What Is the Purpose of a Systematic Review?

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• Published: 13 July 2020

Use and value of systematic reviews in English local dominance public health: a qualitative report

BMC Public Health book xx, Commodity number:1100 (2020) Cite this commodity

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Abstract

Groundwork

Responsibility for public health in England transferred from the National Wellness Service to local regime in 2013, representing a dissimilar decision-making environment. Systematic reviews are considered the gold standard of evidence for clinical decision-making but little is known about their use in local government public wellness. This report aimed to explore the extent to which public health conclusion-makers in local government appoint with systematic reviews and how they do and then.

Methods

Semi-structured interviews were conducted with senior public health practitioners (n = 14) in Yorkshire and the Humber local authorities. Sampling was purposive and involved contacting Directors of Public Health direct and snowballing through cardinal contacts. Contiguous or phone interviews were digitally recorded, transcribed verbatim and analysed using the Framework Method.

Results

Public health practitioners described using systematic reviews directly in decision-making and engaging with them more than widely in a range of ways, frequently through a personal delivery to professional evolution. They saw themselves as having a office to advocate for the use of rigorous evidence, including systematic reviews, in the wider local authority. Systematic reviews were highly valued in principle and public health practitioners had relevant skills to discover and appraise them. Withal, the extent of use varied past individual and local authorization and was express by the complication of decision-making and diverse barriers. Barriers included that there were a express number of systematic reviews bachelor on certain public health topics, such as the wider determinants of health, and that the narrow focus of reviews was not reflective of circuitous public wellness decisions facing local authorities. Reviews were used aslope a range of other show types, including grey literature. The source of evidence was often considered an indicator of quality, with specific organisations, such every bit Public Health England, Overnice and Cochrane, specially trusted.

Conclusions

Inquiry use varies and should be considered within the specific decision-making and political context. There is a need for systematic reviews to be more cogitating of the decisions facing local potency public wellness teams.

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Background

In 2013 responsibility for public health conclusion-making in England transferred from National Wellness Service (NHS) main care trusts to upper-tier and unitary local authorities (LAs) as office of the Health and Social Care Act 2012. LAs became responsible for commissioning a number of specific public wellness functions, such as sexual wellness services, smoking abeyance, drugs and booze services and obesity programmes, with a band-fenced budget provided to deliver these functions [1]. Also equally commissioning these services, it was intended that public health teams could influence decisions on policy and commissioning within other parts of the authority that impacted the wider determinants of health, such as housing [1]. Each LA has a Director of Public Health (DPH), which is a statutory position held by a consultant in public health, responsible for leading on public health locally [ii]. DsPH are supported by other consultants, who are qualified as public wellness specialists and registered with a professional person trunk [2].

Public health has long been viewed as an evidence-based field of study with principles based on evidence-based medicine (despite critiques of this framing) [3]. Senior public health professionals are trained in evidence use as part of the 5-twelvemonth grooming program (or equivalent experience) prior to condign registered consultants [4]. All the same, LAs represent a different policy-making environment to the NHS in a number of ways. Firstly, elected politicians are involved in decision-making [five,six,7], which has the potential to touch on on evidence employ [6]. Secondly, research has shown that cultures of evidence use are different in non-wellness sectors, such equally transport, planning and housing, with which public health teams are at present expected to work [viii]. At that place take also been large reductions in the ring-fenced public health grant since the transfer [9] and there is evidence that public health practitioners (PHPs) see themselves as having less influence or condition in some means since the transfer [5, 7, 10].

Systematic reviews are an important type of evidence for public health practice every bit they synthesise all available primary enquiry studies to provide a more than reliable estimate of intervention effectiveness [11], or a reliable overview of findings on problems such every bit disease prevalence and risk factors for developing a illness [12]. While, historically, much of the initial development of systematic review methodology took place within medical enquiry, its awarding to public health questions has proceeded quickly, and is now widely accustomed as an important function of the evidence mural informing public health policy [xiii, 14]. This expansion of domain has in turn facilitated a shift in methods, as systematic reviewers have realised the limitations of a model focused mainly on reviewing randomised trials. Increasingly, systematic reviews are investigating barriers and facilitators to implementing interventions and exploring the views and experiences of dissimilar stakeholders [12]. At that place is besides a range of other types of evidence review available (e.thou. scoping reviews, rapid reviews), generally characterised by less rigorous methodology [15]. Systematic reviews are considered the gold standard of evidence-based decision-making in clinical settings [16] but there take been criticisms of the systematic review evidence base of operations in public health. These include a reliance on rigorous study designs that are less widely-used in public health enquiry [17], few reviews on the social determinants of health [xviii], a large number of reviews with uncertain conclusions [xix], and a lack of consideration of policy implications [20].

Given the number of systematic reviews published and the growing literature on strategies to meliorate their uptake in decision-making [21,22,23], it is important to understand how practitioners in different contexts perceive their value and apply. Although some studies have explored systematic review use in public health [24, 25], much of the prove utilise literature considers academic research in general [half dozen, eight, 26]. A more in-depth understanding of the barriers and facilitators to systematic review utilise in LAs could help systematic review authors and commissioners to better meet the evidence needs of PHPs. Generally research has constitute relatively limited direct utilize of academic evidence in policy-making [6, 8, 26]. However, potential complexities in the human relationship between prove and policy take been highlighted, for instance the argument that enquiry should focus on the influence of ideas on policy [27].

There has been limited research on the use of show in LAs since the transfer of public health. A systematic scoping review published in 2017 identified viii studies on local public wellness controlling in England that explored evidence use after the transfer to some extent [6], although a number have been published since then [10, 28,29,30,31,32]. To our cognition, there has been no study focusing specifically on the apply of systematic reviews in the context of local public health decision-making since the transfer. The aim of this study was to explore the extent to which public health decision-makers in LAs engage with systematic reviews or other evidence reviews and how they do and so [33]. Given the complexities in the evidence-policy relationship, this was explored in terms of both direct utilise in controlling and wider date. Decision-makers were defined every bit PHPs working within LA public health teams and contributing to the controlling process for policy or commissioning decisions in public health or other related areas.

Methods

Semi-structured qualitative interviews were conducted with PHPs in the Yorkshire and the Humber region.

Sample

Sampling was purposive and targeted senior PHPs in LAs, specifically DsPH and public health consultants, as they were considered most likely to be able to provide insight into controlling. Recruitment was undertaken in 2 phases. Firstly, the DsPH at all 15 upper-tier and unitary LAs in the Yorkshire and the Humber region were invited to participate in the report or provide details of a colleague who may be able to have part. The 2nd phase involved snowballing through key contacts to recruit further participants. Although sampling focused on DsPH and consultants, other public health staff were interviewed where specific individuals were recommended as having useful insight into the use of show by the DsPH contacted or through snowballing. All potential participants were invited to participate through e-mail with an data canvas provided. Sampling was iterative and continued until information saturation was judged to have been reached by the researcher conducting interviews.

Procedure

All participants provided written informed consent. An interview schedule was adult for the study, with questions derived from the study aims but tailored to dissimilar task roles (come across Additional file 1). Participants were asked about their role and involvement in making or supporting decisions, the straight use of reviews in policy-making or commissioning (including identifying reviews and whatsoever assessment of quality), other ways in which they engaged with research evidence and the value and utilize of reviews in relation to primary research. They were also asked to reflect on how valuable systematic review show was, annihilation that could be washed to better the usefulness of reviews and how important it was that review methods were robust. Interviews were conducted face-to-face or over the telephone by one researcher (ES). Interviews were recorded using a digital recorder and transcribed verbatim, with identifying information removed. Ethical approving was granted by the University of York Health Sciences Research Governance Committee.

Analysis

Interview data were analysed using the Framework Method [34], as it allows analysis of themes across interviews, while retaining a sense of the views of each individual participant [35]. In this case information technology was important to consider information within the context of the role of each participant (e.m. DPH, consultant). The Framework Method is appropriate in studies where all interviews covered similar issues, and it can be used with an inductive, deductive or combined approach [35]. In this example a combined approach to assay was used, with a framework that included deductive themes based on in the interview schedule and inductive themes identified through open coding of v interviews. NVivo 12 was used to code transcripts with the framework themes and generate framework matrices for each of the 7 chief categories. Coded data was summarised into the matrices. The framework was revised as necessary throughout coding and analysis. Coding and analysis were conducted past one researcher (ES), with framework matrices and the terminal analysis checked and refined by a second (TL).

Results

Participants

Fourteen interviews were conducted between June and September 2018, with participants from ten of the 15 LAs in the region. One LA declined to participate due to time constraints and four DsPH did not respond. V participants were DsPH, five were consultants and one was a public health speciality registrar. The remaining three were other PHPs, all of whom had a function of their remit related to evidence or research use. Eight participants worked for metropolitan district councils (covering urban areas) and 6 worked for non-metropolitan councils. These LAs represented a mix of deprived and more affluent areas, co-ordinate to the English language Alphabetize of Multiple Deprivation [36]. Interviews lasted between 19 and 46 min. Two were conducted over the telephone and the remainder were face-to-face at LA offices.

Findings have been grouped below under the thematic categories used in the framework analysis and illustrated with bearding quotations from the data. The first four categories focus on the utilisation of systematic reviews in conclusion-making. The remaining categories describe themes that emerged around the broader context of show use and the role of PHPs within the local dominance. Key findings under each thematic category are summarised in Table 1.

Table ane Summary of central findings from framework analysis

Full size tabular array

Utilisation of reviews

Use of systematic reviews in decision-making

Participants considered utilise of the evidence base to be an important function of public health decision-making:

"it's certainly function of the culture of our public health team and I would say all of our services, when we are looking at reviewing them, when we're looking at service specifications etc., one of the things we exercise is what's the best available evidence and … that's something that we keep looking for" (DPH02).

Equally office of this, systematic reviews were used by all public health teams to some extent; both in directly informing public health decisions and influencing decisions in the wider LA. Examples of systematic review use mainly involved the commissioning of services, including employ in needs assessments and service specifications, simply there were also examples of use in policy-making. Examples ranged from completely proactive use at the start of the determination-making process to reactive use, supporting or refuting a proposed decision.

However, participants did non rely exclusively on systematic reviews and discussed using other types of evidence aslope or instead of them, including grey literature and primary inquiry. In particular, evidence summaries or briefings from trusted organisations and National Institute for Health and Care Excellence (Prissy) guidance were highly valued and to some participants comparable to systematic reviews. Most participants mentioned specific trusted organisations, especially Public Health England (PHE), Dainty and the King's Fund, with i consultant explaining that Prissy and PHE were seen equally "unbiased" and "independent" (Consultant05). Information technology was pointed out that these summaries often collate evidence from reviews or are "reports … which … mistiness the gap between a systematic review and other things" (DPH01). When asked about systematic reviews, participants would frequently talk most these grey literature reports instead and some used these more oft than systematic reviews. For example, one DPH said that their team tended to utilise evidence through "briefings rather than actually going to search for the actual systematic review" (DPH05). The approach to using principal research ranged from some participants who highlighted the gamble of basing decisions on unmarried studies to others who believed the relative value of reviews and main research depended on factors such as the decision, the audition or the context the main enquiry was undertaken in:

"I remember they're both equally important...it does but depend on what's bachelor and … the question yous're trying to respond. I wouldn't put one higher than the other" (Consultant02)

The extent of systematic review utilize varied past remit, personal approach to evidence and role, with consultants and other PHPs using them more than DsPH. One of several consultants who used them extensively explained how this may not be widespread:

"I've got colleagues who work on other parts of public health … they aren't regularly … accessing periodical manufactures then I'm kind of similar well … how's evidence driving what you do? And I think they're probably more reliant on a lot of the policy stuff that comes out of Public Health England for example" (Consultant03)

Systematic review employ too differed between LAs. While it was clearly part of the culture in some public health teams to regularly consider research evidence in decisions, a few participants suggested that their team had less of a systematic arroyo to incorporating bear witness:

"We're moving in that direction. I don't think as a local dominance we especially accept a history of doing that" (Other01)

Finding and selecting reviews

Participants had literature searching and disquisitional appraisal skills only in practice these were not always used, with time a pregnant bulwark:

"it'southward really difficult the way you work hither, y'all don't have the time to kind of do the kind of critical appraisal type arroyo that y'all would in other settings perhaps" (Consultant03)

Some participants stressed that literature searches were quick and most participants also found systematic reviews through other routes, including through colleagues and networks, Google and trusted online sources. Quality was frequently assessed informally rather than through critical appraisal tools. In that location was a theme of relying on "gut instinct" (Consultant03) and making intuitive, quick judgements on quality or using reviews from sources that were trusted to exist of good quality. Trusted sources of systematic reviews that were mentioned included Cochrane and specific bookish departments in the UK.

At that place was a range of views on the value of non-systematic evidence reviews (e.yard. rapid reviews). Some participants expressed a preference for systematic reviews, just best-selling that sometimes there was a need to use other types of review, for example in areas with limited evidence. For others, it depended on the situation or other factors that were considered more important than methodology, such as reliability, accessibility, source or face validity:

"I call back some of the stardom between working in practice public health and working in bookish public health is that in academic public health we become really caught upwardly with methodology and labelling and the purpose of this and … what it is and what information technology isn't and I think in exercise public health, if the publication has face up validity in that feels like it hangs together and it resonates with your experience and it feels practical and so it'south got some actionable things in information technology, so even if you lot had concerns nearly the robustness of the methodology then you'd probably however think information technology was worth thinking nearly" (Other03)

Barriers to use

Barriers to using systematic reviews within LAs included availability of relevant reviews, the narrow focus of research questions, access to journal articles, and the involvement of politicians who may favour other evidence types in controlling.

The limited number of relevant systematic reviews available was viewed as a primal barrier. Participants discussed how there was much more than systematic review bear witness available for healthcare public health and other clinically-focused topics, compared to the wider determinants of health, communities and social intendance:

"the local authorization is a social model of public health whereas when we were in the NHS, it was more of a clinical model of … public health, although nosotros did do the social aspects also but this is much more than around the social determinants of wellness, the causes of the causes. So really there might be opportunity to do systematic reviews moving forrad that really do focus … on our new function, role and opportunities" (DPH05)

Most participants had to use principal research at times because of limited availability of systematic reviews:

"Often I call back with the areas I'm interested in, like wider determinants, developed social intendance, in that location it would e'er be primary research considering they but there isn't a lot of other stuff." (DPH03)

Yet, in that location were opposing views, including one consultant who said that there were "loads of good social care papers and systematic reviews out there" (Consultant04). Systematic reviews were likewise seen as beingness narrow in their focus by some participants, as they tended to cover single issues, while public health decisions could be complex:

"systematic reviews nevertheless tend to be quite topic-based. So you'll go a systematic review on smoking abeyance or a systematic review on physical activeness or 1 on alcohol consumption. You won't or less common would be to find a systematic review that talked to you near customs evolution and creating safer environments for people to live in." (Consultant01)

A few participants raised the limited number of systematic reviews on how to organise services, highlighting that this was the subject of many public health decisions. It was too suggested that more reviews that addressed context through qualitative or realist methods would be useful for controlling.

A meaning barrier was restrictions on access to full journal manufactures, which was a major source of frustration for some participants:

"I would say there's a huge problem with accessing publications. So if you practise find stuff that you want to look at the original commodity, I hateful … I've got an Athens countersign so that's great, I can become into what the NHS has subscribed to but that is and so limited" (Consultant02)

While some public health teams worked effectually the limited admission, others mentioned using abstracts only or relying on open admission publications.

Near participants highlighted that systematic reviews were not ever applicable to the context they were working in, in terms of generalisability to population and place or taking into account the LA context. Principal research undertaken in a local or similar context was particularly valued:

"I remember you demand to start with the systematic review, that gives you the overall picture, but very often you would detect that it's the localised studies that then are the ones that are probably more powerful in terms of moving things" (DPH02)

Issues were raised effectually whether systematic review findings could be translated and implemented within the specific context of LA decision-making, taking into consideration local issues such as upkeep and remit.

Some participants felt that evidence was viewed differently in a political organisation, with anecdotal evidence from constituents and local evidence particularly valued by councillors. Some participants too saw political ideology or strategy every bit a bulwark to implementing prove:

"you tin accept all the bear witness, golden standard evidence that says this is the course of activity but there may exist competing bear witness from a political ideology perspective or whatever that y'know just means sorry but nosotros own't going to do it" (Consultant02)

Still, once again, there was some divergence on this:

"we usually have … robust conversations but nosotros don't accept to sort of compromise really in what … we want to practice. The council and politicians generally do accept the evidence-based recommendations." (Consultant05)

Improving the usefulness of systematic reviews

Other than addressing the barriers above, participants were able to suggest several specific ways that systematic reviews could exist improved to exist more useful. It was suggested that good executive summaries were of import, particularly due to time constraints. Several participants also spoke of the value of systematic reviews providing recommendations on implementation and practice. The inclusion of economic evidence, such as return on investment, in systematic reviews was also suggested:

"if information technology's a systematic review that also includes … toll effectiveness testify so including the economic basis, that often can help broaden the arguments so information technology moves from just beingness does this intervention work … [to] actually is there a good financial reason for doing it?" (Registrar01)

Participants from ii LAs wanted better links with universities, in terms of input into research priorities, academics visiting LAs to explicate their research or translation of systematic reviews into guidance for practice:

"I suppose that's part of what we attempt to do locally is translate the systematic reviews into useful pieces but sometimes nosotros don't have the connexion with the academics that we could benefit from." (DPH01)

One DPH was interested in the potential for more secondments of academics to LAs and vice versa. Another consequence raised was the need for systematic reviews to be disseminated then that PHPs were enlightened of new research. An online resource where all systematic reviews could be chop-chop institute and accessed and email updates on newly published reviews were both suggested.

Evidence and professional roles in the LA context

Role of PHPs in advocating for prove employ

A key theme that emerged was that senior PHPs saw themselves as having a office advocating for the use of prove inside LA decisions.

For some, this commitment to evidence use was conspicuously linked to their sense of identity as a public health professional. For case, a number of consultants and DsPH referred to their public health training or were self-reflective about their use of show. Some expressed feelings of regret or sadness that they no longer employed skills such as literature searching or disquisitional appraisal, or kept up-to-date with research:

"I experience like I've let that side of my subject field become abroad considering I'm and then busy but trying to do the 24-hour interval job … and some Directors of Public Health I know are much meliorate at keeping up with evidence or … good at having like … an area of involvement that they keep up to. I think I rely a lot on experts … or when I exercise go to kind of CPD events but … it'south a failing of mine really that I should spend a chip more than fourth dimension keeping upward with it" (DPH03)

PHPs were involved in trying to influence decisions across the public health squad, including those of elected members and other parts of the LA, such as social care and the wider determinants of wellness. Some participants too saw themselves as having a office to interpret and summarise prove for determination-makers:

"I see myself as a bit of a broker betwixt kind of taking the academic information and presenting that in a manner that's meaningful to kind of the audience that I'yard working with, exist information technology kind of planners or commissioners or clinical leads." (Consultant03)

Every bit office of this influencing role, some teams used specific pieces of evidence to persuade and influence conclusion-makers to support a certain position:

"there's the more than reactive stuff where something's happening or somebody says something and...I then have to go and look for testify to either back up or refute or we know that there's evidence that supports or refutes only having to sort of put information technology forwards to change the management of travel I suppose" (Consultant02)

Some of this was akin to what has been described as political or symbolic evidence apply, where prove is used to justify a pre-determined position [37, 38]:

"Sometimes it can exist held upwardly as 'well this isn't merely my idea, these people are maxim this' and that tin can be quite helpful" (Other03)

Notwithstanding, evidence was also used in more than nuanced ways:

"… we live in a organisation that's intrinsically unfair and I do recollect there's something effectually evidence challenging some of those power structures that are really helpful" (DPH03).

"they [systematic reviews] can besides assistance with changing thinking about something … they may help us think through a particular issue or they may assistance united states commission a scrap of research locally or they may help united states have conversations with people. And then I think they have a role but … I don't think it's that- and I don't think to be fair I don't think it'southward ever been that actually linear process" (Other03).

Some other example of evidence use that was distinct to straight instrumental application to existing problems was the active response to new show equally information technology was published:

"I suppose … the other thing that we might await at, the other way that we'd use evidence, whether systematic reviews or individual studies, would be what we do when they come out. So there might exist significant ones published and and so in that location'd be the question of we would and then potentially await at our policy and how we might want to develop our policy based on those." (DPH04)

Engagement with research outside controlling

PHPs frequently engaged with systematic reviews and other enquiry exterior decision-making processes. The main reasons for this were maintaining noesis, professional development and interest and information technology was sometimes expressed as a personal commitment. For example, i consultant had personal subscriptions to journals. Some other consultant described themselves as a "large bear witness person", explaining that:

"I understand healthcare and social care through the research. That's just the fashion I've e'er washed it." (Consultant04)

However, two consultants regarded it every bit an integral role of their chore to keep up-to-engagement with new bear witness:

"we use evidence and systematic reviews and published prove summaries from NICE and other national organisations … simply every bit part of our day task really. We're always on the lookout for new show, new summaries, any changes … that might shift our noesis and our thinking" (Consultant05)

Enquiry was encountered through a wide range of different routes, including broadcasting from other organisations, Twitter, conferences, periodical clubs, and professional networks.

Value of systematic reviews in local authority context

Despite varying apply, systematic reviews were highly valued in principle by nearly participants, particularly consultants, and seen as an of import contribution to public health work:

"they definitely have a place, they're definitely very useful and nosotros need to have them, even if they're not ever acted on" (Consultant02)

Their value was expressed by some participants as their ability to save them time by preventing the need to search for, assess or summarise literature themselves. Relatively few participants explicitly stated that they valued them because they were high quality evidence but their perceived quality was frequently implicit when participants discussed their use. Some participants described a feeling of condolement or lack of worry when using systematic review evidence:

"the sort of comfort of knowing … there's somebody who'southward done this really, really well" (Consultant04).

Nonetheless, some participants expressed limits to the value and bear on of systematic reviews inside LA decision-making. DsPH tended to talk more than about the limits of reviews and the complex nature of decision-making. A theme emerged that published prove was "only office of the puzzle" (DPH02) in decision-making:

"it's only the start of the process to … build your example. The of import thing is being able to argue your case and influence from that. And so … for instance you lot tin design your service, y'all can get-go your policy on the basis of the evidence but yous can't [be] quoting bear witness to people indefinitely because it doesn't you don't come beyond well. Yous take to be able to put … everything into context and also have to reflect reality of funding, … political decisions" (Registrar01)

There were too contesting interpretations of evidence within LAs and a limited understanding of systematic reviews and other research outside of public health teams was highlighted. 1 consultant described how this could pb to difficult conversations when non-public health colleagues presented bear witness that may be of limited quality or relevance. As previously discussed, a key theme that emerged was the power of local and anecdotal evidence within LAs:

"I think there's a broader notion of what constitutes evidence and not quite so much the bureaucracy of evidence that I'1000 used to from a more than NHS, medical … golden standard systematic reviews through to observational stuff or any. Whereas … there'south a hierarchy in that setting and I think in local government it's more horizontal so what a scattering of people accept said in a focus group is considered to be as important equally a systematic review" (Consultant02)

Trying to innovate inquiry evidence to counter this was non always effective and could be received badly:

"Sometimes the word 'testify' or 'this has come from the research' doesn't always go down well with members and some of that is because local government really likes stuff that'south relevant locally." (Other03)

In particular, international evidence and research from other parts of the Great britain could be disregarded or challenged past elected members:

"whereas doctors, whereas health people I retrieve will concord national prove quite strongly, I think with when people work very locally, they're a fleck similar 'well that's all well and practiced merely information technology doesn't employ to me' a bit more" (DPH03)

Despite the battling interpretations of evidence, the promotion of evidence within the LA was not always framed as PHPs working against an environment that was resistant to bookish bear witness. I participant said that, within a stakeholder grouping, public wellness would be seen equally "the evidence guru" (Registrar01) and relied on to interpret the bear witness base. Another participants suggested that public health teams had the potential to increase skills and understanding of testify within the wider LA.

Discussion

Interviews with PHPs demonstrated that systematic reviews are used directly in controlling, as office of a culture of evidence use in the LA public wellness workforce. A wider appointment with systematic reviews and other research that is arguably intrinsic to senior public health roles, and sometimes expressed as a personal delivery to developing knowledge, was also noted. PHPs saw themselves as having a role advocating for the use of show inside the LA and in some cases translating the academic evidence base. Nevertheless, the extent of systematic review use varied betwixt individuals and LAs. Use tin can be limited in the LA context, despite the fact systematic reviews are highly valued in principle and PHPs take a high level of exposure to research and appropriate skills to use it. Bear witness is seen as only one factor in determination-making processes that can exist circuitous and there are contesting interpretations of prove. There are also a number of barriers to systematic review employ in LAs, including time constraints, involvement of politicians and restricted admission to periodical manufactures. There are also barriers associated with the research available, including a lack of reviews published on topics relevant to LA public wellness. Systematic reviews can exist seen as too narrow in their focus and not sufficiently reflective of the complex decisions facing PHPs. Other evidence is used alongside or instead of systematic reviews, with grey literature reports from specific trusted sources especially valued. The source of evidence was important to participants and used as a quick style to judge quality and reliability.

This report confirms findings from previous studies on public health decision-making which found that a wide range of evidence beyond academic research is used, local knowledge and testify is particularly valued, and anecdotal evidence is powerful [three, six, eight, 26, 28, 39, 40]. Credibility of evidence is ofttimes adamant through the reputation of the author or institution rather than the methodological quality of the research [8, 25]. Findings confirmed a number of practical barriers identified in previous studies, including access to research [vi, 8, 26, 28, 41]. Findings are also consistent with recent enquiry on LAs that has highlighted the office of PHPs in framing evidence for others and the impact of politics on evidence utilise [28, xl]. Even so, compared with other evidence types, inquiry use has been seen every bit limited and mainly symbolic or conceptual (influencing decisions indirectly past contributing to general enlightenment [37, 38]) rather than instrumental (directly applied to a problem [37, 38]) [eight, 26, 39]. Specifically, while previous enquiry has establish evidence in support of systematic review use in public heath settings [25, 26, 39], at that place was express instrumental utilise in controlling [25] and reviews were perceived as less valuable than some other evidence types [25, 39]. While this study reiterates some of the limitations of systematic reviews, information technology establish that they were used extensively and frequently instrumentally by some, albeit not all, PHPs, who valued them highly. For some participants, the use and promotion of rigorous bear witness, including systematic reviews, was an important part of their identity and part as a public health professional.

Nonetheless, this study raises questions over how easily examples of evidence use tin can be categorised as instrumental, symbolic or conceptual in political contexts. Although participants described research testify being used in a 'tactical' manner, this did e'er equate to symbolic testify use. In this context, fifty-fifty policies or positions that had been informed instrumentally by evidence however had to exist sold politically to elected members, sometimes requiring the tactical utilise of specific pieces of evidence. A few participants also spoke about implementing new research findings every bit they were published, which is closer to the knowledge-driven model described by Weiss [37].

Findings reiterate the complication and heterogeneity of decision-making processes and bear witness use [6, 26]. They also reinforce before findings that the idea of 'evidence-based' policy does not adequately capture the complexity of bear witness-policy relationships in practise [3, 27, 42]. Conventional hierarchies of evidence may not accost the wide, systemic nature of the challenges faced in public wellness practice (as opposed to narrowly defined research questions), or other stakeholders' divergent preferences for prove. Utilise of systematic reviews can exist express past a perceived lack of relevance and systematic review authors and commissioners should consider widening the evidence base of operations to meet public wellness needs, equally has previously been suggested [28]. The systematic review community has begun to recognise the need to address questions of relevance to practise and policy, and is now more routinely involving stakeholders in question-setting [43] and developing methods to address more circuitous questions [44]. In that location are as well more than efforts to take account of context [45, 46] and implementation [47] issues in systematic reviews. Recent discussion has also focused on how show syntheses such as systematic reviews can improve meet the needs of policy-makers beyond all policy areas, including involvement of policy-makers throughout, accessible language and open access publication [48]. Lack of time and admission to publications are barriers that would need to be addressed within the public health community, although both may prove difficult to address without increased public health funding. The positive framing of the promotion of evidence utilise by some PHPs suggests that there may be opportunities for public health to play a role in increasing ambition and chapters for using research across the wider LA.

Limitations

This report was based on a limited number of interviews in ten LAs. Information technology was clear that many of the participants had a item involvement in evidence apply so the findings may not reverberate the full range of attitudes towards systematic reviews held past PHPs. Sampling focused on senior PHPs who had completed the public health speciality grooming program and findings may not be generalisable to staff who have received less training in evidence use. As participants were working in one region of England only, some findings may not be generalisable to LAs in other regions. It has been suggested that there are specific drivers of wellness inequalities in the North of England and thus different priorities to other regions [49]. As highlighted by the findings of this research, context is important and not all findings will apply to other public health settings. Participants were aware that the interviewer worked for a university department specialising in systematic reviews, which may have influenced some of their responses. This also introduces possible bias into data drove and analysis. The authors may have shown bias towards more favourable views of systematic reviews, given their own views, although authors were conscious of this risk and effort was taken to avert this.

Conclusions

This written report contributes to the understanding of the use of systematic reviews in conclusion-making, and more specifically the use of evidence in LA public health later on the transfer of decision-making from the NHS. While information technology confirms a number of barriers and limitations to systematic review use found in previous studies, information technology also plant differences with research undertaken in other public health settings. For example, some individuals used systematic reviews extensively, including directly use in decision-making processes and wider engagement, albeit alongside a range of other evidence. This reiterates the importance of because evidence use with reference to the specific context and actors involved, in this case senior PHPs in LAs. Findings also highlight the complexity of decision-making and the fact that systematic reviews need to be more cogitating of the decisions facing PHPs in LA public health.

Availability of data and materials

The dataset generated and analysed during the current report is non publicly available and cannot be shared due to confidentiality, as participants are potentially identifiable from the information contained in the information.

Abbreviations

DPH:

Director of Public Health

LA:

Local authority

NHS:

National Health Service

Overnice:

National Institute for Health and Care Excellence

PHP:

Public health practitioner

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Acknowledgements

Nosotros would similar to thank Alison Patey, Public Health Consultant, Hull Metropolis Quango, for help and communication with developing the interview schedule, and Professor Amanda Sowden, Deputy Manager, Heart for Reviews and Broadcasting for comments and advice on the manuscript.

Funding

This work received no external funding.

Author data

Affiliations

1. Eye for Reviews and Broadcasting, University of York, York, YO10 5DD, UK

   Emily South & Theo Lorenc

Contributions

ES conceptualised and designed the study, conducted interviews, analysed interview information and drafted the manuscript. TL contributed to the conception and design of the study, checked and refined the framework matrices and analysis and contributed to writing the manuscript. All authors read and canonical the final manuscript.

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Correspondence to Emily Due south.

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South, E., Lorenc, T. Utilise and value of systematic reviews in English local say-so public health: a qualitative report. BMC Public Health twenty, 1100 (2020). https://doi.org/10.1186/s12889-020-09223-i

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• Received: 06 April 2020

• Accepted: 06 July 2020

• Published: 13 July 2020

• DOI : https://doi.org/x.1186/s12889-020-09223-ane

Keywords

• Systematic reviews
• Show
• Policy-making
• Local government

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