title: Trading quality for relevance: non-health decision-makers' use of evidence on the social determinants of health.
abstract: OBJECTIVE
  Local government services and policies affect health determinants across many sectors such as planning, transportation, housing and leisure. Researchers and policymakers have argued that decisions affecting wider determinants of health, well-being and inequalities should be informed by evidence. This study explores how information and evidence are defined, assessed and utilised by local professionals situated beyond the health sector, but whose decisions potentially affect health: in this case, practitioners working in design, planning and maintenance of the built environment.
  
  
  METHODS
  A qualitative study using three focus groups. A thematic analysis was undertaken.
  
  
  METHODS
  The focus groups were held in UK localities and involved local practitioners working in two UK regions, as well as in Brazil, USA and Canada.
  
  
  METHODS
  UK and international practitioners working in the design and management of the built environment at a local government level.
  
  
  RESULTS
  Participants described a range of data and information that constitutes evidence, of which academic research is only one part. Built environment decision-makers value empirical evidence, but also emphasise the legitimacy and relevance of less empirical ways of thinking through narratives that associate their work to art and philosophy. Participants prioritised evidence on the acceptability, deliverability and sustainability of interventions over evidence of longer term outcomes (including many health outcomes). Participants generally privileged local information, including personal experiences and local data, but were less willing to accept evidence from contexts perceived to be different from their own.
  
  
  CONCLUSIONS
  Local-level built environment practitioners utilise evidence to make decisions, but their view of 'best evidence' appears to prioritise local relevance over academic rigour. Academics can facilitate evidence-informed local decisions affecting social determinants of health by working with relevant practitioners to improve the quality of local data and evaluations, and by advancing approaches to improve the external validity of academic research.
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McGill
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK.
authors.forename: Matt
authors.initials: M
authors.lastname: Egan
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Petticrew
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK Stoke-on-Trent City Council, Stoke-on-Trent, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Mountford
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Milton
authors.affiliation: Department of Public Health and Policy, University of Liverpool, NIHR School for Public Health Research, Liverpool, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Whitehead
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Lock
mesh_terms: D001938:Brazil; D002170:Canada; D002958:City Planning; D003657:Decision Making; D004779:Environment Design; D055317:Evidence-Based Practice; D017144:Focus Groups; D006798:Housing; D006801:Humans; D009111:Local Government; D011640:Public Policy; D036301:Qualitative Research; D064890:Social Determinants of Health; D014186:Transportation; D006113:United Kingdom; D014481:United States
keywords: Public health; QUALITATIVE RESEARCH; policy
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