information from different sources. Although quantitative data provide an excellent oppor- tunity to determine how variables are related for large numbers of people, these data provide little understanding of why these relationships exist. Qualitative data, on the other hand, can help provide information to explain quantita- tive findings, or what has been called “illumi- nating meaning” (153). One can find many ex- amples of the use of triangulation of qualitative and quantitative data to evaluate health pro- grams and policies including AIDS-prevention programs (50), occupational health programs and policies (79), and chronic disease preven- tion programs in community settings (66). Audiences for EBPH There are four overlapping user groups for EBPH (56). The first includes public health 180 Brownson · Fielding · Maylahn Annu. Rev. Public Health 2009.30:175-201. Downloaded from Access provided by Liberty University on 10/10/16. For personal use only.
practitioners with executive and managerial re- sponsibilities who want to know the scope and quality of evidence for alternative strategies (e.g., programs, policies). In practice, however, public health practitioners frequently have a relatively narrow set of options. Funds from federal, state, or local sources are most often earmarked for a specific purpose (e.g., surveil- lance and treatment of sexually transmitted dis- eases, inspection of retail food establishments). Still, the public health practitioner has the op- portunity, even the obligation, to carefully re- viewtheevidenceforalternativewaystoachieve the desired health goals. The next user group is policy makers at local, regional, state, na- tional, and international levels. They are faced with macrolevel decisions on how to allocate the public resources of which they are stewards. This group has the additional responsibility of making policies on controversial public issues. The third group is composed of stakeholders who will be affected by any intervention. This includes the public, especially those who vote, as well as interest groups formed to support or oppose specific policies, such as the legality of abortion, whether the community water supply should be ﬂuoridated, or whether adults must be issued handgun licenses if they pass back- ground checks. The final user group is com- posed of researchers on population health is- sues, such as those who evaluate the impact of a specific policy or program. They both develop and use evidence to answer research questions. Similarities and Differences between EBPH and Evidence-Based Medicine The concept of evidence-based practice is well established in numerous disciplines includ- ing psychology (136), social work (58), and nursing (115). It is probably best established in medicine. The doctrine of evidence-based medicine (EBM) was formally introduced in 1992 (53). Its origins can be traced back to the seminal work of Cochrane that noted many medical treatments lacked scientific effective- ness (41). A basic tenet of EBM is to deempha- Table 3 Contextual variables for intervention design, implementation, and adaptation
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