Case Study: Developing a public health prevention framework for reducing alcohol and drugs harms

The evidence gap and service need

Bradford Council’s public health team identified that there was a lack of evidence on what constitutes a public health prevention approach to alcohol and drugs locally to guide policy and practice. Working with embedded researchers from the University of York, as part of the Evidence into Practice and Policy Hub (Hub) in the Bradford Health Determinants Research Collaboration (HDRC), the public health team identified the need for a rapid review of existing published literature to:

Identify and summarise the evidence on the key features of a public health prevention approach to reducing alcohol and drugs harms.
Develop a framework which could:
1. inform a Health and Wellbeing Board ‘development session on the harms of alcohol and drug use in the District, and
2. structure and guide the policy and practice of the District’s Combatting Alcohol and Drugs Partnership, its partners and service providers.

Bridging the evidence gap: the role of HDRC embedded researchers

Working closely with public health officers, embedded researchers have:

Completed a rapid evidence review
Developed a public health prevention approach framework to structure and guide policy and practice across the district – the ‘BETRR prevention framework.’
Worked with public health colleagues to disseminate research findings in presentations to Wellbeing Board and the Combatting Alcohol and Drugs Partnership (CADP).
Disseminated research findings to public, professional and academic audiences through a publicly available research report, a policy brief for practitioners, and poster presentation at a national conference.

The embedded researchers are continuing to work with public health colleagues to support their longer-term goal of embedding the prevention framework in policy and practice by:

Providing advice and guidance on developing monitoring and evaluation processes that reflect the prevention approach to support commissioning.
Identifying risk factors and transition points of relevance to preventing harmful alcohol and drug use, to support interventions.

Guiding policy and practice: the public health approach and framework

To take a strategic approach to prevention, a clear framework, shared language and understanding is needed for success. Guided by wider public health prevention research, the review identified five key features of a strategic public health prevention approach:

Understand social groups at risk, including during key life transitions
Reduce health harms via a ‘cycle of BETRR prevention’ framework (Before and Early, and Treatment to prevent Relapse in Recovery) - see image below
Take a multi-sectoral systems approach involving communities
Ensure decisions are evidence-informed
Focus on equity, participation, addressing stigma and human rights

Five intervention pathways to prevention were also identified (access to life’s essentials, education, development, literacy and skills, power and control, disruption and regulation, partnership). These can be mapped against current initiatives to identify gaps in prevention and future solutions.

Use in policy and practice

There have been four main uses of the work to date.

Policy development and advocacy. The rapid review evidence has been used to support policy development by providing an independent academic evidence base for policy and practice. Public health colleagues are using the evidence to shape and influence the strategic direction of work across the District. Critical discussion among CADP partners is now based around the evidence and this is supporting a shift in the focus of practice.

Development of a strategic framework to structure District wide policy and practice. Based on the evidence, the BETRR prevention framework has been developed. This is proving important in developing a shared understanding and language for strategic development. It is also supporting the identification of strategic priorities. For example, following a recent alcohol needs assessment, an action plan has been designed which incorporates the BETTR prevention framework.

Shifting the focus of practice. The new framework is supporting a move toward prevention approaches based around identifying risk and protective factors, and practical interventions at different stages along the prevention pathway.

Culture change. The public health team are collaborating with partners to push change in the way evidence and types of evidence are used. There are two aspects to this. The first is moving away from data that is seen as anecdotal or the reliance on proxy measures based on routinely collected data, which might not be the best data for practice. The second is supporting public health colleagues to develop a more prevention-focused monitoring and evaluation framework to support the commissioning cycle.

“There is a lot that’s anecdotal evidence and a lot we do just because that is the data that we have so the review evidence is big for us, and we are trying to push that through our delivery groups. It’s a bit of a drip drip effect and you have to keep on doing it. It's always so positive to bring something like that in (the evidence review) because it seems to trigger things in people.”

-Public Health Consultant

Four lessons for developing evidence informed policy and practice

Four lessons for evidence informed policy and practice can be drawn from this case study.

Policy-led demand for evidence creates windows of opportunity and builds in relevance. The demand for evidence was created by a developing policy agenda. Public health officers were already interested in moving alcohol and drugs policy and practice toward a preventative and public health focussed approach. This policy agenda created space for an independent and credible academic evidence base to inform the policy and practice agenda. The policy agenda made the research possible. It was officers who identified the evidence gap and framed the research aims. This meant that the use value of evidence was built in from the start.
Evidence must be translated into practical tools for practice. Research evidence does not speak for itself. Nor does it come with a ‘how to use in practice’ guide. Applying research evidence in practice is a specialist skill. It requires working closely with practitioners and a deep understanding of policy and practice contexts. The translation of the research evidence into a framework for guiding local policy and practice was key to the research findings being of practical use value.
The legitimising value of independent academic research is powerful. For officers, the independent, academic nature of research is important. It offered credibility and an independent “evidence voice.” This was, and is, useful in policy advocacy - officers can call on the evidence to provide credibility. When this evidence also reinforces existing professional knowledge and expertise it is powerful. In this case study, it was not the fact that the research produced new findings that was important. It was its value in providing legitimacy to, and confidence in, professional knowledge and expertise.
Local authorities need additional resource and capacity to conduct research and develop evidence informed practice. Without the additional resource provided by the HDRC, the public health team would not have had the capacity to undertake the research and develop the prevention framework.