1. College of Public Health and Human Sciences
Public Health Policy Institute
Synthesizing Evidence about Effective Public Health Policies
Presenter: Jeff Luck
Date: August 21, 2012

2. Synthesizing Evidence About Effective Public Health Policies
Assessing quality of evidence
Systematic reviews
Example sources of public health policy reviews
Identifying policy options
November 26, 2018
Public Health Policy Institute

3. What do we mean by “evidence?”
Aspects of study quality
Clearly articulated policy or intervention
Evaluation design—target population and comparison group(s)
Measures of cost and health impact (outcomes)
Reproducible in other communities
Sources of evidence
Case studies and Reports
Peer-reviewed publications
Reviews and syntheses
Individual studies are diverse and not always conclusive
Start with things that have actually been done elsewhere
November 26, 2018

4. Pubmed can help, but…
Do basic search, then narrow by Review, Systematic Review, Meta-analysis

5. Published studies Types of reviews Reviews Systematic reviews
(narrative/literature/
traditional)
Systematic reviews
Meta-analysis
Source: Armstrong, R and E Waters,

6. Key elements of a systematic review
Start with an answerable question
Search comprehensively for evidence
Abstract study results objectively
Assess quality of studies
Synthesize results
Assess applicability and transferability of results
Document all steps performed
Source: Armstrong, R and E Waters,

7. Example Systematic Review Topics
School-based driver education for the prevention of traffic crashes Helmets for preventing head and facial injuries in bicyclists
Source: Armstrong, R and E Waters,

8. Results from systematic reviews
Helmets reduce bicycle-related head and facial injuries for bicyclists of all ages involved in all types of crashes including those involving motor vehicles. The results provide no evidence that drive education reduces road crash involvement, and suggest that it may lead to a modest but potentially important increase in the proportion of teenagers involved in traffic crashes. Results from this review suggest that area-wide traffic calming in towns and cities may be a promising intervention for reducing the number of road traffic injuries and deaths. However, further rigorous evaluations of this intervention are needed.
Source: Armstrong, R and E Waters,

9. Start with an answerable question
Are mass media (or school- or community-based) interventions effective in preventing smoking in young people?
PICO(T) Chart
Problem, population
Intervention
Comparison
Outcome
Types of studies
Young people under 25 years of age
a) Television
b) Radio
c) Newspapers
d) Bill boards
e) Posters
f) Leaflets
g) Booklets
a) School-based interventions
b) No intervention
a) objective measures of smoking (saliva thiocyanate levels, alveolar CO)
b) self-reported smoking behaviour
c) Intermediate measures (intentions, attitude, knowledge, skills)
d) Media reach
a) RCT
b) Controlled before and after studies
c) Time series designs
Source: Armstrong, R and E Waters,

10. Compendia of systematic reviews
Reviews vary in scope and quality
Precision of question
Types of studies included
Assessment of study quality
How results are synthesized
Applicability to local context
Several organization therefore compile and assess reviews
Can be browsed or searched by public health policy topic
November 26, 2018

11. The first place to look: The Community Guide from CDC
November 26, 2018

12. Across the border: Health Evidence
November 26, 2018

13. Across the pond: Evidence for Policy and Practice
November 26, 2018

14. Other sources: CDC programs
November 26, 2018

15. Foundations, e.g., RWJF
November 26, 2018

16. Advocacy Organizations, e.g., Health Living Research
November 26, 2018

17. University Research Centers, e.g., UCLA
November 26, 2018

18. Identifying evidence-based policy options
Multiple potential policy options are better than just one
Allows room for decisions by elected officials or senior leaders
Provides alternatives if initial option is not feasible or does not gain strong stakeholder support
May tap into different potential funding streams
Use reviews or individual studies that:
Clearly describe implementation steps and requirements as a basis for planning
Have a similar enough community context
Provide specifics about impacts of the policy
November 26, 2018