Evidence-Based Public Health Selecting Evidence-Based Interventions Joanne Rinker 1

Assessing your community Establishing goals and objectives Finding evidence Selecting best- fitting EBI AdaptingImplementingEvaluating 3

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 3

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 4

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 5

EBS 3 ________ EBS 2 ________ Assessing Fit Assessment Findings/ Stakeholder Priorities Prioritized health goals Behavioral/ environmental objectives Intended population Implementation venues Resources Compare EBS 1 ________ 6

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? 8

Community Guide and RTIPS RTIPS: 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 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 9

YoursRTIPs 1RTIPs 2 Community G. Provider Reminder Health Goal Colorectal Cancer yes Behavior Objective Screeningyes Population Caucasian, uninsured, 50+ African American Filipino Americans yes Venue Churches, public health, CHCs yes Resources 10

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 - 11

Community Guide and RTIPS Community Guide School Based Programs in the Community Guide, takes me to interventions in RTIPS. 12

Goal: Prevent Obesity Interventions 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 13

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 14

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. 15

Activity: Selecting an EBS Activity 16

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20 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.

21 Intervention Criteria Our Health PriorityWalking Maps How does this fit your priority? Stairwell to Better Health How does this fit your priority?? YesSomeNoYesSomeNoNo TopicPhysical Activity Audiences (Ex: age, gender, race, ethnicity, socioeconomic status) Worksite Employees 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

22 Our Health PriorityWalking Maps How does this fit your priority? Stairwell to Better Health How does this fit your priority? YesSomeNoYesSome NoNo 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 23

Questions? 24