Cultures of evidence among decision makers in non-health sectors: systematic review of qualitative evidence

Abstract

BackgroundMany non-health public policy sectors might have effects on population health outcomes. Views of decision makers about research evidence are less well understood in these sectors than in health care or public health. With the recent move of public health in England to local authorities, there is a need to investigate the cultures of evidence in other policy sectors. MethodsWe undertook a systematic review of qualitative evidence. 28 database sources were searched for both published and unpublished work: Applied Social Sciences Index and Abstracts, Campbell Library, CENTRAL, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Conference Proceedings Citation Index—Science, Conference Proceedings Citation Index—Social Science and Humanities, Copac, Criminal Justice Abstracts, Database of Abstracts of Reviews of Effects, EconLit, Enviroline, Health Technology Assessment, Medline, Medline In-Process, National Criminal Justice Reference Service, National Health Service Economic Evaluation Database, OAIster, OpenGrey, PAIS International, PsycINFO, Science Citation Index, Social Care Online, Social Policy and Practice, Social Science Citation Index, Social Services Abstracts, Transportation Research Information Services Database, and Zetoc. The searches were done in October, 2012, and were not limited by date. The searches located 13 131 records. Studies were included if they encompassed local policy makers or practitioners in transport, housing, urban planning and regeneration, crime and policing, or licensing; and reported qualitative data on views, beliefs, or experiences of research evidence. Study quality was assessed with the instrument in the National Institute for Health and Care Excellence Public Health methods manual. Study findings were synthesised with a thematic analysis approach with EPPI-Reviewer 4 software. The protocol for this review can be found on the School for Public Health Research website: http://sphr.lshtm.ac.uk/our-research/publications/projects/. Findings16 studies were included. Decision makers use many different sources of information to inform decisions, many of which are not research evidence, as traditionally conceived. Several factors affect decision makers' use of evidence, including practical issues such as capacity and organisational factors. However, the relevance and usefulness of research studies seem to be more important; much research is seen as unable to show the complexity of practice and as preoccupied with theoretical concerns to the exclusion of practical applicability. The credibility of evidence is also important, but often derives mainly from the personal or institutional authority of those producing it. The scope of decision making is often constrained by political feasibility or acceptability, or by legislation or guidance, which means that the use of evidence may not be practicable. Local decision makers seem to mainly use evidence tactically to support policy choices and are often sceptical about the evidence-based policy agenda. InterpretationCompared with health care or public health, cultures of evidence in non-health sectors present different issues, which may lead to problems for public health decision makers working with colleagues in other sectors or advocating for policy-level interventions to promote health. Health practitioners and policy makers should take into account the differing ecologies of information in other sectors. Researchers may also benefit from taking a broader perspective on evidence use, which takes into account the whole decision-making process, and the interaction of academic research with more informal and situated forms of knowledge. Linear models of knowledge translation may not capture the complexity of potential relations between knowledge and practice and the wide variation in the understanding of decision makers of the concept of evidence. The findings call into question the assumption that increasing the uptake of research evidence is likely to lead to better decisions. FundingThis work was supported by the National Institute for Health Research (NIHR)'s School for Public Health Research. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health.