NCCMT Webinar: Healthy Weights focused Methods and Tools to Support Evidence Informed Decision Making
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This webinar on evidence-informed decision-making (EIDM) draws on The National Collaborating Centre for Methods and Tools (NCCMT)'s seven-step process, with reference to methods and tools for each step that are specific to healthy weights. The National Collaborating Centre for Methods and Tools is funded by the Public Health Agency of Canada and affiliated with McMaster University. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada. NCCMT is one of six National Collaborating Centres (NCCs) for Public Health. The Centres promote and improve the use of scientific research and other knowledge to strengthen public health practices and policies in Canada. Visit the NCCMT website (www.nccmt.ca) or contact nccmt@mcmaster.ca for more information.
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NCCMT Webinar: Healthy Weights focused Methods and Tools to Support Evidence Informed Decision Making
- 1. Follow us @nccmt Suivez-nous @ccnmo Funded by the Public Health Agency of Canada | Affiliated with McMaster University The views expressed here do not necessarily reflect the views of the Public Health Agency of Canada. Healthy Weights-Focused Methods and Tools to Support Evidence-Informed Decision-Making Susan Snelling, PhD Senior Knowledge Translation Specialist May 26, 2016
- 2. Follow us @nccmt Suivez-nous @ccnmo Poll Question #1 2 How many people are watching today’s webinar with you? a) Just me b) 1 to 3 c) 4 to 5 d) 6 to 10 e) More than 10
- 3. Follow us @nccmt Suivez-nous @ccnmo Housekeeping • TC line will be muted during the webinar Use Q&A to post comments / questions during the webinar • ‘Send’ questions to All (not privately to ‘Host’) Connection issues • Recommend using a wired Internet connection (vs. wireless), • WebEx 24/7 help line: 1-866-229-3239 Q&A
- 4. Follow us @nccmt Suivez-nous @ccnmo Housekeeping Experiencing feedback? • Click Audio Broadcast at the bottom of the Participants panel to join or leave the audio broadcast.
- 5. Follow us @nccmt Suivez-nous @ccnmo Poll Question #2 5 Where are you connecting from today? a) BC b) AB c) SK d) MB e) ON f) QC g) NB h) NS i) PEI j) NL k) YK l) NWT m) NU n) Outside Canada
- 6. Follow us @nccmt Suivez-nous @ccnmo Outline of Today’s Webinar • Introduction to NCCMT • A model for evidence- informed decision making • Steps in the process of evidence-informed public health With reference to methods and tools relevant for chronic disease (specifically healthy weight promotion) practitioners that can be found in the NCCMT Registry of Methods and Tools 6
- 7. Follow us @nccmt Suivez-nous @ccnmo National Collaborating Centre for Methods and Tools (NCCMT) Vision • The effectiveness and efficiency of Canada’s public health system will be guided by the production, sharing and use of high quality evidence. Mission • The NCCMT will enhance evidence-informed public health practice and policy in Canada by providing leadership and expertise in supporting the uptake of what works in public health into practice. 7
- 8. Follow us @nccmt Suivez-nous @ccnmo What is Evidence-Informed Public Health? … the process of distilling and disseminating the best available evidence from research, context and experience, and using that evidence to inform and improve public health policy and practice. 8
- 9. Follow us @nccmt Suivez-nous @ccnmo Poll Question #3 9 What sector are you from? a) Public Health Practitioner b) Health Practitioner (Other) c) Education d) Research e) Federal/Provincial/Territorial Government f) Municipality g) Non-Governmental Organization h) Other
- 10. Follow us @nccmt Suivez-nous @ccnmo NCCMT Registry of Methods and Tools Resources to support use of research evidence in public health http://www.nccmt.ca/resources/registry A free, searchable, online collection of knowledge translation methods and tools for public health • Summary statements • Web links (when available) to Methods and Tools 10
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- 12. Follow us @nccmt Suivez-nous @ccnmo What are methods and tools? A process or series of steps to organize a Knowledge Translation activity Dissemination framework Method An instrument to carry out the steps of a Knowledge Translation activity Dissemination checklist Tool 12
- 13. Follow us @nccmt Suivez-nous @ccnmo A Model for Evidence-Informed Decision-Making in Public Health 13
- 14. Follow us @nccmt Suivez-nous @ccnmo Stages in the process of Evidence-Informed Public Health 14
- 15. Follow us @nccmt Suivez-nous @ccnmo Scenario: Setting the Stage for Evidence Use • Working on healthy weights promotion focused on children • Concern about weight stigma and weight bias • Opportunity to work with early childhood education settings How can the steps of Evidence-Informed Public Health be applied to this scenario? 15
- 16. Follow us @nccmt Suivez-nous @ccnmo 16 Evidence-Informed Public Health Clearly define the question or problem
- 17. Follow us @nccmt Suivez-nous @ccnmo Define the question PICO P population I intervention C comparison O outcome 17
- 18. Follow us @nccmt Suivez-nous @ccnmo Frameworks can help when defining the question 18 http://www.aacorn.org/AbouComm-2517.html
- 19. Follow us @nccmt Suivez-nous @ccnmo Define the question: Apply our scenario PICO P population: children 0-5 years in ECE setting I intervention: intended to improve healthy weight, diet, physical activity C comparison: no intervention or usual care O outcome: change in BMI, eating habits, or physical activity 19
- 20. Follow us @nccmt Suivez-nous @ccnmo Recommended Tool: Define Developing an Efficient Search Strategy Using PICO http://www.nccmt.ca/resources/search/138 Use it to develop an evidence-search question using the PICO format. 20
- 21. Follow us @nccmt Suivez-nous @ccnmo 21
- 22. Follow us @nccmt Suivez-nous @ccnmo Stages in the process of Evidence-Informed Public Health 22 Efficiently search for research evidence
- 23. Follow us @nccmt Suivez-nous @ccnmo Recommended Tool: Search NCCMT Search Pyramids http://www.nccmt.ca/resources/search/181 http://www.nccmt.ca/learningcentre/EN/index.php • Pre-populated with good sites for finding evidence related to ‘healthy habits’ for adults and for children. • Start at the top for the most synthesized evidence. • Saves time • Systematic approach to searching 23
- 25. Follow us @nccmt Suivez-nous @ccnmo National Guideline Clearinghouse 25
- 26. Follow us @nccmt Suivez-nous @ccnmo 26
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- 36. Follow us @nccmt Suivez-nous @ccnmo Tips for “Search” • Choose the highest possible level on the Pyramid • Pre-appraised sources make your search more efficient • NCCMT online module on Searching through Learning Centre 36
- 37. Follow us @nccmt Suivez-nous @ccnmo Evidence-Informed Public Health 37 Critically and efficiently appraise the research methods
- 38. Follow us @nccmt Suivez-nous @ccnmo Recommended Tools: Appraise Critically Appraising Practice Guidelines: The AGREE II Instrument http://www.nccmt.ca/registry/view/eng/100 Tools to Assess the Methodological Quality of Systematic Reviews: AMSTAR http://www.nccmt.ca/registry/view/eng/97 Critical Appraisal Skills Programme: Checklists http://www.nccmt.ca/resources/search/87 38
- 39. Follow us @nccmt Suivez-nous @ccnmo Tips for “Appraise” • Appraise is a filtering step, looking for sources of bias • Answers the question: is this research/review of good enough quality that I should read further? • All research has flaws! But some flaws are more serious than others. 39
- 40. Follow us @nccmt Suivez-nous @ccnmo Additional Resources • Refer to NCCMT’s online learning modules for additional practice: • http://www.nccmt.ca/professional-development/modules • Week-long course at McMaster University: “What is Evidence-Informed Decision Making (EIDM)?” • http://ccebn.mcmaster.ca/workshop.html 40
- 41. Follow us @nccmt Suivez-nous @ccnmo Evidence-Informed Public Health 41 Interpret information; understand how to prioritize conflicting results
- 42. Follow us @nccmt Suivez-nous @ccnmo Recommended Tool: Synthesize Briefing Note: Decisions, Rationale and Key Findings Summary http://www.nccmt.ca/resources/search/137 Use it to create briefing notes to inform decision- makers. Use ‘actionable messages’ to inform program and policy development. 42
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- 44. Follow us @nccmt Suivez-nous @ccnmo Tips for “Synthesize” • Bring good quality evidence together to determine results and implications • If results ‘conflict’, prefer sources that are highest quality, most recent, most relevant to your question • Identify actionable findings that can guide decisions 44
- 45. Follow us @nccmt Suivez-nous @ccnmo Evidence-Informed Public Health 45 Adapt the information to the local community
- 46. Follow us @nccmt Suivez-nous @ccnmo A Model for Evidence-Informed Decision-Making in Public Health 46
- 47. Follow us @nccmt Suivez-nous @ccnmo Frameworks can help when adapting 47 http://www.aacorn.org/AbouComm-2517.html
- 48. Recommended Tools: Adapt - Applicability and Transferability of Evidence 48 http://www.nccmt.ca/resources/search/227 http://www.nccmt.ca/resources/search/24 http://www.nccmt.ca/resources/search/78
- 49. Follow us @nccmt Suivez-nous @ccnmo Online Learning Module Assessing the Applicability and Transferability of Evidence 49
- 50. Follow us @nccmt Suivez-nous @ccnmo Tips for “Adapt” 50 • In developing a local approach, consider: • Research evidence • Stakeholder perspectives • Media coverage – what’s going on in community • Political context • Local and regional data reports • Financial and human resources • How can you adapt potential interventions to be appropriate for your community?
- 51. Follow us @nccmt Suivez-nous @ccnmo Evidence-Informed Public Health 51 Decide whether (and plan how) to implement the change in practice or policy
- 52. Follow us @nccmt Suivez-nous @ccnmo http://www.nccmt.ca/resources/search/81 52 Recommended Tool: Implement
- 53. Follow us @nccmt Suivez-nous @ccnmo Evidence-Informed Public Health 53 Assess the effectiveness of the change in practice or policy
- 54. Follow us @nccmt Suivez-nous @ccnmo Recommended Tool: Evaluate Improving Future Decisions: Optimizing the Decision Process from Lessons Learned http://www.nccmt.ca/resources/search/194 Use it to evaluate your use of evidence in making decisions. A reflective practice tool. 54
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- 56. Follow us @nccmt Suivez-nous @ccnmo Tips for “Evaluate” Determine how effective you were at using an evidence-informed approach: • What process did you follow? • What can you learn from your process? • How could you improve your use of evidence? • How will you know if people are using the evidence? Have they changed their practice? • Was the intervention adapted effectively at your local level? You may need to gather baseline data before you start if you want to assess change. 56
- 57. Follow us @nccmt Suivez-nous @ccnmo Stages in the process of Evidence-Informed Public Health 57
- 58. Follow us @nccmt Suivez-nous @ccnmo Poll Question #4 58 How familiar are you with the methods and tools described today? a) I am not familiar with any of the methods/tools b) I have heard of one or more of the methods/tools c) I have used one or more of the methods/tools
- 59. Follow us @nccmt Suivez-nous @ccnmo Poll Question #5 59 In your experience, which step in Evidence-Informed Public Health is the most challenging to do well? a) Define b) Search c) Appraise d) Synthesize e) Adapt f) Implement g) Evaluate
- 60. Follow us @nccmt Suivez-nous @ccnmo Poll Question #6 60 To what extent will the methods or tools described today be useful in your practice? a) Very useful b) Somewhat useful c) Not at all useful d) Don’t know
- 61. Follow us @nccmt Suivez-nous @ccnmo Poll Question #7 61 What are your next steps? (Check all that apply) a) Access a method/tool referenced in the presentation b) Read an NCCMT summary about a method/tool described today c) Consider using the methods/tools in practice d) Tell a colleague about the methods/tools
- 62. Follow us @nccmt Suivez-nous @ccnmo • Use Q&A to post comments and/or questions • ‘Send’ questions to All (not privately to ‘Host’) Q&A Your Comments/Questions
- 63. Follow us @nccmt Suivez-nous @ccnmo Availability of the Slides and Audio Recording • The PowerPoint presentation (in English and French) and English audio recording will be available at: • PowerPoint: http://www.slideshare.net/nccmt • Audio Recording: https://www.youtube.com/user/nccmt 63
- 64. Follow us @nccmt Suivez-nous @ccnmo Join NCCMT for our next webinar NCCMT Spotlight on Methods & Tools: Equity-Integrated Population Health Status Reporting Action Framework Presenters: Lesley Dyck, Knowledge Translation Specialist, NCCDH & Susan Snelling, Senior Knowledge Translation Specialist, NCCMT DATE: Tuesday, June 7, 2016 TIME: 1:00-2:30 pm https://health-evidence.webex.com/health- evidence/onstage/g.php?MTID=eddc558722a11817e6f8d01502ef27d83 Interested in sharing best practices within your organization? Are you engaged in creating community health status reports? Are you interested in learning about how to improve health equity? Join us for a webinar to learn how the Equity-Integrated Population Health Status Reporting Action Framework can help you.
- 65. Follow us @nccmt Suivez-nous @ccnmo Your Feedback is Important Please take a few minutes to share your thoughts on today’s webinar. https://nccmt.co1.qualtrics.com/SE/?SID=SV_eJ26 mrXyYJ68L0V
- 66. Follow us @nccmt Suivez-nous @ccnmo For more information about the National Collaborating Centre for Methods and Tools: NCCMT website www.nccmt.ca Contact: nccmt@mcmaster.ca 6666
Editor's Notes
- EIPH provides a systematic approach to incorporate research evidence in program and policy decisions. EIPH is defined as the process of distilling and disseminating the best available evidence from research, context and experience, and using that evidence to inform and improve public health policy and practice. Put simply, it means finding, using and sharing what works in public health.
- Removed Mental Health Practitioner that had been (b)
- Where would you go to find resources to help you use research evidence in your work? Within the Registry of Methods and Tools, we have mapped out which methods and tools could help you with each step of the wheel. -the Registry is a collection of KT resources which are relevant for public health =the purpose of the Registry is to make KT resources more accessible -we do this by: -by identifying and filtering knowledge translation resources that are relevant to public health, and -by creating summary statements of those resources to save time for practitioners -our summary statements contains web-links to methods and tools, in addition to supplemental resources that you may find helpful in using the resource
- -here’s a screenshot of the Registry - visitors can access a number of user stories about how people have used methods and tools in their work, recent updates and new resources which have been added, and browse resources in the Registry
- So why is there a distinction between methods and tools? Why is it important that there is a difference? -methods can help you to organize the approach that you use to accomplish a task through a process or series of steps -sometimes methods can help you to learn about a particular aspect of KT and how you think about it -for example, you may want to learn about knowledge management and a method would be a good place to start -tools provide a way to do a task, whether it is critical appraisal of evidence or adapting evidence to your setting -tools can include workplans, instruments, checklists, some sort of tangible product =the value add of having both methods and tools is that you can use both together to accomplish a task – for example, you may access a method on stakeholder engagement to learn why you need to reach out to your stakeholders during your project and what you hope to achieve in doing so -a tool on stakeholder engagement would help your group identify and document the steps you’ve taken in the process
- When working on healthy weights promotion, we need to think not only about what the research says, which is the focus of what I will discuss, but also other factors – like what preferences are there for how to approach this topic? What values do we and others bring to the decision about what to do? What does our expertise tell us about where to focus – obesity, or healthy living?
- -the EIPH wheel illustrates the steps involved in evidence-informed practice -the wheel is a guide for practitioners and decision makers to determine how to address a particular issue by systematically incorporating research evidence in the decision making process -there are 7 steps in the EIPH process that starts with clearly defining the problem, Searching the research literature Appraising the evidence you find Synthesizing or summarizing the research on your issue Adapting and interpreting the findings to your local context Implementing the evidence or appropriate intervention Evaluating your implementation efforts.
- Or if a qualitative question, Population and Situation (P and S)
- Can help to have a framework to help define the kind of evidence you are searching for. I won’t go into the model in detail, but in our scenario to follow through this webinar, Working on healthy weights promotion focused on children; Concern about weight stigma and weight bias and Opportunity to work with early childhood education settings We might define that we are interested in finding and using research evidence that speaks to several of the relevant factors: eating habits, physical activity, body weights AND with attention to Culture and Mindset, Environments, and historical and social factors. Research can help us understand some of this, and we also just need to be aware that our decisions about what intervention to implement will be influenced by many factors.
- Can also be important to ask people in the population, or who have a role to play in the possible interventions: what evidence should we be looking for? That’s not the same as asking “ what fiings should we be looking for?” People may already have ideas about ‘what would work” that are not based on evidence. We use these steps to guide us in looking to the evidence.
- -posted on the Registry of Methods and Tools
- gives useful prompts to help you come up with a searchable question Says clinical questions but doesn’t have to be clinical
- And other pyramid topics Free access; Need to log-in
- Can also be helpful if you are stuck on the right keywords to search – find a relevant source and see how they index! May not be specific enough to your exact question – ECE settings
- As noted under syntheses and synopses of syntheses, HE is a good source for systematic reviews of research evidence related to public health
- Too many! Go back and refine your search.
- You might go back and look at other reviews as well – see how their methods and inclusions differ. Not so much about their conclusions right now. We’re in SEARCH!
- If you still don’t find what you need in syntheses, you sometimes have to go to single studies. You can try PubMed, or the other sources listed here. If you were trying to see what research has found about weight bias, and whether interventions can increase weight bias or weight stigma, you might have to go to single studies if there aren’t any reviews. HOWEVER, note that you are not being ‘systematic’ in your search if you just pick out some single studies, so be careful that you are not cherry picking or introducing bias in what you choose among single studies.
- In this example we might use AGREE II on the NICE guideline, or AMSTAR for the review – although HE pre-appraises!
- Workshop in May every year
- Sisson review: Most interventions had the intended effect on the target: obesity 48% (n = 14), physical activity 73% (n = 30), diet 87% (n = 39), and screen time 63% (n = 5). “Based on these studies, it seems that interventions to prevent excess weight gain may be most effective when targeting children at greater risk, such as those in higher weight categories.” “In summary, the majority of reviewed interventions had a favorable effect on physical activity outcomes. Interventions focusing on the child care center environment and that include structured physical activity during the day, parental engagement, staff training and wellness, and technical support and training, seemed to facilitate positive changes.” “A multi-level intervention focusing on the child care center environment, policies and practices, staff training, and personal health in addition to child engagement and parental support and outreach would be a goal for future obesity-prevention interventions, and is consistent with obesity prevention recommendations.”
- Discuss findings from Sisson
- Research suggests we can be effective in affecting weight, eating, activity in ECE settings. As we think about adapting to our community, we bring in questions about – would we do this? What is acceptable? Can we afford it? Bring in framework again (next slide)
- Focus on eating habits, physical activity, body weights AND with attention to Culture and Mindset, Environments, and historical and social factors. When adapting, gives us other things to think about and consider.
- Second is from CRICH- an adaptation with additional health equity content – so might be very relevant for evidence-informed decisions related to vulnerable populations
- Determine whether to reduce or drop services currently being offered?
- Resource also has case studies and worksheets Really good for stakeholder engagement, which can happen earlier in the process – but I’ve shown it here because it’s strong for implementation considerations.
- -the EIPH wheel illustrates the steps involved in evidence-informed practice -the wheel is a guide for practitioners and decision makers to determine how to address a particular issue by systematically incorporating research evidence in the decision making process -there are 7 steps in the EIPH process that starts with clearly defining the problem, Searching the research literature Appraising the evidence you find Synthesizing or summarizing the research on your issue Adapting and interpreting the findings to your local context Implementing the evidence or appropriate intervention Evaluating your implementation efforts.
- thank you for attending today’s workshop For more information about the NCCMT or to access any of the resources noted in these slides, please consult the NCCMT website or contact the Centre directly.