Evaluating capacity for evidence-informed decision-making within an Australian public health policy environment

Abstract The research project undertaken for the degree of Doctorate of Philosophy (PhD) reported in this thesis examined research use within policy and program decision-making processes in two government agencies: WorkSafe Victoria and the Transport Accident Commission. These agencies are responsible for workplace and transport injury prevention and rehabilitation compensation in the Australian state of Victoria. This PhD research project sought to: provide a detailed understanding of the ‘everyday’ operating context of these agencies; identify factors that affect decision-making generally; identify factors that affect research use specifically; and inform the development of an intervention to drive and support increased research use in these agencies. This research project was designed based on the following premises: contextual factors can affect individual, organisational and external capacity for research use; there are (relatively) few studies examining research use in Australian government public health policy and program environments; there is lack of evidence of effectiveness of interventions designed to increase research use in policy environments; to enhance effectiveness, theory-guided context-specific research is needed to inform research translation intervention development. To address the research aims and questions a mixed method formative evaluation was undertaken. This included: quantitative policy document content analysis (N=128); qualitative interview (N=33); and quantitative survey (N=405). The content analyses of policy documents revealed that academic research evidence was the information type referred to least often and that internal policy and medical and clinical evidence were the information types referred to most frequently. Qualitative analysis of interview data found that the following external factors affected decision-making and research use: stakeholder feedback and action, ministerial and government input, legal feedback and action, injured persons and the media. Organisational level factors affecting policy and program decision-making identified in the qualitative analysis included: resources, competing priorities, management and staff and engagement, politics and ideology, relationships and networks. Qualitative analysis also revealed ‘research push’ and ‘research pull’ factors that affected research use. Key ‘research pull’ factors included: resources, access and awareness, politics and policy process, management support. Key ‘research push’ factors included: research communication and research relevance. Quantitative analysis of survey data showed that academic research evidence was the information type used least often to inform decision-making. Internal data and reports was the most frequently used. Analyses also revealed significant differences in use of academic research across: the two agencies studied; role focus groups; role levels; and level of education. Further analyses of survey data identified significant predictors of research use, including: skills for research use, relevance of research, internal prompts for use of research, intentions to use research in the next 12 months. These findings have led to the development of recommendations for intervention design, implementation and evaluation, particularly focused on addressing the factors identified in the interview and survey data analyses. It is recommended that the research translation intervention be implemented in two phases. First research translation structures and process are to be established. Then research translation support tools and activities are to be developed and implemented to enhance and support the established structures and processes.