This method has five sections.
Evidence-based public health includes two main areas:
- evidence of the effectiveness of interventions and how evidence can be applied to programs and policies
- defining health risks and risk assessment, where uncertainties in the decision-making process have an impact on risk assessment
There are three basic requirements for addressing uncertainties in risk assessments:
- Systematically identify and evaluate the sources of uncertainties.
- Evaluate their combined effect on the outcome of the assessment.
- Communicate this to decision-makers.
II: How to give evidence-based guidance when evidence is scarce and time is limited?
The risk assessment process consists of:
- Stage 0: Preparatory
- Stage 1: Threat detection/verification
- Stage 2: Assessment of risk
- Stage 3: Developing advice
- Stage 4: Implementation
- Stage 5: Monitoring and evaluation
To see tools for each stage, see Annex 2.
III: The usefulness of EBM grading tools for grading evidence and recommendations for the field of public health
This method assesses tools for grading the quality of evidence and the development of public health guidelines. The report provides brief descriptions of each organization's approach to developing guidelines and making recommendation:
- World Health Organization – Subcommittee on the Use of Research Evidence (SURE)
- GRADE, The Grading of Recommendations Assessment, Development and Evaluation Working Group, provides a framework to move from assessing evidence to making a recommendation. The GRADE approach is being used in different ways by other organizations to appraise evidence for guideline development. To see challenges on applying GRADE in public health settings, see Annex 5 in the appendix.
- The National Institute for Health and Clinical Excellence (NICE)
- The Scottish Intercollegiate Guidelines Network (SIGN) (see Annex 6)
- Centers for Disease Control and Prevention (CDC)
- National Health and Medical Research Council (NHMRC)
- Centre for Evidence Based Medicine (CEBM)
The following tools for appraising evidence are discussed:
- AGREE (Appraisal of Guidelines Research & Evaluation) tool to appraise guidelines (to see a summary statement on AGREE II tool in the Registry, click here)
- CONSORT (Consolidated Standards of Reporting Trial) statement for reporting randomized controlled trials
- TREND (Transparent Reporting of Evaluations with Non-randomized Designs) statement – a checklist to guide reporting of non-randomized controlled trials of public health intervention.
(For more information on appraising evidence on public health interventions, see a module developed by NCCMT - click here)
IV: Assessing and assuring quality to guideline development for health protection and control of communicable diseases
The report provides a description of the AGREE II instrument and its limitations, and discusses its application for communicable disease guidelines. Also, the Guideline Evaluation Tool (GET5), a shorter and adapted version of the AGREE II, is discussed (see Annex 7 and 8 for the GET5 tool).
V: EBM methods for public health—the use of consensus methods
Consensus methods can be used in different ways for public health guidance. For example, when:
- defining the key questions and selecting relevant data sources and type of evidence needed;
- assessing which outcomes are essential when grading evidence and informing the strength of the recommendation;
- translating the summary of evidence into recommendations;
- revising recommendations; and
- endorsing the final recommendations.