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“…If we did not respect the evidence, we would have very little leverage in our quest for the truth.” Carl Sagan

“…If we did not respect the evidence, we would have very little leverage in our quest for the truth.” Carl Sagan. Getting the Evidence: An introduction to Evidence-Based Public Health. Fall 2007 Erika L. Sevetson, MS Ebling Library, UW – Madison. Session Objectives.

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“…If we did not respect the evidence, we would have very little leverage in our quest for the truth.” Carl Sagan

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  1. “…If we did not respect the evidence, we would have very little leverage in our quest for the truth.” Carl Sagan

  2. Getting the Evidence:An introduction to Evidence-Based Public Health Fall 2007 Erika L. Sevetson, MS Ebling Library, UW – Madison

  3. Session Objectives • Learn the definition of EBPH • Introduction to the process of EBPH • Learn steps to finding the evidence

  4. Definition: Evidence-based Public Health • “the development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models” Source: Brownson, R.C. et al, Evidence-based public health, Oxford University Press, 2003.

  5. Community Needs & Values Scientific Evidence Resources EBPH (adapted and modified from Muir Gray)

  6. Key Differences between EBM and EBPH

  7. Why is EBPH important? • Provides assurance that decision making is based on scientific evidence and effective practices • Helps ensure the retrieval of up-to-date and reliable information about what works and doesn’t work for a particular public health question • Provides assurance that one’s time is being used most efficiently and productively in reviewing the “best of the best” information available on the particular public health question

  8. Why is EBPH important? • During the past century, average life expectancy increased by approximately 30 years in industrialized countries • Only about 5 years of that improvement is attributable to preventive services and medical care - Bunker et. al. 1994

  9. Some Key Characteristics of EBPH • Intervention approaches developed based on the best possible scientific information • Theory and systematic planning approaches are followed • Problem solving is multi-disciplinary • Sound evaluation principles are followed • Results are disseminated to others who need to know and take action

  10. Advantages to Using EBPH • Higher likelihood of success • A move away from decision-making that relies too heavily on: • History • Anecdotes • Pressure from policy makers • Identify common indicators • Defend/expand an existing program • Advocate for new programs • New knowledge is generated to help others

  11. When is EBPH used? • when it’s important to have scientific evidence to support decision making • when evaluating the effectiveness and cost benefits of health programs • when establishing new health programs • when policies are being implemented • when conducting literature reviews for grant projects.

  12. Steps in the EBPH Process 1) Formulating a clear question from a public health problem 2) Searching the literature 3) Appraising the evidence 4) Selecting the best evidence for a public health decision 5) Linking evidence with public health experience, knowledge, practice, and the community’s values and preferences 6) Implementing findings in public health practice and programs 7) Evaluating results. Source: Jenicek, Milos and Sylvie Stachenko. 2003. Evidence-based public health, community medicine, preventive care. Medical Science Monitor: 9(2): p, SR2.

  13. Quantify the issue Conduct literature review Define the issue Develop program or policy options Evaluate the program or policy Develop plan Evidence-Based Public Health

  14. Steps in Searching the Public Health Literature • Determine the public health problem and define the question • Select information sources • Identify key concept and terms • Conduct the search • Select documents for review • Abstract relevant information from the documentation • Summarize and apply the literature review Source: Adapted from Brownson. Evidence-based public health. Oxford University Press, 2003, p. 128.

  15. Step 1: Determine/Define the question (Evidence types) Type 1Something should be done Type 2This should be done Type 3How the intervention should be done

  16. Step 1: Determine/Define the question • P =Patient/Population/Problem • I =Intervention/Item of interest • C =Comparison • O =Outcome

  17. A Scenario C – no comparison/placebo You coordinate social activities for a few of the city’s senior centers. The latest Behavioral Risk Factor Surveillance System (BRFSS) survey showed that seniors in your state are not participating in regular exercise or many other health promotion behaviors. You’ve heard that physical activities for older adults can have a host of benefits, and would like to submit a grant to begin an exercise program. You must find literature supporting the effect of exercise programs in reducing injuries or decreasing risk of chronic disease in the elderly. P I O

  18. PICO • P = inactive seniors • I = community exercise programs • C = no comparison • O = reduced injuries/chronic disease

  19. The question… • In inactive senior populations, are formal exercise programs effective in reducing injuries and chronic disease associated with the aging process?

  20. Step 2: Select information sources • Systematic Reviews and Meta-analyses • Practice Guidelines • Journal Literature • Best Practices

  21. Types & Sources of Evidence • Systematic Review: critical assessment and evaluation of research that attempts to address a focused question using methods designed to reduce the likelihood of bias. • Meta-Analysis: overview that incorporates a quantitative strategy for combining the results of several studies into a single pooled or summary estimate. Source: R.C. Brownson et al, Evidence-Based Public Health, Oxford: Oxford University, 2003.

  22. Types & Sources of Evidence • Practice Guidelines: systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances; may be developed by government agencies, institutions, or by the convening of expert panels. Source: R.C. Brownson et al, Evidence-Based Public Health, Oxford: Oxford University, 2003.

  23. Types & Sources of Evidence Journal literature: Source: Guide to Research Methods: The Evidence Pyramid: <http://servers.medlib.hscbklyn.edu/ebm/2100.htm>.

  24. “The best is the enemy of the good”-Voltaire

  25. The problem of randomized trials and parachutes…. The effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials…. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute. Smith and Pell, BMJ, 2004

  26. Types & Sources of Evidence • Best Practices:Public health programs, interventions, and policies that through experience have been evaluated, shown to be successful, and have the potential to be adapted and transformed by others working in the same field. • Lacks rigorous evaluation of a systematic review or meta-analysis • Applied across a variety of public health areas • Vary widely in scope, methods, and quality • Expert opinion to systematic methods • Some are very influential • Best Practices for Comprehensive Tobacco Control Programs

  27. Evidence spectrum Weak Strong Local needs assessment Meta analysis/ Systematic review/ Evidence-based guidelines No evidence/ case reports Best Practices

  28. Step 3: Identify key concept and terms • In inactive senior populations, are formal exercise programs effective in reducing injuries and chronic disease associated with the aging process?

  29. Step 3: Identify key concepts and terms • P = inactive seniors • I = community exercise programs • C = no comparison • O = reduced injuries/chronic disease P Seniors/senior citizens elderly aged I exercise physical activity recreation program development program evaluation effective programs

  30. Step 4: Searching the literature • Best Evidence Resources http://ebling.library.wisc.edu/EBPH

  31. Cochrane Collaboration

  32. PubMed

  33. Partners in Information Access for the Public Health Workforce

  34. NICHSR: National Information Center on Health Services Research & Health Care Technology

  35. Step 7: Summarize and apply the literature review • Appraising the Evidence & Evaluating the Results • What type of study/evidence is it? • What are the results? • Are the results valid? • Were all important outcomes considered? • Was an explicit process used to ID evidence? • Has the guideline been subjected to peer review and testing? • Can the results be applied to my context?

  36. Thank You Erika Sevetson esevetson@library.wisc.edu 608.262.9506 http://ebling.library.wisc.edu/EBPH

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