Decoding the Evidence Myth:

1
Decoding the Evidence Myth

• The Realities of Evidence Based Public Health

2
Evidence (n) a thing or things helpful in
forming a conclusion or judgment Webster
3
Evidence Based Decision Making

• Should something be done?
• What should be done?
• How should it be done?
• How do I know its working?

4
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
5
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
6
Types of Scientific Evidence

• Individual studies
• Literature reviews
• Expert reviews
• Systematic reviews
• Meta-analysis

7
Examples of Systematic Review Based Guidelines

• Guide to Clinical Preventive Services
• Guide to Community Preventive Services

8
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.
9
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
10
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
11
Remainder of Session

• Dr. Eduardo Sanchez
• Dr. Reed Tuckson
• Discussion