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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making
An evolution has occurred in the categorical presentation of summary conclusions regarding the evidence base for public health interventions. The committee gave special weight to the classification systems used by the Washington State and Texas public health departments and noted their congruence with current academic assessment schema—particularly those of Brownson and colleagues (2009) and a paper commissioned for this report on the current review of environmental and policy interventions for childhood obesity prevention undertaken by Transtria (see Appendix B for more information on this project). Although there are differences in nuance among the various proposed schema, as noted earlier, clear communication among professionals requires the adoption of a uniform lexicon for reporting.
When possible, the summary of evidence concerning likely effectiveness should also provide an estimate of the magnitude of the effect. In the case of quantitative data, specific statistical tools will help in describing the uncertainty surrounding these estimates. In the case of qualitative data or data that are less directly applicable to the decision-making context, the range of likely results will be more difficult to describe. In this case, qualitative descriptions of prior experiences in similar settings, which are always valuable adjuncts to research results, may be the only basis for decision making.
Reporting Likely Reach and Impact. An intervention should be categorized as universal, selective, or indicated. Within the universal category, evidence for the reach and uptake of the intervention should be summarized, in quantitative terms when possible. In some cases, widespread reach may allow for significant impact from interventions that are of relatively low absolute effectiveness. An example is distributing guidance on healthful eating through the health care or education system, which may be inexpensive, involve minimal risk, and be capable of reaching a large number of community members. Presented with evidence for a sizable potential impact, decision makers may adopt interventions of this sort as part of a larger portfolio.
How Do We Implement This Information for Our Situation?
The final part of the summary should address the implementation of the potential intervention. This section, which will most commonly be in narrative form, should describe (1) the personnel and other resources deployed in the studies examined; (2) if applicable, the relationship between the size of the program staff and the population reached; (3) the institutional relationships required for implementation; and (4) any other resource requirements that would aid decision makers in understanding how best to apply the results of previous efforts to planning this intervention.
In many cases, interventions may need to be adapted to fit the local context. Community participation in this process may lead to better understanding of the local context for implementation. When sufficient data are available, realist reviews (Pawson et al., 2005) may be undertaken to guide decision makers in making adapta-