Bridging the Evidence Gap in Obesity Prevention A Framework to Inform Decision Making (2010) / Chapter Skim
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7 Assembling Evidence and Informing Decisions
7 Assembling Evidence and Informing Decisions
Pages 133-158
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• Successful evidence gathering, evaluation, and synthesis for use in obesity prevention usually involves a number of disciplines, each with its own methodologies and technical language. The development of a uniform language and structure for summarizing and communicating the relevant evidence in a system atic, transparent, and cross-disciplinary way is critical.
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Bridging the Evidence Gap in Obesity Prevention 134
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report Local Government Actions to Prevent Childhood Obesity (IOM, 2009)
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Decision makers may need to weigh highly effective interventions that reach only a modest number of people against less effective interventions that reach the entire population at risk; they may decide to bring promising interventions to scale even in the face of incomplete information. The Systems Perspective: Logic Models and the Complexity of Interventions Reducing the proportion of the population that is overweight or obese is the ultimate goal of all obesity prevention activities; reducing individual caloric intake and/or increasing individual physical activity among at-risk persons are intermediate out comes required to achieve this goal.
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Systems sum maries will seldom provide precise estimates of effects of a particular intervention or interventions; instead, they may highlight areas of concern or provide decision makers with options for monitoring and evaluating new interventions. Evaluating the Effectiveness of Interventions Traditional evidence syntheses emphasize assessment of the effectiveness of potential interventions.
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adjudicate between different theories." The realist approach allows decision makers to apply prior evidence, even in circumstances where complete fidelity to the original studied intervention (i.e., conducted as planned) may not be practical Bridging the Evidence Gap in Obesity Prevention
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The committee's decision to include evidence derived from many types of studies, qualitative data, and alternative data sources hitherto considered unworthy of inclu sion is based on recently published evidence. Examining the inclusion and exclusion of observational studies along with randomized controlled trials (RCTs)
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Box 7-2 Blending Theory, Expert Opinion, and Local Wisdom: Tobacco Control Efforts In the latter part of the 20th century, innovators in schools, worksites, restaurants, towns, cities, and states enacted clean air policies and conducted smoking prevention and cessation programs, with varying degrees of evidence supporting their actions (Eriksen, 2005; Mercer et al., 2005) ; similar patterns can be seen in other public health successes of the period, such as injury control (Martin et al., 2007)
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, each intervention may also be examined to determine uptake -- the proportion of the intended population that the intervention will actually reach. Consider, for example, two different universal interventions: tax policies may well reach the entire population, although the effect may be variable depending on indi vidual resources, while public awareness campaigns designed to reach an entire com munity typically reach only a portion of the community, depending on the outreach Assembling Evidence and Informing Decisions
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Yet if an intervention then does not work -- if the results in the application fall short of those in the scien Bridging the Evidence Gap in Obesity Prevention
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Decision makers should also consider whether the research process, including recruitment and informed consent procedures, screening, and attrition, led to an unrepresentative pool of subjects on which the studies' conclusions were based. This issue is akin to that of the representativeness of the cases on which the conclusions were based.
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Clarity is particularly important in complex public health arenas, such as obesity prevention, that necessarily involve experts from many different disciplines, each with its own jargon and standards for communication. Use of a uniform language and structure to report the process and Bridging the Evidence Gap in Obesity Prevention
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recommendations and Evidence-Based • Identify and summarize research gaps Recommendations Reach, Effectiveness, Framework for Criteria for translating research into practice (Kaiser Permanente Institute Adoption, systematically for Health Research, 2010) : Implementation, considering strengths • Reach Maintenance and weaknesses of • Effectiveness (RE-AIM)
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• Feasibility • Sustainability • Effects on equity • Potential side effects • Acceptability to stakeholders Matching, mapping, Combining of theory, Criteria for identifying program components and interventions (Green and pooling, and professional experience, Kreuter, 2005) : patching and local wisdom • Matching the evidence with appropriate intervention targets with the science • Mapping the adaptation of an intervention to the setting, population, based evidence in the and time at hand process of planning an • Pooling information about prior interventions intervention • Patching together evidence-based practices, theory-based programs, and practice-based experiences conclusions of evidence synthesis makes the information easier for decision makers to understand as they consider each potential intervention or set of interventions that combine individual actions or strategies (both referred to from this point further as reporting on a potential intervention)
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Summary of lessons learned from previous implementation in other settings and relevant local considerations Question Asked by the Decision Maker As described in Chapter 1, there are a wide variety of decision scenarios related to obesity prevention policies and programs. A decision maker may be faced with a deci sion about a specific, populationwide policy change with a potential direct impact on physical activity or other weight-related behavior of adults or children.
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Collecting evidence in accordance with this typology will help expand the perspective on the forms of evidence that are potentially relevant to answering the obesity prevention question asked by the decision maker and on the potential sources from which to gather that evidence. The strategy used to locate evidence for each potential intervention depends on the context of the question being asked, as well as Bridging the Evidence Gap in Obesity Prevention
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(1) Rationale: Our logic model is simple -- removing soda machines from the high schools will result in reducing the caloric intake of our high school students and help decrease the rates of obesity.
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Finally, the third part of the table should summarize the evidence that answers How do I implement this information for our situation? This evidence helps the decision maker assess how a potential intervention should be implemented to Bridging the Evidence Gap in Obesity Prevention 0
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of the intervention to obesity prevention, or the systems view taken to understand the implications of the intervention for the outcome of interest. Logic models can help predict what effect Assembling Evidence and Informing Decisions
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framework, the report should present decision makers with a summary of the estimated effectiveness of the potential intervention, following the approach of the Washington State Department of Health (2005) , which was subsequently cited and applied by the Texas Department of Health State Health Services (2006)
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and a paper commissioned for this report on the current review of environmental and policy inter ventions for childhood obesity prevention undertaken by Transtria (see Appendix B for more information on this project)
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The management of systems knowledge Bridging the Evidence Gap in Obesity Prevention
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2007. A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: A realistic synthesis of the evi dence.
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. Bridging the Evidence Gap in Obesity Prevention
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2005. Drawing possible lessons for obesity prevention and control from the tobacco control experience.
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