Evidence-informed public health decision-making in local government

Deposited with permission of the author. © 2011 Dr. Rebecca ArmstrongEvidence-informed decision-making is an emerging area of interest within public health. Debates have moved beyond what constitutes evidence towards exploring ways in which a range of evidence can be used to inform decisions. Strategies to facilitate this process, often referred to as knowledge translation (KT), have been used in clinical settings and are increasingly being applied to public health. However, little is known about the effectiveness of such strategies as applied to this context. This thesis, using Victorian local government as a case study, explores the potential of KT strategies to facilitate evidence-informed decision-making (EIDM). The thesis aimed to address 5 key research questions: 1. What KT strategies are described in the literature? 2. What international research has been conducted to explore the effectiveness of these strategies? 3. What types of evidence are used by Victorian local governments and how is it used within the context of decision-making? 4. What KT strategies are most applicable to Victorian local governments to support EIDM? 5. How might these strategies be operationalised and what are the implications for evaluation? In order to answer these questions the thesis comprises three main studies: a systematic review of the effectiveness of knowledge translation strategies; a statewide survey of Victorian local governments; and a qualitative study exploring decision-making processes in Victorian local government. The systematic review confirmed assertions that there is limited evidence of the effectiveness of knowledge translation strategies in public health settings. Only one controlled study was identified which found that targeted messages show potential for increasing research utilisation. The statewide survey provided an insight into the breadth of definitions applied to evidence within local governments. A range of influences on decision-making processes were identified. The barriers and facilitators to EIDM were generally consistent with previous literature. The qualitative study provided an in-depth exploration of the decision-making processes that exist within local government. These included influences that impact directly on decisions and those that appear to influence the decision-making processes indirectly. A range of options for facilitating decision-making emerged from both the statewide survey and the qualitative study. The thesis concludes by outlining an intervention framework for testing knowledge translation strategies within this context. This framework is the basis of KT4LG, an exploratory cluster randomised controlled trial (RCT) being implemented in Victoria, Australia. As one of few studies in this area, this thesis makes a unique contribution to the national and international literature on the potential of knowledge translation strategies to facilitate evidence-informed decision-making