Selecting an Evidence-based Approach (EBA) with the Best Fit Image courtesy of Naypong at FreeDigitalPhotos.net

Assessing your Community Implementing & Evaluating Establishing Goals & Objectives; Planning for Evaluation Finding Evidence Selecting Best Fitting EBAs Adapting Where do We Stand?

Session Objectives Describe basic principles for selecting an approach that fits the organization and population Assess the fit between approaches and the organization and population Select an approach that fits the organization and population

Refresher: Types of EBAs Program o Intervention that includes instructions and specifies materials Policy o System of laws, regulatory measures, courses of action, or funding priorities Strategy o Broad recommendation

Steps for Selecting Candidate EBAs 1.Obtain information about EBAs 2.Assess fit by comparing candidate EBAs with community assessment findings according to fit criteria a. Basic fit b. Detailed fit 3.Select EBA based on fit and strength of evidence

Obtain General Information about EBAs

EBA 3 ________ EBA 2 ________ Assessing Basic Fit Community Assessment Findings  Health goals  Behavioral/ environmental objectives  Priority population  Organization/coalition (capacity and resources) Compare EBA 1 ________

Assessing Detailed Fit To assess detailed fit, get EBA materials such as: Educational materials (e.g., handouts, booklets, etc.) Protocols and implementation guides Information from EBA website and EBA developers Journal articles or other literature about the EBA

Detailed Comparison of EBAs & Community Assessment Findings 1.Health goals, behavioral and environmental objectives 2.Determinants - objectives 3.Delivery possibilities and preferences 4.Characteristics of priority population 5.Organization/ coalition/ community context

1.Health Problem, Behavior Compare the community assessment findings to the EBA: Community assessment –Prevalence & seriousness of health problem, behaviors –Objectives related and specific behaviors, e.g., Evidence-based approach (EBA) –Which behavioral outcomes were effectively changed? 1. Decide to get colorectal cancer screening 2. Choose type of screening test 3. Make appointment for screening 4. Keep appointment

1.Health Problem, Environment Community assessment, e.g., –Lack of available and accessible screening facilities –Objective: Increase availability and accessibility of screening facilities EBA –Are these issues addressed by the EBA?

2.Determinants Mild fear arousal Belief selection Persuasive communication Methods Modeling FOBT Determinants Attitudes Self-Efficacy Beliefs Awareness, Risk perception Reduce CRC morbidity & mortality Access to Free/low cost tests Behaviors & Environment Health ObjectivesGoal

Methods to Use to Influence Determinants * From Bartholomew, LK, Parcel GS, Kok G, Gottlieb NH, & Fernandez ME (2011) Planning Health Promotion Programs: An Intervention Mapping Approach. San Francisco: Jossey-Bass

3.Delivery Community assessment –Capacity and resources: setting, channels, personnel, e.g., via general-audience oriented or ethnic-audience oriented channels; via community health workers Population: which used, preferences/ attitudes? Capacities and resources: which channels available EBA –Delivery setting, format, program deliverers, channels used

4.Priority Population Community assessment –Priority population’s characteristics Evidence-based Approach –Statistics* –Pictures* –Language* *Kreuter M.W., Lukwago, S.N., Bucholtz, D.C., Clark, E.M., & Sanders-Thompson, V. (2003) Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav, pp American Cancer Society, Surveillance Research, 2013 Image courtesy of stockimages at FreeDigitalPhotos.net

5.Capacity and resources Community assessment ̶Existing programs/ facilities ̶Facilitators and barriers for implementation ̶Infrastructure, leadership, other roles ̶Capabilities, willingness, and resource EBA ̶What is needed for implementation? ̶Which contextual factors influenced effectiveness?

Selecting an EBA EBA Selection Tool

Activity: Comparison Tool Activity with Nutrition Programs

Activity: Comparison Tool Activity 1.Read the case community information and the 2 EBA program descriptions individually 2.Complete the Comparison Tool in a small group 3.Discuss: –Share what fit and didn’t fit for each program. –Which program would you choose? 4.Share decisions and rationale with the large group

Additional Considerations What is the relevance & strength of the evidence? How much certainty is there about the effectiveness of the EBA? “Real world” effectiveness vs “ideal world” efficacy Systematic review vs a single program evaluation

Real World Effectiveness & RE-AIM REACH your intended target population EFFECTIVENSS or efficacy ADOPTION by target staff, settings, or institutions IMPLEMENTATION consistency, costs and adaptations made during delivery MAINTENANCE of intervention effects in individuals and settings over time

Single Study vs. Review of Multiple Studies Research Tested Intervention Programs (RTIPS) Community Guide Recommended Strategies +_ +Scenario 1Scenario 3 _Scenario 2Scenario 4

Take-home Points: Importance of Selecting an EBA with the Best Fit Refer to your community assessment when considering fit Select evidence-based programs, strategies and policies that fit your o Goals and objectives, including for determinant change o Delivery possibilities and preferences o Characteristics of the priority population o Organization/coalition/community context Select EBAs with a stronger evidence base

Questions?