Bridging the Evidence Gap in Obesity Prevention A Framework to Inform Decision Making (2010) / Chapter Skim
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6 Evaluating Evidence
6 Evaluating Evidence
Pages 115-132
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From page 115... ...
It presents a detailed typology of evi dence that goes beyond the traditional simple evidence hierarchies that have been used in clinical practice and less complex public health interventions. This chapter focuses on the question of how one judges the quality of different types of evidence in making deci sions about what interventions to undertake.
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From page 116... ...
. Specif y O pp Questions or tu e ni tiv tie ec s sp Identify and gather the to Locate r Pe G t ypes of evidence that are en Evidence s potentially relevant to the er em questions at st e Sy Ev i de Apply standards of qualit y nc Evaluate e as relevant to different Evidence t ypes of evidence Select and summarize the Assemble relevant evidence according O Evidence to considerations for its use pp or tu e ni tiv tie ec s sp to r Pe G Inform Use evidence in the en s decision-making process Decisions er em at st e Sy Ev i de nc e FIGURE 6-1 The Locate Evidence, Evaluate Evidence, Assemble Evidence, Inform Decisions (L.E.A.D.)
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From page 117... ...
Finally, the chapter addresses the issue of the trade-offs that have to be made when the available evidence has limitations for answering the question(s) at hand -- a particular concern for those who must make decisions about complex, multilevel public health interventions such as obesity prevention.
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From page 118... ...
Also as discussed in previous chapters, decision makers need to recognize the interrelated nature of factors having an impact on the desired outcome of complex public health interventions. They should view an intervention in the context in which it will be implemented, taking a systems perspective (see Chapter 4)
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From page 119... ...
. This model takes into account the RESOURCES AND INPUTS SECTORS OUTCOMES STRATEGIES AND ACTIONS Health Adequate Program Structural and Institutional Outcomes Funding Coordination, Outcomes GOVERNMENT • Increase federal, Surveillance, and • Increase funds appropriated by Industry Reduce BMI state, and local health Congress to support obesity Training Communities department budgets prevention research and improve Levels in the • Improve coordination of Schools substantially to match program implementation.
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From page 120... ...
Can the evidence from a study or group of studies be generalized to the multiple settings, populations, and contexts in which the evidence would be applied? Are the interven tions studied affordable and scalable in the wide variety of settings where they might Bridging the Evidence Gap in Obesity Prevention 0
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From page 121... ...
. The Cochrane Collaboration has followed this line of evidence evaluation in its systematic reviews, as has the evidence-based medicine movement (Sackett et al., 1996)
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From page 122... ...
Reprinted by permission of SAGE Publications. Bridging the Evidence Gap in Obesity Prevention
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From page 123... ...
. The Community Preventive Services Task Force, which is overseeing systematic reviews of interventions designed to promote population health, is giving increasing attention to generalizability in a standardized section on "applicability." Numerous textbooks on research quality have tended to concern themselves primarily with designs for efficacy rather than effectiveness studies, although the growing field of evaluation has increasingly focused on issues of practice-based, real-time, ordinary settings (Glasgow et al., 2006b; Green and Lewis, 1986, 1987; Green et al., 1980)
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From page 124... ...
Much of what we think we know about the causes of obesity and the current obesity epidemic, for example, is based on the evaluation of evidence using existing criteria. In thinking about the development of a contemporary framework to guide decision making in the complex settings of public health, however, the commit tee decided to advance a broader view of appropriate evaluation criteria.
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From page 125... ...
: • Assignment to treatment and control groups and blinding • Degree of potential confounding • Classification of outcomes and follow-up • Appropriate analysis (e.g., "intention to treat") Study design is evaluated by levels of evidence (as in those of the Canadian Task Force on the Periodic Health Examination or the Task Force on Community Preventive Services and the U.S.
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From page 126... ...
Parallel Evidence Quality is determined by the underlying study designs of the parallel evidence sources in the same way that it is determined for the primary evidence. Expert Knowledge Questions to consider when appraising expert knowledge include (World Cancer Research Fund and American Institute for Cancer Research, 2007)
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From page 127... ...
However, expert knowledge can be of value in evaluating evidence and can also be viewed with certain quality criteria in mind (Garthwaite et al., 2008; Harris et al., 2001; Petitti et al., 2009; Turoff and Hiltz, 1996; World Cancer Research Fund and American Institute for Cancer Research, 2007)
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From page 128... ...
An example is the International Tobacco Control Policy Evaluation Project, a multidisciplinary, multisite, international endeavor that aims to evaluate and understand the impact of tobacco control policies as they are imple mented in countries around the world (Fong et al., 2006)
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From page 129... ...
Preventive Services Task Force: A review of the process. American Journal of Preventive Medicine 20(3, Supplement)
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From page 130... ...
2009. A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantita tive and mixed methods primary studies in mixed studies reviews.
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From page 131... ...
World Cancer Research Fund and American Institute for Cancer Research.
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