Self perceived relevance statements
When asked what types of cases they faced, the practitioners were inclined to mention administrative cases or cases that could be solved with reference to a law or regulation, for instance regarding noise levels, water or air quality. When discussing health services planning, e.g. the planning of psychiatric services or youth health services, they seemed to be more occupied with the organisation of these services than with their content. They also felt that they had many cases that called for their professional judgement rather than factual knowledge:
"A number of cases are [...] more about common sense. When the neighbour's bird sings so loudly in the mornings that it disturbs people's sleep. Well, it's hard to find any research-based knowledge about this, [it's better] to discuss this with someone who's dealt with something similar before."
"A number of our cases are on that level, - and then there are cases like noise from a rifle range, when I phoned people all over the place and found things here and there, but it was hard to find people who knew much."
"I think the most difficult cases are those that are not covered by law regulations. I would like to know how people around the table here deal with cases like that, for instance thirty cats in a housing area..."
"This whole area is pretty inaccurate. [...] You have to use your head and your common sense in most cases. For instance, if you want to keep more than 202 cats the local board of health must approve this. What about a horse - is a horse more than 202 cats? What about 10 hens and 2 cats? Are they worth more than 202 cats? One could make a whole list of questions like this...
Since they did not readily and voluntarily report cases that were suitable for searching research-based information, we started probing for answers. We got very different answers varying from the negative to the extremely positive:
"I'm not very interested in the actual research, but I have to know everything on whether it is common practice to use that particular [noise] limit in that type of decision.
"Experience-based public health, we mustn't make this too scientific, because we're using what we think is reasonable knowledge, which is based on regulations, right?
"I think that working evidence-based has meaning for a great deal of the issues that are covered by environmental health care. But when dealing with other parts of public health, like management and organisation, I don't know how relevant it is. Then I think that examples and models that have been used elsewhere may be just as important.
"For me, research is the truth"
It would be fair to say, however, that their general viewpoint was that they rarely had to deal with questions requiring research-based information. They would, however, utilise this information source when such cases did arise:
"Some cases you want to explore more deeply and then it would be useful with documentation".
"[...] the point has to be that we have a university environment where we can look for knowledge, because knowledge is power in our setting too. And getting information from other places in this setting obviously gives weight to our arguments."
They also thought that because of the possibilities created by the information technology for the public to stay well informed, working evidence-based would become more and more important:
"As a small comment to the relationship between evidence-based and experience-based knowledge, I would think that evidence-based knowledge is becoming more important and that we're sort of being forced into being well documented."
These viewpoints did not necessarily seem to lead to an identification and generation of more questions suitable for seeking research-based information. One of the participants, for example, reported that in their municipality, statistics showing high numbers of abortion among teenage girls had contributed to the establishment of a youth health centre. When asked how they knew that this was the most effective measure they could take, for instance compared to giving a more school-based intervention, the answer showed that this had not been an issue for discussion:
"Well, establishing adolescent health services have been one of our priorities. We also have tried to work in other areas, e.g. giving information on sexual behaviour and about living together, in secondary school, - so we have been there as well."
During the focus group conversations we identified a number of broader themes where scientific information could be of relevance. These included psychiatry, noise pollution, infection control, problems relating to refugees, preventive measures against lifestyle diseases, planning rehabilitation, prevention of accidents and different initiatives towards children and youngsters. These themes were described very generally, with an unclear problem definition. We were able to identify six cases as clearly formulated problems qualifying for searching research-based information (in table 3).
Observation and interviews
Self perceived relevance statements
In the interviews, as in the focus group discussions, the public health doctors generally expressed a positive attitude towards the use of research-based information. Good documentation was believed to be useful when promoting issues to be discussed by politicians:
"...the more documentation and background material, the more the reason for advancing the case [.....] for political treatment. A case that is supported by research results would be of great value in advancing a case politically".
They were also open to seeking out this kind of information to a greater extent:
"When I think about it, there are probably more cases than we think. I suppose we could probably [identify] more cases based on the types of problems we have [....], but it's possible that we're a bit restrained about this because we don't feel that anyone is interested".
If the barriers were fewer they would have made searches:
"Yes, I think I would have [done this], especially when working on projects or when I work with prevention".
They also felt that research-based information could be useful when preparing for talks:
"In giving talks, yes, that would have been useful. Then you usually go through your own literature and often you find that there are [still things you don't know]. And instead of calling somebody and getting it over the 'phone, it would have been better to have it in print".
The main purpose of the observation was to explore whether there really were as few cases in public health practice where the use of research-based information would have been appropriate as expressed during the focus group discussions. To estimate a potential information need we took as our starting point the content of their work, and especially the cases they were to decide about. The questions faced by the public health practitioners may indicate the potential for utilising the knowledge generated from research.
During the six observation days the observer (LF) attended 13 meetings. All meetings could be classified as interdisciplinary working, co-operation or information exchange meetings either within the same department as the physician or with health personnel in other departments (table 4).
During the observation period we identified 22 cases/questions qualifying for searching research-based information (table 3), nine of which were identified in the largest municipality. These cases, adding to the cases identified in the focus groups, exemplify the questions a public health doctor in Norway may face. We did, in fact, observe research-based information being used, especially by the practitioner in the largest municipality. This was Norwegian research that had been gathered passively, either through the mass media or because it had been passed on by colleagues.
None of the six doctors identified any questions that they had needed an answer to during the day of observation or during the past few days. When asked the following question: "Do you remember ever having a problem/question/case where you looked for research-based information?", three of the practitioners identified three questions from table 3 as questions they had either sought scientific information for or as questions where such information might have been useful (questions 4, 20, 22).