Dataset Information

Dementia Prevention: optimizing the use of observational data for personal, clinical, and public health decision-making.

ABSTRACT: Worldwide, over 35 million people suffer from Alzheimer's disease and related dementias. This number is expected to triple over the next 40 years. How can we improve the evidence supporting strategies to reduce the rate of dementia in future generations? The risk of dementia is likely influenced by modifiable factors such as exercise, cognitive activity, and the clinical management of diabetes and hypertension. However, the quality of evidence is limited and it remains unclear whether specific interventions to reduce these modifiable risk factors can, in turn, reduce the risk of dementia. Although randomized controlled trials are the gold-standard for causality, the majority of evidence for long-term dementia prevention derives from, and will likely continue to derive from, observational studies. Although observational research has some unavoidable limitations, its utility for dementia prevention might be improved by, for example, better distinction between confirmatory and exploratory research, higher reporting standards, investment in effectiveness research enabled by increased data-pooling, and standardized exposure and outcome measures. Informed decision-making by the general public on low-risk health choices that could have broad potential benefits could be enabled by internet-based tools and decision-aids to communicate the evidence, its quality, and the estimated magnitude of effect.

SUBMITTER: Dacks PA

PROVIDER: S-EPMC4487813 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

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Dementia Prevention: optimizing the use of observational data for personal, clinical, and public health decision-making.

Dacks Penny A PA Andrieu Sandrine S Blacker Deborah D Carman Aaron J AJ Green Allan M AM Grodstein Francine F Henderson Victor W VW James Bryan D BD Lane Rachel F RF Lau Joseph J Lin Pei-Jung PJ Reeves Barnaby C BC Shah Raj C RC Vellas Bruno B Yaffe Kristine K Yurko-Mauro Karin K Shineman Diana W DW Bennett David A DA Fillit Howard M HM

The journal of prevention of Alzheimer's disease 20140201 2

Worldwide, over 35 million people suffer from Alzheimer's disease and related dementias. This number is expected to triple over the next 40 years. How can we improve the evidence supporting strategies to reduce the rate of dementia in future generations? The risk of dementia is likely influenced by modifiable factors such as exercise, cognitive activity, and the clinical management of diabetes and hypertension. However, the quality of evidence is limited and it remains unclear whether specific i ...[more]

PMID: 26146610

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Project description:BackgroundThe use of research evidence to underpin public health policy is strongly promoted. However, its implementation has not been straightforward. The objectives of this systematic review were to synthesise empirical evidence on the use of research evidence by public health decision makers in settings with universal health care systems.MethodsTo locate eligible studies, 13 bibliographic databases were screened, organisational websites were scanned, key informants were contacted and bibliographies of included studies were scrutinised. Two reviewers independently assessed studies for inclusion, extracted data and assessed methodological quality. Data were synthesised as a narrative review.Findings18 studies were included: 15 qualitative studies, and three surveys. Their methodological quality was mixed. They were set in a range of country and decision making settings. Study participants included 1063 public health decision makers, 72 researchers, and 174 with overlapping roles. Decision making processes varied widely between settings, and were viewed differently by key players. A range of research evidence was accessed. However, there was no reliable evidence on the extent of its use. Its impact was often indirect, competing with other influences. Barriers to the use of research evidence included: decision makers' perceptions of research evidence; the gulf between researchers and decision makers; the culture of decision making; competing influences on decision making; and practical constraints. Suggested (but largely untested) ways of overcoming these barriers included: research targeted at the needs of decision makers; research clearly highlighting key messages; and capacity building. There was little evidence on the role of research evidence in decision making to reduce inequalities.ConclusionsTo more effectively implement research informed public health policy, action is required by decision makers and researchers to address the barriers identified in this systematic review. There is an urgent need for evidence to support the use of research evidence to inform public health decision making to reduce inequalities.

Project description:BackgroundPublic health decision-making structures in England have transformed since the implementation of reforms in 2013, with responsibility for public health services and planning having shifted from the "health" boundary to local authority (LA; local government) control. This transformation may have interrupted flows of research evidence use in decision-making and introduced a new political element to public health decision-making. For generators of research evidence, understanding and responding to this new landscape and decision-makers' evidence needs is essential.MethodsWe conducted a systematic scoping review of the literature, drawing upon four databases and undertaking manual searching and citation tracking. Included studies were English-based, published in 2010 onwards, and were focused on public health decision-making, including the utilisation or underutilisation of research evidence use, in local (regional or sub-regional) areas. All studies presented empirical findings collected through primary research methods or through the reanalysis of existing primary data.ResultsFrom a total of 903 records, 23 papers from 21 studies were deemed to be eligible and were included for further data extraction. Three clear trends in evidence use were identified: (i) the primacy of local evidence, (ii) the important role of local experts in providing evidence and knowledge, and (iii) the high value placed on local evaluation evidence despite the varying methodological rigour. Barriers to the use of research evidence included issues around access and availability of applicable research evidence, and indications that the use of evidence could be perceived as a bureaucratic process. Two new factors resulting from reforms to public health structures were identified that potentially changed existing patterns of research evidence use and decision-making requirements: (i) greater emphasis among public health practitioners on the perceived uniqueness of LA areas and structures following devolution of public health into LAs and (ii) challenges introduced in responding to higher levels of local political accountability.ConclusionsThere is a need to better understand and respond to the evidence needs of decision-makers working in public health and to work more collaboratively in developing solutions to the underutilisation of research evidence in decision-making.

Project description:BackgroundPublic health professionals are increasingly expected to engage in evidence-informed decision making to inform practice and policy decisions. Evidence-informed decision making involves the use of research evidence along with expertise, existing public health resources, knowledge about community health issues, the local context and community, and the political climate. The National Collaborating Centre for Methods and Tools has identified a seven step process for evidence-informed decision making. Tools have been developed to support public health professionals as they work through each of these steps. This paper provides an overview of tools used in three Canadian public health departments involved in a study to develop capacity for evidence-informed decision making.MethodsAs part of a knowledge translation and exchange intervention, a Knowledge Broker worked with public health professionals to identify and apply tools for use with each of the steps of evidence-informed decision making. The Knowledge Broker maintained a reflective journal and interviews were conducted with a purposive sample of decision makers and public health professionals. This paper presents qualitative analysis of the perceived usefulness and usability of the tools.ResultsTools were used in the health departments to assist in: question identification and clarification; searching for the best available research evidence; assessing the research evidence for quality through critical appraisal; deciphering the 'actionable message(s)' from the research evidence; tailoring messages to the local context to ensure their relevance and suitability; deciding whether and planning how to implement research evidence in the local context; and evaluating the effectiveness of implementation efforts. Decision makers provided descriptions of how the tools were used within the health departments and made suggestions for improvement. Overall, the tools were perceived as valuable for advancing and sustaining evidence-informed decision making.ConclusionTools are available to support the process of evidence-informed decision making among public health professionals. The usability and usefulness of these tools for advancing and sustaining evidence-informed decision making are discussed, including recommendations for the tools' application in other public health settings beyond this study. Knowledge and awareness of these tools may assist other health professionals in their efforts to implement evidence-informed practice.

Dataset Information

Dementia Prevention: optimizing the use of observational data for personal, clinical, and public health decision-making.

Publications

Dementia Prevention: optimizing the use of observational data for personal, clinical, and public health decision-making.

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