Evidence and Public Policy

The benefits of autonomous vehicles (AVs) are widely acknowledged, but there are concerns about the extent of these benefits and AV risks and unintended consequences. In this article, we first examine AVs and different categories of the technological risks associated with them. We then explore strategies that can be adopted to address these risks, and explore emerging responses by governments for addressing AV risks. Our analyses reveal that, thus far, governments have in most instances avoided stringent measures in order to promote AV developments and the majority of responses are non-binding and focus on creating councils or working groups to better explore AV implications. The US has been active in introducing legislations to address issues related to privacy and cybersecurity. The UK and Germany, in particular, have enacted laws to address liability issues; other countries mostly acknowledge these issues, but have yet to implement specific strategies. To address privacy and cybersecurity risks strategies ranging from introduction or amendment of non-AV specific legislation to creating working groups have been adopted. Much less attention has been paid to issues such as environmental and employment risks, although a few governments have begun programmes to retrain workers who might be negatively affected.

Social work practitioners must act every working day in the face of uncertainty. This uncertainty arises in part because knowledge is often difficult to locate or sometimes lacking regarding: the systems context the population being served; the particular client system; the set of problems the client system is experiencing; as well as the various interventions that could be selected. It seems reasonable
to explore ways to reduce the experience of uncertainty, and narrow, if not eliminate, the knowledge gaps that arise in such situations. The generic idea of evidence-based practice has been advanced for some time as an approach to support practitioners in their day-to-day work. This article has two foci. First, it will briefly and selectively review attempts to make social work practice more evidence based. Second, it will describe one stage in the evolution
of a Web-based service ( Information for Practice [IP]). IP
is a long-term project with the mission of keeping practitioners informed about news and new scholarship in the field, so that they can more easily make their practice more evidenced based.

KEYWORDS best practices, clearinghouse, evidence-based practice, evidence-informed practice, grey literature, knowledge dissemination, literature review, open access, practice guidelines,
translational research

Background: Public health (PH) policymakers are encouraged to use evidence in the decision-making process.
However, little is known about what types of evidence policymakers working in local settings prefer to use. This
study aims to evaluate policymakers’ needs and sources of information, at regional and local levels. Methods: An
electronic survey with telephone follow-up was carried out among PH policymakers and evidence producers
(n = 152) working in a large UK city. Respondents were asked which types of evidence they used regularly,
found most useful and what were their main sources of information. Semi-structured interviews (n = 23) added
were analysed quantitatively in addition to the categorical data generated by the survey. Results: Policymakers use
a much greater range of evidence and information than is often indicated in the literature on evidence-based
policy. Local data were by far the most used (n = 95%) and most valued (n = 85%) type of information, followed by
practice guidelines. The main sources of information were Government websites (84%), followed by information
obtained through personal contacts (71%), including PH professionals, council officers and politicians. Academics
were rarely consulted and research evidence was rarely seen as directly relevant. Conclusions: Policymakers use a
wider range of evidence types than previously discussed in the literature. Although local data were most valued by
policymakers, results suggest that these were accessed through personal contacts, rather than specialized organizations.
Systems to provide local high-quality evidence for PH policy should be supported.

This article discusses research capacity building and its relevance for health practitioners using allied health professionals (AHPs) as a case example. Allied health professionals is a term used to represent a diverse group of health workers, each with a discrete clinical focus, whose needs for research capacity building are likely to be similar to one another and to other medical and nursing professionals. The work of AHPs challenges many current research paradigms being complex and multidisciplinary in nature, often delivered in community settings and focusing on holistic outcomes. This article examines some of the current drivers in the healthcare context and highlights tensions for AHPs in developing their research base in basic science and applied health research. The authors argue for a strategic approach to research capacity building and examine the implications of current policy initiatives for AHP roles and activity in research. The importance of a sustained approach to capacity building is underscored.

This guide is for policy makers and practitioners who are either commissioning research, are developing a public mental health strategy, or are choosing an intervention for implementation and are confronted by conflicting sources of information. It outlines criteria for good evidence on interventions for mental health promotion (MHP) and mental disorder prevention (MDP) and aims to support the critical appraisal of existing evidence and informed decision making.
The profound burden and costs of the health, social and economic impacts of mental disorders necessitate public mental health actions, not only to treat, but also to prevent disorders and to promote positive mental well-being. Decisionmakers need robust evidence to support good decisions when designing
strategies, as do professionals when selecting interventions for implementation.
They need to consider not only whether something actually works, but in what circumstances and at what cost. Many interventions may be culturally sensitive, and need to be evaluated separately for each setting, culture or region. To accommodate the complexity of public health interventions, evidence should be considered in its broad terms.
Without evidence of effectiveness it is difficult to make a case for investmentin mental health. Moreover in the absence of good evidence there is a danger that policies and practices may be introduced that are either harmful, wasteful, or both. This is particularly true of complex interventions in public health and health promotion, which can be delivered across many different sectors and are not usually subject to the same mandatory requirements for evaluation as health care treatments.
When assessing the evidence for an intervention, the pooled evidence from different sources and studies should be scrutinised, through a stepwise critical appraisal of studies and the evidence they entail.
First, the study methodology should be assessed for the risk of systematic bias, i.e. the risk that the study’s outcomes are a result of something other than the intervention under evaluation. Hierarchies of study categories have been constructed to support the assessment of risk of bias. The risk of selection bias, i.e. that the intervention group and the control group differ from each other at baseline and thus are not comparable, is minimised in the well performed randomised controlled trial (RCT). To avoid assessment biases, the study outcomes should be measured independently whenever possible, regardless of whether the study is a RCT or not. In MHP and MDP, RCTs are not always feasible, and, ordered according to increasing risk of systematic bias, non-randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and ecological studies also contribute to the evidence.
Second, even in the case of high quality study methodology, every study needs to be assessed for applicability to the real world, i.e. its generalizability.
Evidence from a well-performed RCT may offer no support whatsoever to decision-making if the population of the study differs from the target population,
if the intervention cannot be replicated, or if the outcome measured lacks relevance. In many cases, cohort studies or ecological studies are performed in more “real-life” circumstances than RCTs. Pragmatic RCTs, also known as, naturalistic RCTs, are an effort to combine the advantages of RCTs (low risk of selection bias) with the advantages of observational studies, but may not always be feasible in MHP and MDP.
Third, qualitative studies offer a complementary approach to generating evidence which sometimes has been overlooked. Quantitative and qualitative approaches are not mutually exclusive, and qualitative studies answer many questions which cannot be answered by quantitative studies.
Fourth, evidence needs to be assessed in combination with cost data. It is important not only to look at the evidence on the effectiveness of promotion and prevention strategies but also their resource implications.
The complex process of assessing existing evidence for MHP and MDP can be supported by the use of guidelines for critical appraisal of studies, developed by different groups. This document presents an example of a matrix that matches types of research questions that want to be answered with corresponding types of evaluative studies that will most likely be able to generate that answer accurately.
Lastly, in each case, issues in the transferability of the available evidence needs to be considered when making decisions about going to scale in different settings, cultures or regions. Many interventions in MHP and MDP are culturally sensitive, and need to be evaluated separately in each setting, culture or region.
The primer concludes that there is sufficient evidence for promotion and prevention in mental health; quantitative and qualitative studies are available that can provide answers to the questions we might want to know. Considering and weighing evidence by appraising how it has been generated can help informed decision making. However there is still room to, in general, improve the quality of the research designs applied to evaluate the efficacy and effectiveness of interventions for prevention and promotion in mental health. These interventions should include long-term follow-ups to give sufficient time for interventions to show effect and to provide an accurate estimation of the duration of effects. It is important to note that proven efficacy or effectiveness is no guarantee that programmes or policies will work similarly in different cultural or economic environments. New studies should focus on identifying the mechanisms and processes of adaptation and reinvention without losing initial efficacy.
There are many guides to the generation and use of evidence. Our aims in writing this short primer were to set out as clearly as possible the strengths and limitations of different methods of evaluation, to consider potential bias in study results, to examine how generalisable results may be to real world settings, to describe how quantitative and qualitative approaches should be combined to enhance the use of information, and to suggest how to strengthen the evidence base of  mental health promotion and mental disorder prevention at the European level.

THE PURPOSE OF THIS FRAMEWORK DOCUMENT

This is a Framework Document on evidence-based reintegration programme design, prepared by the United Nations Institute for Disarmament Research (UNIDIR) for the Inter-agency Working Group(IAWG) on Disarmament, Demobilization and Reintegration (DDR). The purpose of this Framework Document is to develop and introduce a Conceptual Framework for working with evidence in the design of reintegration programmes to support efforts towards greater local impact at the field level. This is critical to achieving strategic goals at both the national and the international levels.

The general task of a Conceptual Framework is to lay out the central concern to be addressed, provide a way of thinking about that concern (in the sense of a theoretical orientation), and identify ways of treating, engaging or addressing that concern (in the sense of both practical and methodological requirements). A Conceptual Framework sets up the foundations for a shared vocabulary and orientation to complex phenomena and provides direction and focus to practices developed in response.

Taking direction from both the Integrated Disarmament, Demobilization and Reintegration Standards (IDDRS) and the IAWG’s strategic priority areas as established for 2012–2014,1 this framework is designed to support locally effective implementation of existing (and developing) policy on reintegration programming by directing attention to the operational needs of reintegration practitioners involved with programme design and strategic planning. As such, it is a highly pragmatic endeavour to advance the means by which policy is implemented.

Because these tasks inherently involve negotiating the complex space between local realities on the one hand, and the strategic objectives set out by high-level political actors on the other (such as national governments, existing peace treaties, United Nations Security Council resolutions, United Nations Development Assistance Frameworks, Poverty Reduction Strategy Papers etc.) the framework developed here treats evidence-based programme design as both a diagnostic and a design process.

It is a diagnostic process in that it is used for identifying and learning about local reintegration contexts, and that learning can directly contribute to crafting locally effective programming activities that serve strategic goals, but which are not always known a priori or are identified by predetermined assessments. It is a design process in that it facilitates both adaptation and innovation in programming through the use of evidence as a way of addressing problem-solving tasks.

The primary audience for this document is practitioners of the IAWG’s member organizations. This is a diverse group of organizations and professionals. Therefore, the framework developed here is intended to provide broadly applicable and practical assistance relevant to tasks and requirements involved in programme design at various levels and junctures.
A secondary audience is the wider community of peace, security and development professionals concerned with how to better move knowledge to action in order to achieve greater success in their efforts.
A key objective in this Framework Document is to create an approach to evidence-based programme design that is responsive to the central challenge of negotiating field-level realities with strategic objectives (in the form of policies etc.) in a manner that is pragmatic, practical and productive.

In addressing this goal, the Framework Document focuses on two procedural steps central to evidence-based programme design, namely the identification of evidence, and the application of evidence to the design of activities that serve strategic goals in a local context.

The limited extent to which research evidence is utilised in healthcare and other public services is widely acknowledged. The UK government has attempted to address this gap by funding nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). CLAHRCs aim to carry out health research, implement research findings in local healthcare organisations, and build capacity across organisations for generating and using evidence. This wide-ranging brief requires multifaceted approaches; assessing CLAHRCs’ success thus poses challenges for evaluation. This paper discusses these challenges in relation to seven CLAHRC evaluations, eliciting implications and suggestions for others evaluating similarly complex interventions with diverse objectives.