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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, explicit, and judicious use of current best evidence in making decisions about care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
  • Evidence-based Public Health
    • Development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models.

Sources
Evidence-based Medicine: What it is and What it isn't
Sackett D, Rosenberg W, Gray JA, Haynes R, Richardson W; BMJ 1996; 312:71-72.
Evidence-based Public Health
Brownson R, Baker E, Leet T, Gillespie K; Int J Qual Health Care15 (5): 443-444

Evidence-based Practices and Promising Practices
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) Community Guide to Preventive Services 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.

Other clearinghouses may use less stringent standards for labeling interventions as “evidence-based”. Promising practices can be defined with even less precision. Examples of definitions of evidence-based and promising practices include:

  • “Evidence-based public health practice is the development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems and appropriate use of behavioral science theory and program planning models.”
    Evidence-Based Public Health
    Brownson, R., Baker, E., Leet, T., & Gillespie, K.; 2003

Using Different Forms of Evidence to Inform Decisions
Rural practitioners can use different forms of evidence to help them make decisions about:

  • Whether a particular problem should be addressed
  • What should be done to address the problem
  • How any actions should be carried out

Table 4-1 shows available evidence types classified by levels of strength. It distinguishes between evidence-based strategies and effective strategies. It also includes fairly new and untested strategies, but can clarify which ones have a record of effectiveness.

Table 4-1. Criteria Used to Classify Levels of Evidence

Evidence-based strategies
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 strategies
Published in high-quality, peer-reviewed studies and evaluation reports. Effective strategies produce significant positive health or behavioral outcomes, and policy, environment, or economic impacts.
Promising strategies
Based on evidence from published or unpublished evaluation studies or exploratory evaluations. Promising strategies show meaningful, plausible positive health or behavioral outcomes, and policy, environment, or economic impacts.
Emerging strategies
Include newly implemented innovations that may be in the process of being tested by researchers.

Source
Accelerating Evidence Reviews and Broadening Evidence Standards to Identify Effective, Promising, and Emerging Policy and Environmental Strategies for Prevention of Childhood Obesity
Brennan L, Castro S, Brownson RD, Claus J, Orleans T; Annual Rev. Public Health. 32: 199-223; Jan. 3, 2011

It has been noted that evidence is in the eye of the beholder. While policymakers may look for information about costs and benefits concerning evidence, a practitioner working in a community-based organization might find anecdotes more useful. Figure 4-1 shows how different forms of evidence fall along a spectrum from objective to subjective.

Figure 4-1

Source
Evidence-based Public Health: A Fundamental Concept for Public Health Practice
Brownson RC, Fielding JF, Maylahn CM; Annual Rev. Public Health 2009. 30:175-201


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Funding for this project was supported by Grant Number U56RH05539 from the Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services. The contents of this website are solely the responsibility of the authors and do not necessarily represent the official views of the funder.