Fluoride Action Network



  • Understanding how policy and practice develop has the potential to facilitate best use of evidence to improve health.
  • Yet studies exploring key actors’ perceptions of the mechanisms through which, policy and practice develop are limited.
  • This study explores the processes involved in the development of a complex, NHS intervention, in Scotland (Childsmile).
  • Findings show blending of research evidence, practitioner knowledge and values, policy, and political and local context.
  • As an example of ‘intelligent policy making’, the case illustrates the feasibility of knowledge transfer at a national level.

Increased political enthusiasm for evidence-based policy and action has re-ignited interest in the use of evidence within political and practitioner networks. Theories of evidence-based policy making and practice are being re-considered in an attempt to better understand the processes through which knowledge translation occurs. Understanding how policy develops, and practice results, has the potential to facilitate effective evidence use. Further knowledge of the factors which shape healthcare delivery and their influence in different contexts is needed.

This paper explores the processes involved in the development of a complex intervention in Scotland’s National Health Service (NHS). It uses a national oral health programme for children (Childsmile) as a case study, drawing upon key actors’ perceptions of the influence of different drivers (research evidence, practitioner knowledge and values, policy, and political and local context) to programme development. Framework analysis is used to analyse stakeholder accounts from in-depth interviews. Documentary review is also undertaken.

Findings suggest that Childsmile can be described as an ‘evidence-informed’ intervention, blending available research evidence with knowledge from practitioner experience and continual learning through evaluation, to plan delivery. The importance of context was underscored, in terms of the need to align with prevailing political ideology and in the facilitative strength of networks within the relatively small public health community in Scotland. Respondents’ perceptions support several existing theoretical models of translation, however no single theory offered a comprehensive framework covering all aspects of the complex processes reported. Childsmile’s use of best available evidence and on-going contribution to knowledge suggest that the programme is an example of intelligent policy making with international relevance.

*Original abstract online at https://www.sciencedirect.com/science/article/abs/pii/S0277953613003870