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. 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.
Using Mixed Methods
Evidence of program effectiveness can also be supplemented through qualitative methods such as case studies, interviews, focus groups, and expert opinion supporting a programs' effectiveness. These methods also provide a more in depth understanding of the program, how it functions, and why it is (or is not) effective.
