a case story: eidm in public health in canada
TRANSCRIPT
A Case Story: Evidence-informed decision making in public health in
Canada
FUSE Knowledge Exchange in Public HealthDurham University, UK
April 12, 2011
Health Evidence Peel Public Health Maureen Dobbins PhD Megan Ward MD, MHSc, CCFP, FRCPC Lori Greco MHSc Beverly Bryant Kara DeCorby MSc
Telling the story
• About the partners• Project background• Objectives • Methods• Results• Learning
Project Partners
Project Partners
Region of Peel Public Health• West of Toronto• 2nd largest public health unit in the
Province of Ontario
Health Evidence• Based at McMaster University• Dedicated to a public health
system informed by the best-available evidence
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
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
Health Evidence Funders
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 Brokering
Health Evidence
• online registry – 2300 reviews
• evaluated interventions
• quality-assessed
• searchable by commonly-used public health terms
• two page summaries
• updated quarterly
FormulaNOthanks.ca
Next Step?
Objective
• Determine if the available research literature supported a claim of improved cognitive development due to breastfeeding.
EIDM Model
National Collaborating Centre for Methods and ToolsHaynes B, DiCenso, A., Ciliska D., & Guyatt, G. 2005
EIDM Process
Health Evidence Support
Decision
The Question
Is breastfeeding exclusively for 6 months associated with enhanced cognitive development outcomes in children when compared with formula feeding?
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
Findings
Findings
4 studies moderate quality6 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
Decision Factors
• Research evidence
• Public health experience, beliefs
• Public health credibility
• Audience assessment
context
Decision
- Concept for the ‘IQ’ poster was deferred- Continued with infection, weight
✔✔✗
Learning and Challenges
• Imperative to understand feelings and experiences of staff
• Staff highly value tacit knowledge and experience
• Inconsistent valuing of research• Research is evolving
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
Questions? …..Thank you!
Peel HealthMegan WardAssociate Medical Officer of [email protected]
Beverley BryantManager of Education and [email protected]
Health Evidence
Maureen DobbinsDirector
Lori Greco
Knowledge Broker,