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Evidence-based health policy: context and utilisation


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  • Dobrow, Mark J.
  • Goel, Vivek
  • Upshur, R. E. G.
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    Evidence-based decision-making is centred on the justification of decisions. In the shift from an individual-clinical to a population-policy level, the decision-making context becomes more uncertain, variable and complex. To address this we have developed a conceptual framework for evidence-based decision-making, focusing on how context impacts on what constitutes evidence and how that evidence is utilised. We present two distinct orientations towards what constitutes evidence, representing different relationships between evidence and context. We also categorise the decision-making context based on the ways in which context impacts on evidence-based decision-making. Furthermore, we invoke the concept of axes of evidence-based decision-making to describe the relationship between evidence and context as we move from evidence-based medicine to evidence-based health policy. From this, we suggest that it may be more important how evidence is utilised than how it is defined. Based on the research and knowledge utilisation literature, we present a process model of evidence utilisation, which forms the basis for the conceptual framework for context-based evidence-based decision-making. The conceptual framework attempts to capture the role that context plays in the introduction, interpretation and application of evidence. We illustrate this framework with examples from policy development for colorectal cancer screening.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 58 (2004)
    Issue (Month): 1 (January)
    Pages: 207-217

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    Handle: RePEc:eee:socmed:v:58:y:2004:i:1:p:207-217

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    Keywords: Evidence-based decision-making Health policy Context Evidence utilisation;


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    Cited by:
    1. de Goede, Joyce & Putters, Kim & van Oers, Hans, 2012. "Utilization of epidemiological research for the development of local public health policy in the Netherlands: A case study approach," Social Science & Medicine, Elsevier, vol. 74(5), pages 707-714.
    2. Deas, L. & Mattu, L. & Gnich, W., 2013. "Intelligent policy making? Key actors' perspectives on the development and implementation of an early years' initiative in Scotland's public health arena," Social Science & Medicine, Elsevier, vol. 96(C), pages 1-8.
    3. Rosella, Laura C. & Wilson, Kumanan & Crowcroft, Natasha S. & Chu, Anna & Upshur, Ross & Willison, Donald & Deeks, Shelley L. & Schwartz, Brian & Tustin, Jordan & Sider, Doug & Goel, Vivek, 2013. "Pandemic H1N1 in Canada and the use of evidence in developing public health policies – A policy analysis," Social Science & Medicine, Elsevier, vol. 83(C), pages 1-9.
    4. Kurko, Terhi & Silvast, Antti & Wahlroos, Hannes & Pietilä, Kirsi & Airaksinen, Marja, 2012. "Is pharmaceutical policy evidence-informed? A case of the deregulation process of nicotine replacement therapy products in Finland," Health Policy, Elsevier, vol. 105(2), pages 246-255.
    5. Green, Andrew & Gerein, Nancy & Mirzoev, Tolib & Bird, Philippa & Pearson, Stephen & Anh, Le Vu & Martineau, Tim & Mukhopadhyay, Maitrayee & Qian, Xu & Ramani, K.V. & Soors, Werner, 2011. "Health policy processes in maternal health: A comparison of Vietnam, India and China," Health Policy, Elsevier, vol. 100(2), pages 167-173.
    6. Hodgetts, Katherine & Elshaug, Adam G. & Hiller, Janet E., 2012. "What counts and how to count it: Physicians’ constructions of evidence in a disinvestment context," Social Science & Medicine, Elsevier, vol. 75(12), pages 2191-2199.


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