Evidence use in public health : case study on the decision to reopen K-12 public schools during the COVID-19 pandemic in British Columbia

Introduction: The current COVID-19 pandemic has emerged as the most urgent and challenging public health issue of our time. Public health decisions on how to curb infection rates have been required in the face of limited and sometimes contradictory evidence. There is currently limited understanding of how decision-makers use evidence in public health practice. This thesis aimed to 1) identify the types of evidence that public health decision-makers considered and 2) determine how evidence was weighed for the provincial decision to reopen K-12 public schools in British Columbia (BC) from March to June 2020. Methods: A qualitative, two-phase, multiple-methods study design was employed. Phase 1 included an organizational map, timeline of key events, and document analysis. Phase 1 informed the context and generated preliminary results. Phase 2 consisted of semi-structured key-informant interviews (n = 6) with senior public health and education decision-makers from BC to understand their perspectives on the use of evidence for the K-12 school reopening decision. Results: The organogram and timeline illustrated the nuanced relationships that existed between public health and education officials in addition to the small number of individuals with decision-making authority. The 62 documents included in the document analysis (12 official documents, 34 Twitter posts, and 16 newspaper/print media) found science and research to be the primary sources of evidence, with public needs and stakeholder engagement also being considered. Key-informant interviews reported reliance on practitioner expertise, observed and predictive epidemiological data locally and globally, and public needs (of children, parents, and teachers) for the reopening decision. The initial uncertainty of COVID-19 placed significant weight on scientific input. The context of BC and institutional trust were additional factors that influenced the reopening of K-12 public schools. Conclusion: This study highlighted that the initial uncertainty of COVID-19 made it challenging to make decisions based on evidence. This study concluded that scientific findings were the main source of input guiding the K-12 school reopening. However, public needs, experience and expertise, and contextual factors such as BC’s geography and institutional trust were all additional identified sources of evidence that was considered for the K-12 school reopening decision.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat