Evidence based decision making to strenghten local governance : nutritional health interventions

Since 2001, district governments have had the main responsibility for providing public health care in Indonesia. One of the main public health challenges facing many district governments is improving nutritional standards, particularly among poorer segments of the population. Developing effective policies and strategies for improving nutrition requires a multi-sectoral approach encompassing agricultural development policy, access to markets, food security (storage) programs, provision of public health facilities, and promotion of public awareness of nutritional health. This implies a strong need for a coordinated approach involving multiple government agencies at the district level. Due to diverse economic, agricultural,and infrastructure conditions across the country, district governments’ ought to be better placed than central government both to identify areas of greatest need for public nutrition interventions, and devise policies that reflect local characteristics. However, in the two districts observed in this study—Bantul and Gunungkidul—it was clear that local government capacity to generate, obtain and integrate evidence about local conditions into the policy-making process was still limited. In both districts, decision-makers tended to rely more on intuition,anecdote, and precedent in formulating policy. The potential for evidence-based decision making was also severely constrained by a lack of coordination and communication between agencies, and current arrangements related to central government fiscal transfers, which compel local governments to allocate funding to centrally determined programs and priorities.

An analysis of cyclists crashes to identify ITS-based intervention

Cycling provides a number of health and environmental benefits. However, cyclists are more likely to suffer serious injury or be killed in traffic accidents than car drivers and the estimated cost of crashes in Australia is $1.25AU billion per year. Current interventions to reduce bicycle crashes include compulsory helmet use, media campaigns, and the provision of cycling lanes, as well as road user education and training. It is difficult to assess the effectiveness of current interventions as there is no accurate measure of cyclist exposure in South East Queensland (SEQ). This paper analyses cyclist crash characteristics in Queensland with the view to identifying appropriate Intelligent Transport Systems (ITS) based intervention to reduce cyclist injury and death. The inappropriateness of some ITS interventions to improve cyclist safety is highlighted and a set of ITS interventions are identified, based on Queensland crash data 2002-2006.

Developing a culture of enquiry to sustain evidence-based practice

Evidence-based practice (EBP) is having a significant effect on the health service environment. It constructs a language that bridges the healthcare disciplines and the clinical and managerial components of health services. Most experienced clinicians in nursing, medicine and allied health now recognise that the contemporary healthcare environment calls for our practice to be justified by sound, credible evidence. There is pressure on all clinicians to accommodate innovation, while at the same time ensuring their practice is effective, safe and efficient (Forbes & Griffiths 2002). Consequently, EBP in healthcare is having a profound effect on nursing and the way we think about nursing. There are many available models for research utilisation that are dependent on organisational strategies for change. This chapter describes the relationship between organisation and culture, and explores the notion of cultural change; that is, developing a culture of inquiry that can sustain evidence-based practice. We begin this chapter with a clear conception of what we mean by EBP and what we mean by ‘culture’.

Evidence-based practice : information professionals' experience of information literacy in the workplace

Evidence-based practice is increasingly being recognised as an important issue in a range of professional contexts including education, nursing, occupational therapy and librarianship. Many of these professions have observed a relationship or interface between evidence-based practice and information literacy. Using a phenomenographic approach this research explores variation in the how library and information professionals are experiencing evidence-based practice as part of their professional work. The findings of the research provide a basis for arguing that evidence-based practice represents the professional's enactment of information literacy in the workplace.

Evidence-based practice

Introduction This chapter traces the history of evidence-based practice from its roots in evidence-based medicine to contemporary thinking about the usefulness of such an approach to practice. It defines evidence-based practice and differentiates it from terms such as evidence-based medicine, evidence-based policy and evidence-based healthcare. As evidence-based practice is concerned with identifying ‘good evidence’, this chapter will first describe the nature and production of knowledge, as it is important to understand the subjective nature of knowledge and the research process. The chapter considers the necessary skills for evidence-based practice, and discusses the processes of attaining the necessary evidence and its limitations. We examine the barriers and facilitators to identifying and implementing ‘best practice’ and when evidence-based practice is appropriate to use. The chapter concludes with a discussion about the limitations of evidence-based practice and the potential use of other sources of information to guide practice.

Teachers reporting child sexual abuse : towards evidence-based reform of law, policy and practice

This report presents the results of the largest study ever conducted into the law, policy and practice of primary school teachers’ reporting of child sexual abuse in New South Wales, Queensland and Western Australia. The study included the largest Australian survey of teachers about reporting sexual abuse, in both government and non-government schools (n=470). Our research has produced evidence-based findings to enhance law, policy and practice about teachers’ reporting of child sexual abuse. The major benefits of our findings and recommendations are to: • Show how the legislation in each State can be improved; • Show how the policies in government and non-government school sectors can be improved; and • Show how teacher training can be improved. These improvements can enhance the already valuable contribution that teachers are making to identify cases of child sexual abuse. Based on the findings of our research, this report proposes solutions to issues in seven key areas of law, policy and practice. These solutions are relevant for State Parliaments, government and non-government educational authorities, and child protection departments. The solutions in each State are practicable, low-cost, and align with current government policy approaches. Implementing these solutions will: • protect more children from sexual abuse; • save cost to governments and society; • develop a professional teacher workforce better equipped for their child protection role; and • protect government and school authorities from legal liability.

Testing a belief-based intervention encouraging sun safety among adolescents in a high risk area

Objective. To provide a preliminary test of a Theory of Planned Behavior (TPB) belief-based intervention to increase adolescents’ sun protective behaviors in a high risk area, Queensland, Australia. Methods. In the period of October-November, 2007 and May-June, 2008, 80 adolescents (14.53 ± 0.69 years) were recruited from two secondary schools (one government and one private) in Queensland after obtaining student, parental, and school informed consent. Adolescents were allocated to either a control or intervention condition based on the class they attended. The intervention comprised three, one hour in-school sessions facilitated by Cancer Council Queensland employees with sessions covering the belief basis of the TPB (i.e., behavioral, normative, and control [barrier and motivator] sun-safe beliefs). Participants completed questionnaires assessing sun-safety beliefs, intentions, and behavior pre- and post-intervention. Repeated Measures Multivariate Analysis of Variance was used to test the effect of the intervention across time on these constructs. Results. Students completing the intervention reported stronger sun-safe normative and motivator beliefs and intentions and the performance of more sun-safe behaviors across time than those in the control condition. Conclusion. Strengthening beliefs about the approval of others and motivators for sun protection may encourage sun-safe cognitions and actions among adolescents.

An evidence-based approach to professional development planning in large state educational systems

This paper presents a systems-level approach for adjudicating the prioritization, selection, and planning of inservcie professional development (PD) for teachers. We present a step-by-step model for documenting and assessing system-wide 'bids' for professional development programs

Changing academic practice to prepare nursing undergraduates for an evidence-based approach

Evidence based practice (EBP) has been accepted as a process to assist health professionals in clinical decision making to improve patient outcomes. It requires applying skills in a prescribed sequence to critique existing practices. Many countries, including Australia, require nurses to demonstrate competencies in EBP skills to be registered. In the last ten years, this has lead to universities incorporating EBP in undergraduate nursing degree courses. The literature reports many challenges including students’ difficulties in critically appraising research evidence, and their need for both simplification of the process and extensive support. The purpose of our study was to investigate the effectiveness of a standalone introductory EBP subject for a diverse group of third-year undergraduates, based on a novel but challenging approach to assessment. Despite many changes made in the second iteration of the subject, most students’ perceptions of the subject’s difficulty remained unchanged. This research aligns with the issues identified in the literature and has wider applicability to the teaching of rapidly changing disciplines, where evidence-driven consumers have easy access to information and expect up-to-date practices.

A national roll out of an insufficiently evaluated practice : how evidence based are our end-of-life care policies?

There has been increasing international efforts to ensure that health care policies are evidence based. One area where there is a lack of ‘effectiveness’ evidence is in the use of end-of-life care pathways (EOLCP) (1). Despite the lack of evidence supporting the efficacy of the EOCLP, their use has been endorsed in the recent national palliative care strategy document in the UK (2). In addition, a publication endorsed by the Australian Government (titled: Supporting Australians to live well at the End of Life- National Palliative Care Strategy 2010) (3), recommended a national roll out of EOLCP across all sectors (primary, acute and aged care) in Australia. According to this document, it is a measure of “appropriateness” and “effectiveness” for promoting quality end-of-life care.

The Maori social science academy and evidence-based policy

This paper focuses on recent moves to forge stronger linkages between the Māori social science academy and the policy industry. A critical appraisal of this development is offered, with particular attention given to the desirability of enhancing the academy’s role in the policy process, given the policy industry’s continued privileging of Eurocentric theory and research methodologies within the developing evidence-based environment. The paper ends with a discussion of the possibilities and problems associated with engagement with the policy industry, particularly as these relate to the various roles members can (or are forced to) take; either as ‘insiders’ (such as policy workers and contract researchers), or independent, critical ‘outsiders’. The author concludes that the best that insiders can hope for are incremental, largely ineffective changes to Māori policy, while independent members of the academy are best placed to speak on behalf of Māori, Māori communities, hapu and iwi.