National Collaborating Centre for Methods and Tools

Background Physical activity among children and adolescents is associated with lower adiposity, improved cardio‐metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. Objectives The purpose of this review update is to summarise the evidence on effectiveness of school‐based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school‐based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school‐based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school‐based interventions are more effective than others in promoting physical activity and fitness in this target population. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. Selection criteria Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school‐attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health‐related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. Data collection and analysis Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random‐effects meta‐analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. Main results Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi‐component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow‐up were the most common sources of bias. Results show that school‐based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate‐certainty evidence) and may lead to little to no decrease in sedentary time (MD ‐3.78 minutes/d, 95% CI ‐7.80 to 0.24; 16 studies; low‐certainty evidence). School‐based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low‐certainty evidence). School‐based physical activity interventions may result in a very small decrease in BMI z‐scores (MD ‐0.06, 95% CI ‐0.09 to ‐0.02; 21 studies; low‐certainty evidence) and may not impact BMI expressed as kg/m² (MD ‐0.07, 95% CI ‐0.15 to 0.01; 50 studies; low‐certainty evidence). We are very uncertain whether school‐based physical activity interventions impact health‐related quality of life or adverse events. Authors' conclusions Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school‐based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.

BACKGROUND: Public health surveillance plays a vital role in informing public health decision-making. The onset of the COVID-19 pandemic in early 2020 caused a widespread shift in public health priorities. Global efforts focused on COVID-19 monitoring and contact tracing. Existing public health programs were interrupted due to physical distancing measures and reallocation of resources. The onset of the COVID-19 pandemic intersected with advancements in technologies that have the potential to support public health surveillance efforts. OBJECTIVE: This scoping review aims to explore emergent public health surveillance methods during the early COVID-19 pandemic to characterize the impact of the pandemic on surveillance methods. METHODS: A scoping search was conducted in multiple databases and by scanning key government and public health organization websites from March 2020 to January 2022. Published papers and gray literature that described the application of new or revised approaches to public health surveillance were included. Papers that discussed the implications of novel public health surveillance approaches from ethical, legal, security, and equity perspectives were also included. The surveillance subject, method, location, and setting were extracted from each paper to identify trends in surveillance practices. Two public health epidemiologists were invited to provide their perspectives as peer reviewers. RESULTS: Of the 14,238 unique papers, a total of 241 papers describing novel surveillance methods and changes to surveillance methods are included. Eighty papers were review papers and 161 were single studies. Overall, the literature heavily featured papers detailing surveillance of COVID-19 transmission (n=187). Surveillance of other infectious diseases was also described, including other pathogens (n=12). Other public health topics included vaccines (n=9), mental health (n=11), substance use (n=4), healthy nutrition (n=1), maternal and child health (n=3), antimicrobial resistance (n=2), and misinformation (n=6). The literature was dominated by applications of digital surveillance, for example, by using big data through mobility tracking and infodemiology (n=163). Wastewater surveillance was also heavily represented (n=48). Other papers described adaptations to programs or methods that existed prior to the COVID-19 pandemic (n=9). The scoping search also found 109 papers that discuss the ethical, legal, security, and equity implications of emerging surveillance methods. The peer reviewer public health epidemiologists noted that additional changes likely exist, beyond what has been reported and available for evidence syntheses. CONCLUSIONS: The COVID-19 pandemic accelerated advancements in surveillance and the adoption of new technologies, especially for digital and wastewater surveillance methods. Given the investments in these systems, further applications for public health surveillance are likely. The literature for surveillance methods was dominated by surveillance of infectious diseases, particularly COVID-19. A substantial amount of literature on the ethical, legal, security, and equity implications of these emerging surveillance methods also points to a need for cautious consideration of potential harm.

BACKGROUND: There are growing professional expectations for nurses to engage in and develop competence in evidence-informed decision-making (EIDM) due to opportunities for improved client and community outcomes and provision of the highest quality of care. However, EIDM is underdeveloped, with low implementation rates among nurses. The use of indicators to assess EIDM performance has potential to encourage nurses' engagement in EIDM through competence recognition and support assessment of strengths and competency gaps for individual nurses and organizations. Currently, the state of evidence regarding measures that assess EIDM competence attributes (i.e., knowledge, skills, beliefs/values, behaviors) among nurses is unknown. This systematic review aims to address this gap through a narrative synthesis of the characteristics and psychometric properties of EIDM competence measures. METHODS: The search strategy, developed in consultation with a Health Sciences Librarian, consists of online databases, contacting experts, hand searching reference lists, key journals, websites, conference proceedings, and grey literature. Studies will be included if the following criteria are met: (1) sample includes practicing nurses and data for nurses are reported separately; (2) conducted in any healthcare setting; (3) quantitative or mixed-methods design; (4) reports use or testing of a measure assessing EIDM competence attributes (i.e., knowledge, skills, attitudes/values, and/or behaviors); and (5) published in English. Screening will be conducted independently by two reviewers using a two-stage process: (1) title and abstract level; and (2) full-text level. Data extraction of study characteristics (e.g., sample, setting) will be conducted by a single reviewer and checked for accuracy by a second reviewer. Psychometric properties of acceptability, reliability, and validity evidence for each measure will be independently extracted by two reviewers. Data on measures will be synthesized narratively according to acceptability, number of validity evidence sources established, and reliability of scores. Data pertaining to population and healthcare setting will also be reported for each measure. DISCUSSION: This systematic review will provide a current understanding about the state of evidence with respect to EIDM competence measures in nursing to assist in determining potentially relevant and robust measures for use in different nursing practice settings. SYSTEMATIC REVIEW REGISTRATION: Protocol registered in PROSPERO Registration #: CRD42018088754.

Background: The COVID-19 pandemic has disrupted the healthcare and public health sectors. The impact of working on the frontlines as a healthcare or public health professional has been well documented. Healthcare organizations must support the psychological and mental health of those responding to future public health emergencies. Objective: This systematic review aims to identify effective interventions to support healthcare workers' mental health and wellbeing during and following a public health emergency. Methods: Eight scientific databases were searched from inception to 1 November 2022. Studies that described strategies to address the psychological impacts experienced by those responding to a public health emergency (i.e., a pandemic, epidemic, natural disaster, or mass casualty event) were eligible for inclusion. No limitations were placed based on study design, language, publication status, or publication date. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute critical appraisal tools. Discrepancies were resolved through discussion and a third reviewer when needed. Results were synthesized narratively due to the heterogeneity of populations and interventions. Outcomes were displayed graphically using harvest plots. Results: A total of 20,018 records were screened, with 36 unique studies included in the review, 15 randomized controlled trials, and 21 quasi-experimental studies. Results indicate that psychotherapy, psychoeducation, and mind-body interventions may reduce symptoms of anxiety, burnout, depression, and Post Traumatic Stress Disorder, with the lowest risk of bias found among psychotherapy interventions. Psychoeducation appears most promising to increase resilience, with mind-body interventions having the most substantial evidence for increases in quality of life. Few organizational interventions were identified, with highly heterogeneous components. Conclusion: : https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=203810, identifier #CRD42020203810 (PROSPERO).

Since December 2019, there has been a global explosion of research on COVID-19. In Canada, the six National Collaborating Centres (NCCs) for Public Health form one of the central pillars supporting evidence-informed decision making by gathering, synthesizing and translating emerging findings. Funded by the Public Health Agency of Canada and located across Canada, the six NCCs promote and support the use of scientific research and other knowledges to strengthen public health practice, programs and policies. This paper offers an overview of the NCCs as an example of public health knowledge mobilization in Canada and showcases the NCCs' contribution to the COVID-19 response while reflecting on the numerous challenges encountered.

BACKGROUND: Understanding organizational mechanisms that protect the mental health of the healthcare workforce during pandemics and epidemics is critical to support decision-making related to worker health and safety. This systematic review aimed to identify organizational-level factors, strategies or interventions that support the mental health of healthcare workers during pandemics or epidemics. METHODS: A comprehensive search was used, including online databases, a grey literature review, and handsearching of reference lists. Studies were eligible for inclusion if they described implementing or testing organizational-level factors, strategies or interventions to support healthcare workers' mental health during pandemics or epidemics. There were no limitations by language, publication status, or publication date. Two reviewers independently conducted screening, data extraction, data analysis and quality appraisal, with conflicts resolved through discussion or third-party arbitration. Data analysis was guided by the Job Demands-Resources Model. A narrative synthesis is presented, given the high degree of heterogeneity across studies. RESULTS: A total of 10,805 articles from database searches and 190 records from other sources were screened. The final review included 86 articles. Studies were of low (n = 11), moderate (n = 39), and high quality (n = 36). Regarding job demands, 40 studies explored high work pressure or heavy workload factors, with the majority investigating working hours (n = 32). Increased working hours may be associated with an increased risk of diverse mental health outcomes. Regarding job resources, leadership factors, strategies (support, appreciation, responsiveness; n = 19) and leadership interventions (n = 3) may be associated with decreased burnout, anxiety, stress, and increased well-being. The availability and adequacy of personal protective equipment (n = 20) may be associated with decreased burnout, anxiety, depression, and stress. Mixed findings were reported on associations between diverse mental health outcomes and training and education (n = 28) or peer support (n = 3). Results should be interpreted cautiously given the high heterogeneity among factors, strategies, and interventions assessed and outcomes measured. CONCLUSIONS: Organizational-level mechanisms can critically influence the mental health of healthcare workers' during pandemics and epidemics. More focused attention is needed to explore and act on the integral role of leadership and the availability of protective equipment to support healthcare workers' mental health.

BACKGROUND: During the COVID-19 pandemic, the public health workforce has experienced re-deployment from core functions such as health promotion, disease prevention, and health protection, to preventing and tracking the spread of COVID-19. With continued pandemic deployment coupled with the exacerbation of existing health disparities due to the pandemic, public health systems need to re-start the delivery of core public health programming alongside COVID-19 activities. The purpose of this scoping review was to identify strategies that support the re-integration of core public health programming alongside ongoing pandemic or emergency response. METHODS: The Joanna Briggs Institute methodology for scoping reviews was used to guide this study. A comprehensive search was conducted using: a) online databases, b) grey literature, c) content experts to identify additional references, and d) searching reference lists of pertinent studies. All references were screened by two team members. References were included that met the following criteria: a) involved public health organizations (local, regional, national, and international); b) provided descriptions of strategies to support adaptation or delivery of routine public health measures alongside disaster response; and c) quantitative, qualitative, or descriptive designs. No restrictions were placed on language, publication status, publication date, or outcomes. Data on study characteristics, intervention/strategy, and key findings were independently extracted by two team members. Emergent themes were established through independent inductive analysis by two team members. RESULTS: Of 44,087 records identified, 17 studies were included in the review. Study designs of included studies varied: descriptive (n = 8); qualitative (n = 4); mixed-methods (n = 2); cross-sectional (n = 1); case report (n = 1); single-group pretest/post-test design (n = 1). Included studies were from North America (n = 10), Africa (n = 4), and Asia (n = 3) and addressed various public health disasters including natural disasters (n = 9), infectious disease epidemics (n = 5), armed conflict (n = 2) and hazardous material disasters (n = 1). Five emergent themes were identified on strategies to support the re-integration of core public health services: a) community engagement, b) community assessment, c) collaborative partnerships and coordination, d) workforce capacity development and allocation, and e) funding/resource enhancement. CONCLUSION: Emergent themes from this study can be used by public health organizations as a beginning understanding of strategies that can support the re-introduction of essential public health services and programs in COVID-19 recovery.

Abstract Background Public health continuously evolves to address an uncertain future, and public health professionals must effectively and efficiently adapt to changes. Evidence-informed decision making (EIDM) is one way to adapt to change. The National Collaborating Centre for Methods and Tools (NCCMT) provides high quality resources, training and mentorship to support the EIDM process through both in-person and distance-based formats. Freely accessible resources including online training opportunities can help public health professionals globally put evidence into practice and be ready to respond to change. Objectives The NCCMT's work is driven by the belief that everyone deserves optimal health and well-being and this can be achieved by using the best available evidence in practice. Our training and education resources include thirteen online learning modules, an EIDM skills assessment, video series, a rapid review guidebook and regular webinars, amongst others. These resources are self-paced and they can be accessed when and where it is most convenient for public health professionals. Results The NCCMT's resources are highly accessed, with over 320, 000 visits to the NCCMT website from around the world from April 2018-March 2019. There were also over 42,000 downloads of knowledge products in the same time period. The NCCMT's resources have been integrated into public health organizations and curriculum in public health postsecondary programs in Canada. We are continuously evolving by engaging our users. We will be launching an updated version of our Learning Centre in April 2020. Conclusions The NCCMT houses useful resources for all public health professionals to learn about finding, understanding, and using evidence. Public health professionals from around the world have used the NCCMT's educational resources to put evidence into practice. The NCCMT is committed to working with global organizations to support them to achieve their EIDM goals. Key messages The NCCMT supports public health professionals to use the best available evidence in practice. The NCCMT offers high quality resources, training and mentorship to public health professionals.

BACKGROUND: There is limited evidence about the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic. The objectives of this study were to determine the prevalence of burnout, symptoms of anxiety and depression, and intention to leave among the Canadian public health workforce, and associations with individual and workplace factors. METHODS: A cross-sectional study was conducted using data collected by a Canada-wide survey from November 2022 to January 2023, where participants reported sociodemographic and workplace factors. Mental health outcomes were measured using validated tools including the Oldenburg Burnout Inventory, the 7-item Generalized Anxiety Disorder scale, and the 2-item Patient Health Questionnaire to measure symptoms of depression. Participants were asked to report if they intended to leave their position in public health. Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the associations between explanatory variables such as sociodemographic, workplace factors, and outcomes of mental health, and intention to leave public health. RESULTS: Among the 671 participants, the prevalence of burnout, and symptoms of depression and anxiety in the two weeks prior were 64%, 26%, and 22% respectively. 33% of participants reported they were intending to leave their public health position in the coming year. Across all outcomes, sociodemographic factors were largely not associated with mental health and intention to leave. However, an exception to this was that those with 16-20 years of work experience had higher odds of burnout (aOR = 2.16; 95% CI = 1.12-4.18) compared to those with ≤ 5 years of work experience. Many workplace factors were associated with mental health outcomes and intention to leave public health. Those who felt bullied, threatened, or harassed because of work had increased odds of depressive symptoms (aOR = 1.85; 95% CI = 1.28-2.68), burnout (aOR = 1.61; 95% CI = 1.16-2.23), and intention to leave (aOR = 1.64; 95% CI = 1.13-2.37). CONCLUSIONS: During the COVID-19 pandemic, some of the public health workforce experienced negative impacts on their mental health. 33% of the sample indicated an intention to leave their role, which has the potential to exacerbate pre-existing challenges in workforce retention. Study findings create an impetus for policy and practice changes to mitigate risks to mental health and attrition to create safe and healthy working environments for public health workers during public health crises.

Abstract Structural racism is the historical and ongoing reinforcement of racism within society due to discriminatory systems and inequitable distribution of key resources. Racism, embedded within institutional structures, processes and values, perpetuates historical injustices and restricts access to structural factors that directly impact health, such as housing, education and employment. Due to the complex and pervasive nature of structural racism, interventions that act at the structural level, rather than the individual level, are necessary to improve racial health equity. This systematic review was conducted to evaluate the effects of structural-level interventions on determinants of health and health outcomes for racialized populations. A total of 28 articles are included in this review, analyzing interventions such as supplemental income programs, minimum wage policies, nutrition safeguard programs, immigration-related policies, and reproductive and family-based policies. Most studies were quasi-experimental or natural experiments. Findings of studies were largely mixed, although there were clear benefits to policies that improve socioeconomic status and opportunities, and demonstrable harms from policies that restrict access to abortion or immigration. Overall, research on the effects of structural-level interventions to address health inequities is lacking, and the evidence base would benefit from well-designed studies on upstream policy interventions that effect the structural determinants of health and health inequities and improve daily living conditions.

AIM: The purpose of this study is to: (a) describe public health nursing roles over the course of the COVID-19 pandemic in Ontario, Canada; (b) describe the contextual factors that influence public health nursing role implementation; and (c) describe nurses' perceived impact of their roles on client outcomes and professional/personal nursing practice. DESIGN: Descriptive multiple case study. METHODS: Recruitment of public health nurses (PHNs), working in direct service or administrative leadership positions, in an Ontario public health unit will be conducted through purposive and snowball sampling. Nursing roles will be compared and contrasted across three cases differentiated by geographic setting: urban, urban-rural, northern. In each geographic case, a priori estimates of sample size will include 10 PHNs providing direct care and at least five nurses in an administrative leadership role; with an overall estimated study sample size of 45 individuals. Demographic data will be collected using an online anonymous survey. Individual semi-structured interviews with PHNs, and focus groups with nursing administrators will be conducted via telephone and audio-recorded. Individual interviews and focus groups will be transcribed verbatim. Reflexive thematic analysis will be used to generate emergent themes in each case and cross-case synthesis will be used to compare and contrast patterns across geographic cases. DISCUSSION: Expected findings will provide an in-depth analysis of the rapidly evolving roles and functions of PHNs throughout the COVID-19 pandemic and their impact on individuals, families and communities. As well, findings will provide a new understanding about the contextual barriers and facilitators of PHN role implementation in their working environments. IMPACT: Study findings can support decision-making in relation to funding, resource allocation and supportive work structures and processes at a public health system and/or individual public health organization level.

ABSTRACT Objectives Disasters, such as the current COVID-19 pandemic, disrupt daily life, increase uncertainty and stress, and may increase long-term risk of adverse cardiometabolic outcomes, including heart disease, obesity and diabetes. The objective was to conduct a systematic review to determine the impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course. Design A systematic search was conducted in May 2020 using two electronic databases, EMBASE and Medline. All studies were screened in duplicate at title and abstract, and full-text level. Studies were eligible for inclusion if they assessed an association with population-level or community disaster and cardiometabolic outcomes. There were no restrictions on year of publication, country or population. Non-English and earthquake-related studies were excluded. Data were extracted on study characteristics, exposure (e.g., type of disaster, name of specific event, region, year), cardiometabolic outcomes, and measures of effect. Study quality was evaluated using the Joanna Briggs Institute critical appraisal tools. Results A total of 58 studies were included, with 24 studies reporting the effects of exposure to disaster during pregnancy/childhood and 34 studies reporting the effects of exposure during adulthood. Studies included exposure to natural (60%) and human-made (40%) disasters, with only 3 (5%) of these studies evaluating previous pandemics. Most studies were conducted in North America (62%). Most studies reported increased cardiometabolic risk, including increased cardiovascular disease incidence or mortality, diabetes, and obesity. Few studies investigated potential mechanisms or identified high risk subgroups. Conclusions Understanding the long-term consequences of disasters on cardiometabolic outcomes across the life-course may inform public health strategies for the current COVID-19 pandemic. This review found strong evidence of an increased association between disaster exposure and cardiometabolic outcomes across the life-course, although more research is needed to better understand the mechanisms and preventative efforts. PROSPERO registration CRD – 42020186074 Strengths and limitations of this study This systematic review is one of the first to review the literature on disasters, including pandemics, and subsequent cardiometabolic outcomes throughout the life-course. A comprehensive search strategy was developed in consultation with Health Science Librarians at McMaster University, which resulted in 58 studies that were eligible for inclusion into the review. Due to the heterogeneity of the included studies, a meta-analysis was not conducted. This review contributes a synthesis of the literature on the impact of disasters and cardiometabolic outcomes, that can help to inform public health strategies for the current COVID-19 pandemic.

Although evidence-informed decision making is an important part of the field of public health inspection, finding the time to stay informed of current research can be a challenge amidst day-to-day job expectations. This article will explore how two Public Health Inspectors (PHIs) from Ottawa Public Health, a municipal public health unit in Ontario, incorporated evidence-informed decision making (EIDM) into their work. They built their EIDM skills through participating in the 18-month Knowledge Broker (KB) Mentoring Program offered by the National Collaborating Centre for Methods and Tools. The program required a substantial time commitment, including nine in-person workshop days and dedicated hours to practice research appraisal skills and to complete a rapid review. The inspectors were approved and supported to spend the necessary time; however, they still found it difficult to designate hours for learning while balancing their frontline inspection workload. This article will share observations about the PHI’s involvement, including benefits and challenges as well as factors that facilitated their successful completion of the KB Mentoring Program.

The National Collaborating Centre for Methods and Tools’ (NCCMT) Rapid Evidence Service conducts rapid reviews on priority questions to respond to the needs of public health decision-makers. Given the vast quantity of literature available, a key challenge of conducting rapid evidence syntheses is the time and effort required to manually screen large search results sets to identify and include all studies relevant to the research question within an accelerated timeline. To overcome this challenge, the NCCMT investigated the integration of artificial intelligence (AI) technologies into the title and abstract screening stage of the rapid review process to expedite the identification of studies relevant to the research question. The NCCMT is funded by the Public Health Agenda of Canada and affiliated with McMaster University.

Abstract The COVID-19 public health crisis has produced an immense and quickly evolving body of evidence. This research speed and volume, along with variability in quality, could overwhelm public health decision-makers striving to make timely decisions based on the best available evidence. In response to this challenge, the National Collaborating Centre for Methods and Tools developed a Rapid Evidence Service, building on internationally accepted rapid review methodologies, to address priority COVID-19 public health questions. Each week, we receive requests from public health decision-makers and frame the prioritized topics into searchable questions. We develop and conduct a comprehensive search strategy and critically appraise all relevant evidence using validated tools. We synthesize the findings into a final report that includes key messages, with a rating of the certainty of the evidence using GRADE, as well as an overview of evidence and remaining knowledge gaps. Rapid reviews are typically completed and disseminated within one to two weeks. As of February 25, 2021, we have answered more than 27 distinct questions and completed 21 updates as new evidence emerged. The overview of our process, presented here, provides a real-world example of how review-level evidence can be made available – rapidly and rigorously, and in response to decision-makers’ needs – during an unprecedented public health crisis.

<sec> <title>Résumé</title> Depuis décembre 2019, on assiste à une explosion mondiale de la recherche sur la COVID-19. Au Canada, les six Centres de collaboration nationale (CCN) en santé publique constituent l’un des piliers de la prise de décisions informées par les données probantes, car ils recueillent, résument et traduisent les connaissances émergentes. Financés par l’Agence de la santé publique du Canada et répartis sur le territoire, ils favorisent et soutiennent l’utilisation des résultats de la recherche scientifique et d’autres connaissances pour renforcer les pratiques, les programmes et les politiques en santé publique. Cet article fournit un aperçu de la manière dont les CCN participent à la mobilisation des connaissances en santé publique au Canada, met en évidence leur contribution à la lutte contre la COVID-19 et décrit les nombreuses difficultés rencontrées. </sec>

Abstract Background Evidence-informed decision making (EIDM) is important to ensure that practice is evidence-informed and resources are used efficiently and effectively. However, public health professionals can face barriers to EIDM. Knowledge Brokers can support and champion EIDM within an organization. The National Collaborating Centre for Methods and Tools (NCCMT) developed a Knowledge Broker (KB) Mentoring program, a hands-on mentorship program to develop capacity for evidence-informed decision making. Objectives The objectives of the KB Mentoring program are to build individual and organizational capacity for evidence-informed decision making. The program takes place over 20 months and includes an organizational assessment, nine face-to-face workshop days, monthly webinars, completion of a rapid review, and a period post-program to connect with mentors. Participating cohorts are evaluated qualitatively. Results To date, two cohorts of five organizations each have completed the program (n = 56 participants). At the individual level, participants reported increased: confidence; EIDM knowledge and skills; and interpersonal connections. At the organizational level, the groups reported conducting rapid reviews, critically appraising evidence, and using evidence in program planning decisions. Additionally, organizations have put in place ongoing supports to build EIDM capacity. Participants noted that they would like more support both before and after the program. This recommendation was put in place for the third cohort, currently in progress. Conclusions Participants indicated the KB mentoring program was high quality and increased EIDM capacity and behaviour in their organizations. This innovative program is important across settings and countries as public health continues to face changes to public health practice. In order to scale up the program to diverse geographic settings, an online KB mentoring program is currently in development. Key messages Knowledge Broker mentoring supports public health practitioners to use evidence in practice. Knowledge broker mentoring raises the confidence, knowledge, skills, and connections of participants.

Abstract Background Achievement of evidence-informed decision making (EIDM) requires the integration of evidence into all practice decisions by identifying and synthesizing evidence, then developing and executing plans to implement and evaluate changes to practice. Evidence-informed practice (EIP) involves implementing a specific practice or program with proven effectiveness. This rapid systematic review examines strategies for the implementation of EIDM and EIPs across organizations, mapping facilitators and barriers to the COM-B (capability, opportunity, motivation, behaviour) model for behaviour change. Methods A systematic search was conducted in multiple databases and by reviewing publications of key authors. Articles that describe interventions to shift teams, departments, or organizations to EIDM or EIP were eligible for inclusion. For each article, quality was assessed, and details of the intervention, setting, outcomes, facilitators and barriers were extracted from each included article. A convergent integrated approach was undertaken to analyze both quantitative and qualitative findings. Results Fifty-nine articles are included. Studies were conducted in primary care, public health, social services, occupational health, and palliative care settings. Strategies to implement EIDM and EIP included the establishment of Knowledge Broker-type roles, building the EIDM capacity of staff, and research or academic partnerships. Facilitators and barriers align with the COM-B model for behaviour change. Facilitators for capability include the development of staff knowledge and skill, establishing specialized roles, and knowledge sharing across the organization, though staff turnover and subsequent knowledge loss was a barrier to capability. For opportunity, facilitators include the development of processes or mechanisms to support new practices, forums for learning and skill development, and protected time, and barriers include competing priorities. Facilitators identified for motivation include supportive organizational culture, expectations for new practices to occur, recognition and positive reinforcement, and strong leadership support. Barriers include negative attitudes toward new practices, and lack of understanding and support from management. Conclusion This review provides a comprehensive, in-depth analysis of facilitators and barriers for the implementation of EIDM and EIP in public health and related organizations, mapped to the COM-B model for behaviour change. The facilitators and barriers described in the included studies establish key factors for realizing greater implementation success in the future. Registration PROSPERO CRD42022318994

Abstract Background The Master of Public Health (MPH) is a common graduate-level professional degree that is offered by Canadian Universities. To date, few studies have examined competency-based MPH education in Canada. Objective To examine the degree to which MPH programs' course descriptions align with the Public Health Agency of Canada's (PHAC) core competency categories in order to identify strengths and training gaps in such programs across Canada. Methods A content analysis of MPH programs in Canada was conducted from July 2019 to November 2019. A sampling frame of programs was obtained from a list from the PHAC website. Program information, including mandatory and elective course descriptions was extracted from each program's website and analyzed in NVivo 12. Course descriptions were independently categorized by two researchers into one or more of the seven categories of the core competencies outlined by PHAC. Results We identified 18 universities with MPH programs with 267 courses across Canada. Thematic analysis revealed that 100% of programs had coursework that addressed the “Public Health Sciences” and “Assessment and Analysis” categories; 93% addressed “Policy and Program Planning, Implementation, and Evaluation”; 67% addressed each of “Communication,” “Leadership,” and “Partnerships, Collaboration, and Advocacy”; and only 56% had course descriptions addressing “Diversity and Inclusiveness.” Conclusions We find that Canadian MPH programs may lack course offerings addressing core competency categories relating to diversity and inclusiveness, communication, and leadership. Our findings were limited in scope as we relied on program Web sites; thus, further research should explore course content in more depth than this course description analysis allowed and identify ways to close the MPH curricular gaps we identified. Key messages Further research should be conducted to determine if the current model of competency education in Canada is successfully guiding MPH programs in meeting local and international workforce demands. Continued discussion is needed to raise the importance of MPH competency-based education in Canada.

Abstract Background To support evidence-informed decision making (EIDM) for safe re-opening and operation of schools and daycares, the National Collaborating Centre for Methods and Tools (NCCMT) has maintained since May 2020 a living rapid review answering the following question: “What is the role of schools and daycares in COVID-19 transmission”. Traditional rapid review methodology was modified for the COVID-19 context. This presentation will describe the global reach and usefulness of this living rapid review. Methods Following completion of each update of the living rapid review, findings were disseminated broadly with the aim of informing policy and public health practice. Key dissemination strategies include e-mails to key contacts and a subscriber list; highlight in a monthly newsletter; media outreach; and social media. The review's reach was analyzed using Google Analytics, citation tracking, and qualitative feedback. Results Between May 2020 and April 2021, the living review has been updated 14 times. The posted review has been viewed over 5000 times across 46 countries. The review has been cited and indexed in over 40 sources, including key governmental and non-governmental reports and guidelines. The NCCMT has received positive qualitative feedback on the review's value in informing the public health response related to schools and daycares in various jurisdictions across Canada. Key stakeholders have expanded the review's reach organically as they use the evidence in practice and share the review with their networks. Lessons Using a living rapid review to continuously provide high-quality synthesized evidence amidst the evolving COVID-19 research literature demonstrates a responsive approach to decision makers' requests for evidence. An emerging challenge is reaching the proper stakeholders responsible for EIDM, particularly during public health emergencies with many competing high-priority questions and decisions to be made. Key messages As the evidence landscape changes due to a surge in literature, evidence-informed decision making can be supported by rapid but rigorous syntheses that evaluate quality and emerging recommendations. A long-standing, trusting relationship with decision makers is key to optimizing living rapid review methodology to meet the evidence needs of decision makers despite the changing literature.