Diffusion and dissemination of evidence-based dietary strategies for the prevention of cancer.

We used a systematic review to identify strategies that have been evaluated for disseminating cancer control interventions that promote the uptake of a healthy diet in adults. Studies were identified by contacting technical experts and by searching MEDLINE, PreMedline, CANCERLIT, EMBASE/Excerpta Medica, Psycinfo, cinahl, the Cochrane Database of Systematic Reviews, and reference lists. English-language primary studies were selected if they evaluated the dissemination of healthy diet interventions to individuals, health care providers, or institutions. Studies involving only children or adolescents were excluded.We retrieved 101 articles for full-text screening, and identified nine reports of seven distinct studies. Four of the studies were randomized trials, one was a cohort design, and three were descriptive studies. Six of the studies were rated methodologically weak, and one was rated moderate. Because of heterogeneity, low methodological quality, and incomplete data reporting, the studies were not pooled for meta-analysis. No beneficial dissemination strategies were found. One strategy involving the use of peer educators at the work site, which led to a short-term increase in fruit and vegetable intake, looks promising.Overall, the quality of the evidence is not strong, and the evidence that exists is more descriptive than evaluative. No clear conclusions can be drawn from these data. Controlled studies are needed to evaluate dissemination strategies and to compare dissemination and diffusion strategies that communicate different messages and target different audiences.

Romantic relationships for women with anorexia nervosa: an integrative literature review.

OBJECTIVE: To critically appraise literature concerning romantic relationships for women with anorexia nervosa (AN), and to gain perspective on future research directives. METHOD: Key electronic databases, reference lists, and journals were searched. The search was limited to features of romantic relationships and their quality. Nineteen studies were critiqued and abstracted. RESULTS: All 19 studies used a quantitative design; no qualitative studies were retrieved. Methodological strengths of these studies included confounder control and appropriate statistical analyses for design. Weaknesses included a failure to declare study designs, address sources of bias, and justify study samples, as well as a lack of con-founder control. DISCUSSION: The review drew attention to the varied relational experiences and marked relationship dissatisfaction expressed by women with AN. However, an understanding of relationship quality and its dynamic nature remains limited. Future research should focus on how meanings are negotiated in relationships, providing detailed descriptions of the women's experiences, which is best done with qualitative study. Well-conducted longitudinal research should address questions that cannot be answered by current research designs, such as temporality.

A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions.

BACKGROUND: Several groups have outlined methodologies for systematic literature reviews of the effectiveness of interventions. The Effective Public Health Practice Project (EPHPP) began in 1998. Its mandate is to provide research evidence to guide and support the Ontario Ministry of Health in outlining minimum requirements for public health services in the province. Also, the project is expected to disseminate the results provincially, nationally, and internationally. Most of the reviews are relevant to public health nursing practice. AIMS: This article describes four issues related to the systematic literature reviews of the effectiveness of public health nursing interventions: (1) the process of systematically reviewing the literature, (2) the development of a quality assessment instrument, (3) the results of the EPHPP to date, and (4) some results of the dissemination strategies used. METHODS: The eight steps of the systematic review process including question formulation, searching and retrieving the literature, establishing relevance criteria, assessing studies for relevance, assessing relevant studies for methodological quality, data extraction and synthesis, writing the report, and dissemination are outlined. Also, the development and assessment of content and construct validity and intrarater reliability of the quality assessment questionnaire used in the process are described. RESULTS: More than 20 systematic reviews have been completed. Content validity was ascertained by the use of a number of experts to review the questionnaire during its development. Construct validity was demonstrated through comparisons with another highly rated instrument. Intrarater reliability was established using Cohen's Kappa. Dissemination strategies used appear to be effective in that professionals report being aware of the reviews and using them in program planning/policymaking decisions. CONCLUSIONS: The EPHPP has demonstrated the ability to adapt the most current methods of systematic literature reviews of effectiveness to questions related to public health nursing. Other positive outcomes from the process include the development of a critical mass of public health researchers and practitioners who can actively participate in the process, and the work on dissemination has been successful in attracting external funds. A program of research in this area is being developed.

Factors of the innovation, organization, environment, and individual that predict the influence five systematic reviews had on public health decisions.

OBJECTIVE: To determine the extent to which systematic reviews of public health interventions influenced public health decisions and which factors were associated with influencing these decisions. METHODS: This cross-sectional follow-up survey evaluated the use of five systematic reviews in public health decision making. Independent variables included characteristics of the innovation, organization, environment, and individual. Primary data were collected using a telephone survey and a self-administered organizational demographics questionnaire. Public health decision makers in all 41 public health units in Ontario were invited to participate in the study. Multiple linear regression analyses on the five program decisions were conducted. RESULTS: The systematic reviews were perceived as having the greatest amount of influence on decisions related to program justification and program planning, and the least influence on program evaluation decisions. The greater the perception that one's organization valued the use of research evidence for decision making and that ongoing training in the critical appraisal of research literature was provided, the greater the perception of the influence the systematic review had on public health decisions. CONCLUSIONS: Organizational characteristics are important predictors of the use of systematic reviews in public health decision making. Future dissemination strategies need to promote the value of using systematic reviews for program decision making as well as promote ongoing training in critical appraisal among intended users in Ontario.

Resources to enhance evidence-based nursing practice.

Evidence-based practice means integrating the best available research evidence with information about patient preferences, clinician skill level, and available resources to make decisions about patient care. Barriers to the use of research-based evidence occur when time, access to journal articles, search skills, critical appraisal skills, and understanding of the language used in research are lacking. Resources are available to overcome these barriers and support an evidence-based nursing practice. This article highlights available resources and describes strategies that nurses can use to develop and sustain an evidence-based nursing practice.

The organizational environment and evidence-based nursing.

The Province-Wide Nursing Project (PWNP) was designed to remove some of the structural barriers that can impede the ability of nurses in selected health care settings to assess, implement and evaluate best nursing practice. Literature on capacity building and research utilization suggests that the organization is the most important factor in promoting best nursing practice. Therefore, managers and nursing leaders need to encourage the creation of optimum work environments. A survey undertaken by the PWNP Research Centre team assessed the extent to which the 23 agencies in the 4 Participating Complexes provided supportive environments for evidence-based practice. The Characteristics of Agencies in Participating Complexes: Demographics and Resources questionnaire investigated the resources available to help nurses improve their standards of practice in agencies participating in the project. Larger agencies, especially those associated with academic centres, had considerably more resources than agencies in smaller towns. Participation in the Province-Wide Nursing Project enabled agencies to develop strategies to improve the use of evidence in nursing practice.

Transferring public-health nursing research to health-system planning: assessing the relevance and accessibility of systematic reviews.

A descriptive study was designed to gain an understanding of the research needs, perceptions of barriers to research utilization, and attitudes towards systematic reviews of decision-makers in public health at the level of systems planning. Public-health consultants and managers in Ontario were surveyed about barriers to research utilization and awareness of and attitudes towards systematic reviews as a method of/vehicle for research transfer. Access to 5 completed reviews was provided in summary, abstract, and full form, and on diskette, hard copy, and Internet. A follow-up survey at 3 months assessed use, relevance, application, and further dissemination of the reviews. A total of 242 people in positions of public-health policy and decision-making participated. Respondents reported a great, largely unmet, need for research evidence. They viewed systematic reviews as likely to overcome the barriers to research use related to critical appraisal, time, timeliness, availability, cost and credibility, but not the barriers related to policy climate, authority, or implementation resources. Three months after requesting a review, 93% said they would follow it up; 91% remembered receiving it, and 71% of these had read it while 23% stated it played a part in program planning or decision-making.

Evaluation of two nondieting interventions for obese women.

A randomized trial was conducted to see if there could be effective alternatives to dieting for obese women. It compared a 12-week (1 h/week) education intervention, a 12-week (2 h/week) psychoeducational intervention, and a control group on self-esteem, body dissatisfaction, and restrained eating of obese women. Secondary variables of interest were social adjustment, symptoms of depression, scores on bulimia, and drive for thinness, weight, and blood pressure. Complete data were available at pre- and posttest time for 78 women. A MANCOVA indicated that the psychoeducation group improved over the control group on self-esteem, restraint, and body dissatisfaction. The education group did not differ statistically from the control group at posttest. Means of weight and blood pressure did not change. A nondieting approach can be beneficial to the emotional health of obese women without changing weight and blood pressure risk factors for other morbidity.

Evidence-based nursing: an introduction.

The Art & Science section of Nursing Standard this week is devoted to encouraging nurses to use evidence in their practice. As well as publishing some of the papers from the recent Evidence-Based Nursing conference in London, this report is based on the editorial which appeared in the pilot issue of Evidence-Based Nursing, a new journal jointly published by the BMJ Publishing Group and the RCN Publishing Company. It highlights the importance of using evidence in practice and explores the role of the new journal, which will be launched in November 1997, in helping nurses to achieve this aim.

Evaluation research in public health: barriers to the production and dissemination of outcomes data.

Health outcomes are becoming the currency of health care exchange, and a call for evidence dominates decision making at all levels. This discussion paper reviews methodological and sociopolitical barriers that impede the production and dissemination of outcome research in public health, with particular reference to nursing. Barriers to the production of high-quality research evidence include inaccessible graduate education and inadequate research funding. Also, randomized controlled trials (the ideal design for interventions studies) are uniquely difficult to implement for public health services. Practical and ethical difficulties arise in defining the intervention, implementing random allocation methods, selecting and measuring outcomes, and articulating adequate theoretical frameworks. When health care activity is defined as output, there is a tendency to exclude the ethical standing of preventive, supportive and communitarian functions. The production and interpretation of research results must remain part of a social, political and ethical debate, not a purely scientific one.

A systematic overview of adolescent suicide prevention programs.

The purpose of this systematic overview was to summarize evidence about the effectiveness of adolescent suicide prevention curricula programs. A comprehensive search of published and unpublished literature resulted in retrieval of 11 relevant studies. The findings, of this overview indicate that there is currently insufficient evidence to support curriculum-based suicide prevention programs. The evidence suggests that there may be both beneficial and harmful effects of the programs on students. In most studies, knowledge related to suicide improved as a result of the programs. However, studies found both beneficial and harmful effects on attitudes related to suicide. One study found in increase in hopelessness and maladaptive coping for males following the intervention. The literature suggests that more broadly based comprehensive school health programs should be evaluated for their effectiveness in addressing the determinants of adolescent risk behaviour.

A systematic overview of the effectiveness of home visiting as a delivery strategy for public health nursing interventions.

The purpose of this systematic overview was to assess the evidence for the effectiveness of public health nursing interventions when carried out by the strategy of home visiting. A search of published and unpublished literature resulted in retrieval of 108 articles; 77 articles were judged to be relevant. Validity criteria included method of allocation to the study groups, level of agreement to participate in the study, control for confounders, method of data collection (pretesting of data collection tools, blinding of data collectors to group allocation of study participants), quantitative measure of effect and percentage of participants available at follow-up. Using these criteria, 9 articles were judged to be strong, 5 moderate and 63 weak. There were no reported negative effects of home visiting in the 9 strong articles. Positive outcomes included improvement in children's mental development, mental health and physical growth; reduction in mother's anxiety, depression, and tobacco use; improvement in maternal employment, nutrition and other health habits; government cost saving; and reduced level of care required for the elderly.

Changing nursing practice--trisectoral collaboration in decision making.

In an age of cost containment, agency partnerships have become an essential element for future planning and program implementation. This paper describes a trisectoral collaboration of a hospital, health department, university and school of nursing to compare the efficacy and efficiency of referral decisions of hospital staff nurses to those of the public health liaison nurses (LNs). A process to identify decision criteria was undertaken and an educational programme was designed to assist the staff nurses with the referral process and to assure consistency of decision making. The two groups were then compared. The results of the study found staff nurses, using the decision criteria, identified more patients who required public health nursing visits than did the liaison nurses, refusal rate of the patients to participate was no different, staff nurses cost less than LNs and job satisfaction was not significantly altered for either group. In addition to providing information to guide administrative and clinical decision making, the project also provided a learning experience for the staff of three agencies in conducting research and in using evidence-based practice to change traditional practice.

Comparison of liaison and staff nurses in discharge referrals of postpartum patients for public health nursing follow-up.

The purpose of this study was to compare hospital staff nurses to public health liaison nurses in the accuracy and cost of postpartum referrals for public health nursing follow-up in the community. In the before phase of the study, public health liaison nurses assessed 304 mothers to determine the need for a follow-up visit by the public health nurse. In the after phase, staff nurses assessed 326 mothers. Public health nurses, unaware of the identity of the referring nurse and the referral decision, judged whether their visit had been required. Staff nurses correctly identified a higher proportion of referrals requiring public health nurse follow-up than liaison nurses. Although they referred more clients who did not require a public health nurse visit, costs of referrals by staff nurses remained lower.

Women and obesity. Learning to live with it.

Chronic dieting is not free of risks. Relevant literature is assessed to aid in making the decision about whether an obese woman should attempt weight loss repeatedly. Alternative strategies to weight loss are offered that shift the focus from weight loss to stabilization and from dieting to normalizing eating patterns and intake.