NCCMT Webinar: Injury-Prevention-Focused Methods and Tools to Support Evidence-Informed Decision-Making

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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.
Injury-Prevention-Focused
Methods and Tools to Support
Evidence-Informed Decision-Making
Susan Snelling, PhD
Senior Knowledge Translation Specialist, NCCMT
June 22, 2016

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

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
3

Housekeeping
Experiencing feedback?
• Click Audio Broadcast at the bottom of the
Participants panel to join or leave the audio
broadcast.
4

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
5

Follow us @nccmt Suivez-nous @ccnmo 6
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 & tools
relevant for
injury prevention
practitioners

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

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
8

NCCMT Registry of Methods and Tools
for Knowledge Translation
9

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
10

Evidence… of what?
11

Evidence of the Problem versus
Evidence of Effective Interventions
• Injury Prevention has a lot of data on the
problem: rates of injury, causes, burden…
• Knowing the nature and magnitude of the
problem helps to focus efforts.
12

Example: www.parachutecanada.org
13
Evidence of the
problem comes in
reports on cost,
surveillance
reports…

Evidence of the Problem versus
Evidence of Effective Interventions
• Injury Prevention has a lot of data on the
problem: rates of injury, causes, burden…
• Knowing the nature and magnitude of the
problem helps to focus efforts.
• Knowing the problem doesn’t tell us what
effective interventions are.
• We also want to find the best available
evidence for effective interventions.
14

A Model for Evidence-Informed
Decision-Making in Public Health
15

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.
16

What does it mean for an intervention
to be ‘effective’?
Recommended resource:
http://www.nccmt.ca/resources/search/129
17
Centers for Disease
Control and
Prevention (2011).

Strength of evidence and Effectiveness
18

Stages in the process of
Evidence-Informed Public Health
19

Scenario: Setting the Stage for
Evidence Use in Injury Prevention
• Falls prevention for seniors living
at home
• Opportunity to offer some
programming in partnership with
several stakeholders
How can the steps of Evidence-
Informed Public Health be applied
to this scenario?
20

Clearly define the question or
problem

Frameworks can help:
BEEEACH Model of Categories and
Settings of Interventions
22

Define the question
PICO
P population
I intervention
C comparison
O outcome
23

Define the question: Apply our scenario
PICO
P population: community-dwelling seniors
I intervention: [we’ll leave unspecified]
C comparison: no intervention or usual
care
O outcome: prevention of falls
24

Recommended Tool: Define
Developing an Efficient Search Strategy Using
PICO
Use it to develop an evidence-search question
using the PICO format.
25

Efficiently search for research
evidence

Recommended Tool: Search
NCCMT Search Pyramids
http://www.nccmt.ca/learningcentre/EN/index.php
• Pre-populated with good sites for finding
evidence in public health, and for certain specific
topics.
• Start at the top for the most synthesized
evidence.
• Saves time
• Systematic approach to searching
28

National Guideline Clearinghouse
31

33
www.healthevidence.org

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
42

Critically and efficiently appraise
the research methods

Recommended Tools: Appraise
44
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

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.
45

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
46

Interpret information;
understand how to prioritize
conflicting results

Recommended Tool: Synthesize
Briefing Note: Decisions, Rationale and Key Findings
Summary
Use it to create briefing notes to inform decision-
makers. Use ‘actionable messages’ to inform program
and policy development.
48

Summarize Key Findings from Stubbs
• exercise reduces falls (including the rate, risk,
and odds of falling), with 13/14 pooled analyses
(93%) from 7 meta-analyses demonstrating a
significant reduction.
• multifactorial interventions reduce falls (5/6,
83% reported significant reduction).
• conflicting evidence regarding the influence of
vitamin D supplementation (7/12, 58.3%
reported significant reduction).
49

Bringing it all together…back to the
framework!
50

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
52

Adapt the information
to the local community

A Model for Evidence-Informed
Decision-Making in Public Health
54

Recommended Tools: Adapt
- Applicability and Transferability of Evidence
55

Online Learning Module
Assessing the Applicability and Transferability
of Evidence
56

Tips for “Adapt”
57
• 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?

Decide whether
(and plan how) to implement
the change in practice or policy

https://www.mcmasteroptimalaging.org/
59
Which is more likely to meet the need:
Communicating evidence to partners
and community members

60
Recommended Tool: Implement

Assess the effectiveness
of the change in
practice or policy

Recommended Tool: Evaluate
Improving Future Decisions: Optimizing the
Decision Process from Lessons Learned
Use it to evaluate your use of evidence in
making decisions.
A reflective practice tool.
62

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.
64

65

Poll Question #2
66
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

Recommended tool: Evidence-
Informed Decision Making Checklist
67
 EIDM Phases & Steps
File Path / Link to
Saved Location on:
(insert name of your
network here)
 1. Define question
 Was a clear answerable search question developed?
What was the question?
P
I
C
O

2. Search for relevant evidence
 Was a comprehensive search strategy employed to find the best available evidence to
address this question?
PICO search terms table (See: Developing an Efficient Search Strategy Using PICO)
 Years searched:
Pyramid results (See: Levels & Sources of Public Health Evidence)
Search results (See: Keeping Track of Search Results: A Flowchart)
References saved in reference management software database (e.g. Reference Manager / RefWorks)
What relevance criteria were used to determine evidence for quality assessment:
Primary
Titles and abstracts as found in reference management database
 Save as separate reference management database.
Secondary
Relevance assessment of full document versions
 Save as separate reference management database.
How many papers remained following relevance assessment(s)? (See: Flowchart, above)
 3. Appraise
 Was quality assessment conducted on relevant evidence?
How many papers remained after quality assessment? (See: Flowchart, above)
 4. Synthesize
 What were the results of the review of the evidence?
What were the actionable messages from the evidence?
 5. Adapt.
 NCCMT’s Applicability and Transferability tool;
 AHRQ’s Will It Work Here? A Decisionmaker's Guide to Adopting Innovations
 6. Implement.
 7. Evaluate.

Poll Question #3
68
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

• Use Q&A to post comments
and/or questions
• ‘Send’ questions to All (not
privately to ‘Host’)
Q&A
Your Comments/Questions
69

Poll Question #4
70
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

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
71

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_9EIx
wibAzI4IgcJ
72

For more information about the
National Collaborating Centre
for Methods and Tools:
73
NCCMT website www.nccmt.ca
Contact: nccmt@mcmaster.ca

NCCMT Webinar: Injury-Prevention-Focused Methods and Tools to Support Evidence-Informed Decision-Making

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NCCMT Webinar: Injury-Prevention-Focused Methods and Tools to Support Evidence-Informed Decision-Making