without making implicit value judgments (NRC, 1978, 1996). The solution to this dilemma ideally lies in the development and application of new approaches for integrating scientific considerations with social and normative considerations in a transparent, fair, and competent manner (Renn et al., 1995; NRC, 1996; Klinke and Renn, 2002).

Although randomized controlled trials (RCTs) are the gold standard for testing interventions in clinical and public health research, it is not always feasible, appropriate, or ethical to use that methodology in conducting population-based research; furthermore, RCTs may not always illuminate the complexity of some population-based prevention strategies (Robinson et al., 1998; Briss et al., 2000).

Therefore, the evidence base regarding public health prevention efforts often involves the integration of a range of research methodologies. Several health promotion and disease prevention initiatives have implemented comprehensive population health programs using a broader integrated approach to the evidence. For example, Table 3-4 illustrates the different approaches required for guiding the design of individual and community-based approaches to CVD prevention (Osaka Declaration, 2001).

TABLE 3-4 Comparison of Individual and Community Approaches for CVD Prevention

Clinical Practice Approaches for Individuals

Community and Population-Based Approaches for Health Promotion

The evidence standards are RCTs

The evidence standards are RCTs and outcome and process evaluations that use both quantitative and qualitative methods

The focus is on individual patients

The focus is on the community

Less than a therapeutic dose is unacceptable

Preventive dose rarely applies

Easier to treat an individual

Difficult to scale up health promotion programs that reach the entire population

Outcomes of interventions are individual change

Outcomes are to change social norms, environments, and the behavior of entire populations

Interventions can focus on most factors relevant to outcomes

Interventions rarely take on social determinants external to the community

SOURCE: Adapted from Osaka Declaration, 2001.



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