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Building Capacity for Evidence-Informed Practice: Lessons from the Ontario Public Health Association’s Towards Evidence-Informed Practice (TEIP) Program

Contents

I Introduction
II The Changing Public Health Landscape
III Defining Evidence-Informed Public Health Practice
IV Practical Tools for Public Health
V Les Outils TEIP Disponibles en Français
VI TEIP Master Trainer Workshops
VII Stories from the Field
VIII Building a Culture of Evidence-Informed Practice
IX Moving forward

-submitted by Dayna Albert and Julie Wong, OPHA –TEIP Program

I Introduction

The Ontario Public Health Association (OPHA) has a long history of supporting the public health community through resource development and capacity building initiatives.  The Towards Evidence-Informed Practice (TEIP) program is one such example.  Since 2005 TEIP has led the field in developing processes, tools and training to strengthen capacity for evidence-informed practice [1] and practice based learning. [2]

II The Changing Public Health Landscape

The public health landscape in Ontario has changed significantly in recent years with the introduction of the:

These seminal documents situate program evaluation, public health research, knowledge exchange and evidence-informed decision-making as skills fundamental to public health practice.

Although public health practitioners have a history of using evidence and evaluation to inform planning and to report to stakeholders, the ever-increasing volume of evidence and changing expectations for evaluative data have led to a demand for new knowledge, new skills, new tools and new supports.

III Defining Evidence-Informed Public Health Practice

The National Collaborating Centre for Methods and Tools recently coined a succinct and suitable definition of evidence-informed public health practice:
“The process of distilling and disseminating the best available evidence, whether from research or from actual practice, and using that evidence to inform and improve public health practice and policy. Put simply, it’s finding, using and sharing what works in public health.”

IV Practical Tools for Public Health

Initially, the field turned to evidence-based medicine as a model for evidence-informed public health. This led, in the early years, to an emphasis on identifying and implementing ‘best’ and ‘promising’ practices and focusing on academic research and systematic reviews as the ‘best’ sources of evidence. Unlike the practice of medicine, however, much of public health practice is context-sensitive, yet the tools of evidence-based medicine are largely insensitive to issues of context.

TEIP tools are the result of partnering with frontline practitioners, public health researchers and knowledge exchange experts to design, field-test and implement user-friendly, relevant and systematic tools to support evidence-informed public health practice.  

TEIP Program Assessment Tool

  • Strengthens new or existing programs by applying evidence-informed criteria associated with best and promising health promotion and chronic disease prevention practices.
  • Based on research by the University of Waterloo Population Health Research Group.
  • Supports continuous program improvement while respecting local experience and context.

TEIP Program Evidence Tool

  • Comprehensive set of guidelines and worksheets to search for, interpret and apply relevant and credible sources of evidence
  • Minimizes the need for critical appraisal skills
  • User-friendly knowledge management worksheets help practitioners avoid getting ‘lost in the evidence’.
  • Additional features include: Glossary, Evidence 101 and Tips & Resources sections

TEIP Program Evaluation Tool  

  • User-friendly guidelines to help practitioners develop realistic, useful and relevant evaluation plans
  • Developed in consultation with Dr. Brian Rush of Virgo Evaluation Planning and Consultants
  • Additional features include: Glossary, Evaluation 101 and Tips & Resources sections

All tools are available at http://teip.hhrc.net/tools/index.cfm.

TEIP facilitates use of its tools by providing:

  • FREE access to TEIP Tools, including guidelines and worksheets from the TEIP website.  
  • Permission to adapt TEIP Tools and worksheets to meet local needs through a Creative Commons licensing agreement.
  • Online learning modules for each tool.
  • Master Trainer workshops to train organizational champions.

V Les Outils TEIP Disponibles en Français

Grâce à l'appui de l'Agence de Santé Publique du Canada, les outils TEIP a été traduite en Français. Les versions françaises sont disponibles sur le site Web de TEIP.

VI TEIP Master Trainer Workshops

Since 2008 TEIP has been delivering Master Trainer (MT) Workshops to develop local champions and to build organizational capacity for evidence-informed public health practice.  
TEIP MT Workshops:

  • Demonstrate by example how to teach others to use TEIP Tools.
  • Build confidence and skills to apply evidence and evaluation.
  • Facilitate discussion and planning to build organizational supports.

After the workshop, TEIP Master Trainers can access:

  • TEIP training slides, facilitator notes and workshop activities to facilitate training of colleagues
  • TEIP discussion forum for Master Trainers
  • TEIP webinars and online learning modules.

VII - Stories from the Field

Lorette Dupuis, Family Health Specialist in Chronic Disease and Injury Prevention at the Ottawa Public Health Unit has kindly consented to share her experiences with the TEIP Program.

TEIP:  On which TEIP Tools did you receive training?
Lorette:  On the TEIP Program Assessment and TEIP Program Evaluation Tools.
TEIP:  How do TEIP Tools compare to other tools?
Lorette: TEIP Tools are comparable to others but much simpler to use.  
TEIP:  Have TEIP MT Workshops and TEIP Tools impacted your practice, department and/or organization?
Lorette: It has made my task as Family Health Specialist easier. I support staff in program planning and implementation. The TEIP Program Assessment Tool was used to prepare teams for operational planning. The teams that took the time to answer the questions and completely assess their programs developed comprehensive program plans for the coming year and were able to complete the departmental logic model with ease. In some teams, Master Trainers have become Chair of their evaluation workgroups. Members of other divisions are using the tools as personal resources to enhance their own work.  
TEIP:  How can other public health organizations benefit from TEIP MT Tools and resources?
Lorette:  Other public health organizations can benefit from these resources as TEIP Tools align well with the Public Health Core Competencies, so regardless of professional designation, the Tools can be used to assess, plan, implement, evaluate and communicate.
TEIP: Anything else you’d like to share?
Lorette:  It’s been so effective that our Branch is considering another TEIP Master Trainer Workshop so that more staff are trained in the use of the TEIP Tools.

Recently, dietetic interns from the Northern Ontario Dietetic Internship Program used the TEIP Evidence Tool to assist in planning their research projects.

“The TEIP (Evidence) Tools have helped to organize our evidence into one document, helped to synthesize evidence and build connections, and helped with information sharing with other team members.  In conjunction with the information in the online program modules, (the TEIP Evidence Tool) has facilitated proposal and report development by easily identifying key themes as well strengths and limitations of collected evidence.”

– Sarah Santianni, Northern Ontario School of Medicine

VIII Building a Culture of Evidence-Informed Practice

Practitioners understand that skills and training are necessary but insufficient to sustain a change in practice. A culture of evidence-informed practice with clear expectations and adequate supports must be imbedded into every aspect of practice and sustained by both systemic (i.e., national and provincial stakeholders) and organizational supports.  
 
Public health organizations need to assess and implement local supports in order to sustain evidence-informed practice. The exact solutions will vary from organization to organization due to differences in culture and context.  Below is a small sample of organizational support strategies:

  • Medical Officers of Health who actively champion evidence-informed practice.
  • Corporate policies which invest in evidence and evaluation.
  • Support for local champions to train and support their colleagues.
  • Inclusion of evidence-informed practice activities in job descriptions.
  • Provision of dedicated time for these activities.
  • Recognizing staff who engage in evidence and evaluation activities.
  • Fostering a culture which openly shares lessons learned.

If you would like to share examples of organizational practices or policies to support evidence-informed public health practice, please email Dayna dalbert@opha.on.ca.

IX Moving Forward

In June 2011, TEIP is hosting a webinar on the topic of building an organizational culture to support evidence-informed practice.  Stories from a range of public health settings (both large and small) will be shared with the intention of stimulating a lively discussion to generate additional strategies and suggestions. Stay tuned for details.

TEIP gratefully acknowledges the support of the Ministry of Health Promotion and Sport (2005 – 2010) and the Public Health Agency of Canada (2008 – 2010).  

Beginning July 2011 TEIP Master Trainer Workshops, webinars and evaluation services will continue to be available from the Ontario Public Health Association through a fee-for-service agreement.  Please contact Dayna Albert dalbert@opha.on.ca for further information.

Note: To browse through examples of how TEIP tools have been used, please refer to the catalogues in the knowledge exchange session of the TEIP website: http://teip.hhrc.net/workshops/index.cfm

References

1. The process of distilling and disseminating the best available evidence, whether from research or from actual practice, and using that evidence to inform and improve public health practice and policy. http://nccmt.ca/en/modules/eidm/keydocs/glossary.php

2. Processes that enable ongoing improvement and learning from program evaluations and related knowledge exchange processes. Centre for Behavioural Research and Program Evaluation (2008). Towards an Enabling System for Knowledge Development and Exchange: Planning to Support Evaluation and Practice-base Learning – Project Overview.