Background Studies have generally found limited use of academic research in policy-making. In 2013 the context for public health decision-making in England changed from the NHS to local authorities (LAs). This represents a different policy environment; however, public health is still considered an evidence-based profession. Despite systematic reviews being regarded as the best available evidence for health decision-making, little is known about how they are used in local government. As the relationship between evidence and policy is potentially complex, it is important to consider the role of research beyond directly informing decisions. The aim of this study was to explore the extent to which public health decision-makers in LAs engage with systematic review evidence and how they do so.
Methods Semi-structured interviews were conducted with senior public health professionals involved in decision-making in Yorkshire and the Humber LAs. Sampling was purposive with recruitment in two phases; contacting Directors of Public Health (DsPH) directly and snowballing through key contacts. Other professionals were interviewed where recommended by DsPH. Face-to-face or telephone interviews were digitally recorded and transcribed verbatim, and data analysed using the framework method.
Results Public health professionals (n=14) in ten LAs were interviewed, including DsPH (n=5) and consultants (n=5). Participants viewed evidence use as an important part of their roles, and had a high level of relevant skills. However, public health teams and individuals differed in the extent to which they used systematic reviews. Some consultants used systematic reviews extensively; for other participants, while they were highly valued in principle, their value and impact in practice was limited by various barriers and the nature of decision-making in LAs. Barriers included time constraints, a lack of relevant reviews, limited applicability to LA context and the role of evidence in a political organisation. Evidence, including systematic reviews, was sometimes used to directly inform decisions but also used tactically. Participants regularly engaged with research evidence outside the decision-making process, often through a personal commitment to maintaining knowledge.
Conclusion Systematic reviews are used in LA public health in various ways but use varies and is limited by a range of factors. Decision-making processes can be complex, with systematic reviews used in conjunction with other evidence types, and therefore research use should be seen within the political context. This qualitative study developed understanding of systematic review use but a limitation is that there may be professionals less committed to evidence use that were not included in the sample.
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