Evidence-informed decision making – process and results to inform a breastfeeding program in a public health unit in Ontario

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Presented at the Canadian Public Health Association Centenary Conference Public Health in Canada: Shaping the Future Together, June 16, 2010

Saúde e medicina

Outline

• About the partners
• Project background
• Objectives
• Methods
• Results
• Learning

Project Partners
Region of Peel Public Health
• West of Toronto
• 2nd largest public health unit in
Ontario

Health Evidence
• Based at McMaster University
• Dedicated to a Canadian public
health system informed by the
best-available evidence

Peel Public Health
• Cities of Mississauga,
Brampton and Town of
Caledon – population
>1.25 million

• Higher proportion of
children, young
families and
immigrants than rest
of Ontario

Baby-friendly Designation

• Baby Friendly Community Health
Service - in June 2009:
– seven Point Plan outcome criteria
were met; 5 years to achieve
– awarded by the Breastfeeding
Committee for Canada, the national
authority for WHO/UNICEF
– Baby-friendly Initiative

Health Evidence

Provide and promote access to the best
available evidence
– Registry
– Literature searches & summaries
– Facilitated evidence reviews

Provide knowledge‐brokering services
– Customized EIDM training
– Mentoring and Knowledge Broker

Health Evidence
• online registry –
1900 reviews
• evaluated
interventions
• updated
quarterly
• quality-assessed
• searchable by
commonly-used
public health
terms
• two page
summaries

Key Message Development

Goal: To provide the best available
evidence about the health
consequences of formula feeding and
to support informed decision-making
with a comprehensive website to
build efficacy and confidence to
breastfeed

EIDM Model

National Collaborating Centre for Methods and Tools
Haynes B, DiCenso, A., Ciliska D., & Guyatt, G. 2005

EIDM Process

Assess
applicability
Interpret
Appraise
the quality
Search
for
evidence
Define
the
questio
n

Objective

• Determine if the available research
literature supported a claim of improved
cognitive development due to
breastfeeding.

Methods

• Define the question
• Search the literature
• Relevance & quality assessment
• Critical appraisal
• Interpretation
• Decision-making

The Question

Is breastfeeding exclusively for 6
months associated with enhanced
cognitive development outcomes in
children when compared with
formula feeding?

The Search

• Database searches of Medline, Embase,
CINAHL (2005-2009), searches run
June 10, 2009

• Search terms were limited to results
relating to humans, and English
language

Findings

1261
articles

1221
40 excluded
retrieved (design,
relevance)

10 30 excluded
included (quality)

Findings

4 studies moderate quality
6 had serious methodological flaws

Good quality evidence suggested:
- No relationship between
breastfeeding and cognitive
development when you control for
maternal characteristics including IQ,
socio-environmental factors

Decision Factors

• Research evidence
define
question
• Public health
search
&
appraise
experience, beliefs context
apply

• Public health
credibility
Evidence-informed decision
• Audience assessment

Decision

- Concept for the ‘IQ’ poster was deferred
- Continued with infection, weight

Learning and Next Steps

• Crafting messaging to explain these
findings
• Continue to mine the literature
• For Clients: create web pages with
information about findings in language
that is suitable to all literacy levels and
add to the FormulaNOthanks.ca website
• For Staff: Ongoing EIDM training,
organizational supports and opportunities

Thank you!

Peel Health Health Evidence
Beverley Bryant, Maureen Dobbins
Manager of Education and Research Director
Beverley.bryant@peelregion.ca dobbinsm@mcmaster.ca

Angela Garrison, Lori Greco
Family Health Supervisor Knowledge Broker,
Angela.garrison@peelregion.ca lgreco@mcmaster.ca

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Health Evidence a organisé un webinaire de 60 minutes afin d’examiner les interventions sur Internet offrant une rétroaction personnalisée pour la perte de poids chez les adultes en surpoids et obèses. Anna Haste, chercheuse associée à l’Université de Newcastle, a animé la séance et a présenté les résultats de son récent examen systématique : Sherrington, A, Newham, J, Bell, R, Adamson, A, McColl, E, & Araujo-Soares, V. (2016). Systematic review and meta-analysis of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults. Obesity Reviews, 17(6), 541-551. http://www.healthevidence.org/view-article.aspx?a=systematic-review-meta-analysis-internet-delivered-interventions-providing-29586 Alors que la prévalence de l’obésité augmente, les interventions classiques en matière de perte de poids démontrent l’existence d’obstacles à la mise en œuvre et des résultats mitigés en ce qui concerne l’efficacité. Cette revue systématique et méta-analyse examinent l’impact des interventions livrées sur Internet offrant une rétroaction personnalisée pour la perte de poids chez les adultes en surpoids et obèses, par rapport au groupe témoin ne recevant pas de rétroaction personnalisée. Douze essais contrôlés randomisés, comptant un total de 3547 participants, sont inclus dans cet examen. Les données probantes suggèrent que les interventions sur Internet offrant une rétroaction personnalisée augmentent la perte de poids de 5 % après 3 et 6 mois, et diminuent l’IMC et le tour de taille après 3, 6 et ≥ 12 mois. Ce webinaire a présenté un aperçu de l’efficacité des interventions sur Internet offrant une rétroaction personnalisée pour la perte de poids chez les adultes en surpoids et obèses.

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Health Evidence™

Health Evidence hosted a 60 minute webinar examining the effectiveness of workplace interventions for reducing sitting at work. Click here for access to the audio recording for this webinar: https://youtu.be/psmac6jkbMM Dr. Nipun Shrestha, MBBS, MPH, Postgraduate Student at Victoria University led the session and presented findings from his recent Cochrane review: Shrestha N, Kukkonen-harjula KT, Verbeek JH, Ijaz S, Hermans V, & Bhaumik S. (2016). Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews, 2016(3), Art. No.: CD010912. http://healthevidence.org/view-article.aspx?a=workplace-interventions-reducing-sitting-work-28404 Office work has become sedentary in nature. Increased sitting has been linked to increase in cardiovascular disease, obesity and overall mortality. This review examines the impact of workplace interventions to reduce sitting at work. Two cross-over randomized control trials, 11 cluster randomized trials and 4 controlled before-and-after studies, including 2180 participants are included in this review. Findings suggest that sit-stand desks may decrease workplace sitting. This webinar examined the effectiveness and components of interventions that reduce sitting at work.

Reducing sitting time at work: What's the evidence?

Health Evidence™

Health Evidence presented an interactive 90 minute workshop at the 2017 Cochrane Canada Symposium. Participants learned about techniques, strategies, and resources to create interactive social media content, engage on platforms, tailor strategies with analytics; and [simultaneously] built a custom social media toolkit using the resource above. Access the workshop slides here: http://ow.ly/lLbV30bMjyh

My Social Media Toolkit

Health Evidence™

Build a Social Media Toolkit! Strategies for organisations to engage and opti...

Health Evidence™

Health EvidenceTM a organisé un webinaire de 60 minutes afin d’examiner l’efficacité de l’étiquetage nutritionnel des menus en ce qui a trait à la diminution de la consommation d’énergie lors des repas pris à l’extérieur. Sofia Lourenço, M.Sc., Gestionnaire de projet senior, Société danoise du cancer et Jodie Anne Littlewood, Baccalauréat en nutrition et santé mondiale, Société danoise du cancer, ont animé cette session et ont présenté les résultats de leur dernière revue systématique : Littlewood J., Lourenço S., Iversen C., & Hansen G. (2016). Menu labelling is effective in reducing energy ordered and consumed: A systematic review and meta-analysis of recent studies. Public Health Nutrition, 19(12), 2106-2121. http://healthevidence.org/view-article.aspx?a=menu-labelling-effective-reducing-energy-ordered-consumed-systematic-review-meta-29695

L'étiquetage des menus pour réduire les commandes de produits à forte densité...

Health Evidence™

Health Evidence hosted a 60 minute webinar examining the effectiveness of menu labelling on reducing energy consumption. Click here for access to the audio recording for this webinar: https://youtu.be/ju5uucv3dEE Sofia Lourenço and Jodie Anne Littlewood from the Danish Cancer Society led the session and presented findings from their recent review: Littlewood J, Lourenço S, Iversen C, & Hansen G. (2016).Menu labelling is effective in reducing energy ordered and consumed: A systematic review and meta-analysis of recent studies. Public Health Nutrition, 19(12), 2106-2121. http://www.healthevidence.org/view-article.aspx?a=menu-labelling-effective-reducing-energy-ordered-consumed-systematic-review-meta-29695 Menu labelling is a tool to inform consumers of energy content of meals in the eating-out environment and help consumers make informed decisions. This review examines the effectiveness of menu labelling to reduce energy consumption. Fifteen studies, including 17, 859 participants are included in this review. Evidence suggests that menu labelling reduces overall energy consumed and ordered in the eating-out environment. This webinar examined the effectiveness of menu labelling to reduce energy consumed in the eating-out environment.

Menu labelling for reducing energy ordered and consumed: What’s the evidence?

Health Evidence™

Health Evidence hosted a 60 minute webinar examining the effectiveness of school-based interventions for preventing HIV, sexually transmitted infections and pregnancy in adolescents. Click here for access to the audio recording for this webinar: https://youtu.be/yCeIEQ4OTCc Amanda Mason-Jones, Senior Lecturer in Global Public Health, Faculty of Science, University of York led the session and presented findings from her recent Cochrane review: Mason-Jones A, Sinclair D, Mathews C, Kagee A, Hillman A, & Lombard C. (2016). School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents.Cochrane Database of Systematic Reviews, 2016(11), CD006417 http://healthevidence.org/view-article.aspx?a=school-based-interventions-preventing-hiv-sexually-transmitted-infections-29881 Sexually active adolescents are at risk of contracting HIV and STIs. Unintended pregnancy can have detrimental impact on young people’s lives. This review examines the impact of school sexual education programs on number of young people that contract STIs and number of adolescent pregnancies. Eight cluster randomized control trials, including 55,157 participants are included in this review. Findings suggest there is little evidence that school programs alone are effective in improving sexual and reproductive health outcomes for adolescents. This webinar examined the effectiveness and components of interventions that prevent HIV, STIs and adolescent pregnancy.

School-based interventions to prevent HIV, STIs & adolescent pregnancy: What'...

Health Evidence™

Health EvidenceTM a organisé un webinaire de 90 minutes afin d’examiner l’efficacité des cigarettes électroniques pour la cessation tabagique. Muhannad Malas and Robert Schwartz ont animé cette session et ont présenté les résultats de leur dernière revue systématique : Malas M, van der Tempel J, Schwartz R, Minichiello A, Lightfoot C, Noormohamed A, et al. (2016). Electronic cigarettes for smoking cessation: A systematic review. Nicotine & Tobacco Research, 18(10), 1926-1936. http://healthevidence.org/view-article.aspx?a=electronic-cigarettes-smoking-cessation-systematic-review-29830

Les cigarettes électroniques pour la cessation tabagique : quelles sont les d...

Health Evidence™

Health Evidence hosted a 90 minute webinar examining the effectiveness of electronic cigarettes for smoking cessation. Muhannad Malas and Robert Schwartz led the session and presented findings from their recent review: Malas M, van der Tempel J, Schwartz R, Minichiello A, Lightfoot C, Noormohamed A, et al. (2016). Electronic cigarettes for smoking cessation: A systematic review. Nicotine & Tobacco Research, 18(10), 1926-1936. http://healthevidence.org/view-article.aspx?a=electronic-cigarettes-smoking-cessation-systematic-review-29830 Cigarette smoking is among the top causes of preventable death and disease. Electronic cigarettes have been increasing in popularity among smokers who report using them for quitting or reducing smoking. This review examines the effectiveness of electronic cigarettes as cessation aids. Sixty two articles, including RCTs, experimental, longitudinal and cross sectional studies are included in this review. Findings suggest there is inconclusive evidence due to low quality of research. This webinar provides a comprehensive overview of current literature examining the effectiveness of electronic cigarettes for smoking cessation.

Electronic cigarettes for smoking cessation: What's the evidence?

Health Evidence™

Health Evidence hosted a 90 minute webinar examining the effectiveness of interventions for preventing elder abuse. Philip Baker, Australia Regional Director APACPH, School of Public Health and Social Work Queensland University of Technology led the session and presented findings from their review: Baker PRA, Francis DP, Hairi NN, Othman S, Choo WY. (2016). Interventions for preventing abuse in the elderly. Cochrane Database of Systematic Reviews, 2016, CD010321 http://www.healthevidence.org/view-article.aspx?a=interventions-preventing-abuse-elderly-29428 Many older adults experience some form of abuse (psychological, physical, and sexual) that often goes unreported. Elder abuse is associated with morbidity and premature mortality. This review examines the effectiveness of interventions for preventing elder abuse in the home, institutions and community settings. Findings of the review suggest there is uncertainty in the effectiveness of educational interventions to improve knowledge of caregivers about elder abuse and uncertainty on its effect of reducing abuse. This webinar will examine the effectiveness and components of interventions that prevent elder abuse.

Interventions for preventing elder abuse: What's the evidence?

Health Evidence™

Health EvidenceTM a organisé un webinaire de 60 minutes afin d’examiner l’efficacité des interventions dirigées par des pairs pour éviter la consommation du tabac, de l'alcool et/ou de drogues chez les jeunes. Georgie MacArthur, Boursière en recherche postdoctorale au National Institute of Health Research, School of Social and Community Medicine, University of Bristol, ont animé cette session et ont présenté les résultats de leur dernière revue systématique : MacArthur G.J., Harrison S., Caldwell D.M., Hickman M., & Campbell R. (2016).Peer-led interventions to prevent tobacco, alcohol and/or drug use among young people aged 11-21 years: A systematic review and meta-analysis. Addiction, 111(3), 391-407. http://www.healthevidence.org/view-article.aspx?a=peer-led-interventions-prevent-tobacco-alcohol-drug-young-people-aged-11-21-29422

Les interventions dirigées par des pairs pour éviter la consommation de tabac...

Health Evidence™

Health Evidence hosted a 60 minute webinar examining the effectiveness of community engagement in public health interventions for disadvantaged groups. Click here for access to the audio recording for this webinar: https://youtu.be/tUZ-u7QbMCY. Alison O'Mara-Eves, Senior Researcher, University College London, EPPI-Centre and Ginny Brunton, Senior Health Researcher, University College London, EPPI-Centre presented findings from their review: O'Mara-Eves A., Brunton G., Oliver S., Kavanagh J., Jamal F., & Thomas J. (2015). The effectiveness of community engagement in public health interventions for disadvantaged groups: A meta-analysis . BMC Public Health, 15, 129. Community engagement is becoming an increasingly popular component included in the development and implementation of public health interventions. Involved community members take on roles that range from merely being informed, to being consulted, to collaborating or leading on the design, delivery and evaluation of public health strategies. This review examines the use of public health interventions with a community engagement component, particularly for its use in reducing health inequities among disadvantaged populations. Findings of the review suggest community engagement in public health interventions has an effect on several health outcomes, including health behaviours and self-efficacy. This webinar will examine the effectiveness and components of public health interventions that include community engagement and the impact on health outcomes.

Community engagement in public health interventions for disadvantaged groups:...

Health Evidence™

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