Applying knowledge to problems has occupied the minds of great philosophers, scientists and other thinkers for centuries. In more modern times, the challenge of connecting knowledge to practice has been addressed through fields such as evidence-based medicine which have conceptualized optimal healthcare as integration of best available research evidence, clinical experience and patients' values [1]. Similar principles apply to evidence-based public policy, and literature in this field has been growing since the turn of the century [2]. The exponential rise in knowledge availability has greatly enhanced the 'supply' side of the evidence-into-practice equation – however, substantial gaps between evidence and practice remain [3]. Policymakers are therefore increasingly looking to academia to optimize evidence-informed policy. This article presents ten considerations for optimising evidence-based policy, drawn from experience in delivering applied behavior change research to government.
Intro -- Title Page -- About this Book -- Imprint and copyright information -- Contents -- Acknowledgements -- About the authors -- Prologue -- Preface -- Introduction -- Chapter 1: Awakening -- Profile. Harry Gordon: The editor's conscience -- Chapter 2: Money -- Profiles. John Cain and John Bolitho: Policy to last -- Profile. Joe Calafiore: Beyond insurance -- Chapter 3: Mortality -- Profile. Frank McDermott: Prevention and cure -- Chapter 4: Change -- Profile. Robert Doyle: Making government work -- Chapter 5: Impact -- Profile. Tony Walker: When time matters -- Profile. Mark Fitzgerald: Never standing still -- Profile. Peter Cameron: Counting and being accountable -- Chapter 6: Survival -- Profile. Belinda Gabbe: Lives worth living -- Epilogue -- Appendices -- References -- Index.
In: Kunstler , B E , Lennox , A & Bragge , P 2019 , ' Changing prescribing behaviours with educational outreach : An overview of evidence and practice ' , BMC Medical Education , vol. 19 , no. 1 , 311 . https://doi.org/10.1186/s12909-019-1735-3
Background: General practitioners (GPs), or family practitioners, are tasked with prescribing medications that can be harmful to the community if they are inappropriately prescribed or used (e.g. opioids). Educational programs, such as educational outreach (EO), are designed to change the behaviour of health professionals. The purpose of this study was to identify the efficacy of EO programs at changing the prescribing behaviour of GPs. Methods: This study included an evidence and practice review, comprising a rapid review supplemented by interviews with people who are familiar with EO implementation for regulation purposes. Seven databases were searched using terms related to health professionals and prescribing. Systematic and narrative reviews published in English after 2007 were included. Non-statistical analysis was used to report intervention efficacy. Three government representatives participated in semi-structured interviews to aid in understanding the relevance of review findings to the Victorian context. Interviews were transcribed verbatim and thematically analysed for emerging themes. Results: Fourteen reviews were identified for the evidence review. Isolated (e.g. EO program delivered by itself) and multifaceted (e.g. EO program supplemented by other interventions) programs were found to change prescribing behaviours. However, limited evidence suggests that EO can successfully change prescribing behaviours specific to GPs. Isolated EO can successfully change health professional prescribing behaviours, although cheaper alternatives such as letters might be just as effective. Multifaceted EO can also successfully change health professional prescribing behaviours, especially in older adults, but it remains unclear as to what combination of interventions works best. Success factors for EO reported by government representatives included programs having practical rather than didactic foci; making EO compulsory; focussing EO on preventing adverse events; using monetary or professional development ...
BACKGROUND: Involving patients in their healthcare using shared decision-making (SDM) is promoted through policy and research, yet its implementation in routine practice remains slow. Research into SDM has stemmed from primary and secondary care contexts, and research into the implementation of SDM in tertiary care settings has not been systematically reviewed. Furthermore, perspectives on SDM beyond those of patients and their treating clinicians may add insights into the implementation of SDM. This systematic review aimed to review literature exploring barriers and facilitators to implementing SDM in hospital settings from multiple stakeholder perspectives. METHODS: The search strategy focused on peer-reviewed qualitative studies with the primary aim of identifying barriers and facilitators to implementing SDM in hospital (tertiary care) settings. Studies from the perspective of patients, clinicians, health service administrators, and decision makers, government policy makers, and other stakeholders (for example researchers) were eligible for inclusion. Reported qualitative results were mapped to the Theoretical Domains Framework (TDF) to identify behavioural barriers and facilitators to SDM. RESULTS: Titles and abstracts of 8724 articles were screened and 520 were reviewed in full text. Fourteen articles met inclusion criteria. Most studies (n = 12) were conducted in the last four years; only four reported perspectives in addition to the patient-clinician dyad. In mapping results to the TDF, the dominant themes were Environmental Context and Resources, Social/Professional Role and Identity, Knowledge and Skills, and Beliefs about Capabilities. A wide range of barriers and facilitators across individual, organisational, and system levels were reported. Barriers specific to the hospital setting included noisy and busy ward environments and a lack of private spaces in which to conduct SDM conversations. CONCLUSIONS: SDM implementation research in hospital settings appears to be a young field. Future research ...
In: Waddell , A , Lennox , A , Spassova , G & Bragge , P 2021 , ' Barriers and facilitators to shared decision-making in hospitals from policy to practice : a systematic review ' , Implementation Science , vol. 16 , 74 . https://doi.org/10.1186/s13012-021-01142-y
Background: Involving patients in their healthcare using shared decision-making (SDM) is promoted through policy and research, yet its implementation in routine practice remains slow. Research into SDM has stemmed from primary and secondary care contexts, and research into the implementation of SDM in tertiary care settings has not been systematically reviewed. Furthermore, perspectives on SDM beyond those of patients and their treating clinicians may add insights into the implementation of SDM. This systematic review aimed to review literature exploring barriers and facilitators to implementing SDM in hospital settings from multiple stakeholder perspectives. Methods: The search strategy focused on peer-reviewed qualitative studies with the primary aim of identifying barriers and facilitators to implementing SDM in hospital (tertiary care) settings. Studies from the perspective of patients, clinicians, health service administrators, and decision makers, government policy makers, and other stakeholders (for example researchers) were eligible for inclusion. Reported qualitative results were mapped to the Theoretical Domains Framework (TDF) to identify behavioural barriers and facilitators to SDM. Results: Titles and abstracts of 8724 articles were screened and 520 were reviewed in full text. Fourteen articles met inclusion criteria. Most studies (n = 12) were conducted in the last four years; only four reported perspectives in addition to the patient-clinician dyad. In mapping results to the TDF, the dominant themes were Environmental Context and Resources, Social/Professional Role and Identity, Knowledge and Skills, and Beliefs about Capabilities. A wide range of barriers and facilitators across individual, organisational, and system levels were reported. Barriers specific to the hospital setting included noisy and busy ward environments and a lack of private spaces in which to conduct SDM conversations. Conclusions: SDM implementation research in hospital settings appears to be a young field. Future research ...
Abstract Background While translation of evidence into health policy and practice is recognised as critical to optimising health system performance and health-related outcomes for consumers, mechanisms to effectively achieve these goals are neither well understood, nor widely communicated. Health Networks represent a framework which offers a possible solution to this dilemma, particularly in light of emerging evidence regarding the importance of establishing relationships between stakeholders and identifying clinical leaders to drive evidence integration and translation into policy. This is particularly important for service delivery related to chronic diseases. In Western Australia (WA), disease and population-specific Health Networks are comprised of cross-discipline stakeholders who work collaboratively to develop evidence-informed policies and drive their implementation. Since establishment of the Health Networks in WA, over 50 evidence-informed Models of Care (MoCs) have been produced across 18 condition or population-focused Networks. The aim of this paper is to provide an overview of the Health Network framework in facilitating the translation of evidence into policy and practice with a particular focus on musculoskeletal health. Case presentation A review of activities of the WA Musculoskeletal Health Network was undertaken, focussing on outcomes and the processes used to achieve them in the context of: development of policy, procurement of funding, stakeholder engagement, publications, and projects undertaken by the Network which aligned to implementation of MoCs. The Musculoskeletal Health Network has developed four MoCs which reflect Australian National Health Priority Areas. Establishment of community-based services for consumers with musculoskeletal health conditions is a key recommendation from these MoCs. Through mapping barriers and enablers to policy implementation, working groups, led by local clinical leaders and supported by the broader Network and government officers, have undertaken a range of integrated projects, such as the establishment of a community-based, multidisciplinary rheumatology service. The success of these projects has been contingent on developing relationships between key stakeholders across the health system. Conclusions In WA, Networks have provided a sustainable mechanism to meaningfully engage consumers, carers, clinicians and other stakeholders; provided a forum to exchange ideas, information and evidence; and collaboratively plan and deliver evidence-based and contextually-appropriate health system improvements for consumers.
INTRODUCTION: Research indicates that health service boards can influence quality of care. However, government reviews have indicated that board members may not be as effective as possible in attaining this goal. Simulation-based training may help to increase board members' ability to effectively communicate and hold hospital staff to account during board meetings. METHODS AND ANALYSIS: To test effectiveness and feasibility, a prospective, cluster-randomised controlled trial will be used to compare simulation-based training with no training. Primary outcome variables will include board members' perceived skill and confidence in communicating effectively during board meetings, and board members' perceptions of board meeting processes. These measures will be collected both immediately before training, and 3 months post-training, with boards randomly assigned to intervention or control arms. Primary analyses will comprise generalised estimating equations examining training effects on each of the primary outcomes. Secondary analyses will examine participants' feedback on the training. ETHICS AND DISSEMINATION: Research ethics approval has been granted by Monash University (reference number: 2018-12076). We aim to disseminate results through peer-reviewed journal publication, conference presentation and social media. TRIAL REGISTRATION NUMBER: Open Science Framework: http://osf.io/jaxt6/; Pre-results.
In: Tull , F , Borg , K , Knott , C , Beasley , M , Halliday , J , Faulkner , N , Sutton , K & Bragge , P 2019 , ' Short message Service reminders to parents for increasing adolescent human papillomavirus vaccination rates in a secondary school vaccine program : a randomized control trial ' , Journal of Adolescent Health , vol. 65 , no. 1 , pp. 116-123 . https://doi.org/10.1016/j.jadohealth.2018.12.026
Purpose: In Victoria (Australia), the human papillomavirus (HPV) vaccine is delivered within a state-wide secondary school vaccine program, administered by local government. This study aimed to test the hypothesis that sending a short message service (SMS) reminder to parents who had consented to their child's receiving the HPV vaccine would lead to greater uptake of the vaccine within the program. The secondary aim was to assess the effect of self-regulatory versus motivational message content in the SMS. Methods: A randomized control trial design was used across 31 schools within seven local government areas. Parents of 4,386 consented adolescents were randomized into three study conditions: motivational SMS versus self-regulatory SMS versus no SMS. Follow-up extended beyond the final school visit to the end of the calendar year to capture those who may have attended a catch-up vaccination session. Results: On the day of the final school visit, 85.71% of consented students in the control condition received the HPV vaccine, compared with 88.35% (2.64% point increase) in the motivational message condition, and 89.00% (3.29% point increase) in the self-regulatory message condition, χ 2 (2, N = 4,386) = 8.31, p =.016. Both intervention messages were similarly effective at increasing vaccination rates. This effect was maintained in the extended follow-up period. Conclusions: The trial findings supported the hypothesis that SMS reminders to parents/guardians would lead to greater uptake of the HPV vaccine in adolescents participating in school-based vaccination. Also, this effect was observed whether we used a motivational or self-regulatory message framework. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12617001307392). Registration Date: September 12, 2017. Retrospectively registered.
In: Faulkner , N , Wright , B , Bragge , P , Lennox , A , Bismark , M M , Boag , J , Boffa , S & Waxman , B 2019 , ' Simulation-based training for increasing health service board members' effectiveness : protocol for a cluster-randomised controlled trial ' , BMJ Open , vol. 9 , no. 4 , e025170 . https://doi.org/10.1136/bmjopen-2018-025170
Introduction Research indicates that health service boards can influence quality of care. However, government reviews have indicated that board members may not be as effective as possible in attaining this goal. Simulation-based training may help to increase board members' ability to effectively communicate and hold hospital staff to account during board meetings. Methods and analysis To test effectiveness and feasibility, a prospective, cluster-randomised controlled trial will be used to compare simulation-based training with no training. Primary outcome variables will include board members' perceived skill and confidence in communicating effectively during board meetings, and board members' perceptions of board meeting processes. These measures will be collected both immediately before training, and 3 months post-training, with boards randomly assigned to intervention or control arms. Primary analyses will comprise generalised estimating equations examining training effects on each of the primary outcomes. Secondary analyses will examine participants' feedback on the training. Ethics and dissemination Research ethics approval has been granted by Monash University (reference number: 2018-12076). We aim to disseminate results through peer-reviewed journal publication, conference presentation and social media. Trial registration number Open Science Framework: http://osf.io/jaxt6/; Pre-results.
AbstractThis paper provides the first known "heatmap" representing Australian public narratives across a range of groups experiencing disadvantage developed from a comprehensive literature review of primary Australian studies between 2020 and 2021. Eleven narratives were identified across 14 population groups with the most frequent being deficit narratives, misrepresentation of the issue and 'absent' narratives (group being described not represented in the narrative). The most frequently described groups were Aboriginal and Torres Strait Islander people, people living with a disability, racial minorities and women. The heatmap resonated with three global review‐level studies and findings of supplementary qualitative interviews. Examination of relationships between the heatmap and empirical Australian disadvantage data enabled identification of missing and misleading public narratives. Attempts to disrupt such narratives can improve the understanding of disadvantage by more truthfully reflecting the lives, experiences and challenges of groups experiencing disadvantage. Updates to the heatmap can enable analysis of the impact of disruption strategies.
AbstractPublic administrators rely on written communications to send information to citizens and stakeholders, and they are among the heaviest users of the postal service. Behavioral science research has identified several techniques that public administrators can use to increase compliance with written requests and, in turn, increase effectiveness. Currently, however, many written communications from government bodies are not written in a manner that utilizes these techniques. It remains an ongoing challenge for public administrators to identify, understand, and use these techniques in the written communications sent by their organizations. This article presents a framework capturing seven prominent techniques in a simple mnemonic—INSPIRE—that is already being used by several government bodies in Australia. It also provides practical examples of how to use each technique and demonstrates that using these techniques could result in large aggregate improvements in effectiveness and socially desirable outcomes of public administrators' written communications.
Background The European Union (EU) aims to optimize patient protection and efficiency of health-care research by harmonizing procedures across Member States. Nonetheless, further improvements are required to increase multicenter research efficiency. We investigated IRB procedures in a large prospective European multicenter study on traumatic brain injury (TBI), aiming to inform and stimulate initiatives to improve efficiency. Methods We reviewed relevant documents regarding IRB submission and IRB approval from European neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Documents included detailed information on IRB procedures and the duration from IRB submission until approval(s). They were translated and analyzed to determine the level of harmonization of IRB procedures within Europe. Results From 18 countries, 66 centers provided the requested documents. The primary IRB review was conducted centrally (N = 11, 61%) or locally (N = 7, 39%) and primary IRB approval was obtained after one (N = 8, 44%), two (N = 6, 33%) or three (N = 4, 23%) review rounds with a median duration of respectively 50 and 98 days until primary IRB approval. Additional IRB approval was required in 55% of countries and could increase duration to 535 days. Total duration from submission until required IRB approval was obtained was 114 days (IQR 75–224) and appeared to be shorter after submission to local IRBs compared to central IRBs (50 vs. 138 days, p = 0.0074). Conclusion We found variation in IRB procedures between and within European countries. There were differences in submission and approval requirements, number of review rounds and total duration. Research collaborations could benefit from the implementation of more uniform legislation and regulation while acknowledging local cultural habits and moral values between countries.
In: Timmers , M , Van Dijck , J T J M , Van Wijk , R P J , Legrand , V , Van Veen , E , Maas , A I R , Menon , D K , Citerio , G , Stocchetti , N , Kompanje , E J O , Åkerlund , C , Amrein , K , Andelic , N , Andreassen , L , Anke , A , Antoni , A , Audibert , G , Azouvi , P , Azzolini , M L , Bartels , R , Barzó , P , Beauvais , R , Beer , R , Bellander , B M , Belli , A , Benali , H , Berardino , M , Beretta , L , Blaabjerg , M , Bragge , P , Brazinova , A , Brinck , V , Brooker , J , Brorsson , C , Buki , A , Bullinger , M , Cabeleira , M , Caccioppola , A , Calappi , E , Calvi , M R , Cameron , P , Lozano , G C , Carbonara , M , Cavallo , S , Chevallard , G , Chieregato , A , Ceyisakar , I , Coburn , M , Coles , J , Kondziella , D & The CENTER-TBI investigators and participants 2020 , ' How do 66 European institutional review boards approve one protocol for an international prospective observational study on traumatic brain injury? Experiences from the CENTER-TBI study ' , BMC Medical Ethics , vol. 21 , no. 1 , 36 . https://doi.org/10.1186/s12910-020-00480-8
Background: The European Union (EU) aims to optimize patient protection and efficiency of health-care research by harmonizing procedures across Member States. Nonetheless, further improvements are required to increase multicenter research efficiency. We investigated IRB procedures in a large prospective European multicenter study on traumatic brain injury (TBI), aiming to inform and stimulate initiatives to improve efficiency. Methods: We reviewed relevant documents regarding IRB submission and IRB approval from European neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Documents included detailed information on IRB procedures and the duration from IRB submission until approval(s). They were translated and analyzed to determine the level of harmonization of IRB procedures within Europe. Results: From 18 countries, 66 centers provided the requested documents. The primary IRB review was conducted centrally (N = 11, 61%) or locally (N = 7, 39%) and primary IRB approval was obtained after one (N = 8, 44%), two (N = 6, 33%) or three (N = 4, 23%) review rounds with a median duration of respectively 50 and 98 days until primary IRB approval. Additional IRB approval was required in 55% of countries and could increase duration to 535 days. Total duration from submission until required IRB approval was obtained was 114 days (IQR 75-224) and appeared to be shorter after submission to local IRBs compared to central IRBs (50 vs. 138 days, p = 0.0074). Conclusion: We found variation in IRB procedures between and within European countries. There were differences in submission and approval requirements, number of review rounds and total duration. Research collaborations could benefit from the implementation of more uniform legislation and regulation while acknowledging local cultural habits and moral values between countries.
Abstract: Background: The European Union (EU) aims to optimize patient protection and efficiency of health-care research by harmonizing procedures across Member States. Nonetheless, further improvements are required to increase multicenter research efficiency. We investigated IRB procedures in a large prospective European multicenter study on traumatic brain injury (TBI), aiming to inform and stimulate initiatives to improve efficiency. Methods: We reviewed relevant documents regarding IRB submission and IRB approval from European neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Documents included detailed information on IRB procedures and the duration from IRB submission until approval(s). They were translated and analyzed to determine the level of harmonization of IRB procedures within Europe. Results: From 18 countries, 66 centers provided the requested documents. The primary IRB review was conducted centrally (N = 11, 61%) or locally (N = 7, 39%) and primary IRB approval was obtained after one (N = 8, 44%), two (N = 6, 33%) or three (N = 4, 23%) review rounds with a median duration of respectively 50 and 98 days until primary IRB approval. Additional IRB approval was required in 55% of countries and could increase duration to 535 days. Total duration from submission until required IRB approval was obtained was 114 days (IQR 75–224) and appeared to be shorter after submission to local IRBs compared to central IRBs (50 vs. 138 days, p = 0.0074). Conclusion: We found variation in IRB procedures between and within European countries. There were differences in submission and approval requirements, number of review rounds and total duration. Research collaborations could benefit from the implementation of more uniform legislation and regulation while acknowledging local cultural habits and moral values between countries.