National Collaborating Centre for Methods and Tools

Although many of us can understand the benefits of seeking BFI accreditation or adopting a breastfeeding best practice guideline in our organization, I have heard from many public health practitioners from across the country that the process seems quite daunting to them and they don't know where to start. There are many individual and organizational barriers to change that they are facing. For example, just one of the many things we'd need to consider is: do we need to change what nurses in our organization are teaching in prenatal and/or parenting classes and home visits related to breasfeeding or formula feeding and the key messages they are providing?

Public health professionals often work with many stakeholders and community groups in external settings as well as working in their own organization. As a result it can be difficult to implement a best practice guideline. Does any have experience with this? There is probably a lot we can learn from each other. What has worked and what hasn't? Why or why not?

Voilà une excellente question que nous nous faisons poser souvent à nos ateliers. Le temps est l'un des plus grands défis à relever lorsqu'il s'agit de faire intervenir, dans le processus décisionnel, des données probantes issues de la recherche. L’idéal, c’est que vous ayez défini clairement votre question et que vous cherchiez dans donneesprobantes-sante.ca pour trouver un examen systématique de grande qualité et pertinent (synthèse) et peut-être un sommaire d'une à quatre pages (synopsis de synthèse). Le site a été conçu pour faire économiser temps et ressources aux utilisateurs.

S'il est important de vérifier d'abord à un niveau supérieur de la pyramide des 6 S et de continuer en descendant, c'est que vous pouvez économiser du temps et vous vous assurez de ne pas rater des données probantes issues de la recherche de grande qualité, pertinentes et plus synthétisées. Il n'existe pas de sources de données probantes qui sont des « systèmes » de santé publique existants. Cependant, vous devriez commencer par examiner, au niveau suivant de la pyramide, les lignes directrices sur la pratique clinique appelées « sommaires » (reportez-vous au module en ligne Introduction to evidence-informed decision making for a review of searching (Introduction à la prise de décisions fondée sur des données probantes pour un examen de recherche). Si vous avez trouvé un sommaire pertinent et de grande qualité, il vous permettra d'économiser le temps et l'énergie nécessaires pour : évaluer de manière critique les examens systématiques ou les études primaires concernant la question; examiner les découvertes importantes dans toutes les sources; et résumer les données probantes qui en ressortent. N'oubliez pas que vous devez évaluer de manière critique les données probantes issues de la recherche à tous les niveaux de la pyramide des 6 S.

Tant mieux si vous pouvez trouver une réponse rapide à votre question sur donneesprobantes-sante.ca, d'autant plus que l'évaluation critique y a déjà été effectuée. Bien que certaines questions de santé publique ne soient peut-être pas rattachées à une ligne directrice pertinente sur la pratique clinique ou à d'autres données probantes de niveau « sommaire » et issues de la recherche, il est bon de vérifier s'il existe une ligne directrice qui concerne votre question ciblée. Par ailleurs, vous devez vous assurer que votre recherche dans donneesprobantes-sante.ca est assez exhaustive pour vous assurer qu'il n'existe pas plusieurs examens systématiques (synthèses) touchant votre question. Si celle-ci est clairement définie, ces étapes ne devraient pas être longues.

That is a great question that we often get asked at our workshops. Time is one of the biggest challenges to getting research evidence into decision making. It is great when you have clearly defined your question and then you do a search on health-evidence.ca and locate a high quality and relevant systematic review (systhesis) and possibly a 1-4 page summary statement (synopsis of a synthesis). The site was designed to save users time and resources.

The reason it is important to check a higher level of the 6S pyramid first and then work your way down the pyramid in your search is that it could save you time, and will ensure you don't miss any high quality, relevant and more synthesized research evidence. There are not any sources of evidence that are ‘Systems’ for public health currently available however you should start by looking first for any clinical practice guidelines at the next level in the 6S pyramid called ‘Summaries’ (Refer back to the online module: Introduction to evidence-informed decision making for a review of searching). If you have found a relevant and high quality 'summary' it will save you the time and energy needed to: critically appraise any relevant systematic reviews or primary studies relevant to the issue, look at key findings across all sources, and summarize the evidence from these sources. Remeber that you need to critically appraise the research evidence at any level of the 6S pyramid.

It is great if you are able to find a quick answer to your question on health-evidence.ca, especially since they have already done the critical appraisal step for you. Although some public health questions may not have a relevant clinical practice guideline or other 'summary' level research evidence it is good practice to check if a guideline exists that is relevant to your focused question. In addition, you need to make sure that your search of health-evidence.ca is thorough enough to ensure that there isn’t more than one systematic review (synthesis) that is relevant to your question. If you’ve clearly defined your question these steps should not take long.

Certaines raisons techniques pourraient être en cause (nous pouvons vous renseigner davantage à ce sujet si vous le souhaitez). L'important, c'est que nous ne voulons certainement pas que le certificat mérité ne vous soit pas décerné. Si vous avez du mal à l'obtenir, faites-nous le savoir. Envoyez-nous simplement une courte note à l'adresse nccmt@mcmaster.ca et nous tâcherons d'y voir clair.

Ne vous en faites pas. Personne ne tient de pointage. Ces questions vous donnent simplement une idée de ce que vous savez déjà...et de ce que vous devez encore apprendre. Lorsque vous aurez terminé le module, vous connaîtrez toutes les réponses.

There are some technical reasons why this might have happened (we can give you more information on that if you're interested). The main thing is, we certainly don't want you to go without a certificate that you've earned. If you are having trouble getting your certificate, please let us know. Just send a quick note to us at nccmt@mcmaster.ca and we'll sort things out.

Don't worry. Nobody's keeping score. Those questions just give you an idea of what you already know … and what you still need to learn. By the time you've done the module, you'll know the answers to all those questions.

Another useful resource for searching high quality public health literature is Public Health +.

Public Health + is a searchable online archive of methodologically strong articles selected from > 140 journals. The articles are rated for relevance to public health and newsworthiness. The abstracts of primary studies and systematic reviews are available to browse or search. Public Health + is updated weekly and it is a good place to search after you have searched health-evidence.ca and you want to see if anything very recent is available that is relevant to your question that has not yet been added to health-evidence.ca OR to identify any high quality and current primary studies related to your situation.

The number of articles in Public Health + is still quite small but it is growing each week.

You can sign up to receive a weekly e-mail updates of the new articles added to Public Health +. The e-mails are usually quite brief and receiving them is a great strategy to help you scan the new high-quality literature relevant to public health that is available.

I should mention that Public Health + is in English only. Health Evidence which was mentioned earlier is available in both English and French.