Selecting an Evidence-based Approach (EBA)

with the Best Fit

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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?