The committee suggests that, to inform decisions using the framework proposed in this volume, the conclusions reported to decision makers be formulated to respond to the three questions shown in Figure 5-2 in Chapter 5: (1) Why should we do something about this problem in our situation? (2) What specifically should we do about this problem? and (3) How do we implement this information for our situation? Translating these questions into the language of evidence-based decision making results in three topics that are addressed in this chapter:
evidence concerning the characteristics of the problem to be addressed in the population targeted by an intervention (“Why” questions);
evidence supporting the theoretical underpinnings of each potential intervention, presented as a logic model, and evidence supporting the impact of the intervention (“What” questions); and
considerations involved in implementation, with an appropriate balance of fidelity and adaptation to achieve optimum results (“How” questions).
While each of these topics has been considered in previous chapters, two major sections form the balance of this chapter: (1) specific guidance for assembling the evidence and other information (theory, professional experience, and local wisdom) to support decision making and (2) a standard template for summarizing the evidence, using the L.E.A.D. framework, to provide information relevant to the needs of decision makers. The third section briefly addresses knowledge integration.
An evidence report should begin with a succinct summary of the problem to be addressed in the decision-making context. In the case of local decision making, for example, this problem statement may be developed most readily by conducting a community assessment, as discussed in the Institute of Medicine (IOM) report Local Government Actions to Prevent Childhood Obesity (IOM, 2009). Community assessments begin with a detailed description of the local conditions to be addressed by an intervention. Local academic partners, public health departments, academic settings, or health information exchanges may be able to provide access to available data and necessary epidemiological or statistical support. Community assessments can also include examining the access of various segments of the community to an optimal environment to support healthy weight, including healthful food and opportunities for physical activity.
The systems thinking discussed in Chapter 4 is important in addressing “why” something should be done about a problem in a particular context. Changes in zoning codes or in agricultural policies, for example, have far-reaching consequences that are best understood by thinking of the larger system implications, often using com-