|dc.description.abstract||Background: Evidence-based decision-making (EBDM) stems from evidence-based medicine (EBM) and involves integrating up to date, valid, and best available research into the decision-making process. Where EBM relies on scientifically rigorous studies such as randomized control trials, EBDM in public health often relies on cross-sectional or natural experiment study designs which is considered lower quality evidence. A growing body of literature suggests that the use of evidence in public health decision making is inconsistent at best. This is important, because within the EBDM model, there is little room for values, beliefs, politics, and current social issues, all of which are realities present in the decision-making process and may help to explain the inconsistent use of evidence in public health decision making.
One important form of evidence for decision making is spatial data displayed on interactive maps. Mapping public health data can increase the level of knowledge about an issue and produce evidence that can then be used to inform and generate policies. Interactive mapping tools and spatial data analysis techniques have been used for a variety of public health scenarios, such as for national health resource management in Poland, and food environments in the UK.
There is a historical closeness of planning and public health, both disciplines emerged out of concerns about the impact of rapid urbanization and industrialization of the 19th century on population health and well-being. Many factors outside the health care system, such as those related to planning in physical and social environments, determine the health and well-being of a population. Many planning theories or models have been developed over the last half century to explain the ways in which decisions are made and offer guidance on how to make better decisions. Using planning theory to provide additional context for public health decision making may be warranted, given the increasingly localized nature of public health, and the place-based, community decisions about complex and multi-sectoral issues frequently made by public health practitioners to improve health.
To ground the research in a current, contentious, and relevant public health issue, this research focuses on food environment decision-making in Canada. The retail food environment (RFE) may be an important determinant of dietary intake and as such has been a primary focus for both researchers and policy makers. Local, provincial, and federal government organizations are increasingly interested in place-based determinants of food choice (i.e., food environments), given that poor diet is responsible for the largest burden of morbidity and mortality. By addressing existing mapping limitations through the creation of a Canadian interactive food environment mapping tool using high quality business register data, interactive, online mapping tools could be a potentially useful form of knowledge translation (KT) and a form of evidence for public health practice.
Research Questions: This project involves the following three objectives, answered across two manuscripts:
a. Use a contentious, place-based public health issue (food environments) to explore the extent to which and how planning theory might be able to provide additional context to public health decision making.
b. Compare and contrast EBDM and planning theories as they relate to public health decision-making related to food environments.
c. Explore how interactive maps are perceived by researchers and practitioners as an “evidence source” for place-based public health decision making related to food environments.
Methods: 25 participants were recruited from two groups, researchers and practitioners, through the method of snowball sampling. There were 10 researchers of the retail food environment interviewed. The remaining participants consisted of 15 practitioners, including representatives regional, provincial, and federal public health, representatives from nutrition organizations, policy makers, and provincial and federal nutrition leaders. Semi-structured interviews were conducted over the phone or video chat depending on participant preference and technological availability. Interview transcripts were analyzed using Meyer and Ward’s pluralistic approach, allowing comparison with theory as well as theory generation.
In Chapter 4, three main findings emerged:
1. Planning theory is a body of literature that can provide additional context for understanding place-based public health decision-making.
2. Researcher and practitioner groups had differences in terms of planning theory alignment with respect to food environment decision making.
3. Participants’ theoretical alignment was neither exclusive nor stable over time: changes to policy, multiple priorities in the decision-making process, and seniority and level of jurisdiction all seemed to influence participants’ theoretical alignment.
In Chapter 5, three main findings emerged:
1. A divide exists between researchers and practitioners on their perspectives of whether an interactive food environment mapping tool is something that would be useful.
2. There are many barriers to decision making faced by both researchers and public health decision makers.
3. Knowledge users provided an in-depth list of conditions of maps that make them more useful, this will inform the creation of an interactive food environment mapping tool.
Conclusion: Over the different chapters of this thesis, the principal objective was to investigate how food environment decisions are being made in Canada with a specific focus on the applications of planning theory and the role of evidence. The interdisciplinary research of the two studies offers a novel approach of planning theory to understand public health decision making, highlight the differences that persist between research and practice, and provide recommendations for the creation of a Canadian interactive food environment mapping tool.||en