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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, BehaviorCompare 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 screening2. Choose type of screening test3. Make appointment for screening4. 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
Objectives Goal
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. 133-146.
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 1 Scenario 3
_ Scenario 2 Scenario 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?
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