A realistic account of evidence-informed tobacco control practice in Ontario public health agencies
Garcia, John Michael
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Policy-makers, research funders, and practitioners acknowledge the need for theories about the uptake of scientific evidence into policy and programs to reduce population-wide risk factors for the major avoidable chronic non-communicable diseases. Models of evidence-informed practice in public health settings have not been developed through systematic scientific inquiry. This study explores and develops a realistic account of evidence-informed tobacco control practice in Ontario public health agencies. In-depth, intensive, semi-structured qualitative interviews were conducted with twelve local public health agency senior executives and other key tobacco control staff in three diverse public health agencies in Ontario, Canada. Interviews explored aspects of tobacco control related decision-making and practice, as well as supports from regional, provincial, and national levels that might enhance tobacco control practice. Interview data were supplemented by field notes and other documentation provided by interviewees, as well as unobtrusive sources. A grounded theory approach to the analysis of textual data identified six major and many subcategories and dimensions implicated in evidence-informed tobacco control practice in local public health agencies. The major category structure includes: information and evidence, interpretation and decision-making, organizational aspects, organizational environment, practice integration, and time. An overall model and five sub-models were developed describing the relations among core category and sub-category factors. Propositions were developed a priori based on an extensive review of the literature. Potentially relevant social theories and concepts were also identified based on a selective review of the literature, including critical realist and other perspectives pertaining to agency-structure issues. Theories and propositions were reviewed, which resulted in a minor modification to the subcategory structure of one branch. Public health agency tobacco control case descriptions were developed based on a final category structure, including six branches, 27 sub-branches, and 98 twigs, and verified (subject to some adjustments) through a member check. Working knowledge is seen to be complex and socially constructed, incorporating aspects of social cognitive and planned behavior theories and Aristotelian intellectual virtues. Realist social theory offers insights into potential change processes. Contributions of the study of theory, practice and methods are discussed, as are strengths and limitations, and areas of needed future research.