Evidence-Based Public Health

Selecting Evidence-Based InterventionsJoanne Rinker

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Assessing your community

Establishing goals and objectives

Finding evidence

Selecting best-fitting EBIAdapting

Implementing

Evaluating

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Learning Objectives

• Describe basic and detailed fit criteria for selecting EBI

• Assess fit of alternative EBI with community assessment data and stakeholder priorities

• Select an EBI that fits or has the potential to fit

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Steps for Selecting Candidate EBI

1. Obtain information about EBI

2. Assess fit by comparing candidate EBI according to fit criteria

3. Select EBI based on fit and strength of evidence

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To Assess Fit, Get Information on EBS

• Information from systematic review findings, journal articles, and websites

• If available:• Educational materials (e.g., handouts, booklets, etc.)• Protocols and implementation guides

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EBS 3

________

________

________

EBS 2 ________

________

________

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Assessing FitAssessment Findings/ Stakeholder Priorities

• Prioritized health goals

• Behavioral/ environmental objectives

• Intended population

• Implementation venues

• Resources

Compare

EBS 1 ________

________

________

________

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Assessment of EBS Fit: Example 1

1. Health goal - Reduce colorectal cancer mortality

2. Behavioral objectives – Increase individuals’ participation in colorectal cancer screening

3. Intended population – Caucasian, uninsured, aged 50 and older

4. Implementation venues – Churches, public health, Community health centers

5. Resources 7

Community Guide and RTIPS

Community Guide• Increasing Cancer Screening: Provider Reminder and

Recall Systems• The Task Force recommends provider reminder systems

based on sufficient evidence of their effectiveness in increasing Colorectal cancer screening by flexible sigmoidoscopy

• Applicability?

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Community Guide and RTIPSRTIPS:• Search Criteria Used: Adults (40-65 years), Available on RTIPs,

Colorectal Cancer Screening, Community, United States

1. Colorectal Cancer Screening Intervention Program (CCSIP)Designed to increase colorectal cancer screening among African

American adults ages 40-64 and 65+. (2010)Setting: Clinical, community, religious, rural, suburban, urban

2. Filipino-American Health Study Designed to increase colorectal cancer screening among Filipino

Americans. (2010) Setting: Community, religious establishments, urban/inner city

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Yours RTIPs 1 RTIPs 2Community G.

Provider Reminder

Health Goal Colorectal Cancer yes yes yes

Behavior Objective Screening yes yes yes

Population Caucasian, uninsured, 50+

African American

40-65+

Filipino Americans yes

Venue Churches, public health, CHCs yes yes yes

Resources

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Assessment of EBS Fit: Example 2

1. Health goal - Prevent obesity

2. Environmental objective – Increase availability of healthier foods and beverages

3. Intended population – School age children

4. Implementation venues – Schools, afterschools

5. Resources -

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Community Guide and RTIPS

Community Guide• School Based Programs in the Community Guide, takes

me to interventions in RTIPS.

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Goal: Prevent ObesityInterventions listed in RTIPS: 1. New Moves

• Designed to promote healthy dietary habits and increase physical activity to reduce obesity (2010)

• Criteria Matched: Adolescents (11-18 years), Available from third party only, Obesity, School-based, United States

• Behavior Modification and Motivation: Overweight/Obese Individuals • Setting: School based

2. Planet Health • School-based program designed to increase physical activity and promote healthy

dietary habits to reduce obesity among 6th, 7th, and 8th grade students. (1999) • Criteria Matched: Adolescents (11-18 years), Available from third party only, Obesity,

School-based, United States • Behavior Modification: School Children• Setting: School based

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Additional Considerations

• What is the relevance & strength of the evidence?

• How much certainty is there about the effectiveness of the EBS?• “Real world” effectiveness vs. “ideal world” efficacy• Systematic review vs. a single program evaluation

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Real World Effectiveness & RE-AIM

RE-AIM: • Reach the target population• Effectiveness or efficacy• Adoption by target settings or institutions• Implementation (consistency of delivery of

intervention)• Maintenance* of intervention effects in individuals and

settings over time.

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Activity: Selecting an EBS

Activity

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Healthier Worksite Initiative: StairWELL To Better Health http://www.cdc.gov/nccdphp/dnpao/hwi/toolkits/stairwell/ The Need One of the reasons employees may not use the stairs as work is because they perceive them as unattractive and/or unsafe. Taking the stairs is one way to be more physically active. At work, employees are often presented with a choice between taking the stairs and taking an elevator or escalator. Choosing the stairs instead of the elevator is a quick way for people to add physical activity to their day. Using the stairs requires little additional time, no wardrobe change, and few additional costs because building code requires stairs.

The Program StairWELL To Better Health is designed to increase your daily physical activity. Developed with employees input, the intervention included included painting and carpeting, framed artwork, motivational signs, and music. Infrared beams were used to track the number of stair users. The focus of a workforce health promotion (WHP) program can vary due to many factors, including type of organization, workforce diversity, resources, and leadership support. Program design provides an opportunity to plan a Workforce Health Promotion program and position it within the organization's overall mission. This increases the potential that program objectives will be realized, such as improving employee health and productivity and reducing medical care expenses for the employer and employee.

Community Guide Finding This program is an example of Point-of-Decision Prompts to Encourage Use of Stairs (Physical Activity), which is recommended by the Guide to Community Preventive Services.

Time Required The intervention was implemented over 3.5 years.

Intended Audience StairWELL To Better Health is intended for all employees in the workplace.

Suitable Settings StairWELL To Better Health is suitable for implementation at a worksite setting.

Required Resources Costs associated with the program's implementation for supplies such as new paint, carpet, framed artwork and motivational signs were less than $16,000.

About the Study In the three years since inception, Healthier Worksite Initiative has worked on a number of demonstration projects, policies, and environmental changes that affect the entire workforce. The activities are guided by an advisory committee made up of representatives from many centers, institutes, offices, and locations. Direct observation, video cameras, and infrared sensors have all been used to track stair usage in past interventions and new technologies are being developed. Healthier Worksite Initiative has worked on improving the stairs and the cafeteria at headquarters and developing a walking trail at a worksite facility. For those outside of the company headquarters, Healthier Worksite Initiative conducted walkability audits at almost every campus, implemented a discount fitness center membership program for employees, and modified a policy that now makes suggestions for healthier foods at company-sponsored meetings and events.

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Healthier Worksite Initiative has worked on improving the stairs and the cafeteria at headquarters and developing a walking trail at a worksite facility. For those outside of the company headquarters, Healthier Worksite Initiative conducted walkability audits at almost every campus, implemented a discount fitness center membership program for employees, and modified a policy that now makes suggestions for healthier foods at company-sponsored meetings and events.

Lessons learned from these activities, examples of new and revised policies that enhance Workforce Health Promotion, and step-by-step instructions for implementing similar programs in other work sites.

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Intervention CriteriaOur Health

Priority Walking Maps

How does this fit your priority?

Stairwell to Better Health

How does this fit your priority??

Yes Some No Yes Some No

Topic Physical Activity  

               

Audiences(Ex: age, gender, race, ethnicity, socioeconomic status)

WorksiteEmployees    

               

Outcomes 

Environmental change: Increased access to places for physical activity

             

Resources needed to use intervention (Ex: Cost, Staff , Expertise, Facilities)

Worksite has:- 4 stairwells & 3 acres for potential paths - $3,000

               

Relationship to what is already happening about the health topic

Partners interested in collaborating: printing company, facilities mgmt, local artists

               

Setting(s) for intervention (Community, School, Worksite, Health Care

 Worksite   

               

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  Our Health Priority Walking Maps

How does this fit your priority?

Stairwell to Better Health

How does this fit your priority?

Yes Some No Yes SomeNo

Intervention Components 

                 

Intervention materials (Ex: templates, brochures, CDs, instruction guide) 

                 

Delivery methods 

Seeking physical structural change to work environment  

               

Length of intervention     

Prefer a sustainable investment that could be ongoing indefinitely (minimum 5 years)

               

Frequency of sessions or meetings   

          

       

Capacity of organization needed to deliver intervention 

Have wellness committee, 2 health promotion staff, and leadership support

               

Evaluation tools      

                 

Summary

• Refer to your community assessment when considering fit

• Select evidence-based strategies that fit your:• Goals and objectives, including for determinant change

• Delivery possibilities and preference

• Characteristics of the priority population

• Organization/coalition/community context

• Select EBS with a stronger evidence base

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Questions?

• Questions?

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