the study can be found on the NIHR project page.
Professor Rosemary Rushmer, Teesside University, firstname.lastname@example.org (Principal Investigator)
Mandy Cheetham, Teesside University, email@example.com
Peter Van der Graaf, Teesside University, P.Van.Der.Graaf@tees.ac.uk
Karen McCabe, Sunderland University, firstname.lastname@example.org
Purpose: Despite the rapidly growing market and media reports of serious adverse events associated with their consumption, research into the use and effects of energy drinks is sparse. Temporary benefits for adults may include increased cognitive performance, enhanced mood, and promotion of wakefulness. However, anecdotal evidence suggests that children who regularly consume energy drinks can become dependent on them and even moderate consumption may be detrimental. There are likely to be health implications associated with excessive caffeine and sugar intake, such as caffeine withdrawal, sleep disruption, dental erosion and type 2 diabetes. There exists a need to synthesise and add to the evidence base on the effects of energy drinks on young people’s health and wellbeing. Qualitative studies have tended to focus on the use of energy drinks with alcohol and to explore the perceptions of university or college-age students. Further research is needed to capture the views and experiences of those under 18 years of age, in a UK context, and without the emphasis on alcohol. This is crucial given that survey results indicate average consumption of energy drinks by children and young people in the UK to be higher than other European countries.
A multi-disciplinary mixed methods approach is being used, consisting of three work packages:
The study findings and their implications will be discussed at a participatory workshop in the local community, before being written up in appropriate formats and shared widely with policy-makers, practitioners and academics interested in understanding the use of energy drinks by children and young people, and the potential impact on health and wellbeing.
Project award: £46,235
Funder: The Children’s Foundation (awarded £14,862 charitable funding towards research costs)
Project dates: From 1 June 2014 to 31 May 2015
Practical implications: The study has the potential to impact on policy, practice and future research locally and nationally in relation to the consumption of energy drinks by children and young people. A detailed report will be submitted to Durham County Council for use in local planning and decision-making in relation to the regulation of energy drinks, which might include a by-law restricting their sale to over 18s. Research summaries will be made available to schools and teachers for use in developing educational materials. Building on the collaborative relationships developed by the Principal Investigator (PI), the study team will feed back emerging findings on an ongoing basis, so that the research can be used to inform local policy and practice. In turn, these stakeholders will guide the policy and practice options to be explored in the participatory workshop. It is anticipated that the findings of this small-scale study will be used to inform the development of one or more larger-scale funding proposals in order to achieve wider impact on children and young people’s health and wellbeing.
Further details about the study can be found on the Centre for Public Policy and Health pages of the Durham University website.
Purpose: Making Every Contact Count is a strategy which encourages all staff working in public sector organisations to consider that every contact they have with a patient, client or service user has the potential to improve the health and wellbeing of the individual or their community. Making Every Contact Count is a mechanism for providing evidence-based brief advice, brief interventions or signposting to other sources of support for a range of issues which affect health and wellbeing.
The Wanless report in 2004 set out the benefits that the healthcare system and individuals could obtain from becoming ‘fully engaged’ in their own health. It has since become clear that more can be done to improve the health of individuals and support them in making healthy lifestyle choices. In recognition that healthier lifestyles improve health and reduce the chance of developing chronic illness, such as diabetes, coronary heart disease, cancer and stroke, public health has become everybody’s business.
This project aims to improve the health and wellbeing of the people of the North East through supporting the implementation of Making Every Contact Count within public sector organisations to encourage staff to deliver evidence-based brief advice, brief interventions or signposting.
Design/Approach: This project involves working with four partner organisations, two NHS Foundation Trusts and two local authorities, to implement and evaluate Making Every Contact Count. The first stage involved discussions with senior staff in these organisations to identify key priorities within the organisations and to identify those members of staff who are best placed to use Making Every Contact Count. All identified staff are receiving training in brief advice and signposting to encourage them to offer these to their patients, clients or service users. A smaller group of staff from each organisation will then go on to attend a two day course in brief interventions, delivered by HealthWORKS Newcastle.
The final stage of the project is to evaluate how Making Every Contact Count is implemented in each of the partner organisations. The evaluation will identify whether, following the programme of skill development and organisational support, staff in each organisation use the principles of Making Every Contact Count with patients, clients and service users and to identify those factors which help or hinder this. All staff completing sessions on Making Every Contact Count will be invited to complete a questionnaire immediately after the training and one month later to gather their views on the strategy, whether they are using it to initiate health-related conversations or signpost people to services and what might prevent them from doing so. Qualitative interviews will assess the impact of the project from the perspectives of senior staff in each organisation through exploring what has worked, what has not worked and how it has impacted on their organisation and with frontline staff to further explore facilitators and barriers.
Findings: Working with senior staff in each partner organisation to identify key priorities for their organisation and development of individual project plans at each site has ensured that the Making Every Contact Count strategy has been approved at a senior level at each project site. Early involvement of key stakeholders in identifying how the project is to operate in each organisation has identified the level to support and training required by frontline staff and what support sessions need to cover to allow staff to feel comfortable and confident in delivering brief advice and brief interventions, including the need to contextualise Making Every Contact Count with low intensity skill development sessions prior to more in-depth training in brief interventions. Full findings of the evaluation will be available in April 2015.
Project award: £100,000
Project dates: From 1 April 2014 to 31 March 2015
Practical implications: The existing evidence base for brief interventions is extensive and these findings will demonstrate how such interventions can be embedded within organisations. This project will identify what is needed within an organisation to support the spread and adoption of evidence based interventions, including engagement of senior staff, changes to policies and procedures and the development and use of skills and knowledge by staff to support health improvement and behaviour change. A full report, describing the findings of the project will be made available and findings will be disseminated at an event in Spring 2015.
The evaluation will allow comparisons to be made both within and between organisations. This will identify issues which may be common to all and those factors which hinder or support implementation with specific staff groups. These findings can be adopted by other organisations to develop the skills and resources needed to improve the health and wellbeing of their patients, clients or service users through the use of evidence-based interventions.
Cultural adaptation of the ‘New life, New you’ behavioural intervention for prevention of type 2 diabetes in Black and minority ethnic populations in an area of social deprivation
Last modified: Tue, 12 Jan 2016 10:55:05 GMT