Review the Evidence Base for the Program

When developing a rural community health program, it is important to review the evidence base related to the program topic. What is the meaning of the term “evidence-based”? Compared to clinical medicine, public health focuses on populations rather than individuals, and on programs and policies rather than clinical care. The definition of evidence-based public health reflects this difference in focus.

Evidence-based Medicine: Conscientious and judicious use of best evidence currently available to make decisions about the care of an individual patient. It combines individual clinical expertise with the best available external clinical evidence from research.
Evidence-based Public Health: Development, implementation, and evaluation of effective programs and policies in public health. It employs scientific reasoning to systematically use data and information systems, and appropriately use behavioral science theory and program planning models.

One obstacle to understanding evidence-based public health practice is the lack of consistent terminology from one source to another. The Centers for Disease Control and Prevention’s (CDC) Guide to Community Preventive Services (“Community Guide”) uses systematic reviews to assess the strength of evidence for intervention effectiveness. Interventions in the guide that are “recommended” have been determined by public health experts to have both strong and sufficient evidence.

Programs may be evidence-based, effective, promising, or emerging.

Evidence-based programs: Published in systematic reviews, syntheses, or meta-analyses whose authors have conducted a structured review of published high-quality, peer-reviewed studies and evaluation reports. Evidence-based strategies produce significant, positive health or behavioral outcomes and/or intermediate policy, environmental, or economic impacts.
Effective programs: Published in high-quality, peer-reviewed studies and have produced significant positive health or behavioral outcomes, and policy, environment, or economic impacts.
Promising programs: Based on exploratory evaluations that show potentially meaningful health or behavioral outcomes, and policy, environment, or economic impacts. They have strong qualitative or quantitative data supporting positive outcomes, but are not yet generalizable to public health outcomes.
Emerging programs: Based on guidelines, protocols, or standards that may be in the process of being evaluated by researchers to measure their positive impact on public health. Emerging practices are new and there is not enough information to make a decision about effectiveness.

Therefore, there is a spectrum of evidence that may support a program—from scientific literature in journals and public health surveillance data (objective) to qualitative data, word of mouth, and personal experience (subjective).

Resources to Learn More

Evidence-based Medicine: What It Is and What It Isn't
Document
This BMJ editorial discusses integrating clinical expertise and external evidence.
Author(s): Sackett, D., Rosenberg, W., Gray, J.A., Haynes, R., & Richardson, W.
Citation: BMJ, 312(7023), 71-2
Date: 1/1996

Evidence-Based Public Health: A Fundamental Concept for Public Health Practice
Document
This article reviews the concepts of evidence-based public health.
Author(s): Brownson, R.C., Fielding, J.E., & Maylahn, C.M.
Citation: Annual Review of Public Health, 30, 175-201
Date: 1/2009

The Community Guide
Website
The Community Guide is a repository of evidence-based and promising policies, programs or strategies on a wide range of topics related to health and disease prevention in communities, including asthma, physical activity, and tobacco.
Organization(s): Centers for Disease Control and Prevention

Evidence-Based Practice
Website
Resources on child well-being and use of rigorously evaluated programs to address the needs of children and encourage healthy development.
Organization(s): Annie E. Casey Foundation