Lesson 2. Introduction to Evidence-Based Public Health (EBPH) Interventions

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Headshot of Robert (Bob) Lutz, MD, MPH · Public Health course director
Robert (Bob) Lutz
MD, MPH · Public Health course director
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Headshot of Jaime Bowman, MD · Vice Chair, Family Medicine
Jaime Bowman
MD · Vice Chair, Family Medicine
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Headshot of Chaise Zozaya, MPH MBA · Course director
Chaise Zozaya
MPH MBA · Course director
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Table of Contents

Evidence-based public health 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, and 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
Definition
A comprehensive model that guides the planning, implementation, and evaluation of health promotion and other public health programs.
Two main phases
  • 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.
Step 1: Social assessment
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. 
Step 2: Epidemiological assessment
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. 
Step 3: Educational + ecological assessment

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. 
Step 4: Administrative + policy assessment

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. 

Step 5: Implementation

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. 

Step 6: Process evaluation

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?
Step 7: Impact evaluation

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. 

Step 8: Outcome evaluation

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. 

Best used for
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. 

Definition
A framework recognizing that behavior is influenced by multiple levels of factors, not just individual choice.
Levels
Individual:
  • Knowledge
  • Attitudes
  • Skills

Interpersonal:
  • Family
  • Friends
  • Social networks

Organizational:
  • Schools
  • workplaces
  • organizations

Community:
  • Relationships among organizations
  • Cultural norms

Policy/Environment:
  • Local
  • State
  • National laws and policies
Best used for
Designing interventions that address multiple levels of influence, such as obesity, substance use, or violence prevention.
Health belief model
Definition
A psychological model that explains and predicts health behaviors by focusing on attitudes and beliefs of individuals.
Key concept 1

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.”
Key concept 2

Perceived severity
How serious is the condition?

Example
How serious would it be if I did get 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.”
Key concept 3

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/family 
Key concept 4

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.” 
Key concept 5

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 
Key concept 6

Self-efficacy

Confidence in the ability to take action 

Example

Do I feel confident 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. 
Best for

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
Definition
A visual representation that links program resources, activities, outputs, and outcomes. Helps with planning, implementation, and evaluation.
Component 1
Inputs

Resources (staff, money, partners).

Component 2
Activities

What the program does (workshops, campaigns).

Component 3
Outputs

Direct products (e.g., number of sessions held).

Component 4
Outcomes
  • Short-term: Learning or attitude changes.
  • Intermediate: Behavior changes.
  • Long-term: Health status or environmental changes.
Best for
  • 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 
  • Smoking cessation programs
  • Taxation
  • Smoke-free laws 
Primary

Maternal and child health 
Nurse-family partnership home visits
Primary/Secondary

Injury prevention 
  • Helmet laws
  • Seatbelt campaigns 
Primary

Chronic disease 
Diabetes Prevention Programs (DPP)
Primary/Secondary

Infectious disease 
  • Contact tracing
  • Community testing for HIV/TB 
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. 

readings and resources
  1. 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. 
  2. 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. 
  3. 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. 
  4. 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. 

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