Applying a Nursing Framework to Understand a Governmental Health Promotion Strategy

Sunday, 30 July 2017

Bridget M. O'Connor, BSN
School of Nursing, University of Washington, Seattle, WA, USA
Patty Hayes, MN
Public Health- Seattle King County, Seattle, WA, USA
Jennifer DeYoung, MPA
Public Health - Seattle King County, Seattle, WA, USA


The purpose of this presentation is to describe how Dobbins evidence-based framework was used to design a case study about Best Starts for Kids (BSK), an innovative, governmental initiative to fund health promotion and early intervention for children.


Across the world, the prevalence of chronic illness is escalating, and population health disparities are widening. These international trends are prompting governments to address public health by innovatively shifting investments from illness care to prevention and health promotion.1,2,3,4 There is a need to describe how current governmental initiatives use evidence-based decision making in order to replicate successful strategies in other regions.1,2,3,4 The World Health Organization (WHO) and National Prevention Council both support the evaluation of innovative governmental health initiatives.2.4

This presentation will describe the case study design and rationale, including the systematic literature analyzed to design the case. PubMed and CINAHL databases were searched using the key search terms “health policy,” “government,” and “case study” in the subject line from 2011 to present. The same search was repeated with the addition of “equity” in the subject line. Resulting articles included PubMed, 154 and CINHAL, 73 after duplicate articles were omitted. Inclusion criterion required that articles discussed analysis of comprehensive governmental approaches to health promotion and prevention. Articles that focused on individual programs were excluded.

Of the published case studies reviewed, 8 described the processes of comprehensive approaches to prevention and health promotion policy within the local government environment. Cross sector collaboration and evidence of health disparities were presented as significant factors that contributed to innovative health policy development. What is not clear from this review is how factors such as the culture, relationships, and characteristics of government leaders, organizations, community and innovation itself contributed to the development of evidenced based policies which is important for the dissemination of new approaches. Dobbins’ Dissemination and use of Research Evidence for Policy and Practice framework was chosen to evaluate the development of BSK because it guides the user through the processes of evidenced-based decision making, including looking at factors that contributed to those decisions.5


The process of how BSK was developed will be illustrated in a diagram, depicting the stages of the innovation development based upon Dobbins framework Dissemination and use of Research Evidence for Policy and Practice.5 One purpose of this framework is to provide a model of the process of evidenced-based decision making.5 This case study will integrate Roger’s Diffusion of Innovation’s stages; “knowledge,” “persuasion,” and “decision” to discover the factors that led to the development and passing of the BSK initiative. The knowledge phase is emphasized in the case study by collecting information about how evidence is sought, what evidence influenced the policy makers and stakeholders, and impact of community outreach and engagement. The “knowledge” phase will include looking at hierarchy of evidence that was sought and used. The “persuasion” phase will focus on factors that may have influenced the decision process such as individual, organizational, environmental, and innovation characteristics. The methods used to gather information about the persuasion phase will include document analysis, interviews with 5-8 key participants, and an online survey of the members of the three primary advisory groups to BSK. The “decision” phase will be used to understand types of decisions that were made such as whether to adopt the innovation and how organizational values, beliefs, and culture influenced the decision making.5,6 Questions about decision making factors such as the following will be asked; “Who was involved in the decision to adopt the innovation?,” “What was the stakeholder involvement in the decision making process?” and “How did collaborations across governmental branches influence decision making?”


The Dobbins’ Dissemination and Use of Research Evidence for Policy and Practice was an ideal framework to depict the environmental, individual, organizational, and innovation characteristics that propelled BSK to a levy on the ballot. This presentation is significant for nurses because it illustrates how the Dobbins' framework can be used to describe the development of a governmental initiative. Depicting the processes involved in innovative health policy is necessary in order for the innovation to be disseminated and replicated.