Evidence-based decision-making: practical issues in the appraisal of evidence to inform policy and practice Bronwyn J. Carter 1,2 RN, MPH student, Project Officer, Research Assistant 1 Skills Enhancement for Public Health Project, School of Public Health, La Trobe University, Bundoora, VIC 3083, Australia. 2 Division of Health Studies Research, La Trobe University, Bundoora, VIC 3083, Australia. Email: bronwyn.carter@latrobe.edu.au Abstract Objective. To highlight the differences between a systematic review of the literature and a systematic review of the best available evidence; to discuss practical issues in the appraisal of evidence to inform public health policy and practice; and to make recommendations for next steps in the development of evidence-based decision making in public health. Data sources and selection. Literature and other sources were reviewed including the subject reading list, recom- mended texts and websites for the La Trobe University postgraduate subject Evidence Based Public Health Practice 2007 and other relevant sources identified. Data extraction and synthesis. Relevant opinions were extracted to summarise debate in relation to definitions of evidence, usefulness of systematic reviews, tools for critical appraisal and other practical issues in the translation of evidence into practice. Conclusions. Evidence relevant to decisions regarding public health policy and practice may include evidence from the literature including experimental and observational studies as well as other sources, including policies and opinions of stakeholders. Further development of skills and approaches to the critical appraisal of evidence are required. Recommenda- tions include: mapping of Australian competencies to public health education; development of national guidelines to inform the appraisal of evidence for public health decision making; and promotion of leadership and education in evidence-based approaches, discussion and debate in relation to definitions of evidence, and public health research that generates the best possible evidence. What is known about the topic? Systematic reviews are a well recognised tool for the critical appraisal of evidence to inform decision making. There is a lack of agreement about what constitutes valid evidence for inclusion in such reviews and many policy makers have no training or qualifications in the use of systematised approaches to the critical appraisal of evidence from a range of sources to inform decisions. Approaches to critical appraisal of evidence and skills in appraisal of evidence and evidence-based decision making require further development. What does this paper add? This paper reviews current opinions on what constitutes valid evidence and discusses important differences between a systematic review of the literature as distinct from a systematic review of available evidence. The desirable approach is recognised as the utilisation of the best available evidence from a range of sources to inform decision making, including evidence from observational studies including qualitative data, as well as contextual and colloquial evidence. This paper calls for: mapping of Australian competencies to public health education; development of national guidelines to inform the appraisal of evidence for public health decision making; and the promotion of leadership and education in evidence-based approaches, discussion and debate in relation to definitions of evidence and the promotion of public health research that generates the best possible evidence. What are the implications for practitioners? This paper calls upon practitioners to further develop skills in critical appraisal of evidence from a range of sources to inform policy and practice, and to foster collaborative partnerships between researchers, policy makers, educators, managers and clinicians. Introduction Decisions about health policies are often driven by controversial issues, crises and pressure from interest groups. In contrast, an evidence-based approach to decision-making in health provides a sound rationale for policy and practice. The evi- dence-based public health movement is founded upon the rec- ognition of the importance of the systematic utilisation of valid scientific evidence to inform decisions, as is the evidence- based medicine movement out of which this movement has grown. There is increasing recognition of the importance of considerations other than scientific evidence, however, such as contextual evidence related to cultural and political issues, as well as the particular pragmatics and contingencies of the situation. Ó AHHA 2010 10.1071/AH09778 0156-5788/10/040435 CSIRO PUBLISHING Feature www.publish.csiro.au/journals/ahr Australian Health Review, 2010, 34, 435–440 Health Policy