Using an Evidence-Based Approach to Address Maternal and Child Health

PrioritiesStarr Banks

Kathi WilsonCommunity Guide Branch,

Centers for Disease Control and Prevention

September 5, 2013Association of Maternal & Child Health Programs

Center for Surveillance, Epidemiology, and Laboratory Services (proposed)Division of Epidemiology, Analysis, and Library Services (proposed)

Disclaimer

Any views or opinions expressed by the speaker do not necessarily represent the views of the CDC, HHS, or any other entity of the United States government. Furthermore, the use of any product names, trade names, images, or commercial sources is for identification purposes only, and does not imply endorsement or government sanction by the U.S. Department of Health and Human Services.

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Acknowledgements

This training is brought to you by

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AMCHP/Community Guide 2013 Webinar Series

Part 1 (September 5): • Why use an evidence-based approach?• The Community Guide: a resource for evidence-based strategies.• Locating evidence-based program and policy interventions.

Part 2 (September 10):• Selecting an evidenced-based option that fits your community.• Adapting interventions to fit your community.

Part 3 (September 13):• Using different forms of evaluation methods.• Assessing sustainability of your program.

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Today’s Learner Objectives

Explain the benefits of using an evidence-based approach. Describe the types of findings the Community Preventive

Services Task Force (Task Force) makes about the evidence. Demonstrate how to access broad evidence-based strategies

and related Task Force findings on The Community Guide website.

Locate specific evidence-based program and policy interventions using the Research-Tested Intervention Programs (RTIPs) and Center for Training and Research Translation (Center TRT) websites.

State elements of organizational capacity affecting the use of evidence.

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WHAT IS THE VALUE OF USING AN EVIDENCE-BASED APPROACH TO SELECT INTERVENTIONS?

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What is Evidence?

“The available body of facts or information indicating whether a belief is true or valid.”

Brownson RC, Baker EA, Leet TL, Gillespie KN. 2003. Evidence-Based Public Health. New York: Oxford University Press.

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What is Evidence in Public Health?

Personal experience Word of mouth Program evaluation An intervention research study Systematic reviews of multiple intervention

studies

Practice-based Research-based

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Why Use an Evidence-Based Approach?

Allows for scarce resources to be used wisely. Shortens the time that it takes to develop a program

or policy. Increases your likelihood of success.

Funders are requiring more accountability.

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THE COMMUNITY GUIDE: A RESOURCE FOR IDENTIFYING EVIDENCE-BASED STRATEGIES

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The Community Guide

Evidence-based recommendations and findings• Provide information about the effectiveness of community preventive

programs, services, and policies.• Developed by the Community Preventive Services Task Force (Task

Force).

Systematic reviews• Analyze all available evidence on the effectiveness of community-based

programs, services, and policies in public health.• Assess the economic benefit of all effective programs, services, and

policies.• Highlight critical evidence gaps.• Conducted, with Task Force oversight, by scientists and subject matter

experts from CDC in collaboration with a wide range of government, academic, policy, and practice-based partners.

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What is The Community Preventive Services Task Force?

A non-federal, independent, rotating panel. Internationally renowned experts in public health research,

practice, and policy. Members are appointed by CDC Director; nominated using

broad input from throughout public health and healthcare. Serve without payment.

CDC is mandated to provide scientific, technical and administrative support for the Task Force.

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~ 225 Task Force Recommendations and Findings

• Adolescent Health• Alcohol - Excessive Consumption• Asthma• Birth Defects• Cancer• Cardiovascular Disease• Diabetes• Emergency Preparedness• Health Communication• Health Equity• Worksite

• HIV/AIDS, STIs, Pregnancy• Mental Health• Motor Vehicle Injury• Nutrition• Obesity• Oral Health• Physical Activity• Tobacco• Vaccination• Violence

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21 public health topic areas

Strategies may be informational; behavioral, social; environmental, policy; health system-based.

The Task Force Seeks to Answer Key Questions about Interventions

Do they work? How well? For whom? Under what circumstance are they

appropriate (applicability)? What do they cost? How do they affect health equity? Are there barriers to their use? Are there any harms? Are there any unanticipated outcomes?

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Findings of the Task Force

Recommend• Strong Evidence• Sufficient Evidence

Recommend against• Strong Evidence• Sufficient Evidence

Insufficient evidence to recommend for or against

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What Does Insufficient Evidence Mean?

This does NOT mean the intervention does not work. Insufficient evidence means that more research is needed for

the Task Force to decide if the intervention is effective or not.• Too few studies exist for the Task Force to make a decision.• Not enough studies were of the quality needed for the Task Force to

make a decision.• Enough studies exist, but have inconsistent results for the following

reasons:• Variables other than the intervention could have influenced the results.• The intervention was not carried out in the same way in all the studies.• A substantial subset of studies show a minimal or negative effect.

Consider:• Do better documented alternatives exist for reaching the same goals?

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What to Do with a Recommendation

“Even if it is evidence-based, it is not certainty.”

McGinnis and Foege, 2000

Not a cookbook or a one-size-fits-all solution. Users must combine scientific information (e.g., effectiveness,

cost) with other information (e.g., needs, values, capacities, resources).

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Organizational Capacity Organization

= all parent organizations or agencies in which the program is housed.*

Organizational capacity= having the internal support and resources needed to effectively manage your program and its activities.*

Elements of organizational capacity Pre-implementation – Staffing, training available, ability to recruit Implementation – Participant recruitment, means to track progress Evaluation – Knowledgeable staff, use evaluation results,

*The Program Sustainability Framework, Washington University, St. Louis, MO

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Organizational Readiness Checklist

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What do you think?

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ACCESSING EVIDENCE-BASED STRATEGIES:THE COMMUNITY GUIDE WEBSITE

www.thecommunityguide.org

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What do you think?

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Selecting a Strategy

1. Identify criteria to determine what may “fit” with your audience and/or organization.

2. Acquire information about potential options from evidence-based resources, (e.g., The Community Guide).

3. Review available information about the strategies using fit criteria (e.g., articles, implementation guides, etc.).

4. Decide which option to adopt.

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Strategy Comparison Tool

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The Community Guide: A Source of Evidence-Based Strategies

Aim CG Strategy Intervention Programs

Increase physical activity

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Alive! Diet and Physical Activity Program

Individually-adapted health behavior change programs A New Leaf…Choices

For Healthy Living

LOCATING EVIDENCE-BASED PROGRAM AND POLICY INTERVENTIONS

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www.rtips.cancer.gov

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www.centertrt.org

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Additional Resources

www.researchtoreality.cancer.gov

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www.cancercontrolplanet.cancer.gov

Additional Resources (cont’d)

www.cdc.gov/healthycommunitiesprogram

www.cdc.gov/healthyyouth/schoolhealth

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www.promisingpractices.net

Intervention Comparison Tool

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Homework for Next Webinar (Sep 10) Scavenger Hunt Handout

1. Explore The Community Guide website and answer questions specific to the Task Force-recommended strategy, Behavioral and Social Approaches to Increase Physical Activity: Individually-Adapted Health Behavior Change Programs.

2. Use the RTIPs and Center TRT websites to• Select one program intervention from each that is aligned with the Task

Force-recommended strategy, Behavioral and Social Approaches to Increase Physical Activity: Individually-Adapted Health Behavior Change Programs.

• Answer questions for each program intervention you selected.

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Homework for Next Webinar (cont’d) Intervention Comparison Tool Handout

1. Review your responses on the Organizational Readiness Checklist.

2. Consider the information you gathered about your health priority and community.

3. Fill out only the first blank column “Priority Area for Our Community” based on your community as well as your responses for the Organizational Readiness Checklist. You will fill out the remaining columns during our next webinar.

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Next Webinar…Why Is It Important to Understand Evidence-Based Options?

Assess how much adaptation is needed by gauging its fit to your community and organization.

Review methods, facilitators’ guide or implementation protocol to understand the steps for delivery.

Learn the costs of implementation.

In short, decide which program to use.

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Questions & Discussion

Thank you!

Starr BanksKathi Wilson

Community Guide Branch,Centers for Disease Control and Prevention

Starr Banks smbanks@cdc.gov Kathi Wilson kwilson@cdc.gov

Center for Surveillance, Epidemiology, and Laboratory Services (proposed)Division of Epidemiology, Analysis, and Library Services (proposed)