Reversing the pipeline? Implementing public health evidence-based guidance in english local government.
Reversing the pipeline? Implementing public health evidence-based guidance in english local government.
复制标题
DOI：
10.1186/s13012-017-0589-5
复制
发表时间：
2017-05-12
期刊：
影响因子：
--
通讯作者：
Michie S
中科院分区：
文献类型：
--
作者：
Atkins L;Kelly MP;Littleford C;Leng G;Michie S
在英国，许多公共卫生职能的责任在2013年从国家卫生服务(NHS)移交给了地方政府；这是一个非常不同的政治背景，没有NHS的政策和实践历史被循证指导所告知。这一举措带来的一个问题是，基于证据的指导方针是否会被视为相关、有用和可在地方政府内部实施。这项研究调查了在地方政府背景下实施国家循证公共卫生建议的三个方面：对实施的影响，指南被认为有多有用，以及线性证据-指南-实践模式是否被认为是相关的。31名议员、公共卫生总监、副主任和官员以及其他地方政府工作人员接受了采访，了解他们实施循证指导方针的经验。访谈被告知，并使用行为理论模型(COM-B；能力、机会、动机-行为)进行分析。预算、能力和政治影响等背景问题是对执行工作的重要影响。有人认为准则的用处有限，有人对建议过于抽象、缺乏针对性和没有处理复杂情况或当地变化表示关切。当地证据被视为最好的起点，而不是由传统的线性“证据-指南-实践”模式产生的以证据为基础的指导。当地证据不仅被用来为建议提供背景，而且当建议与当地证据相冲突时，还用来取代建议。地方政府用户不一定认为国家指南适合地方一级的目的，结果是地方证据往往胜过以证据为基础的指南。因此，在制定指南的传统模式与在地方政府工作的公共卫生决策者和从业人员的需求之间存在着紧张关系。需要解决这一紧张局势，以促进执行。实现这一目标的一种方式是逆转或重新设计制定指南的传统渠道，从当地的需要和有效的当地做法实例入手，而不是从从国际科学文献中综合的有效性证据开始。或者，或许除此之外，关于研究证据相关性的培训应该成为当地政府工作人员和议员的例行公事。本文的在线版本(doi：10.1186/s13012-0170589-5)包含补充材料，授权用户可以使用。
In the UK, responsibility for many public health functions was transferred in 2013 from the National Health Service (NHS) to local government; a very different political context and one without the NHS history of policy and practice being informed by evidence-based guidelines. A problem this move presented was whether evidence-based guidelines would be seen as relevant, useful and implementable within local government. This study investigates three aspects of implementing national evidence-based recommendations for public health within a local government context: influences on implementation, how useful guidelines are perceived to be and whether the linear evidence-guidelines-practice model is considered relevant. Thirty-one councillors, public health directors and deputy directors and officers and other local government employees were interviewed about their experiences implementing evidence-based guidelines. Interviews were informed and analysed using a theoretical model of behaviour (COM-B; Capability, Opportunity, Motivation–Behaviour). Contextual issues such as budget, capacity and political influence were important influences on implementation. Guidelines were perceived to be of limited use, with concerns expressed about recommendations being presented in the abstract, lacking specificity and not addressing the complexity of situations or local variations. Local evidence was seen as the best starting point, rather than evidence-based guidance produced by the traditional linear ‘evidence–guidelines–practice’ model. Local evidence was used to not only provide context for recommendations but also replace recommendations when they conflicted with local evidence. Local government users do not necessarily consider national guidelines to be fit for purpose at local level, with the consequence that local evidence tends to trump evidence-based guidelines. There is thus a tension between the traditional model of guideline development and the needs of public health decision-makers and practitioners working in local government. This tension needs to be addressed to facilitate implementation. One way this might be achieved, and participants supported this approach, would be to reverse or re-engineer the traditional pipeline of guideline development by starting with local need and examples of effective local practice rather than starting with evidence of effectiveness synthesised from the international scientific literature. Alternatively, and perhaps in addition, training about the relevance of research evidence should become a routine for local government staff and councillors. The online version of this article (doi:10.1186/s13012-017-0589-5) contains supplementary material, which is available to authorized users.