Article
Localizing Global Evidence: A Systematic Review on the Use of Research Evidence in Local and Regional Decision-Making-Processes in Public Health
Search Medline for
Authors
Published: | September 6, 2024 |
---|
Outline
Text
Background: Sub-national decision making on matters of public health, e.g., in regional or municipal public health services or local governments is crucial for improving public health and mitigating health related hazards. To increase effectiveness and avoid unintended adverse consequences, it is crucial to have these decisions to be based on the best available research evidence. While evidence-use on the national level has been explored in some more detail, the specific processes, barriers, and facilitators for the use of evidence in regional and local decision-making bodies on health is largely unexplored.
Methods: We conducted a systematic review to assess evidence utilization in local public health decision-making within OECD countries and to pinpoint enhancement strategies [1]. We searched the databases Embase, Medline, and Web of Science in November 2023. Additionally, we conducted a search in Google scholar in January 2024. Screening and data extraction was done in duplicate and independently by two experienced researchers. Both, qualitative and quantitative studies were considered for inclusion. Quality of the included studies was assessed using an adaptation of the Critical Appraisal Skills Programme tools for the respective study designs. Qualitative thematic synthesis was applied for synthesizing data.
Results: In total, we included 34 studies. Initial results show that local decision-making processes are shaped by a constellation of factors including thematic focus and scope of evidence utilization, and types of evidence employed, ranging from empirical data to best practices. Evidence syntheses in various forms were considered of particular importance to inform decision-making on local level. Repeatedly, research evidence was described as being used symbolically (e.g., for justifying pre-established decisions), rather than informing decision-making in a conceptual way. The extent to which evidence was integrated varied across contexts, influenced by political, societal, and individual factors. Barriers for evidence-use included aspects of acceptability (e.g., evidence conflicting with political opinions and ideologies), availability (e.g., lack of reliable evidence for context-specific questions), accessibility (e.g., paywalls, scientific jargon and language), and quality/usefulness of evidence. Research evidence was repeatedly characterized as not useful for local decision-making, due to differences in the population, intervention, comparison, or context limiting the transferability or applicability of the evidence to the specific local context. Furthermore, evidence-informed decision-making processes were found to be non-linear, characterized by various steps such as preparation, stakeholder engagement, translation, and networking.
Conclusions: Our preliminary findings underscore the complex, dynamic nature of decision-making processes and the need for nuanced approaches that consider local realities, local and transferable evidence, and multi-dimensional barriers and facilitators to evidence use. Beyond empirical evidence, numerous additional factors emerge as influential, with the acceptability, availability, accessibility, and quality of evidence acting as both barriers and facilitators to effective policy development. Future work will focus on refining our findings and collaborating with public health experts to translate them into practical strategies for local health policy development. To this end, we will discuss the findings with PHS experts in focus groups in fall 2024 to explore opportunities for more effective integration and application of evidence in local health policy and planning.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
References
- 1.
- Arnold L, Bimcok S, Vosseberg F, Stratil JM. Utilization of research evidence in local public health decision-making processes. In: Prospero. 2024. CRD42024502604. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024502604