biomedical points of intervention tested for evidence-based medicine. This is precisely why a systems perspective is core to the L.E.A.D. framework (see Chapter 4).

In a medical setting, resource evaluation for a potential intervention may be straightforward and based simply on the marginal cost of administering the intervention within an existing structure. For example, the British Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria for developing recommendations in a medical setting include resource considerations. The illustrative example offered in a recent description of GRADE assesses the costs of administering magnesium sulfate to prevent pre-eclampsia and provides separate cost/benefit analyses for high-, medium-, and low-income countries (Guyatt et al., 2008a).

The RE-AIM criteria discussed above shift the focus of evaluation of issues of generalizability and reproducibility by setting explicit standards for the reporting of resources used for the implementation and maintenance of interventions (Jilcott et al., 2007). The authors caution that studies often, either by design or inadvertently, indicate additional implementation resources that may not be available outside of a research setting. Armstrong and colleagues (2008) suggest that public health agencies should report data on the resources necessary for program implementation and sustainability, as well as the effectiveness results of pilot interventions.

Other considerations have been proposed for assessing the available evidence with respect to implementation. A notable example is the “filter criteria” for decision makers delineated by Glasziou and Longbottom (1999) and Swinburn and colleagues (2005).

Existing Tools for Assembling Evidence

In the majority of situations encountered, the available data may differ with regard to details of an intervention or the context and/or population in which the intervention would be implemented. In these circumstances, the evidence review should attempt to bridge this gap. Table 7-1 provides brief descriptions and references for existing tools that can be used to assemble the evidence, taking into account the key considerations described above.


Evidence summaries should use a uniform language and structure, for many reasons. A uniform language for drawing and describing conclusions signals that the authors used a consistent set of procedures to evaluate and synthesize the evidence. A uniform language also facilitates communication among different disciplines during policy discussions and decision making. Achieving uniformity may sacrifice nuance; on balance, however, it improves the clarity of communication. Clarity is particularly important in complex public health arenas, such as obesity prevention, that necessarily involve experts from many different disciplines, each with its own jargon and standards for communication. Use of a uniform language and structure to report the process and

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