Bridging the Evidence Gap in Obesity Prevention A Framework to Inform Decision Making (2010) / Chapter Skim
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3 Rationale for and Overview of the L.E.A.D. Framework
3 Rationale for and Overview of the L.E.A.D. Framework
Pages 55-70
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From page 55... ...
improve approaches to the use of evidence to inform decisions about complex population health problems in general. I deally there would be a firm and comprehensive evidence base to inform the myriad decision makers whose actions -- intentionally or unintentionally -- influence the social, policy, and environmental determinants of excess weight gain and the resulting overweight/obesity.
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From page 56... ...
trials and quasi experimental studies at the individual, organizational, and community levels. Although a similarly broad array of research approaches is potentially applicable to environ mental and policy strategies to reduce obesity risk through improved diet and reduced caloric intake and/or increased physical activity, the basic methodologies require different conceptualizations, implementation, and emphases for obesity prevention research -- particularly to inform interventions designed to change policies or environ mental contexts for eating and physical activity.
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The appraisals consist of meta-analyses, systematic reviews, integrative reviews, a review of reviews, evidence syntheses, best practice summaries, and task force recommenda tions. Nearly one-third of the appraisals were published in journals specific to obesity; the other two-thirds appeared in journals focused on medicine, preventive medicine, public health, health promotion, family and community health, health education, nutrition, nursing, epidemiology, endocrinology and metabolism, and psychology.
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The outcome measures for selecting which individual studies to include in the appraisals were similar, and in most cases were cause for excluding a large percentage of studies initially identified for consider ation. As stated in Chapter 2, the ultimate objectives of obesity prevention efforts are lowering the mean BMI level and decreasing the rate at which people enter the upper end of the BMI distribution.
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FUNDAMENTAL EVIDENCE CONCEPTS The Perspective from Evidence-Based Medicine The movement toward evidence-based practice in various public service arenas, including obesity prevention, has been significantly influenced by earlier trends in medicine and published guidelines for evidence standards in evidence-based medicine. For example, the Cochrane Collaboration -- an international, independent nonprofit organization dedicated to making current, accurate information about the effects of health care available -- assembles, maintains, and disseminates systematically collected and reviewed information on health care interventions (The Cochrane Collaboration, 2009)
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The hierarchy characterizes the quality of evidence for decision making at three levels. Systematic reviews of RCTs and individual RCT studies of particular therapies are at the top of this hierarchy, serving as the "gold standard"; next are observational studies and systematic reviews of such studies; and at the lowest level are physiologic studies and unsystematic clinical observations (Guyatt and Rennie, 2002)
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. The principles of evidence-based decision making apply to medicine and to numerous disciplines and approaches in addition to public health, social work, and public policy (the latter being referred to as evidence-based public policy [EBPP]
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reviewed 19 childhood obesity studies to assess the extent to which dimensions of external validity were reported. Their work reveals that some key contextual variables (e.g., cost, program sustainability)
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First, unlike medical therapies focused on individual patient care, obesity pre vention interventions are typically mounted on a relatively large scale and focus on health issues affecting communities at large (at the regional, national, or even global level)
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of research designs continues to be salient, external validity increases greatly in importance when one is identifying and appraising research evidence on public health issues such as obesity. Effective public health interventions need to have generalizability, transferability, and sustainability beyond small-scale research studies (Green and Glasgow, 2006)
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From page 65... ...
Qualitative evidence involves non numerical observations, collected by such methods as participant observation, group interviews, or focus groups. Qualitative evidence can be presented in narrative form as a powerful means of influencing policy deliberations, priority setting, and the propos ing of environmental and policy solutions by telling persuasive stories with an emo tional hook and intuitive appeal.
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From page 66... ...
The committee adapted this general approach for use in policy and programmatic decision making about complex public health problems such as obesity prevention. The Locate Evidence, Evaluate Evidence, Assemble Evidence, Inform Decisions (L.E.A.D.)
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From page 67... ...
Although the framework leads decision makers and investigators through a series of steps, it is important to point out that a user could begin at any point on the framework and return to earlier steps -- for example, from the assemble step back to further elaboration of the questions, broadening the search for evidence accord ingly. For example, a researcher seeking ideas for solution-oriented research could first attempt to identify user questions or examine a report generated during the decide step and work backward to identify research needs encountered in locating or evaluat ing evidence.
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American Journal of Preventive Medicine 28(5, Supplement)
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2002. Users' guides to the medical literature: Essentials of evidence based clinical practice.
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1992. Health promotion through healthy public policy: The contribution of complementary research methods.
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