Evidence-informed decision making – process and results to inform a breastfeeding program in a public health unit in Ontario

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Presented at the Canadian Public Health Association Centenary Conference Public Health in Canada: Shaping the Future Together, June 16, 2010 …

Presented at the Canadian Public Health Association Centenary Conference Public Health in Canada: Shaping the Future Together, June 16, 2010

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  • 1. Outline • About the partners • Project background • Objectives • Methods • Results • Learning
  • 2. Project Partners Region of Peel Public Health • West of Toronto • 2nd largest public health unit in Ontario Health Evidence • Based at McMaster University • Dedicated to a Canadian public health system informed by the best-available evidence
  • 3. Peel Public Health• Cities of Mississauga, Brampton and Town of Caledon – population >1.25 million• Higher proportion of children, young families and immigrants than rest of Ontario
  • 4. Baby-friendly Designation • Baby Friendly Community Health Service - in June 2009: – seven Point Plan outcome criteria were met; 5 years to achieve – awarded by the Breastfeeding Committee for Canada, the national authority for WHO/UNICEF – Baby-friendly Initiative
  • 5. Health Evidence Funders
  • 6. Health Evidence Provide and promote access to the best available evidence – Registry – Literature searches & summaries – Facilitated evidence reviews Provide knowledge‐brokering services – Customized EIDM training – Mentoring and Knowledge Broker
  • 7. Health Evidence• online registry – 1900 reviews• evaluated interventions• updated quarterly• quality-assessed• searchable by commonly-used public health terms• two page summaries
  • 8. FormulaNOthanks.ca
  • 9. Next Step?
  • 10. Key Message Development Goal: To provide the best available evidence about the health consequences of formula feeding and to support informed decision-making with a comprehensive website to build efficacy and confidence to breastfeed
  • 11. EIDM Model National Collaborating Centre for Methods and Tools Haynes B, DiCenso, A., Ciliska D., & Guyatt, G. 2005
  • 12. EIDM Process Assess applicability Interpret Appraise the quality Search for evidence Define the questio n
  • 13. Objective • Determine if the available research literature supported a claim of improved cognitive development due to breastfeeding.
  • 14. Methods • Define the question • Search the literature • Relevance & quality assessment • Critical appraisal • Interpretation • Decision-making
  • 15. The Question Is breastfeeding exclusively for 6 months associated with enhanced cognitive development outcomes in children when compared with formula feeding?
  • 16. The Search • Database searches of Medline, Embase, CINAHL (2005-2009), searches run June 10, 2009 • Search terms were limited to results relating to humans, and English language
  • 17. Findings 1261 articles 1221 40 excluded retrieved (design, relevance) 10 30 excluded included (quality)
  • 18. Findings 4 studies moderate quality 6 had serious methodological flaws Good quality evidence suggested: - No relationship between breastfeeding and cognitive development when you control for maternal characteristics including IQ, socio-environmental factors
  • 19. Decision Factors • Research evidence define question • Public health search & appraise experience, beliefs context apply • Public health credibility Evidence-informed decision • Audience assessment
  • 20. Decision - Concept for the ‘IQ’ poster was deferred - Continued with infection, weight
  • 21. Learning and Next Steps • Crafting messaging to explain these findings • Continue to mine the literature • For Clients: create web pages with information about findings in language that is suitable to all literacy levels and add to the FormulaNOthanks.ca website • For Staff: Ongoing EIDM training, organizational supports and opportunities
  • 22. Thank you!Peel Health Health Evidence Beverley Bryant, Maureen Dobbins Manager of Education and Research Director Beverley.bryant@peelregion.ca dobbinsm@mcmaster.ca Angela Garrison, Lori Greco Family Health Supervisor Knowledge Broker, Angela.garrison@peelregion.ca lgreco@mcmaster.ca