How Context Influences Knowledge Use in Public Health Units
Bonin, Elissa Nicole
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Objective: The effectiveness and efficiency of health promotion programs and policies relies on evidence to inform and guide these practices in an age of increased cost-efficiency and accountability. To achieve impact and continuous improvement requires the application of evidence to inform and guide population and public health decisions. To facilitate the broader use of knowledge derived from research and evaluation, we must identify the factors that facilitate or impede the use of such evidence among pubic health professionals. At the individual level, we have developed considerable understanding of these factors; however, at the organisational level this understanding lags. The purpose of this study was to examine how the organisational context of Ontario health units influences evidence-informed public health practice. Methods: The study employed a multiple case study design. Data sources included interviews, internal health unit documents and correspondence from three health units (reflecting high, moderate and low use of evidence) participating in the SHAPES-Ontario Knowledge Exchange Extension Project. Qualitative analyses using constant comparative methods intended to maximize trustworthiness identified macro-, meso- and micro-environmental level factors related to the use of local tobacco and physical activity data in public health program planning and evaluation. Individual and cross-case analyses determined the extent of each factor’s influence, how the factors inter-related and identified similarities and differences between sites. Results: Several internal contextual factors were directly and indirectly influential on knowledge use. The most directly influential factors were commitment/receptiveness to use evidence, and the leadership and internal co-ordinated action given to facilitate uptake and use. The degree of each of these factors directly influenced the level of knowledge use. Other internal contextual factors were also influential on utilisation however, through a less direct route. This included organisational mandates/priorities as well as previous experiences with knowledge use which were influential on the other contextual factors, as a result indirectly influencing knowledge use. Overall, it appears the more extensive the contextual factor the more extensive the influence, directly or indirectly, on knowledge use. Additionally, several external factors influential on the internal context and knowledge use within health units were identified, including external relationships, external processes and procedures, external mandates and priorities as well as external resources. The need to adapt to these external contextual factors was necessary in order for health units to have a strong working relationship with external parties (i.e., schools and school boards). As a result of this relationship, health units conformed and adapted to external contexts such as the processes/procedures, priorities and resources of schools. In turn, this adaptation process influenced the type of information utilised by health units as well as how the information was used and to what degree. At this point, the inter-relation between external contextual factors as well as direct connections to internal contextual factors was not entirely clear and requires further examination. Conclusions/Implications: Studying these cases has illuminated the processes and structures that contribute or impede evidence-informed practice. The findings and interpretations of this study help to identify organisational supports that facilitate the use of population health intervention research, in turn, contributing to more effective and efficient health programs and policies aimed at improving population health.