Marissa J. Smith, Srinivasa Vittal Katikireddi, Kathryn Skivington and Shona Hilton
This blog post is based on the Evidence & Policy article, ‘Contextual influences on the role of evidence in e-cigarette recommendations: a multi-method analysis of international and national jurisdictions’.
The use of evidence in public health decision-making is not as straightforward as it may seem – people have different ideas of what constitutes ‘evidence’, and how it should be interpreted and used in different contexts. Even when there is agreement on what constitutes evidence, research has shown that the same evidence, used in different contexts can lead to different policy decisions. A current example of this is e-cigarette policies and their recommendations. Our Evidence and Policy article explores how context, broadly defined as the factors that influence decision-making, influences the role of evidence in developing recommendations and how it may contribute to different policy approaches.
We used a multi-methods case study approach which drew upon four data sources: 1) 15 public health bodies’ e-cigarette recommendation documents; 2) seven public health bodies’ documents that detail the processes they used to develop policies; 3) sources of evidence cited in the public health bodies’ recommendation documents; and 4) 15 qualitative interviews with experts working in one of the study jurisdictions included in the study (WHO, UK, Australia, and USA). Triangulation of data was guided by Dobrow et al.’s (2004) conceptual framework which discussed three key components of decision-making: evidence, context and utilisation.
Our study has shown that public health decision-making is complex and does not take place in a vacuum but that there are a variety of factors influencing decisions. We found that internal contextual factors (e.g., the remit of the document and participants involved) influence the decision-making process. However, it was the external contextual factors that provided some possible hypotheses as to why particular approaches were pursued, and how the remits were defined and in turn impacted on internal context.
We found that the framing of policy was influenced by external contextual factors, such as the local epidemiology and the need to be consistent with broader institutional and political contexts. For example, US participants discussed that the prevalence of vaping has increased among young people, highlighting a problem, and this caused concern among policymakers and public health researchers. In contrast, we did not see this in the UK. While e-cigarette use among youths is being monitored, focus was on using e-cigarettes as a smoking cessation tool due to the adult smoking prevalence. Data and evidence relating to the epidemiology of smoking and vaping (external context factor) provide a basis for goals to be prioritised and recommendations to be developed accordingly. In turn, this can influence the remit of the recommendation document (internal context factor), subsequent interpretation of evidence and framing of policy goals.
Based upon this, we propose a modified version of Dobrow et al.’s (2004) conceptual framework to acknowledge the interplay between external and internal contextual factors. In doing so, this reflects the inherent complexity of decision-making and highlights the methodological challenge of understanding how the different elements (decision-making participants, processes, and context) are intertwined.
What is important from our study is understanding not just that there are a variety of contextual factors influencing decision-making, but also how these contextual factors interact to frame policy goals. Every day, decision-makers wrestle with a myriad of factors including evidence, politics, cultural norms, and policy ambitions when developing public health policies and recommendations, especially on novel public health issues (such as e-cigarettes and COVID-19) where the evidence base is still emerging. The dynamic interplay of contextual factors helps to explain why different public health policy approaches are pursued.
Marissa J. Smith, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Square, Glasgow, G3 7HR, UK. Email: marissa.smith@glasgow.ac.uk. Twitter: @Marissa_Smith8
Srinivasa Vittal Katikireddi, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Square, Glasgow, G3 7HR, UK. Twitter: @vkatikireddi
Kathryn Skivington, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Square, Glasgow, G3 7HR, UK. Twitter: @kathrynskiv
Shona Hilton, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Square, Glasgow, G3 7HR, UK. Twitter: @HiltonShona
Image credit: IStock. Used with permission.
Read the original research in Evidence & Policy:
Smith, M.J. Katikireddi, S.V. Skivington, K. and Hilton, S. (2023). Contextual influences on the role of evidence in e-cigarette recommendations: a multi-method analysis of international and national jurisdictions. Evidence & Policy, DOI: 10.1332/174426421X16711062023280.
If you enjoyed this blog post, you may also be interested in reading:
Evidence-based policy or risk minimisation? The regulation of e-cigarettes in Australia
Collaborative knowledge creation and use: common threads in diverse global fields
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