Evidence-Based Public Health

(EBPH)

Haileselasie Berhane (MPH)

1
 Evidence – Based Medicine and PH

Evidence:
• “a thing or things helpful in forming a conclusion
or judgment’’

Evidence based:
• focuses on transparently and reliably matching
appropriate types of evidence to the various types
of decisions.
 Rise of Evidence-Based Medicine

 First described in 1992

 A new approach to teaching medicine.

 Considered as a “revolution in medical practice”

 Definition of EBM

“The integration of best research evidence

with clinical expertise and patient values.”
 Factors Driving EBM
 Overwhelming size of the literature

 Inadequacy of textbooks

 Increased number of RCTs

 Available computerized databases

 Steps of EBM
Convert the need for information into an answerable
question

Track down the best evidences

Critically appraise that evidence

 Integrate the appraisal with one’s clinical expertise and the

individual patient

Evaluate
 Development of EBPH
 First described in 1997
 EBM has fostered development of EBPH
 Epidemiology described as the foundation of both
EBM and EBPH
 EBPH is unique in using complex interventions with
multiple community and societal issues
 Definition of EBPH

“EBPH is the conscientious, explicit, and judicious

use of current best evidence in making decisions
about the care of communities and populations in the
domain of health maintenance and improvement.”

Jenicek (1997)
 Definition of EBPH
“The process of integrating science-based
interventions with community preferences to
improve the health of populations.”
 Cont…
Evidence-based public health is...

• ….the process of distilling and disseminating the best

available evidence from research, context and
experience, and using that evidence to inform and
improve public health policy and practice.
 Cont…
Evidence-informed decisions in public health consider
valuable evidence from a variety of sources:
• best available research evidence
• community health issues and local context
• existing public health resources
• community and political climate

Decision makers must rely on their public health

expertise to integrate all relevant factors into any
conclusions or recommendations
 Steps in Evidence Based Public Health

 In establishment of programs for health promotion

and Preventing disease, four primary decision must
commonly be made

1.Should something be done?

2.What should be done?
3. How should it be done?
4. Is it working or does it need to be modified?
 Decision Type of Evidence
1. Should something Be
done?
What is the burden of Surveillance data (measuring morbidity, mortality,
disease? years of potential life lost)
Survey data
Vital statistics data
Medical utilization data
What is the urgency? Basic medical data ( e.g does the condition or risk
factor progress rapidly or have serious
complications?
Trend data
Is it a priority for the Degree to which the problem is understood (eg.
community? Emerging issues such as swine flu or environmental
hazards might merit more attention than can be
justified based on current burden)
What is the perceived Perceived interest or importance based on surveys,
need? focus groups, or other information
2. What should be done?
What is the nature of the problem?
What works?
What is acceptable to the
community
What can be afforded ?
What is feasible
Type of Evidence
•Information gathered from analysis of
information on causes, natural course of the
problem, and possible points of intervention
•Scientific evidence of effectiveness from
individual evaluation studies
•Systematic reviews of evaluation studies
Information about community members
understanding and approval of possible
intervention strategies from:
Focus group discussion
 Key interviews
Meetings
Information based on comparison of typical
costs and cost effectiveness and local assets
 organizational assessment
3.How should it be Type of Evidence
done?
What steps are needed to Documentation from previous implementation of the
implement this specific intervention and other related interventions.
intervention Available polices, guidelines
 experience from others who have implemented the
intervention

What barriers must be Documentation from previous implementation of

overcome to implement specific intervention and other related interventions
this intervention  experience from others who have implemented the
intervention
Focus groups

4. Is it working or does it need

to be modified?

Is it being implemented well? Process measured from checklists, interviews and

other data collection tools, program monitoring
What does the Focus group
community think? Interview
Less formal data collection
Political process
Is it improving health risks Achievement of behavior or health outcomes
or outcomes? from evaluation and program monitoring efforts
 EBM and EBPH: Similar steps
 State the scientific question of interest.

 Determine what information is needed to answer the

scientific question.

 Identify the relevant evidence.

 Determine the best course of action considering the patient

or population.

 Evaluate process and outcome

 Why implement
Evidence- Based Public Health?
• Effectively transfer knowledge from research
into practice and policy.
• Efficiently use limited health care resources.
• Create programs and actions that are both
effective and appropriate for our communities
and target populations.
• Improve client satisfaction.
• Strengthen public health
 Barriers to
Evidence-Informed Public Health
• Lack of time
• Difficulty accessing research
• Lack of skills or confidence with critically appraising
evidence
• Difficulty interpreting results
• Challenges with applying research findings to local
context and setting
• Insufficient power or support to make a change
• Environment/organizational culture
(Keifer et al.,2005; Retsas, 2000; Thomas et al., 2004)
 Stages in the process of
Evidence-Informed Public Health
• The strategy employed requires;

– a clear delineation of the relevant question(s);

– a thorough search of the literature relating to the

questions;

– a critical appraisal of the evidence, and its applicability

to the health problem; and

– a balanced application of the conclusions to the problem.

THANK YOU