Evidence-Based Practice and Business Planning

The Journal of Public Health Management and Practice recently got a compelling letter from Colleen Bridger, the health director of Gaston County NC, about the lack of good public health research that is grounded in real public health practice. Here's the gist of her letter:

My concern is the following: how many times do we locals need to hear from the folks in the academic ivory towers how we are not doing it right, before those folks actually spend some time in our shoes trying to figure out why?

Colleen's concern with the public health research being published is that it is not replicable in the real world-- and researchers aren't helping to figure out why not:

I do not believe it is because local health officials are stubbornly clinging to our tried and true methods, nor do I believe it is because we do not know how to understand or interpret research results. I believe that just like in clinical medicine where there is a vast difference between a drug's efficacy in clinical trials and its actual effectiveness in real-world applications, a parallel exits in real-world public health. Have any academicians tried to implement a best practice obesity prevention intervention in a local community outside the scope of a research project? We cannot exclude participants because they do not meet our selection criteria and we cannot pay them to participate, only cajole. Yes, I understand the need to develop gold standard research studies to identify what works, but we are missing the implementation component.

Obviously, searching for evidence-based interventions is a critical part of any public health business plan. Your communities count on you to do things that are likely to work. Colleen points out that our system throws up barriers though. The gold standard research studies can't be replicated on a budget. The more relevant programs from the practice community can't be evaluated-- or the evaluations can't be published because they aren't up to the standards of academic journals.

And good luck finding the write-ups of the programs that fail.

It is much easier now than it was 10 years ago for managers in public health to do the library work to find the relevant research. With Web 2.0 technologies, it should get easier for managers to find their "community of practice," to communicate with the other people across the country who are doing similar work. Neither of those things addresses Colleen's issue, though. Kellogg's program to fund community-based research scholars is the right approach.

-- Steve Orton