The National Prevention Strategy advocates for the development and implementation of effective, evidence-based health promotion programs.
The Case for Evidence-Based Programs
Evidence-based health promotion programs are founded on the best available research and recommended on the basis of a systematic review of the published, peer reviewed research. A systematic review recommends a health promotion program's implementation based on the quality, quantity, and consistency of the scientific literature supporting the program's effectiveness.
The benefit of implementing evidence-based programs is that one can have greater confidence in their effectiveness because they have been carefully tested. There is a strong demand for health promotion programs to meet the DoD's public health needs and the DoD must be a sound steward and ensure that Service members and their families receive the best available evidence-based health promotion programs with increasingly scarce resources. However, many programs have not yet adequately demonstrated that they are evidence-based. Program owners are not always held accountable for ensuring their programs are based on strong scientific evidence prior to implementation, ensuring their programs are fully evaluated, and for defending their programs' effectiveness to external reviewers, inspectors, auditors, evaluators, and higher-level leadership.
What Constitutes Evidence
Promoting evidence-based practice for health promotion programs begins with providing clear guidance regarding what constitutes evidence of a health promotion program's effectiveness. What follows is an effort to offer the DoD operational guidelines to promote evidence-based practice for health promotion programs based on existing literature in the field of prevention science.
These guidelines can aid health promotion program owners to identify effective health promotion programs for implementation, defend their programs' effectiveness, and identify ways to increase their programs' evidence of effectiveness. The guidelines can also be used along with other criteria (e.g., feasibility, utility, cost effectiveness, and sustainability) as a strategic framework to evaluate existing evidence in support of DoD health promotion programs.
Documenting Evidence
Health promotion program owners can begin to demonstrate the evidence supporting their programs through a written document that clearly articulates the expected relationship between services and intended outcomes (i.e., a logic model). Evidence supporting the programs is strengthened by past evaluations of similar programs that demonstrate a relationship between services and intended outcomes, a manual or protocol for implementation, evidence that the program poses no risk of harm to the target population, and a demonstrated commitment to continuous process improvement and ongoing evaluation.
Using Program Evaluation to Build an Evidence Base
Where a systematic review has not been conducted or there is insufficient existing scientific evidence to conduct a systematic review, program owners can develop their evidence base through program evaluation studies that use well-accepted program evaluation methods, such as through quantitative methodology (e.g., cross-sectional questionnaires, quasi-experimental studies, comparative studies, case-control studies. All studies supporting a health promotion programs' effectiveness should be characterized by systematic and objective inquiry. In addition, confidence in a program's effectiveness is increased by evaluation designs that demonstrate a relationship between program services and actual program outcomes through studies that include an appropriate comparison group, prospective measurement of participation in a program and program outcomes, program outcomes that endure at least one year, and program outcomes that replicate across multiple audiences in multiple settings. Often these relationships are measured through quantitative methodology to document numerical data and statistical significance for key outcomes assessed through the evaluation. Quantitative methods may be used across the types of evaluations (e.g., needs assessments, process evaluation, outcome evaluation) to provide evidence on how a program functions and if it is achieving its intended outcomes.
Using Mixed Methods
Evidence of program effectiveness can also be supplemented or enhanced through qualitative methods such as case studies, interviews, focus groups, and expert opinion supporting a programs' effectiveness. Conducting quantitative and qualitative methods allow for greater insight into the program, how it functions, and why it is (or is not) effective. This may optimize the program by providing data-driven opportunities to improve implementation and achievement of program outcomes.
