Decoding the Evidence Myth: The Realities of Evidence Based Public Health

Evidence: (n) a thing or things helpful in forming a conclusion or judgment Webster

Evidence Based Decision Making Should something be done? What should be done? How should it be done? How do I know it’s working?

Should something be done? What is the burden of disease? Surveillance data Survey data Vital statistics data Medical utilization data Cost data What is the urgency?Basic medical data Trend data Is it a priority for the community? What is the perceived need? Degree to which the problem is understood Perceived interest or importance

What should be done? What is the nature of the problem? Analysis of conceptual and empirical information What works?Scientific evidence of effectiveness Individual studies Systematic reviews

Types of Scientific Evidence Individual studies Literature reviews –Expert reviews –Systematic reviews Meta-analysis

Examples of Systematic Review Based Guidelines Guide to Clinical Preventive Services Guide to Community Preventive Services

What should be done? What is the nature of the problem? Analysis of conceptual and empirical information What works?Scientific evidence of effectiveness Individual studies Systematic reviews What is acceptable to the community? Focus groups, key interviews Town hall meetings Anecdote Political processes What can be afforded?Economic analysis and local assets What is feasible?Organizational assessment Experience, interviews etc.

How should it be done? What steps are needed to implement this intervention? Documentation from previous implementation Best process information Anecdotal experience What barriers must be overcome to implement this intervention? Documentation from previous implementation Anecdotal experience Complex systems modeling Focus groups

Is it working? Is it being implemented well? “Process” Measures from checklists, interviews and other data collection tools Achievement of behavior or health outcomes What does the community think? Focus groups Interviews Less formal data collection Political processes Is it improving health risks or outcomes? Achievement of behavior or health outcomes

Remainder of Session Dr. Eduardo Sanchez Dr. Reed Tuckson Discussion