Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan

Background: 

Cognitive impairment in first-episode mania: a systematic review of the evidence in the acute and remission phases of the illness

There is evidence of cognitive impairment that persists in the remission phase of bipolar disorder; however, the extent of the deficits that occur from the first onset of the disorder remains unclear. This is the first systematic review on cognitive functioning in the early stages of bipolar I disorder. The aim of the study was to identify the patterns and degree of cognitive impairment that exists from first-episode mania. Three electronic databases (MEDLINE, PsycINFO and PubMed) were systematically searched for studies published from January 1980 to June 2014. Eligible studies were separated into two groups: acute and remission. The Newcastle-Ottawa quality assessment scale was utilised to measure the quality of the included studies. A total of seven studies (three acute and four remission), including 230 first-episode mania and 345 healthy control participants, were eligible for the review. The studies in the acute phase only examined aspects of executive functioning, with impairments identified in cognitive flexibility, though not in response inhibition and verbal fluency relative to healthy controls. The most consistent finding during the remission phase was a deficit in working memory, whereas in the other domains, the findings were equivocal. Non-verbal memory and verbal fluency were not impacted in remission from first-episode mania. In conclusion, deficits are present in some but not all areas of cognitive functioning during the early stages of bipolar I disorder. Further research is warranted to understand the longitudinal trajectory of change from first-episode mania.

Prosecutors’ perceptions of the utility of video-evidence for adult complainants of sexual assault

Playing an adult sexual complainant’s video-recorded police interview as the basis for his or her evidence-in-chief is a reform Australia could adopt to help improve criminal justice responses to these cases. This article presents a qualitative evaluation of prosecutor’s support for this reform and their views about what conditions would determine its utility. Focus groups were held with 13 prosecutors from across New Zealand (which already has this reform) and Australia. Collectively, prosecutors supported the availability of video-evidence for adult complainants. They perceived the utility of this reform depends on the following conditions: (1) the quality of the police interview; (2) how credibly the complainant presents on video; (3) contextual factors that influence the complainant’s ability to give live evidence; and (4) the degree of stakeholder support. These findings suggest that Australia should extend video-evidence to adult complainants of sexual assault guided by careful planning aroundthese four areas.

Prosecutors’ perceptions of how to improve the quality of evidence in domestic violence cases

Limited evidence in domestic violence prosecutions is a persistent problem. Focus groups with 13 prosecutors from across Australia and New Zealand were used to explore how to improve the quality of evidence collected and presented in these cases. A thematic analysis identified three main strategies: improving the quality of investigations by initial police responders, supporting the complainant and tailoring the trial process to the domestic violence context. The most discussed strategy within these categories has previously received little attention– police video recording the complainant's initial account and using that video as the basis for the complainant's courtroom testimony.

Clinical trial adaptation by matching evidence in complementary patient sub-groups of auxiliary blinding questionnaire responses

Clinical trial adaptation refers to any adjustment of the trial protocol after the onset of the trial. Such adjustment may take on various forms, including the change in the dose of administered medicines, the frequency of administering an intervention, the number of trial participants, or the duration of the trial, to name just some possibilities. The main goal is to make the process of introducing new medical interventions to patients more efficient, either by reducing the cost or the time associated with evaluating their safety and efficacy. The principal challenge, which is an outstanding research problem, is to be found in the question of how adaptation should be performed so as to minimize the chance of distorting the outcome of the trial. In this paper we propose a novel method for achieving this. Unlike most of the previously published work, our approach focuses on trial adaptation by sample size adjustment i.e. by reducing the number of trial participants in a statistically informed manner. We adopt a stratification framework recently proposed for the analysis of trial outcomes in the presence of imperfect blinding and based on the administration of a generic auxiliary questionnaire that allows the participants to express their belief concerning the assigned intervention (treatment or control). We show that this data, together with the primary measured variables, can be used to make the probabilistically optimal choice of the particular sub-group a participant should be removed from if trial size reduction is desired. Extensive experiments on a series of simulated trials are used to illustrate the effectiveness of our method.

A guide to clarifying evidence in Australian child forensic interviews

Purpose – Interviewing victims of child sex abuse requires considerable care in order to minimise error. Due to children’s heightened suggestibility any question asked of a child could potentially incite error that could undermine the witness’s credibility. A focus group was conducted in order to facilitate the development of guidance for interviewers around the circumstances in which it is necessary to ask children follow-up questions in an interview. The paper aims to discuss these issues.

Design/methodology/approach – Seven Crown prosecutors representing every Australian state and territory (with the exception of one small state) were issued with 25 hypothetical narrative accounts of child abuse and asked to indicate what information, if any, required follow-up in the child’s narrative. Their responses and rationale for requiring following up in some cases and not others were discussed.

Findings – Thematic analysis revealed three recommendations to guide questioning: whether the case involved identification or recognition evidence; the presence of contextual features that may influence the witness’s memory, or that should trigger a particular line of questioning; and whether the information can or should be sought at a later stage by the trial prosecutor, rather than by the interviewer. Practical implications – The recommendations are discussed within the context of their implications for interviewing, that is, how each recommendation could be implemented in practice.

Originality/value – The present study extends prior literature by elucidating principles to guide decision making across interview topic areas. The need for such guidance is highlighted by research suggesting that topics such as offender identity, offence time and place, and witnesses are a source of overzealous questioning in interviews.

An exploratory cluster randomised controlled trial of knowledge translation strategies to support evidence-informed decision-making in local governments (The KT4LG study)

Background: Childhood overweight and obesity is the most prevalent and, arguably, politically complex child health problem internationally. Governments, communities and industry have important roles to play, and are increasingly expected to deliver an evidence-informed system-wide prevention program. However, efforts are impeded by a lack of organisational access to and use of research evidence. This study aims to identify feasible, acceptable and ideally, effective knowledge translation (KT) strategies to increase evidence-informed decision making in local governments, within the context of childhood obesity prevention as a national policy priority.
Methods/Design: This paper describes the methods for KT4LG, a cluster randomised controlled trial which is exploratory in nature, given the limited evidence base and methodological advances. KT4LG aims to examine a program of KT strategies to increase the use of research evidence in informing public health decisions in local governments. KT4LG will also assess the feasibility and acceptability of the intervention. The intervention program comprises a facilitated program of evidence awareness, access to tailored research evidence, critical appraisal skills development, networking and evidence summaries and will be compared to provision of evidence summaries alone in the control program. 28 local governments were randomised to intervention or control, using computer generated numbers, stratified by budget tertile (high, medium or low). Questionnaires will be used to measure impact, costs, and outcomes, and key informant interviews will be used to examine processes, feasibility, and experiences. Policy tracer studies will be included to examine impact of intervention on policies within relevant government policy documents.
Discussion: Knowledge translation intervention studies with a focus on public health and prevention are very few in number. Thus, this study will provide essential data on the experience of program implementation and evaluation of a system-integrated intervention program employed within the local government public health context. Standardised programs of system, organisational and individual KT strategies have not been described or rigorously evaluated. As such, the findings will make a significant contribution to understanding whether a facilitated program of KT strategies hold promise for facilitating evidence-informed public health decision making within complex multisectoral government organisations.

Determinants of pregnancy, and induced and spontaneous abortion in a jointly determined framework: Evidence from a country wide district level household survey in India

This study provides evidence on the principal determinants of pregnancy and abortion in India using a large country-wide district-level data set (DLHS 2007). The paper provides an economic framework for the analysis of pregnancy and abortion. The study distinguishes between induced and spontaneous abortion and compares the effects of their determinants.

The results show that there are wide differences between induced and spontaneous abortions in terms of the sign and magnitude of the estimated effects of several of their determinants, most notably wealth, the woman’s age and her desire for children. The study makes a methodological contribution by proposing a trivariate probit estimation framework that recognizes the joint dependence of pregnancy and induced and spontaneous abortion, and provides evidence in support of this joint dependence.

The study reports an inverted U-shaped effect of a woman’s age on her pregnancy and both forms of abortion. The turning point in each case is quite robust to the estimation framework. A significant effect of contextual variables, at the village level, constructed from the individual responses, on a woman’s pregnancy is found. The effects are weaker in the case of induced abortion, and insignificant in the case of spontaneous abortion. The results are shown to be fairly robust. This paper extends the literature on the relation between son preference and fertility by examining the link between mother’s son preference and desire for more children with abortion rates.

Socio-demographic and work setting correlates of poor mental health in a population sample of working Victorians: application in evidence-based intervention priority setting

Interventions to promote mental health in the workplace are rapidly gaining acceptability as a means to prevent, screen, treat and effectively manage the growing disease burden of depression and anxiety among working people. The objective of this study was to identify socio-demographic and work setting correlates of poor mental health to consider alongside other evidence in priority setting for workplace mental health promotion (MHP). Multiple logistic regression was used to model the probability of poor mental health (SF-12) in relation to socio-demographic (gender, age, education, marital status and occupational skill level) and employment factors (workplace size and type, industrial sector, employment arrangement and working hours) in a population-based cross-sectional survey of 1051 working Victorians. As a result, poor mental health was (21% prevalence overall) higher in working females than in males and decreased with increasing age. Only one employment factor was significant in demographically adjusted multivariate analyses, showing an increase in the odds of poor mental health with increasing working hours. It is concluded that based on the prevalence of poor mental health, Victorian work settings with high proportions of younger workers, and younger working women in particular, should be prioritized for workplace MHP. Thus, together with other research demonstrating particularly poor psychosocial working conditions for young working women, sectors with an over-representation of this group (e.g. service sector) could be prioritized for workplace MHP alongside young and blue-collar males (also a priority due to low mental healthcare service use).

Evidence-based strategies to promote physical activity among children, adolescents and young adults: review and update

This paper updates evidence reviewed in the first edition of Getting Australia Active on effective physical activity (PA) intervention strategies among children, adolescents and young adults. Intervention studies published between 1999 and September 2003 were identified using electronic databases and hand searching. A total of 28 discrete studies were identified (31 papers). Six of nine studies reported significant effects on child or youth PA in school settings. Those that incorporated whole-of-school approaches including curriculum, policy and environmental strategies appeared to be more effective than those that incorporated curriculum-only approaches. Five of 10 studies with children and two of five studies with adolescents reported increased PA or decreased sedentary behaviour in other settings. Interventions that included contact with families generally appeared to be most effective. One study with adolescents provided some evidence of the potential effectiveness of interventions based in primary care. Two of four papers reported modest short-term results among young adults, including increased PA stage of change or a higher likelihood of being adequately physically active, but none showed any evidence of sustained increases in PA. There is an urgent need for additional studies examining interventions aimed at young adults. Across the three life stages, future studies should include objective PA measures, longer-term follow-up, larger sample sizes, a specific focus on PA (rather than weight) and culturally-specific strategies that build evidence in Australian populations. Future studies should target high risk groups and a broad range of settings and strategies focusing on reducing sedentary behaviours as well as increasing PA.

Accountants and valuations in Australian family court proceedings

This paper investigates issues related to the role of accountants in presenting expert evidence in the form of share valuations in Family Court of Australia proceedings. By providing a background to the valuation rules applied by the Family Court and examining relevant cases, the paper emphasises that considerable ambiguity exists. The paper highlights some of the inconsistencies that are evident from reported decisions and stresses the difficulties that judges have experienced with valuations presented by accountants in Family Court cases. It is evident that the courts, despite the legal precedents, continue to have considerable difficulty with valuation issues and methodologies. By exploring issues related to accounting based valuations in the context of Australian family law cases, the present paper examines accounting in a particular social and institutional setting. The paper is interdisciplinary in nature, in that issues extending over accounting, finance and legal boundaries are considered.

If the price is right : vagueness and values clarification in contingent valuation

The use of willingness to pay to value the benefits of health care is increasing. Much of this work assumes that health preferences are well formed or complete and readily revealed if the right question is asked in the right way. We examined this assumption, seeking evidence in a mixed-methods study that explored the meaning and implications of vague responses to a payment-scale based willingness to pay exercise.

One-half of the sample said that their vagueness meant that their maximum willingness to pay was actually greater than the amount that they had previously said it was. Thirty percent agreed that they would probably pay £10 more than a sum that they had previously said they would most definitely not pay, if they found this to be the cost of the vaccine. Interview data supported the view that the payment scale had failed to elicit the maximum willingness to pay and that some participants used the information on cost to help clarify their values, in contrast to the theory underpinning willingness to pay. The results suggest a need to consider values-clarification in health economic evaluations. Copyright © 2002 John Wiley & Sons, Ltd.

Wholly online learning in environmental science

In recent years there has been a significant shift in the way courses and subjects are delivered to students in tertiary institutions. Advances in technology have resulted in a change to the traditional face-to-face lecture and tutorial teaching format, with many subjects in tertiary education now available online. Although research has explored the advantages and disadvantages of online learning, there has been little attention paid to this teaching format in the field of environmental science. In particular, there is little evidence in the literature to suggest that this method of teaching is appropriate for studies in environmental science or for environmental science students. This study examined the outcomes from a wholly online subject in environmental science at Deakin University, Australia. More specifically, the study aimed to investigate student views about online learning in environmental science as well as online group work. Questionnaires were distributed to all students who completed the core second year subject Society and Environment in semester 1, 2005. Although many of the responding students (n = 48) recognised the benefits of wholly online learning, the findings suggest that most prefer to learn in a face-to-face environment. This paper examines the implications of these findings for future online teaching methods in this discipline.