Adoption and implementation of a diabetes prevention model to inform local authority commissioning decision-making: a qualitative study

Fieldwork has been completed. Fifteen interviews and Three focus groups were conducted between July and December 2015. In addition, a series of observations of commissioning meetings were undertaken to directly explore decision making practices. The participants were responsible for decision-making and commissioning of public health services within a local authority setting. Interviews and focus groups were analysed using thematic analysis to generate preliminary categories and overarching themes.

New knowledge generated

The findings of the investigation were grouped into four themes titled: beliefs about the model, a tool in the evidence toolkit, barriers to implementation, and transferability between epistemological contexts. These themes summarise the utility of an economic model to facilitate decision-making within a local authority setting for public health management. The themes reflect the beliefs and attitudes of staff towards economic models and the barriers and facilitators that promote or inhibit their use in practice. As well as the contingencies that influence how effectively the model can be transferred between the epistemologies of academia and real-world public health practice.

Economic models have high perceived utility in local authority decision-making for public health management. Participants reported positive beliefs regarding the principles of economic modelling for decision-making. However, the adoption and implementation of economic models to assist actual decision-making in practice was limited. The model had reduced utility outside of the context for which it was developed. For the public health practitioners it was one tool in a ‘toolkit’ that could be selected to assist decision-making. The implication of our findings for practice is to highlight the anticipated barriers that local authority decision-makers face during commissioning decisions. These barriers prevent them from applying economic models developed in the academic environment directly into practice.

Outputs

Two papers have been written and pending submission to:

1.     Social Science & Medicine

2.     Implementation Science

Conference presentation at HSRUK June 2016.

What counts as evidence? Acceptability of a health economics decision tool to inform commissioning by Local Authorities Tom Sanders, University of Sheffield

Conference presentation at BSA Medical Sociology Group Annual Conference Sept 2016.

 

Engagement with practice

A grant application was submitted in 2015 (unsuccessful) to the NIHR Obesity Prize, arising directly from collaborations with staff at Doncaster Council.

The ROI modelling work at Doncaster also informed a grant application to the RfPB Obesity Call (2016), for a feasibility study of a social media intervention to facilitate healthy weight and lifestyle among women at post partum.

A small grant from Sheffield CCG was awarded to explore optimal service models for post partum weight management support. This grant was developed as a direct result of collaborations with Doncaster Council and the ROI modelling study.

A further grant proposal was submitted in November 2016 to the RfPB, which was informed by elements of the ROI study.