Defining Evidence

Session Objectives

• Define evidence-based public health practice

• Discuss two important targets of evidence-based intervention

- behavior of individuals and groups

- environment

• Discuss benefits and challenges associated with using evidence

What do you think of when you hear “evidence-based”?

Question

What is evidence?

“the available body of facts or information indicating whether a belief is true or valid”

Brownson R.C., Baker, E.A., Leet T.L., Gillespie, K.N. (2003). Evidence-Based Public Health. New York: Oxford University Press.

What is evidence in public health?

• Personal experience

• Word of mouth

• Program evaluation

• An intervention research study

• Systematic reviews of multiple intervention studies

• Surveillance data

Research and Practice Create Evidence

• Evidence derived from research:

– Intervention that has been tested in a research study

– Systematic review of multiple studies

– Policy analysis

• Evidence derived from practice:

– Intervention or policy developed, implemented and evaluated in an organization, community or geographic region

Social Ecological Model

• Health is affected by a variety of factors including:

– individual characteristics

– attitudes and behaviors of peers

– physical surroundings / environment

– policies in community

• Public health approaches should include activities that produce change at multiple levels of the model

– individuals

– environments

– policies

Social Ecological Model

Different Evidence-based Options for Promoting Public Health

Environment or Behavior

Strategies(recommended after systematic review)

PoliciesPackaged Programs

Evidence-based Approaches

Packaged Programs

Interventions that include instructions and specify materials needed to implement with success

Pool Coolavailable on RTIPS

and at www.poolcool.org

Body and Soulavailable on RTIPs

Pathways to Freedomavailable on RTIPs and

the CDC’s website

Pool Cool Sun-Safety Program • Aim: Raise awareness, motivation and sun protection practices to

reduce skin cancer

• Setting: swimming pools

• Target audience: children enrolled in swimming lessons

• Program components: • Eight 5-minute lessons during swim class

• Five optional sun-safe Poolside Activities

• Sun safety signs

• Program materials: • Developed in efficacy and diffusion trials and process evaluations

• Available for free, online

Policies

• A system of laws, regulatory measures, courses of action, and funding priorities concerning a given topic– Public policy: regulation set by government or

local authorities (e.g., laws for coverage, ordinances)

– Organizational policy: organizational rule or regulation (e.g., worksite health plans, patient navigation services)

Public Policy

• North Carolina enacted legislation that prohibits the purchase of tobacco products by persons under the age of 18

Organizational Policy

Food Item Recommendation Rationale Examples of what would be IN and OUT

Beverages Contain 100% fruit juice with no added sweetener

Fruits/vegetables contain necessary nutrients

IN: Vegetable and fruit juice

Snacks, sweets, and sides

Sugar: No more than 35% by weight

Eliminate foods that •Are high in calories•Are low in nutrients•Promote dental caries

IN: Some granola bars, trail mix, animal crackers, fat-free fudge bar, frozen fruit barOUT: Some granola bars, some cookies, all candy

A school or workplace implements Recommendations for Cafeteria, Vending, and Break Room Food Standards in Utah Workplaces

Evidence-based Strategies

• Broad recommendation based on systematic review of multiple studies

The Community Guide: A Source of Evidence-based

StrategiesAim: Increase physical activity 

Environmental strategy:Point-of-decision prompts

Program Material:

  

Aim: Increase CRC screening

Individual strategy: Small media

Program Material:

Discussion

• What are some challenges you have encountered in using evidence?

• How have you addressed those challenges?

Take Home Points: Advantages of Evidence-based Options

• Adds value to a grant application

• Saves time and resources during planning and implementation

• Helps focus your evaluation

• Increases your likelihood of success

Take Home Points

• There are different types of evidence-based approaches (i.e., packaged programs, policies, strategies)

• Evidence-based approaches can:

• Increases your likelihood of success

• Saves time and resources instead of new program development

Questions?