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

Abstract

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.

Good practice characteristics of diet and physical activity interventions and policies: an umbrella review

“… Costs related to behavior change (e.g., costs of an hour of PA gained per person) Systematic reviews [ 39 , 51 , 95 , 107 , 111 , 112 , 115 ]; Stakeholders’ documents [ 46 , 76 , 114 ]; Position reviews [ 116 ]. Total financial costs of interventions/policies (total budget per participant) Systematic reviews [ 53 , 95 , 101 , 111 , 112 , 115 , 117 ]; Stakeholders’ documents [ 45 ]; Position reviews [ 8 , 48 , 60 , 78 ]; Outcomes Outcomes measured with valid, reliable, and sensitive tools Systematic reviews : Indicated in all included systematic reviews; Stakeholders’ documents [ 14 , 44 , 62 ]. Effects specified as clinically significant (e.g., moving from sedentary to physically active) Systematic reviews [ 53 , 57 , 67 , 96 , 113 , 117 ]; Stakeholders’ documents [ 10 , 14 , 45 ]; Position reviews [ 47 , 79 , 116 ].…”

“… Effect sizes (besides significant effects) Systematic reviews [ 23 , 28 , 31 , 36 , 75 , 92 , 99 , 122 ]; Stakeholders’ documents [ 44 , 45 , 63 , 63 separate for intervention and policies]; Position reviews [ 60 , 88 ]. Reach Reach (the strategy is likely to involve a large percentage of the target population; reaching entire target population) Systematic reviews [ 53 , 59 , 94 , 100 , 107 , 112 , 117 , 123 ]; Stakeholders’ documents [ 10 , 44 , 63 , 83 , 118 , 119 ]; Position reviews [ 8 , 26 , 48 , 86 ]. Inclusiveness: health, age, and gender contexts (individuals with low mobility or comorbidities participate; including people of different age within target group) Systematic reviews [ 53 , 59 , 94 , 100 , 107 , 112 , 117 , 123 ]; Stakeholders’ documents [ 14 , 44 , 45 , 46 , 62 , 63 ,...…”

“… Feasibility Adoption by target staff, settings, or institutions (representativeness of staff, settings, institutions; exclusion of settings, staff, institutions; characteristics of those who adopted vs those who did not) Systematic reviews : [ 39 , 94 , 100 , 117 ]; Stakeholders’ documents: [ 44 , 118 ]. Feasible/acceptable for providers (fitting their skills; no external specialists needed for implementation), feasible and acceptable for stakeholders, and participants Systematic reviews : [ 26 , 29 , 39 , 94 , 112 ]; Position reviews : [ 47 , 48 , 78 , 88 ]. Maintenance-sustainability Maintenance (effects maintained over time with institutional support; continuation within the realm of the institution) Systematic reviews : [ 39 , 94 , 112 , 117 ]; Stakeholders’ documents: [ 62 , 119 ].…”

Physical Activity Interventions in Latin America

“…Yet, doing nothing while waiting for more evidence is unacceptable, 14 and evidence-based action should be focused on using the “best evidence available” as opposed to the “best evidence possible.” 17–19 The L.E.A.D. framework (Locate Evidence, Evaluate Evidence, Assemble Evidence, Inform Decisions) was developed in 2008 by an IOM committee to address the evidence gap for complex decision making about public health problems such as obesity prevention 20 .…”

Examining the evidence for policy and environmental strategies to prevent childhood obesity in black communities: new directions and next steps

“…With input from the expert advisors, the evidence review team then rigorously reviewed and rated all study groupings for population-level effectiveness and impact based on indicators derived from the RE-AIM framework (20) and several authoritative evidence review systems, including the Community Preventive Services Task Force (21), the Cochrane Collaborative (22) and relatively newer systems or frameworks (4,(16)(17)(18)(23)(24)(25)(26)(27)(28)(29). For example, rating criteria and definitions included intervention strategy complexity (which assesses intervention feasibility in conjunction with the quantity and difficulty of intervention components), effectiveness (i.e.…”