Evidence-based public health (EBPH) practice is a systematic process of using the best available evidence to make decisions about public health interventions and policies. Evidence-based approaches in public health disease prevention involve using the best available research and data to inform decisions about interventions and policies, aiming to improve population health and reduce disease burden.
Key elements include:
- Engaging communities.
- Using data systematically.
- Making decisions based on evidence.
- Applying program planning frameworks.
- Conducting sound evaluations.
- Disseminating findings.
Key elements of EBPH
Engaging the community
Public health solutions must be responsive to the people they aim to serve.
Community-based participatory research (CBPR), focus groups, stakeholder interviews, town halls.
Using data and information systems
- Identify health trends.
- Target interventions.
- Measure impact.
- CDC WONDER.
- BRFSS.
- NHANES.
- Electronic health records.
- GIS mapping.
Making decisions based on evidence
Use high-quality research (RCTs, systematic reviews, epidemiological studies) and local context to guide action.
- Quantitative (data sets, trials).
- Qualitative (interviews, lived experience).
Applying common program planning frameworks
PRECEDE–PROCEED Model
A comprehensive model that guides the planning, implementation, and evaluation of health promotion and other public health programs.
- PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation): Focuses on planning by identifying desired outcomes and working backward to determine strategies.
- PROCEED (Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development): Focuses on implementation and evaluation of interventions.
Understand community needs and quality of life.
- Gather information on:
- Community perceptions.
- Social indicators (education, employment, housing, crime, etc.)
- Life satisfaction and priorities.
- Methods:
- Focus groups.
- Community forums.
- Surveys.
- Interviews.
- Example: Residents report that neighborhood safety and access to fresh food are major concerns affecting their wellbeing.
Identify health issues and determinants.
- Use data to define:
- Health problems (e.g., diabetes, obesity, injuries).
- Behavioral causes (e.g., poor diet, lack of exercise).
- Environmental causes (e.g., no parks, fast food density).
- Data sources:
- CDC data.
- Local health departments.
- Hospital records.
- Example: Obesity rates in the area are 20% higher than the national average, largely due to low physical activity and poor diet.
Identify factors influencing behaviors and environment.
Focus on
- Predisposing factors:
- Knowledge.
- Attitudes.
- Beliefs.
- Values.
- Reinforcing factors:
- Social support.
- Peer influence.
- Feedback.
- Enabling factors:
- Resources.
- Accessibility. skills.
- Laws.
Example
- Predisposing: People believe healthy food is too expensive.
- Reinforcing: Families encourage eating fast food.
- Enabling: Few grocery stores, no safe walking paths.
Identify the resources, policies, and barriers needed to implement the intervention.
Assess
-
- Organizational capacity.
- Funding availability.
- Staff readiness.
- Existing policies or political support.
Example
The city has a grant for nutrition education, but local schools lack staff to implement it without additional training.
Deliver the program based on your planning.
Develop
- Timeline.
- Activities (e.g., cooking classes, park development).
- Staff roles.
- Communication plans.
Example
Launch a community-based program that includes weekly cooking classes, fitness clubs, and a media campaign promoting healthy lifestyles.
Assess whether the program is being implemented as planned.
Monitor
- Participation rates.
- Program fidelity.
- Staff performance.
- Budget use.
Example
- Did all the cooking classes happen as scheduled?
- Did materials get distributed on time?
Measure the immediate effects of the program on participants.
Look for changes in
- Knowledge.
- Attitudes.
- Behaviors.
- Environmental conditions.
Example
After 3 months, participants eat more vegetables and exercise more regularly.
Measure the long-term outcomes related to the original health goals.
Assess changes in
- Disease incidence.
- Health-related quality of life.
- Community-level health indicators.
Example
After 2 years, obesity rates have dropped by 10%, and more residents report improved well-being and access to healthy food.
Comprehensive program planning, especially when community engagement is important.
| Step | Focus | Key question |
|---|---|---|
|
Social assessment |
Community needs and quality of life
|
What matters to this community?
|
|
Epidemiological assessment |
Health issues and causes |
What are the main health problems and why? |
|
Educational and Ecological |
Behavioral influences |
What drives these behaviors? |
|
Administrative and policy |
Resources and readiness |
What supports or limits program delivery? |
|
Implementation |
Program launch |
Are we delivering what we planned? |
|
Process evaluation |
Program delivery |
Is the program running correctly? |
|
Impact evaluation |
Short-term effects |
Are we changing behaviors/attitudes? |
|
Outcome evaluation |
Long-term results |
Is population health improving? |
Social ecological model
A framework recognizing that behavior is influenced by multiple levels of factors, not just individual choice.
A framework recognizing that behavior is influenced by multiple levels of factors, not just individual choice.
- Knowledge.
- Attitudes.
- Skills.
- Family.
- Friends.
- Social networks.
- Schools.
- Workplaces.
- Organizations.
- Relationships among organizations.
- Cultural norms.
- Local.
- State.
- National laws and policies.
Designing interventions that address multiple levels of influence, such as obesity, substance use, or violence prevention.
Health belief model
A psychological model that explains and predicts health behaviors by focusing on attitudes and beliefs of individuals.
Perceived susceptibility
How likely am I to get the condition?
Example
How likely am I to get the flu?
Insight
Many college students believe they’re young and healthy, so flu isn’t a threat.
Strategy
- Use personal stories: “Even healthy young adults get the flu.”
- Data: “1 in 4 college students get the flu each year.”
Perceived severity
How serious is the condition?
Example
How serious would it be if I got the flu?
Insight
Students often think the flu is just a mild cold.
Strategy
- Infographics showing:
- Missed classes.
- Days in bed.
- ER visits.
- Peer testimonials:
- “I missed finals because of the flu.”
Perceived Benefits
Will the action reduce my risk?
Example
Will getting the flu vaccine actually help?
Insight
Some students are unsure if the vaccine works.
Strategy
- Promote clear messaging:
- “The flu vaccine reduces risk by up to 60%.”
- Highlight benefits:
- Staying healthy during exams.
- Protecting friends and family.
Perceived barriers
What’s stopping me?
Example
What’s stopping me from getting the flu vaccine?
Common barriers
- Time.
- Cost.
- Fear of needles.
- Misinformation.
Strategy
- Convenience: Pop-up clinics in dorms and student centers
- Free shots with student ID
- Reframe fear: “It takes 2 seconds—less than a TikTok video.”
Cues to action
What triggers the behavior (e.g., reminder, media)?
Example
What will trigger me to act now?
Strategy
- Text/email reminders: “Flu shots today at the library 11am to 3pm!”
- Posters, flyers, social media by trusted campus influencers.
- Professors reminding students at the end of class.
Self-efficacy
Confidence in the ability to take action.
Example
Do I feel confident that I can do this?
Insight
Students might not know where or how to get vaccinated.
Strategy
- Step-by-step guide: “How to get your flu shot on campus.”
- Videos showing peers going through the process.
- Clear signage and directions at vaccine clinics.
Programs focused on behavior change, like vaccination uptake, screening, or smoking cessation.
From the example, by addressing each aspect of the Health Belief Model, the program increases the likelihood that students will choose to get vaccinated. It does this by shifting their beliefs, lowering obstacles, and supporting behavior change.
Logic models
A visual representation that links program resources, activities, outputs, and outcomes. Helps with planning, implementation, and evaluation.
Inputs
Resources (staff, money, partners).
Activities
What the program does (workshops, campaigns).
Outputs
Direct products (e.g., number of sessions held).
Outcomes
- Short-term: Learning or attitude changes.
- Intermediate: Behavior changes.
- Long-term: Health status or environmental changes.
- Clarifying program goals and logic.
- Aligning resources with outcomes.
- Developing evaluation strategies.
| Framework | Focus | Strength |
|---|---|---|
|
PRECEDE–PROCEED |
Planning + evaluation
|
Comprehensive, community-focused
|
|
Social ecological model |
Multilevel influences on behavior |
Useful for complex, layered issues |
|
Health belief model |
Individual behavior change |
Good for tailored messaging |
|
Logic model |
Planning + evaluation |
Clear visualization of program pathways |
goal
Guide design, implementation, and evaluation of interventions.
Conducting sound evaluation
- Process.
- Impact.
- Outcome evaluations.
- Identify what works.
- What doesn’t.
- How to improve.
Disseminating what is learned
- Publish findings.
- Policy briefs.
- Community reports.
- Webinars.
- Spread successful interventions.
- Promote replication and scaling.
Application areas
Examples of evidence-based interventions
| Area | Intervention | Prevention level |
|---|---|---|
|
Immunization |
School-entry vaccine mandates
|
Primary
|
|
Tobacco control |
|
Primary |
|
Maternal and child health |
Nurse-family partnership home visits |
Primary/Secondary |
|
Injury prevention |
|
Primary |
|
Chronic disease |
Diabetes Prevention Programs (DPP) |
Primary/Secondary |
|
Infectious disease |
|
Secondary |
EBPH ensures public health actions are effective, efficient, and equitable. By following a structured approach—community engagement, evidence use, planning, evaluation, and dissemination—public health professionals can address complex challenges like chronic disease, health inequities, and infectious threats.
- Practitioner perspectives on building capacity for evidence-based public health in state health departments in the United States. Implementation Science Communications (2020). Discusses how to adapt and scale interventions in real-world contexts.
- Tools for Implementing an Evidence-Based Approach in Public Health Practice. CDC PCD: Frieden (2012). Introduces the Health Impact Pyramid for prioritizing public health actions.
- Lessons learned in promoting evidence-based public health: Perspectives from managers in state public health departments. Brownson et al. (2018). Reviews competencies needed for EBPH.
- Evidence-Based Public Health: A Fundamental Concept for Public Health Practice. Annual Review of Public Health (2009). Offers an in-depth foundation on EBPH concepts.