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The work leading to this publication arose out of discussion in the leading Australian committee for allocating health related research funds†. The committee considered the difficulties that can arise when established methods for evaluating evidence based medicine are used to evaluate research on public health interventions. When workshops of experts considered these issues they concluded that established methods of evidence appraisal provide a useful starting point for evaluating evidence of all types of health interventions but recommended that the methods should be expanded or adapted to take account of the specific issues in public health.
From this came the development of a draft schema (stage one), resulting in a discussion document in May 2000, based on literature reviews and consultation with senior public health researchers and practitioners. Then came a series of trials (stage two), resulting in the development of the document under review.
The schema covers two stages of appraisal—firstly the appraisal of individual papers or reports to determine whether they provide credible and useful information about an intervention(s) and, secondly, the formulation of conclusions about the value of the available evidence. The process of reviewing published and other literature on public health interventions and of using these findings is seen to involve at least six steps. These are: identifying the purpose of the literature review and formulating the review question(s); finding and collating the studies to be reviewed; appraisal of each article or report; formulation of a statement on the body of evidence; publication of the review findings; and, application of the review findings to policy and practice.
Section 1 of the document deals with setting the scope of any review; section 2 considers the papers in any review; section 3 with describing the results from the papers; section 4 with interpretation of each article; section 5 with summarising the body of evidence. Appendix 1 discusses the hierarchy of study design and the levels of evidence. Appendix 2 has a series of supplementary guides on reviews, random control trials, observation studies, economic evaluation, and qualitative studies. Appendix 3 has a sample table for summarising all the papers reviewed. There is a short list of references, primarily of Australian work.
The critical issue in public health and in injury prevention is that Cochrane style methods of assessing evidence do not work well for population based interventions or in dealing with evidence developed outside the framework of the medical model‡. This leads to certain classes of literature and methods being excluded from the development of an overview of the evidence. This in turn leads to limitations on the interventions that are funded and evaluated, further diminishing the evidence base for the future. The document is seen as a “work in progress” intended to facilitate critical appraisal of evidence and the role of evidence in public health policy and practice. It will be interesting to see the degree to which this process addresses these problems.
↵* The NPHP is a formal Australian structure for officers of the Commonwealth, States, and Territory governments to come together to develop a joint Australian intergovernmental agenda for public health.
The National Public Health Partnership Group (NPHPG) is a subcommittee of the Australian Health Ministers’ Advisory Council (AHMAC). The council’s role is to support the Australian Health Ministers’ Conference (AHMC), by providing strategic advice on health issues and by acting as a forum for planning, information sharing, and innovation.
↵† National Health and Medical Research Council (NHMRC).
↵‡ This formulation of the issue is from Jerry Moller.
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