Background: Cultures and structures of public-health decision making are shifting towards greater devolution and localism. As generators and synthesisers of evidence we need to respond to these changes if we are to continue to support public-health decision makers to make informed and judicious evidence-based choices. This study examines evidence use within recently restructured local public-health decision-making structures in England, although the challenges described have wide applicability.
Objectives: The overarching aim is to critically examine whether our own research outputs are fit for purpose in supporting decision making in new public-health structures (specifically local authorities as the municipal government is now leading local public health). We aim to identify areas where research evidence could make a greater contribution and the barriers to this taking place.
Methods: This research took on an iterative design and we present findings from: (i) a systematic scoping review of the literature of local public health evidence use patterns in England; (ii) documentary analyses of local strategies; (iii) qualitative interviews and fieldwork with public health officials in local authorities.
Results: Our scoping review revealed three clear trends in evidence use: (i) the primacy of local evidence; (ii) an important role for local experts; and, (iii) high value placed on local evaluation evidence of varying methodological rigour. Contrary to some of the existing literature suggesting that evidence use is sparse, documentary analyses revealed a complex and diverse set of evidence-use patterns, and we present typologies of evidence use that emerged. Finally, our qualitative interviews revealed some of challenges to effective evidence use, and areas where there was greater potential for evidence to make a contribution in the commissioning process.
Conclusions: In addition to identifying ways in which evidence can be more effectively implemented, an important contribution of this study is to refute some of the literature that adopts a ‘deficit model’ approach in attempting to understand local evidence-use patterns.