Project Overview > Concepts

The Link to Best Practice

The Need for Identifying Best Practice

Increasingly, health promotion practitioners are challenged to select approaches that have evidence of relevant impact and a high likelihood of success. To identify these approaches many planners will undertake a review of the literature, both published (often peer-reviewed) and unpublished. This process is not only time consuming, it is also often duplicated across communities. Catalogues of best practice and systematic reviews have become popular resources to find this information.

Practitioners are able to make better informed decisions when the tools they use have been reviewed for quality and evidence base. Initiatives such as this catalogue of situational assessment tools, which provide this evidence base, are often referred to as "best practices." Hence, this resource and catalogue has been created.

How the Concept of Best Practice Worked for this Project (back to top)

Each situational assessment tool in this catalogue has been reviewed for its value and appropriateness to Ontario workplace health promotion intermediaries and practitioners.

Two expert reviewers considered each tool using criteria that assessed effectiveness (validity and reliability testing), plausibility, and practicality for use in Ontario workplaces. Using the criteria, the reviewers identified each tool as a recommended, promising or not recommended practice. These identifiers have the following implications:

Recommended – The tool is recommended for use in Ontario workplaces. It is seen as being plausible and practical for implementation and may or may not have been evaluated (i.e., reliability and validity testing may or may not have taken place) in Ontario workplaces.

Promising – The tool is identified as a promising practice for use in Ontario workplaces. It has highly promising aspects of plausibility and practicality and may or may not have been evaluated (i.e., reliability and validity testing may or may not have taken place). Because of certain limitations of the tool, reviewers could not "recommend" it; however, it is seen as a valuable tool to be included in the catalogue – a tool that has "promise."

Not recommended – The tool is not recommended for use in Ontario workplaces. Due to both general and specific limitations, the tool is not plausible, practical and may not have been evaluated. Although the tool may have particular strengths, it was not seen as appropriate for use in Ontario workplaces. Review panel members assessed and identified five tools as not recommended practices. Due to confidentiality issues, the results of these five tools will not be shared.

It is important to note, however, why these five tools were not recommended. Each of the five tools were not recommended for one or more of the following reasons:

• The tool had limited reference or relevance to CWHP.
• The tool had a limited focus.
• The tool was not easily accessible to Ontario workplaces.
• The survey structure was poor.
• The quality of the questions was poor.
• The analysis/reporting was poor.
• Ease of implementation was poor.

Many of the recommended and promising tools included in this catalogue have the attributes of the principles of good practice.

This Catalogue in Relation to Other Best Practice Resources (back to top)

Although there are best practice collections on specific topics (such as nutrition programs for the workplace), there does not appear to be any other Canadian resources that address one of the major tasks of intermediaries in supporting CWHP – selecting and implementing a situational assessment tool.

THCU intentionally chose an approach to identifying best practices that was consistent with other approaches, especially in Ontario, specifically, the Program Training and Consultation Centre (PTCC) and the Heart Health Resource Centre. For example, the labels of "recommended" and "promising" in THCU's review results are consistent with those of PTCC's.

Variations in Terms (back to top)

Although best practice initiatives are needed and helpful, there are tremendous variations in what the term best practice means among those who identify and promote them, as well as the practitioners considering using them. There are no widely accepted cross-organizational standards or guidelines about:

• what constitutes a best practice
• how an intervention or process should be assessed to determine whether or not it qualifies
• the terms that are used to indicate a best practice.

These terms include "gold standard," "good," "better," "best," "recommended," "model," and "promising."

The term originated in the medical/clinical setting where "best practice" was applied to practice guidelines for medical procedures. In order to be assessed as "best," there are requirements for generally rigorous scientific testing protocols such as randomized control trials (RCT). By design, these experiments occur in very clinical, controlled environments and the results are often definitive "cause and effect" statements. However, this methodology is less common and does not work as well in the ecological world of health promotion where there are many more variables to consider.

Limitations of a Best Practice Approach (back to top)

Because of the ecological nature of health promotion, it is also difficult, if not impossible, to assume that when an initiative has the desired effect in one setting, the same effect will be seen in another setting, however similar (be it a school, a workplace, a home, or a municipality.) Also, the process of delivering the best practice in another setting will likely be altered, so it is difficult to ensure that the elements that made it "best" (often referred to as the "integrity" of an initiative) are preserved. These limitations should be taken into account when using recommended or promising tools in this catalogue, or any other best practice.

For this catalogue, THCU conducted a substantial but not exhaustive search for potential tools, so it would be misleading to suggest that all the "best" tools have been compiled.