Getting to Outcomes: Step 03. Best Practices
This step guides you through the best available research evidence on building CEP to help you select an EBPH approach.
What Is This Step?
GTO Step 3 prompts you to consider using an EBPH approach to building CEP. This means including (1) the best available research evidence; (2) practitioner expertise and other available resources; and (3) the characteristics, needs, and values of the target community to make a decision about the best approach to take among the possible options. Step 1 helped you to consider practitioner expertise and community resources and Step 4 will help you examine fit with the characteristics, needs, and values of the target community. In this step, you will learn how to examine the research evidence on outcomes of CEP programs and begin to assess which might be most appropriate for your goals and desired outcomes.
Why Is This Step Important?
Funders often require the use of evidence-based approaches. Healthy People 2020 calls for the use of “policies and practices that are driven by the best available evidence and knowledge.”
The Core Competencies for Public Health Professionals (PDF) , from the Council on Linkages Between Academia and Public Health Practice, support an evidence-based approach to public health.
The reason for this trend is that evidence-based approaches are known to achieve outcomes (when used effectively). Using an evidence-based approach:
- increases the likelihood of achieving goals and desired outcomes
- promotes confidence among funders and stakeholders that you are using the best approach possible
- usually comes with many features that newly created, untested approaches do not have, such as tools to track outcomes and previous results about what outcomes to expect
How Do I Carry Out This Step?
Start by gathering information about the best research evidence available on specific EBPH approaches or interventions. You do not need to gather and synthesize all available evidence yourself—it can be overwhelming. You can identify the best available evidence by using tools that synthesize, interpret, and evaluate the research literature. For example, the primary purpose of systematic reviews is to critically analyze and summarize evidence from evaluations of specific approaches or interventions. One place to find systematic reviews on emergency preparedness and related topics is:
- The Community Guide. The Task Force on Community Preventive Services has systematically reviewed more than 200 interventions to produce evidence-based recommendations on population-level interventions on a variety of topics (e.g., adolescent health, social environment, vaccines), including emergency preparedness.
Not all EBPH approaches and programs will be reflected in systematic reviews. You can also find evidence in scientific articles and online by:
Searching for review articles in publications databases, such as PubMed or Google Scholar, using keywords (for example, literature review, systematic review, CEP). Here are some recent examples:
- J. Levac, D. Toal-Sullivan, and T. L. O’Sullivan, “Household Emergency Preparedness: A Literature Review,” Journal of Community Health, Vol. 37, No. 3, 2012, pp. 725–733. This paper presents a synthesis of available literature on household preparedness published over the past 15 years (62 papers).
- Kohn, S., J. L. Eaton, S. Feroz, A. A. Bainbridge, J. Hoolachan, and D. J. Barnett, “Personal Disaster Preparedness: An Integrative Review of the Literature,” Disaster Medicine and Public Health Preparedness, Vol. 6, No. 3, 2012, pp. 217–231. This paper contains a review of 36 papers describing the current state of evidence concerning personal disaster preparedness.
Searching for intervention evaluation articles in publications databases, such as PubMed or Google Scholar, using keywords (for example, evaluation, CEP, intervention, or program). Here are a few recent examples of articles targeting preparedness among youth, Latino immigrant communities, and adults who are disabled and living independently in the community:
- P. Powell, M. Smith, and L. Black, “Involving Youth in CEP: Impacts of a Multistate Initiative,” Journal of Youth Development, Vol. 4, No. 4, 2016, p. 19. This paper describes the evaluation of the Alert, Evacuate, and Shelter program, which identified and trained youth/adult teams to use geospatial technology to map shelter locations and evacuation routes.
- K. R. Ronan, K. Crellin, and D. M. Johnston, “Community Readiness for a New Tsunami Warning System: Quasi-Experimental and Benchmarking Evaluation of a School Education Component,” Natural Hazards, Vol. 61, No. 3, 2012, pp. 1411–1425. This paper describes the evaluation of a brief in-school educational program that aimed to make children more knowledgeable and prepared for hazards generally but also in more specific relation to the rollout of a new tsunami warning system.
- D. Eisenman, D. Glik, L. Gonzalez, R. Maranon, Q. Zhou, C. Tseng, and S. Asch, “Improving Latino Disaster Preparedness Using Social Networks,” American Journal of Preventive Medicine, Vol. 37, No. 6, 2009, pp. 512–517. This paper describes a randomized control trial testing a disaster preparedness program fielded in low-income Latino communities with lay health promoters. See the following links:
- D. Eisenman, A. Bazzano, D. Koniak-Griffin, M. A. Lewis, C. Tseng, K. Lamb, and D. Lehrer, “Peer-Mentored Preparedness (PM-Prep): A New Disaster Preparedness Program for Adults with Developmental Disabilities,” Intellectual and Developmental Disabilities, Vol. 52, No. 1, 2014, pp. 49–59. This paper describes a wait-list control design evaluation of a disaster preparedness program developed for adults with developmental disabilities who are living independently in the community. Download (PDF)
Searching the “gray” literature (literature published outside of a commercial publisher) using Internet search tools to find government or business reports. Here are some examples:
- The U.S. Department of Health and Human Services has emergency preparedness fact sheets, tools, videos, and reports on a wide range of emergency preparedness topics (including mental health, communication, and cultural and linguistic competency) and populations (including children, older adults, and individuals with access or functional needs) on its Public Health Emergency website.
- The CDC has state-developed tools and resources to reach out to community members about emergency preparedness on its website.
Next, use the Evidence Synthesis Tool to help you weigh how each specific approach you have identified in your review aligns with the goal and desired outcomes that you created in the Logic Model Tool and the SMART Desired Outcomes Tool in GTO Step 2, as well as the best available research evidence. Complete this tool for as many approaches, programs, or interventions as you would like to consider. Using information in the completed tool, complete GTO Steps 4 and 5 to narrow your choices to one.
Tools Used in This Step
Example Evidence Synthesis Tool
Make plenty of copies of the tool. You will need a copy of Section 2 of the tool for each EBPH approach under consideration. We provide only one example here—for ROAD-MAP, the program ultimately chosen by the Townville LHD team after consideration of two other options. ROAD-MAP was selected for implementation in Townville after assessment of other options concluded that they were not appropriate. Townville also used this tool to assess the National Family Caregiver Support Program’s Just in Case: Emergency Readiness for Older Adults and Caregivers but found, by using the Evidence Synthesis Tool, that it did not employ teaching methods to actively involve participants and offered only fact sheets (i.e., it did not provide necessary activities and materials for staff and participants to use). Another EBPH approach that was considered, a media campaign approach to older adult education, proved too costly to implement after doing the capacity assessment in GTO Step 5. You also may be considering among options. The completed tools for each option will help you make comparisons and sometimes difficult choices among different options to narrow to a final decision.
In Section 1:
- In the first column, record the types of sources you reviewed for determining the best available evidence.
- In the second and third columns, list the specific approaches or programs suggested by each source and briefly summarize the evidence presented.
In Section 2:
- Respond to each characteristic (yes or no) as to whether the goal, influential factors, and behaviors targeted in the selected approach match those you identified in GTO Steps 1 and 2.
- Complete the column on the right for each characteristic. This will help you start thinking about issues of fit, which is addressed in GTO Step 4.
- Completed by: Project team/manager
- Date: January
- Program: ROAD-MAP
Section 1: Summary of Best Available Evidence
What sources did you explore to find the best available evidence?
|Source of evidence||Did you review this source? Yes/No||What approaches did it suggest using?||What is the evidence for those approaches?|
|1. Systematic review||No|
|2. Journal articles||Yes||UCLA Community Preparedness ROAD-MAP: This program, designed to improve disaster preparedness among adults living independently in the community, consists of four two-hour classes co-taught by a health educator and peer mentors.||The UCLA Community Preparedness ROAD-MAP program was developed using strategies from two other programs evaluated via randomized designs. The evaluations found that earthquake safety knowledge and preparedness supplies significantly increased from prior to the intervention to after the intervention (Eisenman, Glik, et al., 2009).|
|3. Gray literature||No|
Section 2: Assessment of Evidence-Based Approach
For each specific EBPH approach or program identified in Section 1, complete the following assessment of how its features relate to community needs, influential factors, behaviors, goals, and/or desired outcomes.
- Approach being considered: UCLA Community Preparedness
- Program: ROAD-MAP
|Evidence-based approach features and how they relate to our needs, behaviors, goals, and/or desired outcomes||Does the program have these features? Yes/No||What would we need to change to make the program fit our needs?|
|1. Focuses clearly on our identified goals||Yes|
|2. Focuses on the specific behaviors we have identified that lead to the goals||Yes|
|3. Addresses the determinants we selected in GTO Step 2 (e.g., knowledge, attitudes)|
|4. Provides necessary activities and materials for staff to use||Yes||Additional pre-/post-testing materials will be needed to evaluate outcomes.|
|5. Employs teaching methods to actively involve participants||Yes|
|6. Employs activities, instructional methods, and behavioral messages appropriate to our target population||Yes||May have to adjust content to better suit the culture and language of the local community|
When you finish working on this step, you should have:
- Completed the Step 3 tool
- Developed an understanding of the best available evidence in your topic area
- Reviewed the best available approaches to find those that will help you achieve your goals and desired outcomes
- Selected one or more approaches to consider further
Before Moving On
You’ve figured out which approaches or programs are in line with your community’s most urgent needs and the best available evidence. Now you are ready to move on to the next step in the GTO process – making sure your selected approach(es) or program(s) “fit” (Step 4) well with your target population, community, and your organization and that you have the capacity (Step 5) to carry them (if multiple options are still on the table) out well. If you already have a program selected, Steps 4 and 5 can help you fine-tune your work in a way that helps maximize your resources and increase your chances of success.