dition, most studies in the EBPH literature are academic-based research, usually with external funding for well-established investigators. In contrast, in developing (110) countries and in impoverished areas of developed countries, the evidence base for how best to address common public health problems is often limited, even though the scope of the problem may be enor- mous. Cavill compared evidence-based inter- ventions across countries, showing that much of the evidence base in several areas is limited to empirical observations (33). Even in more de- velopedcountries(includingtheUnitedStates), information published in peer-reviewed jour- nals or data available through Web sites and official organizations may not adequately rep- resent all populations of interest. THE FUTURE The United States spends nearly $30 billion an- nually on health-related research (126). A small portion of these expenditures is dedicated to re- search relevant to the practice of public health. Nonetheless, evidence for addressing a number of priority public health problems now exists. Unfortunately, the translation from research to clinical or community applications often occurs only after a delay of many years (8, 19, 91). Ac- celerating the production of new evidence and the adoption of evidence-based interventions to protect and improve health requires several actions. Expanding the Evidence Base The growing literature on the effectiveness of preventive interventions in clinical and com- munity settings (2, 171) does not provide equal coverage of health problems. For example, the evidence base on how to increase immunization 190 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.
Table 6 Competencies in evidence-based public health. Adapted from Brownson et al. (18) Category Domain a Level b Competency 1. Community input C B Understand the importance of obtaining community input before planning and implementing evidence-based interventions. 2. Etiologic knowledge E B Understand the relationship between risk factors and diseases. 3. Community assessment C B Understand how to define the health issue according to the needs and assets of the population/community of interest. 4. Partnerships at multilevels P/C B Understand the importance of identifying and developing partnerships to address the issue with evidence-based strategies at multiple levels. 5. Development of a concise statement of the issue EBP B Understand the importance of developing a concise statement of the issue to build support for it. 6. Grant writing need T/T B Recognize the importance of grant-writing skills including the steps involved in the application process. 7. Literature searching EBP B Understand the process for searching the scientific literature and summarizing search-derived information on the health issue.
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