A New View on Research

If We Want More Evidence-Based Practice, We Need More Practice-Based Evidence Centering Evidence on Contexts & Processes As Much as on the Intervention Washington University October 21, 2009 Lawrence W. Green Department of Epidemiology & Biostatistics School of Medicine and Comprehensive Cancer Center University of California at San Francisco

The Language of Population Health & the Rules of EvidenceWhat We Know is Needed What RCTs Seek & Test Comprehensive Isolation of independent variable Ecological Randomizable experimental units Upstream determinants Proximal, not distal determinants Multi-sectoral intervention Intervention controlled Participatory Blinded, double-blinded, triple… Adapted to cultures, contexts Standardized Tailored to individuals “Fidelity” to the tested form Professional discretion Protocol controlled Social justice Equality, not equity

The Prevailing Standard of Evidence: The Randomized Controlled Trial Change in Mediating outcome variables Intervention variable(s) expected to tested by measured change, comparison and based on with a control compared previous condition ? between evidence and experimental theory & control groups--Interventions highly standardized. --Comparison based on average--Interventions reduced to simplistic form change for each group--Everything else held constant. --Subgroup analysis discouraged--Clients randomized, no choice. --Dropouts discounted, ignored--Interventionists highly trained, --Cut-off date for outcomes oftenrestrained & supervised; no discretion. too soon for change to occur

Mediating and Moderating Variables Mediator Intervention Outcome or Program Variable(s) Mediator Moderators ModeratorsGreen & Kreuter, Health Program Planning: An Educational and EcologicalApproach. 4th ed. New York: McGraw-Hill, 2005. Green & Glasgow, E&HP, 2006.

A New View on Research

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