Assessing knowledge-based public health decision-making in Norwegian municipalities.

Background: Public health efforts promoting health through everyday settings demand integrated use and local customization of scientific evidence, systematic knowledge and community preferences when selecting, implementing, and evaluating interventions. Despite this widespread ideal in public health, short-term opportunities, interest groups or political hot issues are driving decision making. Another challenge has been municipalities' ability to translate knowledge/evidence into decisions and actions. The present study identifies mechanisms and actions facilitating and hindering knowledge-based public health decision making in municipalities in Norway. Methods: Semi-structured interviews were conducted with 37 persons in 12 municipalities. Interviewees included politicians, public health coordinators and other practitioners involved in planning, implementing, and evaluating initiatives. Data containing descriptions of decision-making processes were assessed using content analysis. Results: Results show that municipalities have established sound local knowledge- and evidence bases where data on risks and resources in the national and local population is included. Use of this knowledgebase have been facilitated by knowledge sharing across municipal sectors. Joint learning activities have established shared understandings across sectors and highlighted sector-specific strategies, resources, and challenges. On the downside, lack of evaluations, sector-specific anchoring of goals and friction over resources and responsibilities have hindered application of the knowledge. Conclusions: To improve knowledge-based decision making, municipalities must do good groundwork and extract, integrate, and query the best available scientific evidence and local knowledge when mapping challenges and resources in population health. This knowledge should be integrated in key plans/strategies to establish public health as a cross sectoral matter and lay ground for knowledge-based work. Key message 1: Knowledge-based decision making in public health will not succeed in an environment where public health is not acknowledged as a cross-sectoral matter. Key message 2: To overcome barriers to knowledge-based decision making in public health, capacity building in evaluation is needed.