This document is intended for public health actors who, given their role as health promoters, are interested in how public policy can act as a lever for action that affects population health and its determinants. More specifically, this document seeks to meet the needs of public health actors acting as expert advisors to decision makers during the promotion, adoption, and implementation of public policies. Fulfilling this role requires them to synthesize knowledge about how effective public policies are at promoting health (including how effective they are in a given context) and about the issues surrounding the implementation of these policies.
The objective of this document is to propose a knowledge synthesis method that is applicable to public policies and takes into account not only data linked to their effectiveness, but also data on issues related to their implementation, with the aim of identifying the policies that are most likely to succeed in the specific context in which their implementation is being considered.
The proposed knowledge synthesis method draws inspiration from political science, policy analysis, literature on evidence-informed decision making in public health, literature on evaluation, and theoretical developments related to deliberative processes. Having integrated these various foundational elements, the proposed methodological approach:
- applies an analytical framework that takes into consideration not only the effectiveness of public policies, but also their unintended effects, their effects on equity, and the issues related to their implementation (cost, feasibility, and acceptability); and
- considers a range of quantitative and qualitative data from scientific and non-scientific sources.
Our knowledge synthesis method includes four steps.
The first involves compiling an inventory of public policies that could address the targeted health problem, and choosing the policy on which the knowledge synthesis will focus. The second step is devoted to making explicit the intervention logic (logic model), that is, the sequence of effects expected to link the policy under study to the targeted problem.
The third step, carried out through means of a literature review, involves synthesizing data on the effects of this policy in contexts in which it has already been implemented (effectiveness, unintended effects, effects related to equity) and on the issues related to its implementation (cost, feasibility, acceptability).
Finally, the fourth step aims at enriching and contextualizing the data drawn from the literature, through deliberative processes that bring together actors concerned by the targeted health problem and working within the context in which implementation of the policy is being considered. The aim of the deliberative processes is to have these actors discuss the data drawn from the literature, enrich analysis of the data with their own knowledge, and assess the extent to which the data apply to their own context.
To illustrate the use of this method and to verify its relevance, our team tested it by applying it to a public policy option aimed at addressing obesity. Because of this case study, some of the methodological references used refer to obesity; nevertheless, they are equally applicable to public policies concerned with other issues.
Note: because the production of knowledge syntheses on public policies is still a relatively uncharted area of endeavour and due to the complexity of the subject, our approach should be considered indicative rather than prescriptive. Thus, persons using our method may choose to apply only certain steps and/or to adapt other steps as they see fit, based on the issues at play in their own contexts. Indeed, each step, taken separately, constitutes an interesting tool. This variability does not imply the sacrifice of methodological rigour: it is important to be as explicit and as transparent as possible about the methodological decisions one makes, so that the results (in terms of the knowledge gathered and synthesized) can be assessed with reference to the method that produced them.
This document begins by describing the analytical framework proposed for examining the various dimensions of public policies. Next, it specifies the types and sources of data to be considered in a synthesis of knowledge about a public policy. Finally, it describes the proposed synthesis method, step by step, in sufficient detail to allow public health practitioners to apply it.
Alongside this document, we are publishing a “sister” document that will describe the application of our knowledge synthesis method to public policies in the area of nutrition labelling on food packaging and in restaurants (Morestin et al., in press). The reader is invited to consult this document for a concrete example of the type of knowledge synthesis that can be produced using the method proposed here.
A summary is also available: Method for Synthesizing Knowledge about Public Policies: Summary