For debate. Towards a secure evidence base for health promotion

Green, Jackie; Tones, Keith

doi:10.1093/pubmed/21.2.133

Cited by 90 publications

(82 citation statements)

References 17 publications

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“…However, RCT may not be available for review because of cost, practicality, feasibility or appropriateness for health promotion interventions. If RCT are considered the only valid design there is a risk that evidence could actually be distorted by relying on a research design that does not match the research question or evaluation objectives (Green & Tones, 1999). Nonetheless, consistent results from multiple RCT, identified using a systematic review process as described by The Cochrane Collaboration (The Cochrane Collaboration, 2005) and Oxman (Oxman et al 1991Oxman, 1994), is considered the gold standard on which to base recommendations to change clinical medical practice.…”

Section: Best Practice and Evidencementioning

confidence: 99%

“…Interventions in public health may target individuals, groups, whole communities or populations (Green & Tones, 1999). The distinctions between clinical care and population health are many, starting with the objectives.…”

Section: Best Practice and Evidencementioning

confidence: 99%

“…The goal of population health is to shift the health of whole populations or communities. Evidence-based medicine approaches are designed for individuals (Green & Tones, 1999;Heller & Page, 2001) and generally short-term outcomes are considered as end points. Interventions to shift the health of whole populations take time, and thus for some public health practices surveillance data may provide better indicators of the success of multiple interventions than RCT (Heller & Page, 2001).…”

Section: Best Practice and Evidencementioning

confidence: 99%

“…According to Victora et al (2004) RCT are useful when the causal chain between intervention and outcome is short and simple and results are easily extrapolated. On the other hand, public health interventions are usually large-scale, long-term and complex (Victora et al 2004;Swinburn et al 2005) and may not be easily packaged in a form that is amenable to random allocation (Green & Tones, 1999). In addition, the costs of mounting such large-scale studies may be prohibitive.…”

Section: Best Practice and Evidencementioning

confidence: 99%

“…Mediating factors of interest in public health are usually theory driven and often focused on human behaviours or environmental influences that are not easily amenable to experimental conditions. The appropriate methodology for gathering evidence on mediating factors might include qualitative approaches alone or in combination with more quantitative research designs (McKinlay, 1992;Green & Tones, 1999). The situation in clinical medicine, in which 'bench' research identifies molecular and other biological pathways for disease development and potential cures, is in direct contrast to this approach.…”

Section: Best Practice and Evidencementioning

confidence: 99%

See 4 more Smart Citations

Methods of defining best practice for population health approaches with obesity prevention as an example

McNeil

Flynn

2006

Proc. Nutr. Soc.

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Childhood obesity has reached a crisis stage and has become a population health issue. The few traditional systematic reviews that have been done to identify best practice provide little direction for action. The concept of evidence-based practice has been adopted in health care, and in medicine in particular, to determine best practice. Evidence-based medicine has its origins in the scientific method and for many researchers this concept means strict adherence to standards determining internal validity in order to justify a practice as evidence based. Practitioners addressing population health face challenges in identifying criteria for determining evidence, in part because of the nature of population health with its goal of shifting the health of whole populations. As well, the type of evidence provided by more traditional critical appraisal schema is limiting. Expanded approaches in finding and defining evidence have been proposed that use: expert panels; broad and inclusive search and selection strategies; appraisal criteria that incorporate context and generalizability. A recent synthesis of 147 programmes addressing childhood overweight and obesity provides a concrete example of using a broader approach to identify evidence for best practice (Flynn et al. 2006). Incorporating evaluation and population health frameworks as criterion components in addition to traditional methodological rigour criteria, this synthesis has identified programmes that provide contextual information that can be used to populate what Swinburn et al. (2005) have described as the 'promise table'. Using this approach a range in 'certainty of effectiveness' and a range in 'potential for population impact' are integrated to identify promising strategies. The exercise can provide direction for agencies and practitioners in taking action to address obesity.

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Section: Best Practice and Evidencementioning

confidence: 99%

Section: Best Practice and Evidencementioning

confidence: 99%