Evidence-informed Practice Research Articles

School Health Research Network Wales: Development, implementation & contributing to public health policy

Abstract The School Health Research Network (SHRN) was launched in Wales in 2013 as a strategic partnership between Cardiff University, Welsh Government, Public Health Wales (part of the National Health Service) and Cancer Research UK (a research-focused charity). SHRN is led by a multidisciplinary team in the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) at Cardiff University. SHRN aims to: 1) provide health and well-being data from a biennial survey for national, regional and local stakeholders, including schools; 2) co-produce school-based health improvement research for Wales; and 3) build capacity for evidence-informed public health policy and practice. Building on and integrating with HBSC infrastructure, a transdisciplinary complex adaptive systems (T-CAS) approach has been employed to develop SHRN, for a national culture of prevention for school health improvement. The T-CAS approach focuses on key stages and activities within a continuous network cycle to facilitate systems level change. The five key stages involve establishing transdisciplinary strategic partnerships, resource investment and linkage, network development, coproduction activities and reciprocal outputs. SHRN has successfully established new cross-sector stakeholder partnerships at multiple levels, and embedded network activity within national and local policy. It has established a programme of school engagement activities to secure membership of 212 (100%) secondary schools in Wales and building on HBSC systems and structures has developed a national data infrastructure with the biennial collection of student and school-level health and wellbeing data. SHRN has co-produced scientific evidence and established a new data-led planning system (e.g. 56 research studies co-produced). It has also secured sustainability funding from health and education, while developing research capacity to generate evidence and support professional practice.

Local Authority Champions of Research: a mixed methods proof of concept study

BackgroundThe transition of public health from NHS to local government in England raises new challenges for evidence-informed policy and practice in the context of austerity. The aim of the Local Authority Champions of Research (LACoR) study is to test new methodological approaches to evidence use in local government to address public health priorities, using a whole-system approach. MethodsThis collaborative, UK-based, mixed-methods study includes a rapid review of published literature; a scoping survey of current practice in UK local authorities (LAs) supporting evidence-informed decision making; workshops held in three case study sites with LA staff (n=49); qualitative interviews with stakeholders (n=14), and learning from an embedded researcher working in local government. Participants gave written consent to take part. Workshop and fieldwork notes were written up and interview data were recorded and transcribed. Data generated were combined and analysed using thematic analysis. A prototype logic model will be shared, illustrating the current, and potential, application of research in local government. This study was approved by the Faculty of Medical Sciences Research Ethics Committee, part of Newcastle University's Research Ethics Committee. FindingsResults from the literature review and qualitative interviews will be presented alongside the logic model and practical examples of how a system-wide approach can promote evidence use in local government to improve population health and wellbeing. Our findings highlight a changing culture in local government, which requires a different approach from academia to take account of the multiple types of evidence used, a tendency to prioritise local data, and a desire for longer-term, collaborative relationships with academia. Greater use of co-located, embedded researchers was seen to facilitate understanding of the systems, structures, and political context of decision making in local government, drawing on the skills and expertise of LA staff. Despite pressures on capacity, there is willingness to engage in co-produced research studies that create space to work together to identify realistic evidence-informed solutions. InterpretationThe strength of this study is its transdisciplinary, collaborative approach, and methodological innovation. The findings have the potential to promote transformational change in both academia and local government, recognising that insights are gathered from a small number of LAs. The logic model will be tested and refined in further research. FundingThe Health Foundation.

Exploring substance use and mental health for minority transgender youth: Implications for advanced practice nurses.

Transgender youth, particularly if they are transgender female and of a minority racial or ethnic group (i.e., minority transgender youth [MTY]), are known to have higher incidence of new HIV infections, substance abuse, and suicidality when compared with cisgender youth. Mental health disparities and substance use among MTY, between the ages of 13-24 years, have been underexplored in the United States, although they have serious public health concerns contributing to morbidity and mortality. To examine the US literature to discover what is known about the intersection of substance use, mental health disorders, and associated health risks for MTY. An integrative review exploring experimental and nonexperimental research was conducted from 2010 to 2018 using Cumulative Index for Nursing and Allied Health (CINAHL), PsycINFO, and PubMed. Articles were selected if the research identified MTY, mental health and/or substance use risks, data-driven outcomes, or considerations that could potentially influence MTY outcomes. Ten articles were included in the final selection. All studies addressed mental health, substance use, and/or health risks, although many of the articles explored all transgender youth outcomes without a particular focus on MTY. Identified factors linked to poor health outcomes included socioeconomic vulnerability, substance use, mood disorders, self-harm, and risky sexual behaviors. The authors have provided recommendations regarding culturally appropriate, compassionate, evidence-informed practices for engaging MTY and their families to promote greater well-being for all youth, regardless of gender identity.

A practical guide to make the case for sustainable investment in well-being and health

Abstract Growing health, inequity, economic and environmental challenges threaten the well-being of present and future generations. Current investment policies and practices are unsustainable and result in high human, social, economic and environmental costs. Countries require the tools to build the case for investment in areas of greatest need by applying evidence-informed practice. A practical guide with tools and resources was developed on how to develop an evidence-informed product to make the case for investment in well-being and health equity. Stakeholder interviews with national and international experts in health policy, equity, economics and social sciences were conducted to inform the outline of the guide and identify enablers for creating evidence-informed products. An evidence review gathered tools and resources on how to translate and communicate public health evidence into policy and practice. An international cross-sector expert consultation assured relevance and transferability of the guide across countries, contexts and policies. The guide aims to prevent disinvestment in health and increase investment in prevention as well as mainstream cross-sector investment to target the wider determinants of well-being and health equity. It outlines how to synthesise, translate and communicate public health and health economic evidence into policy and practice and proposes a step-by-step approach following four key phases (i) project scoping and planning, (ii) evidence gathering, synthesis and design, (iii) dissemination and communication, (iv) monitoring and evaluation. The guide presents information to develop an evidence-informed product to make the case for sustainable investment in an innovative and informative way for use by a range of stakeholders. It accounts for policies and contexts and is communicated in a way that is accessible for decision-makers, easy to use and available as hard copy and interactive version. Key messages Investing in well-being and health equity drives and enables sustainable development. Making the case for investment in health equity requires a well-planned, evidence-informed approach.

Contraceptive counseling practices and patient experience: Results from a cluster randomized controlled trial at Planned Parenthood

ObjectivesSystematic reviews of contraceptive counseling interventions have shown inconsistent impact on patient outcomes. The current study assessed the effects of an evidence-informed contraceptive counseling staff training intervention on patient experience, contraceptive selection, and behavior over three months of follow-up. Study designWe randomly assigned 10 Planned Parenthood health centers in the Southeastern US to intervention (staff received contraceptive counseling training) and control (usual counseling) groups. From December 2016–June 2017, patients completed surveys immediately post visit (n = 756) and one and three months after. We compared differences in patients’ counseling experience (e.g., number of evidence-informed practices experienced, satisfaction with counseling), contraceptive selection, and behavior (e.g., method discontinuation, accurate pill use, condom use) between study groups using mixed effect models with health center specified as a random effect. ResultsSeven hundred and fifty-six participants completed the baseline survey; 579 (77%) completed one or both follow-up surveys. The intervention group was more likely to report experiencing all evidence-informed counseling practices (adj. Prevalence Ratio [aPR] = 2.27, 95% CI 1.27, 4.04) with less variation in the number of practices and higher satisfaction with their counseling than the control group (p < 0.01). We found no sustained differences in contraceptive behaviors at both one- and three-month follow-up. ConclusionsWe found immediate positive effects of the intervention on patients’ perceptions of their counseling experience and no differences in changes in contraceptive behavior over time between the study groups. ImplicationsEvidence-based strategies to improve the quality of contraceptive care and subsequent outcomes, while centering patients’ needs and preferences, are needed. The contraceptive counseling intervention offers a tool for increasing consistency in contraceptive counseling practices across health centers and improving patient satisfaction.

Digital entrepreneurship: An interdisciplinary structured literature review and research agenda

This paper provides a structured literature review of digital entrepreneurship to generate insights into recent developments in the field, critique the research to date, and identify opportunities for future research. We have applied the three aspects of critical research – insight, critique, and transformative redefinition – to analyse and synthesise the literature. We distil the definitions of the key constructs and identify three research development phases corresponding to practice development. Analysis of 133 scholarly articles by discipline, time, methodology, geography and theoretical focus informs that digital entrepreneurship research has been fragmented, divergent and slow to respond to practice. However, the field is now rapidly acquiring legitimacy and an identity, growing rapidly and is becoming more interdisciplinary. We explore how established views of entrepreneurial processes and clusters are being upended in a digital world. In outlining the future of the field, a preponderance of single case study and conceptual articles need to be supplemented with longitudinal, mixed methods, multiple case study and quantitative research. More integrative research, preferably presented as dynamic models, would advance the field. Design and action research output, and collaborations with practitioners will yield practice-driven insights. This paper will facilitate an interdisciplinary dialogue for evidence-informed policy and practice.

Evidence-informed policymaking: Modelling nurses' career pathway from registered nurse to advanced practice nurse.

To formulate, validate, and disseminate policy, modelling nurses' career pathway from registered to advanced practice nurse. The evidence-informed policy and practice pathway framework was utilized. Multiple methods were used, including scoping review of literature, consultation of key informants, survey study, and expert group round-table discussions during 5-year project between 2013 and 2018. Through (a) sourcing, (b) using, and (c) implementing the evidence, the expert group worked systematically to formulate a policy on a career pathway from registered to advanced practice nurse. The formulated career pathway includes three competence levels: registered nurse, specialized nurse, and advanced practice nurse, which includes the roles of nurse practitioner and clinical nurse specialist. In addition, validation and dissemination of the policy, as well as its effective implementation and the process of integrating it into practice, were examined. Evidence-informed policymaking is an effective, interactive way to work collaboratively in achieving consensus and translating knowledge into practice. The formulated policy will contribute to the increased awareness, acknowledgement, and implementation of the registered nurses' traditional and new roles within health care environments. Implementing and integrating the policy in national health care policy, legislation, education, and organizations across the country is a work in progress.

Social Constructionism and Social Care: Theoretically Informed Review of the Literature on Evidence Informed Practice Within the Professionalisation of Social Care Professionals Who Work with Children in Ireland

ABSTRACT The professionalisation of social care practice in Ireland, after a period of dormancy, has experienced rapid advancement toward statutory regulation and reform. Yet, the limited literature available in Ireland on the subject matter, almost exclusively predates these changes. This paper presents a theoretically informed commentary on the literature related to Evidence-Informed Practice (EIP) and professionalisation of social care professionals who work with children in Ireland. A key proposition of this paper is that rather than being distinct and autonomous, EIP may be most constructively understood as an integrated feature of professionalisation in social care. This is illustrated within themes identified in the body of literature related to EIP. Overall, the literature review in this paper is explicitly subjective, rather than systematic, and declared as operating broadly from a Social Constructionist orientation. The implicit Social Constructionist approach declared from the outset, is later overtly applied through a theoretical framework derived from Burr ([2015]. Social constructionism (3rd ed.). London: Routledge) and Gergin ([1985]. The social constructionist movement in modern psychology. The American Psychologist, 40(3), 266–275), to inform discussion on EIP within professionalisation of social care professionals. The intention is, that discussion will generate learning for practitioners seeking to improve practice with children in the field, by addressing some of the significant challenges and practice concerns identified in the former review. It is proposed that, because of its nature as a historically and culturally unique moment in time, intensifying professionalisation of social care in Ireland provides a valuable opportunity for practitioners seeking to improve practice with children. This opportunity lies in the potential for practitioners to use the process of professionalisation as a platform to compel higher standards for social care in Ireland, including better standards of EIP, through such measures as lobbying and advocacy work.

The feasibility of implementing education on older person care to practice on medical units: Nurses’ perceptions and the influence of practice context

As part of a larger primary study on evidence-informed practice with hospitalised older people, we aimed to (a) examine nursing staffs' perceptions of the interactive geriatric educational intervention and to explore how perceptions of their work context may influence their ability to enact the evidence-informed assessment and care approaches discussed during the educational sessions and (b) compare differences in perceptions of context between RNs, LPNs and HCAs. A survey-based evaluation that used both closed and open-ended questions was conducted as part of an interactive educational intervention on cognitive impairment and managing responsive behaviours. Data were gathered on participants' perceptions of the education intervention and organisational context. Findings from this study suggest when education is tailored to nurses' articulated educational needs, it is well received; however, barriers to implementation exist. Assessment of the context by using a standardised survey tool to get the nursing staffs' perceptions of organisational context revealed strengths in leadership support and day-to-day interactions with other nurses and healthcare professionals, but potential barriers related to lack of facilitation to transfer new knowledge into practice existed. Providing evidence-based education related to care of older patients and evaluating nursing staffs' perceptions of the education and their context has laid the groundwork for a long-term relationship with the managers and nursing staff on the participating medical units. Further investigation about how best to incorporate the facilitator role into the medical units to support evidence-based practices with older patients is warranted. IMPLICATIONS FOR PRACTICE: While nurses are receptive to new knowledge, the unpredictable workload of acute care creates challenges to implementing this new knowledge. Assessment of contextual factors that influence evidence-informed practice facilitates planning for implementation of new knowledge and support practice change.

Understanding the supports needed for policy implementation: a comparative analysis of the placement of intermediaries across three mental health systems

BackgroundIntermediaries are organisations or programmes that work between policy-makers and service providers to facilitate effective implementation of evidence-informed policies, programmes and practices. A number of intermediaries now exist in well-established mental health systems; however, research on them, and how they may be optimised to support implementation is lacking. This research seeks to understand the puzzling variation in the system placement of intermediaries supporting policy implementation in the mental health systems of Canada (Ontario), New Zealand and Scotland.MethodsUsing a comparative case study approach, the analytic goal was to compare intermediaries across jurisdictions and explain differences in their placement using explanatory frameworks from political science. Data for this analysis were derived from several sources, including key informant interviews, a literature search of published and grey literature on intermediaries and on policy implementation in mental health systems, a review of relevant policy documents and websites, as well as documents and websites relating to the various intermediaries and other interest groups within each system.ResultsThrough the analysis, we argue that the placement of intermediaries supporting policy implementation can be explained through an understanding of the political structures, the policy legacies leading to the current public/private mix of mental health service delivery, and the differing administrative capacities of mental health systems.ConclusionsThis research contributes to our growing understanding of policy-related intermediaries supporting implementation at scale and how we might build appropriate infrastructure in systems to support the implementation of policy and achieve better outcomes for citizens.

Principles of patient-centred care and barriers to their implementation: a case study of breast reconstruction in Australia.

"Patient-centred care" is widely promoted as an ideal goal of health care systems, but is often difficult to achieve in practice. This article has three aims: to develop an original set of generalisable patient-centred care principles (PCCPs); to identify barriers to the implementation of these principles in a real-world setting, using breast reconstruction (BR) services in Australia as a case study; and to document examples of successful patient-centred care in relation to BR. Semi-structured interviews (n = 90) were conducted with 31 breast and plastic reconstructive surgeons, 37 breast cancer health professionals and 22 women who underwent mastectomy as part of their breast cancer treatment and were dissatisfied with their BR experiences. Ten broad PCCPs were derived from our participant interviews. These principles comprised the following: maximising patient choice, access to services, patient and family support and appropriateness of information; minimising patient costs and physical and psychosocial morbidity; and facilitating informed decision-making, interdisciplinary patient management and evidence-informed practice. While the major barriers to the implementation of these PCCPs in relation to BR were resource driven, surgeon-related factors were also identified. These PCCPs highlight areas of need but also provide examples of high quality patient-centred care. They may help to guide a national discussion about minimum standards of BR practice, while allowing for some necessary regional and cultural variation. They also have the potential to be applied more widely to the provision of a range of health services within Australia or internationally.

Special Educational Needs Coordinators' Practice in England 40 Years on From the Warnock Report

The Special Educational Needs Coordinator (SENCO) role in England has been formally established since 1994 to support inclusion. In 2009 it became mandatory for every new SENCO in a mainstream school in England to gain a postgraduate qualification in special educational needs coordination within three years of taking up a post, which includes a compulsory practitioner research component. This study examined 100 assignment abstracts from 50 SENCOs submitted as part of the postgraduate qualification delivered in one university in England between 2015 and 2017. Data were analysed using thematic analysis in Nvivo and yielded four principles underpinning SENCO practice at pupil and whole school levels including diversity in SENCO practice, meaningful assessment, evidence-informed practice and evaluating impact. The findings are discussed in the light of developments in policy and practice in the education of pupils with special educational needs and/or disabilities since the Warnock Report in 1978.

A Centennial of Mary Richmond’s Social Diagnosis: A Celebration and Contemporary Assessment of a Seminal Work

Mary Ellen Richmond is often credited with developing social work as a profession in the United States. In this article, we focus on Richmond’s Social Diagnosis, revisiting this hallmark of social work practice a century after its publication and tracing its foundational ideas at the root of the conceptualization and practice of subsequent giants in social work. Our aim is to recenter and retrace these formative ideas so crucial to the origins of social work as a profession and its subsequent growth and development by examining Richmond’s understanding of social diagnosis, evidence-informed practice, and the helping relationship. A full century after the publication of Richmond’s far-reaching Social Diagnosis seems the most apposite time for such a review and revisit.

P59 EAT Family-Style Dining Intervention Improves Child Care Providers' Responsive Feeding Practices and Children's Dietary Intake

Objective To determine the impact of the Ecological Approach to (EAT) Family Style Dining intervention on childcare providers’ implementation of responsive feeding practices, children's knowledge and familiarity of fruits and vegetables (FV), and dietary intake. Use of Theory or Research EAT Family Style is guided by the socio-ecological theory and includes an implementation strategy, evidence-informed responsive feeding practices and a research-based coaching model emphasizing growth mindset thinking, goal setting and reflecting. Target Audience Childcare providers (n = 45) caring for children (three to five years old) from 11 childcare centers in Nebraska. Child-level data were collected from a sub-sample of 53 children. Program Description EAT Family Style Dining is a 14-week intervention consisting of seven interactive web-based lessons (two hours each) focused on: role modeling, peer modeling, sensory exploration, self-regulation, children serve themselves, praise and rewards, and family engagement. Providers completed one online lesson/week followed by a coaching session with an Extension educator. Evaluation Methods Implementation feasibility was evaluated by childcare providers completing the attention, relevance, confidence and satisfaction (ARCS) survey, along with a pre-post survey reporting knowledge, attitudes, and implementation of responsive feeding practices. Intervention effectiveness was evaluated by changes in children's knowledge and familiarity of FV and dietary intake which were measured using previously validated methods. Results The implementation strategy was feasible. Average ARCS scores for all seven lessons were 4.1 on a 5-point Likert scale. On average, providers’ knowledge, attitudes and implementation scores regarding responsive feeding practices increased from baseline to post-intervention by 22%, 27%, and 29.5% respectively. The intervention was effective. Children's knowledge score for FV [t (52) = 4.550, P P P P Conclusions Overall, the EAT Family Style Dining intervention is feasible in fostering childcare providers’ implementation of responsive feeding practices and provides preliminary evidence for positively impacting children's dietary intake. Funding USDA NIFA.

Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly.

IntroductionRoutine interventions in the practice of medicine often lack definitive evidence or are based on evidence that is either not high quality or of only modest-to-marginal effect sizes. An abnormal urinalysis in an elderly patient presenting to the emergency department (ED) with non-specific symptoms represents one condition that requires an evidence-informed approach to diagnosis and management of either asymptomatic bacteriuria or urinary tract infection (UTI). The emergency provider often will not have access to urine cultures, and the risks associated with antibiotic use in the elderly are not without potentially significant side effects.MethodsWe performed a historical and clinical review of the growing body of literature suggesting measurable differences in the systemic immune response manifest among patients with asymptomatic pyuria and UTI, including increases in the pro-inflammatory cytokine interleukin-6 and the acute phase reactant procalcitonin.ResultsSerum procalcitonin, a peptide that undergoes proteolysis into calcitonin, has been demonstrated to quickly and reliably rise in patients with severe bacterial infections, and may serve as a potentially sensitive and specific marker for identification of bacterial illness.ConclusionIn the absence of validated risk scores for diagnosing UTI in elderly patients presenting to the ED, there may be a role for the use of procalcitonin in this patient population.

Applying the Theoretical Domains Framework to understand knowledge broker decisions in selecting evidence for knowledge translation in low- and middle-income countries

BackgroundHealth-related organisations disseminate an abundance of clinical and implementation evidence that has potential to improve health outcomes in low- and middle-income countries (LMICs), but little is known about what influences a user decision to select particular evidence for action. Knowledge brokers (KBs) play a part as intermediaries supporting evidence-informed health policy and practice by selecting and synthesising evidence for research users, and therefore understanding the basis for KB decisions, can help inform knowledge translation strategies. The Theoretical Domains Framework (TDF), a synthesis of psychological theories, was selected as a promising analysis approach because of its widespread use in identifying influences on decisions to act on evidence-based healthcare guidelines. This study explored its application in the context of KB decisions regarding evidence for use in LMICs.MethodsThe study analysed data collected from participants of a 2015 global maternal and newborn health conference in Mexico. A total of 324 conference participants from 56 countries completed an online survey and 20 from 15 countries were interviewed about evidence use and sharing after the conference. TDF domains and constructs were retrospectively applied and adapted during coding of qualitative data to enhance understanding of the KB decision process in selecting evidence for action.ResultsApplication of the TDF involved challenges related to overlapping constructs, retrospective use, and complexities of global health settings and relevant knowledge. Codes needed to be added or adapted to account for how KBs’ internal reflections on external factors influenced their actions in selecting evidence to share and use, and the decisions they made during the process. Four themes of the rationale for changing the TDF were identified during analysis, namely Influences from Beyond the Organisation, Knowledge Selection as a Process, Access and Packaging of Knowledge, and Fit for Use.ConclusionsTheories of individual behaviour, such as those in the TDF, can enhance understanding of the decisions made by actors such as KBs along dissemination and knowledge translation pathways. Understanding how KBs reflect on evidence and interact with their environment has the potential for improving global dissemination efforts and LMIC-to-LMIC exchange of implementation evidence.

Evidence-Informed Policy and Practice in the Field of Education: The Dilemmas Related to Organizational Design

Evidence-informed policy and practice has been a trend as part of an effort to increase the use of research to improve education at all levels. In many countries, knowledge-brokering initiatives were established to stimulate links between research, policy, and practice. Drawing on a mapping of initiatives in seven countries, this article describes different organizational designs, and discusses potential dilemmas these might imply for the realization of these organizations’ roles. Given different interests involved, the article shows that organizational design is crucial for enhancing legitimacy. Findings indicate a trend toward locating the knowledge-brokering function in a combined policy–science logic.

Preventing pressure injury in nursing homes: developing a care bundle using the Behaviour Change Wheel

ObjectiveTo develop, with nurse specialists and nursing home care staff, a theory and evidence-informed pressure injury prevention care bundle for use in nursing home settings.DesignThe development of a care bundle.MethodsWe...

PROTOCOL: Evidence-informed practice versus evidence-based practice educational interventions for improving knowledge, attitudes, understanding, and behavior toward the application of evidence into practice: A comprehensive systematic review of undergraduate students.

PROTOCOL: Evidence-informed practice versus evidence-based practice educational interventions for improving knowledge, attitudes, understanding, and behavior toward the application of evidence into practice: A comprehensive systematic review of undergraduate students.

Better Government, Better Science: The Promise of and Challenges Facing the Evidence-Informed Policy Movement

Collaborations between the academy and governments promise to improve the lives of people, the operations of government, and our understanding of human behavior and public policy. This review shows that the evidence-informed policy movement consists of two main threads: ( a) an effort to invent new policies using insights from the social and behavioral science consensus about human behavior and institutions and ( b) an effort to evaluate the success of governmental policies using transparent and high-integrity research designs such as randomized controlled trials. We argue that the problems of each approach may be solved or at least well addressed by teams that combine the two. We also suggest that governmental actors ought to want to learn about why a new policy works as much as they want to know that the policy works. We envision a future evidence-informed public policy practice that ( a) involves cross-sector collaborations using the latest theory plus deep contextual knowledge to design new policies, ( b) applies the latest insights in research design and statistical inference for causal questions, and ( c) is focused on assessing explanations as much as on discovering what works. The evidence-informed public policy movement is a way that new data, new questions, and new collaborators can help political scientists improve our theoretical understanding of politics and also help our policy partners to improve the practice of government itself.