Contents
Anecdotal:
Not “Evidence-Informed” or “Evidence-Based”.................................................................. <=
/span>2
Evidence-Informed..........................................=
...........................................................................=
.... 3
Evidence-Based..........................................=
...........................................................................=
........ 4
Introduction
The
Physical Activity Guidelines for
Americans has moved from evidence-informed in 2008 to evidenc=
e-based
in the 2nd edition published in November 20181. <=
span
style=3D'mso-spacerun:yes'> An emphasis in the continuing education
self-study course, The “Evidence-B=
ased”
Physical Activity Guidelines for Americans (2nd edition) (20=
18)2, is to show how evid=
ence
was gathered, the findings and resulting guidelines for 1) physical activity
and 2) health education/promotion to increase regular physical activity. Th=
is
paper gives an overview of evidence used for interventions to avoid harm and
improve health.
Importance of=
Using
Evidence-Based Practices and Findings for CHES®, MCHES® and CPH
Evidence-based is
emphasized because Certified Health Education Specialists (CHES®), the Mast=
er
Certified Health Education Specialists (MCHES®) Certified in Public Health =
(CPH)
and are expected to use evidence-b=
ased
practices. “Evidence” and “evidence-based” are stated In three of the s=
even
areas of responsibility of the Health Education
Specialist Practice Analysis (HESPA) 2015 Competencies3 for CHES=
® and
the MCHES®. And there are four sub-competen=
cies (see
bullet point items below, two competencies are “Advance-1, for MCHES®) stating that CHES® =
;and
the MCHES® should identify, apply and use evidence-based
findings. “Evidence” and “evidence-based” are stated six time in four of th=
e 10
domain areas of the CPH Content Outline.4 NOTE: the term evidence-informed is not listed in the HE=
SPA
Responsibilities and Competencies or CPH Content Outline.
Health Education Specialist Practice Analy=
sis
(HESPA) 2015 Competencies
Area II: Plan Health Education/Promotion
Area V: Administer and Manage Health
Education/Promotion
Area VII: Communicate, Promote, and Advoca=
te
for Health, Health Education/Promotion and the Profession
·
7.3.5 Use evidence-based
findings in policy analysis
· =
7.3=
.6
Develop policies to promote health using evidence-based
findings (Advance-1)
The
Responsibilities and Competencies for Health Education Special=
ists (web
page) have Area=
s of
Responsibility, Competencies and Sub-competencies for Health Education
Specialists 2015 (pdf,
note color coding for Advanced-1
and Advanced-2).<=
/span>
Cert=
ified
in Public Health Content Outline
Doma=
in
Area: Evidence-based Approaches to Public Health
14. Apply evidence-ba=
sed
theories, concepts, and models from a range of social and behavioral
disciplines in the development and evaluation of health programs, policies =
and
interventions
Doma=
in
Area: Public Health Biology and Human Disease Risk
1. Apply evidence-based<=
/b>
biological concepts to inform public health laws, policies, and regulations=
Doma=
in
Area: Program Planning and Evaluation
10. Apply evidence-ba=
sed
practices to program planning, implementation and evaluation
13. Plan evidence-bas=
ed
interventions to meet established program goals and objectives
19. Use available evi=
dence
to inform effective teamwork and team-based practices
Doma=
in
Area: Policy in Public Health
5. Use scientific evi=
dence,
best practices, stakeholder input, or public opinion data to inform policy =
and
program decision-making
Additionally, in 2001 Rimer, Glanz=
and
Rasband5 described why using evidence-based practices is importa=
nt. They
wrote “Health educators and behavioral scientists should care about
evidence-based practice. Our goal is to improve the health of the public. G=
iven
a shortage of resources, we must invest wisely in interventions that are mo=
st
likely to work. Moreover, we do not want to harm people by knowingly exposi=
ng
them to interventions that do not work, especially when there are proven
effective strategies. Using interventions that evidence shows are ineffecti=
ve
not only wastes the resources invested in them but also crowds out alternat=
ive
actions. The best interventions are those with the greatest chance of chang=
ing
something that will make a desired difference.”
Types of Evidence
Anecdotal: Not “Evidence-Informed” or “Evidence-Based”
For
comparisons, it may be useful to see descriptions of health promotion pract=
ice
and findings that are not objective research evidence. Below are examples of how not evidence-based/informed might be=
described.
Key text to consider noting are in bold
and underlined.
From Richard Troiano, PhD (2008 PA
Guidelines Advisory Committee member) GWU Grand Rounds presentation in 2008=
.6
“. .=
.
public health practice . . , is moving towards a science-based, evidence-ba=
sed
paradigm so that we don’t just =
kind
of do what we think is good, but we really have a strong evidentiary
base to support it.”
From US DHHS Office of Assistant
Secretary for Planning and Evaluation7
“In =
the
absence of evidence-based interventions, and often even when evidence-based
approaches exist, program operators frequently rely primarily on their personal experiences and good intentions
without careful consideration of related research evidence. While p=
ast
experience is valuable, ignoring existing evidence and developmental theory=
can
lead to missed opportunities, unintended results, and inefficient progress.=
”
From International Union for <=
u>Health
Promotion and Education8
“The report concludes that programmes . . . are largely driven=
by “informed guesswork, expert hunche=
s,
. . .”11
From
the journal Health Promotion Practice9
“Evidence-based practice is=
an
extension of evidence- based medicine, which=
moves
from “uninformed intuition, unsystematic clinical experience=
, and pathophysiologic ration=
ale”
as the basis of clinical decision making, emphasizing instead the assessmen=
t of
clinical research evidence.”
From article in journal Health
Education and Behavior5
“Do we make decisions based on what
does or does not “work” according to the evidence or based on tradition,
intuition, precedent, and available resources? Would we replace what we =
feel
works best with what we know is better, based on evidence?”
Evidence-Informed
Below are examples of how evidence-informe=
d has
been described. Key text to consider noting are in bold and und=
erlined.
From Richard Troiano, PhD (2008 PA
Guidelines Advisory Committee member) GWU Grand Rounds presentation in 2008=
.6
“The other thing, if we ju=
st
look at those studies, those 560 studies on adiposity, you can see that
there’s quite a variety of study designs incorporated in that number. T=
his
again reflects on why we had to
evolve to this evidence-informed concept
from an evidence-based concept. So out of the 560 studies, a little less than 200 were experimental
but that is both randomized and non-randomized studies.
![](3D"anecdotal-evidenceinformed-evidencebasedweb_files/image002.png")
=
So, if you took the drug t=
rial
model and said I’m only going to rely upon randomized control trials, when
you’re looking at behaviors, you really don’t have much that you can go wit=
h.
So, you really need to cast a wider net and realize the tradeoffs when you’=
re
looking at observational and cross-sectional studies, but they do have
information to contribute.”=
![](3D"anecdotal-evidenceinformed-evidencebasedweb_files/image004.png")
From National Alzheimer’s and Deme=
ntia
Resource Center (NADRC)10, 12
For consideration as evidence-informed=
,
an intervention must have
·&nb=
sp;
substantial research evidence that demonstrat=
es
an ability to improve, maintain, or slow the decline in the health and
functional status of older people or family caregivers.
Evidence-informed interventions
(1)
have been tested by at least one quasi-experi=
mental
design with a comparison group, with at least 50 participants; OR
(2)
have been adapted from evidence-based
interventions.
From article in journal Bri=
tish
Journal of Social Work11
“Evidence-informed practice (EIP) should be understood as excluding non-scientific prejudice=
s and
superstitions, but also as leaving ample room for clinical experien=
ce
as well as the constructive and imaginative judgements of practitioners and
clients who are in constant interaction and dialogue with one another. . . =
. practitioners
will become knowledgeable of a wide range of sources—empirical studies, case
studies and clinical insights—and use them in creative ways throughout the
intervention process.”
Evidence-Based
Below are examples of how evidence-based h=
as
been described. Key text to consider noting are in bold and und=
erlined.
From article in journal Hea=
lth
Education & Behavior5
. . . make decisions based on what does . . .=
“work” according to the evidence=
. .
. replace what we feel work=
s best
with what we know is better, based on evidence?
“Jenicek called evidence-based public health “the process of systematically finding, appraising, and using
contemporaneous research findings as the basis for decisions in public heal=
th.”
From National Alzheimer’s and Deme=
ntia
Resource Center (NADRC) and Administration on Community Living (ACL) to rec=
eive
grants10, 12
For consideration as evidence-based, an
intervention must have
·&nb=
sp;
=
been test=
ed
through randomized controlled trials and
(1)&=
nbsp;
be effective at improving, maintaining, or slowing the decline=
in
the health or functional status of older people or family caregivers;
(2)&=
nbsp;
be suitable for deployment through community-based human servi=
ces
organizations and involve nonclinical workers or volunteers in the delivery=
of
the intervention;
(3)&=
nbsp;
have results published in a peer-reviewed scientific journal; =
and
(4) be transl=
ated
into practice and ready for distribution through community-based human serv=
ices
organizations.
ACL Definitio=
n of
Evidence-Based Programs=
·&nb=
sp;
Demonstrated through evaluation to be
effective for improving the health and well-being or reducing disease,
disability and/or injury among older adults; and
·&nb=
sp;
Proven effective with older adult populati=
on,
using Experimental or Quasi-Experimental Design;* and
·&nb=
sp;
Research results published in a peer-review
journal; and
·&nb=
sp;
Fully translated** in one or more community
site(s); and
·&nb=
sp;
Includes developed dissemination products =
that
are available to the public.
*Experimental
designs use random assignment and a control group. Quasi-experimental desig=
ns
do not use random assignment.
**For
purposes of the Title III-D definitions, being “fully translated in one or =
more
community sites” means that the evidence-based program in question has been
carried out at the community level (with fidelity to the published research=
) at
least once before. Sites should only consider programs that have been shown=
to
be effective within a real-world community setting.
Note: ACL
distinguishes between “evidence-based program” and “evidence-based
service/practice.” Services and practices are within programs. See answer to
question 8 of the Frequently Asked Questions on this page https://a=
cl.gov/programs/health-wellness/disease-prevention. The “Re=
sources”
section on this page also gives three items for “Understanding and Finding =
Evidence-Based
Programs.”
From Physical Activity Guidelines for Americans (2nd
edition)13
Use “. . =
. a
methodology informed by best practices for systematic reviews (SRs) develop=
ed
by the United States Department of Agriculture’s (USDA) Nutrition Evidence =
Library
(NEL),1 the Agency for Healthcare Research and Quality (AHRQ),
Steps to Finding Evidence
The techniques of evidence-based m=
edicine
involve these steps:14<=
s>
(a)&=
nbsp;
asking research questions to precisely def=
ining
the patient or population problem and the information required to solve it,=
(b)&=
nbsp;
conducting an efficient literature search,=
(c)&= nbsp; selecting high-quality relevant studies, <= o:p>
(d)&=
nbsp;
applying rules of evidence to determine th=
eir
validity,
(e)&=
nbsp;
describing the content of the study along =
with
its strengths and weaknesses, and
(f)&=
nbsp;
extracting the health message for applicat=
ion
to the problem.
The Physical Activity Guidelines f=
or
American Advisory Committee followed each of the steps listed below. It was
instructed to examine the scientific literature. The Exec=
utive
Summary15 states that the Committee conducted detai=
led
searches of the scientific literature, evaluated and discussed at length the
quality of the evidence, and developed conclusions based on the evidence as=
a
whole. The Committee used state-of-the-art methods for systematic reviews to
address 38 research questions and 104 subquestions. Part=
E.
Systematic Review Literature Search Methodology16 det=
ails
the process used are described approaches to reviewing research. Part E lis=
ts
and describes the process as:
Step 1: Develop systematic Review Questions
Step 2: Develop Systematic Review Strategy
Step 3: Search, Screen, and Select Evidence to Review
Step 4: Abstract Data and Assess Quality and Risk of Bias
Step 5: Describe the Evidence
Step 6: Complete Evidence Portfolios and Draft Scientific Repo=
rt
A set of steps to assess evidence =
is in
CDC’s online tool, Continuum of Evidence of Effectiveness.
· Effect (effectiveness) – effective through practice constitutes risk of harm
· Internal validity – true experimental design through no research and research with results of negative effect
· Types of evidence/research (randomized contr= ol and meta-analysis / systematic review) through anecdotal / Needs assessment= and design with negative effect
· Independent replication – program replication with evaluation through possible replication / evaluation
· Implementation guidance – comprehensive thro= ugh none or partial
· External and ecological validity – two or mo= re studies with different settings through not real world and possible same or different settings
Questions in the assessment includ=
e:
1.&n=
bsp;
Are there any indications from research or
practice that this strategy has been associated with harmful effects?
2.&n=
bsp;
Does the available research on this strate=
gy
include two or more well-conducted studies (Randomized Control Trial=
s or
Quasi-experimental designs)?
3.&n=
bsp;
Have any of these studies shown significant
effects in areas that you are concerned about?
4.&n=
bsp;
Is the study you are reviewing a Randomized
Control Trial?
5.&n=
bsp;
Does the study you are reviewing use a
Quasi-Experimental design?
6.&n=
bsp;
Has the program or strategy been implement=
ed
in more than one setting?
7.&n=
bsp;
Has the program or strategy been evaluated in almost exactly the same
way in both of these settings?
8.&n=
bsp;
Are any of the following formal systems in
place to support implementation of the program or strategy?
9.&n=
bsp;
If formal systems to support implementation
are in place, are these resources available and accessible?
10.&=
nbsp;
Has the program or strategy been implement=
ed
in two or more applied ("real world") settings?
11.&=
nbsp;
Does the strategy include components that =
are
consistent with an applied setting (i.e. uses materials and resources that
would be available/appropriate in an applied setting)?
12.&=
nbsp;
Has the strategy been implemented in ways =
that
mirror conditions of the “real world” (in other words, delivered in ways th=
at
it would have to be delivered in real world settings)?
Click on the image of the ASSESSMENT tool on the next page to go to the web page with the assessm= ent. The Iink is https://vetoviolence.cdc.gov/apps/evidence/continuumIntro.aspx#&= amp;panel1-8.
NOTE: the tool may work best with the Microsoft Edge browser. The tool uses Adobe Fla= sh Player which may need to be installed on your computer if you find the highlighted boxes don’t appear after completing the assessment.
![](3D"anecdotal-evidenceinformed-evidencebasedweb_files/image006.jpg")
![](3D"anecdotal-evidenceinformed-evidencebasedweb_files/image007.png")
You
can click through and answer the questions without having to login, use as a
Guest. Once you complete the assessment several colored (green, brown, purp=
le,
etc.) should be white showing you where your answers mapped to each dimensi=
on.
This will give you an indicator of the strength of evidence informing the
various aspects of the strategy you are considering. Click on the white box=
es
to learn more about your results.
![](3D"anecdotal-evidenceinformed-evidencebasedweb_files/image009.jpg")
Reasons Evidence-Based May Not be =
Used
From
keynote presentation: “Evidence-Based Public Health” for 2018 Nevada Public
Health Association conference.17
·
Formal training - <50% of public health
workers
·
No single credential or license required –=
but
voluntary credentialing as Certified in Public Health, Certified Health
Education Specialist, Master Certified Health Education Specialist
·
Evidence-based practice needs multidiscipl=
inary
approach and needs multiple perspectives
·
Interventions are based on: 1) political a=
nd
media pressure, 2) anecdotal evidence, 3) “the way it’s always been done
·
Barriers are: 1) lack of funds, skilled
personnel, incentives, time; 2) limited buy-in from leadership and elected
officials
From Pathways to
“Evidence-Informed” Policy and Practice: A Framework for Action=
7
“ . . . hindered by a lack of good-quality, synthesized evidence,
capacity to apply the evidence, and organizational support and resources to
make evidence-based decisions.”
A Visual Description of Evidence: =
the Hierarchy
of Evidence18
The
hierarchy of evidence reflects the relative authority of the literature. Re=
lative
authority can be depicted in a pyramid format where the base of the pyramid
includes research with the lowest quality of evidence (anecdotal) and the t=
op
of the pyramid with the highest quality of evidence ( systematic review, me=
ta-analyses
and random control trials). Quality of evidence refers to the range of bias=
and
opportunity for research to have systematic errors. For example, anecdotal =
or
opinions and editorials can have a significant level of bias based on the
author and their experience. On the other hand, randomized controlled trial=
s or
systematic reviews control for bias through prescribed study designs and
represent the highest level of evidence.
![](3D"anecdotal-evidenceinformed-evidencebasedweb_files/image011.jpg")
Summary
Rimer, Glanz and Rasband4, and the
National Commission for Health Education Credentialing3 state that it is
important for health educators and health promotion professionals to use
evidence-based practices. There is a range of evidence to use for selecting
and/or designing strategies/interventions and policies. Likely least effect=
ive and
could harm and waste resources are interventions based on personal experien=
ces,
tradition, intuition, doing what is thought to be good, and lack of resourc=
es.
Evidence-informed findings can provide support for interventions that could
improve, maintain or slow decline in health. Application of evidence-inform=
ed findings
may leave room for experience, and constructive and imaginative judgements.=
Interventions
and policies from the process of asking research questions, using a systema=
tic
literature review strategy, assessing quality of data, describing the evide=
nce
and applying the evidence is the basis of evidence-based practices.
Thought / Critical Thinking Questi=
ons
Think of a group, committee, organization or health
education/promotion team you might or do work with. Describe the group purp=
ose,
members’ knowledge and experience, and your role (e.g., leader, topic exper=
t,
member).
For the group, team organization y=
ou
described in the previous question and considering your role, how would you=
explain
anecdotal, evidence-informed and evidence-based? How do you or might you in=
fluence
the members t use evidence-based practices and
findings for interventions, strategies, programs and policies.? Explain how=
do
you or would you influence the members to use evidence-based practices and
findings for strategies, programs and policies?
Glossary of Terms*
Anecdo=
tal - evidence in the form of stories=
that
people tell about what has happened to them.
Case-control study - A=
type
of epidemiologic study design in which participants are selected based on t=
he
presence or absence of a specific outcome of interest, such as cancer or
diabetes. The participant's past physical activity practices are assessed, =
and
the association between past physical activity and presence of the outcome =
is
determined.
Cross-sectional study
Intervention - A=
ny
kind of planned activity or group of activities (including programs, polici=
es,
and laws) designed to prevent disease or injury or promote health in a grou=
p of
people, about which a single summary conclusion can be drawn.
Observational study - A=
study
in which outcomes are measured but no attempt is made to change the outcome.
The two most commonly used designs for observational studies are case-contr=
ol
studies and prospective cohort studies.
Prospective cohort study - A=
type
of epidemiologic study in which the practices of the enrolled subjects are =
determined,
and the subjects are followed (or observed) for the development of selected
outcomes. It differs from randomized controlled trials in that the exposure=
is
not assigned by the researchers.
Retrospective study - A=
study
in which the outcomes have occurred before the study data collection has be=
gun.
Fideli=
ty - Fidelity is the degree to which a program, practice,=
or
policy is conducted in the way that it was intended to be conducted. This is
particularly important during replication, where fidelity is the extent to
which a program, practice, or policy being conducted in a new setting mirro=
rs
the way it was conducted in its original setting.
Meta-a=
nalysis - A review of a focused question that follows rigorous
methodological criteria and uses statistical techniques to combine data from
studies on that question.
Quasi-=
experimental - Experiments based on sound theory, and typically have comparis=
on
groups (but no random assignment of participants to condition), and/=
or
multiple measurement points (e.g., pre-post measures, longitudinal design).=
Random
Control Trial (RCT) –
From Physical Activity Guidelines for Americans: A ty=
pe of
study design in which participants are randomly grouped on the basis of an
investigator-assigned exposure of interest, such as physical activity. For
example, among a group of eligible participants, investigators may randomly
assign them to exercise at three levels: no activity, moderate-intensity
activity, and vigorous-intensity activity. The participants are then follow=
ed
over time to assess the outcome of interest, such as change in abdominal fa=
t.
From
Understanding Evidence: A trial in which participants are assigned to
control or experimental (receive strategy) groups at random, meaning that a=
ll
members of the sample must have an equal chance of being sele=
cted
for either the control or experimental groups (i.e..
Flipping a coin, where “heads” means participants are assigned to the contr=
ol
group and “tails” means they are assigned to the experimental group). This =
way,
it can be assumed that the two groups are equivalent and there are no
systematic differences between them, which increases the likelihood that any
differences in outcomes are due to the program, practice, or policy and not
some other variable(s) that the groups differ on.
System=
atic
Review -
From Physical Activity Guidelines for Americans: A review of a clearly defined question that uses systematic and
explicit methods to identify, select, and critically evaluate relevant
research, and to collect and analyze data from the studies includedin
the review.
From=
CDC’s
Understanding Evidence: The assembly, critical appraisal, and
synthesis of all relevant studies of a specific program, practice, or polic=
y in
order to assess its overall effectiveness, feasibility, and “best practices=
” in
its implementation.
* Most definitions are from the Physical A=
ctivity
Guidelines for Americans (2nd edition) are available in the Scientific Report, Appendix H-1. Glossar=
y of
Term [PDF – 874 KB] https://health.gov/paguidelines/second-edition/report/pdf/19_H=
_Appendix_1_Glossary_of_Terms.pdf.
CDC’s Understanding Evidence defin=
itions
in its “Resources” web page https://vetoviolence.cdc.gov/apps/evidence/resourcesIntro.aspx=
#&panel1-7. Scroll down to the box “GLOSSARY.”=
References and Resources
1. Office of Disease Prevention and Health
Promotion (2018). Physical activity guidelines for Americans (2nd
edition). https://health.gov/paguidelines/. Accessed on April 15, 2019.
2. He= alth Education Partners (2019). The evidence-based physical activity guidelines = for Americans. www.health= edpartners.org/ceu/ebpag . Accessed on April 20, 2019.
3. National Commission for Health Education
Credentialing, Inc. (2015). Responsibilities and competencies for health ed=
ucation,
=
https://www.nchec.org/responsibilities-and-competencies. Areas
of Responsibility, Competencies and Sub-competencies for Health Education
Specialists 2015.<=
/span> Accessed on April 15, 2019.
4 National Board of Public Health Examiners
(2019). CPH content outline. https://www.nbphe.org/cph-cont=
ent-outline. Accessed on May 8, 2019.
5 4. Rimer, B, DrPH.
Health Educat=
ion
& Behavior: pp. 231-248=
. , First
Published Apr 1, 2001. https://journals.sagepub.com/doi/pdf/10.1177/109019810102800208
Accessed on April 18,
2015.
6 5.=
Troiano,
R. PhD. PA Guidelines (1st edition), Advisory Committee member
(2008). The 2008 physical activit=
y guidelines
for Americans: development and dissemination of new federal evidence-inform=
ed recommendation.
George Washington University, December 9, 2008 GWU Grand Rounds
presentation
Original and Current links for the mp3 aud=
io
and transcript
![](3D"anecdotal-evidenceinformed-evidencebasedweb_files/image013.png")
www.=
kaisernetwork.org/health_cast/hcast_index.cfm?display=3Ddetail&hc=3D308=
4
kais=
ernetwork.org/health_cast/uploaded_files/120908_gwu_troiana_transcript.pdf<=
/span>
- www.kaisernetwork.org no longer available –
Audio: www.=
healthedpartners.org/ceu/pag2nd/ei-eb/pag01_02_troiano_audio.mp3=
Original Transcript: www.healthedpartners.org/ceu/pag2nd/ei-eb/=
pag01_02_troiano_transcript.pdf
PowerPoint: www.=
healthedpartners.org/ceu/pag2nd/ei-eb/pag01_02_troiano_powerpoint.pdf
Transcript with the audio’s times of
corresponding slides: www.=
healthedpartners.org/ceu/pag2nd/ei-eb/pag01_02_troiano_transcript_with
slide times.pdf
7. U=
.S.
Department of Health and Human Services, Office of the Assistant Secretary =
for
Planning and Evaluation, Office of Human Services Policy (2013). Best inten=
tions
are not enough: techniques for using research and data to develop preventio=
n programs.
=
http=
s://aspe.hhs.gov/system/files/pdf/139251/rb_bestintention.pdf
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idence-based
and evidence-informediInterventions 11. =
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I., Slonim-Nevo, Vered. The myth of evidence-based practice: towards eviden=
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https://acl.gov/programs/health-wellness/disease-prevention#fu=
ture. Accessed on April 17, 2019
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Office
of Disease Prevention and Health Promotion. Physical Activity Guidelines for
Americans (2nd edition (2018), Scientific report, part e. system=
atic
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s://health.gov/paguidelines/second-edition/report/pdf/06_E_Systematic_Revie=
w_Literature_Search_Methodology.pdf. Ac=
cessed
on April 15, 2019.
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15. =
Office
of Disease Prevention and Health Promotion. Physical Activity Guidelines for
Americans (2nd edition), Scientific report, part a. executive su=
mmary
(2015). http=
s://health.gov/paguidelines/second-edition/report/pdf/02_A_Executive_Summar=
y.pdf.
16. =
Center
for Disease Control and Prevention. Injury Prevention & and Control:
Division of Violence Prevention. Understanding evidence: continuum of evide=
nce
of effectiveness. http=
s://vetoviolence.cdc.gov/apps/evidence/continuumIntro.aspx#&panel1-8. Ac=
cessed
on April 23, 2019.
17.
Grizzell, J. (2018). Nevada public health association, keynote presentation:
evidence-based public health. www.healthedpartners.org/cocreator=
s/npha. Ac=
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18.
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evidence-based public health. http=
s://nnlm.gov/classes/problem-prevention-evidence-based-public-health=
. Ac=
cessed
on May 2, 2019.
Additi=
onal
Resources
Toolkit on Evidence-Based Programming for Seniors (Community
Research Center for Senior Health)
A comprehensive guide on finding and implementing evidence-bas=
ed
programs in a community setting.
http://www.evidencetoprograms.=
com/
National
Council on Aging Evidence-Based Program Resources
Guides to understanding, implementing, and building a business
case for evidence-based programs.
https://www.ncoa.org/center-for-healthy-aging/basics-of-evidence-based-p=
rograms/
Evidence-Based Leadership Council
This organization represents a small but notable group of
evidence-based programs that are shown to improve older adult health.
Evidence-Based Programs 101 (one=
-page
pdf)
http=
://www.eblcprograms.org/docs/pdfs/EBPs_101.pdf
The Evidence Continuum
http=
s://www.nationalservice.gov/resources/evaluation/evidence-continuum<=
/a>
https://youtu.be/fzF08edFXmc
Experimental Design: Evidence-based Programs
http://www.episcenter.psu.edu/research/experimentaldesign
![3D"Continuum](3D"anecdotal-evidenceinformed-evidencebasedweb_files/image014.png")
The Differences Between CHES® and CPH
https://www.nchec.org/cph-vs-ches<=
/span>