Evidence-Based Prevention
Access to information is readily available and once we are out of school who wants to research? Well, as a professional you have a responsibility to be knowledgeable about your profession as well as health trends versus evidence-based practices.
Evidence Based Prevention Practices are the top tier standard of care based on the scientific model of care. These practices include a multitude of levels to address the continuity of care and the effectiveness of practices that include the best outcomes. Randomized control trials have been the most promising method of research. Other research methods include clinical observation, qualitative research and process-outcome studies to name a few. Evaluation of the methods and standards to which prevention practices are developed is the key to success in prevention. Are you bored yet?
Effective Evidence-Based Prevention Practices
The purpose of Evidence Based Prevention Practices (EBPP) is to promote effective psychological practice and enhance empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. (APA, 2005, p. 1). Three key components of effective programs include research evidence, clinical expertise, and patient input. Best research evidence according to the APA policy statement is stated as follows, “Best research evidence refers to scientific results related to intervention strategies, assessment, clinical problems, and patient populations in laboratory and field settings as well as to clinically relevant results of basic research in psychology and related fields” (APA, 2005, p. 1).These types of evidence include efficacy, effectiveness, cost-effectiveness, cost–benefit, epidemiological, and treatment utilization (APA Presidential Task Force on Evidence-Based Practice, 2006). Efficacy refers to the positive effects of a program that has been implemented under optimal circumstances. Helping ensure a high-quality program may include all highly qualified and trained professionals. An efficacious program is one that demonstrates benefits to participants under this type of optimal delivery. Effectiveness refers to the beneficial outcomes of a program implemented under more probable circumstances. Most often the ideal circumstance is not as likely. Prevention programs may not have the staffing or resources to fully implement the ideal program. Cost-effectiveness and cost–benefit analyses are concerned with the benefits of a program relative to its cost, including financial costs and other impacts such as side effects.
Did I lose you yet? If you want to be confident in your practice know how to find quality interventions with in your field!
Best Practice Research Design: Randomized Control Trial
Randomized Control Trials (RCTs) have varying efficacy. An effective randomized control trial needs to include a control group, a randomized means of choosing the groups as well as an understanding of the characteristics that impact outcomes either internal or external. An example of an effective randomized control trial includes those such as the trial of the PATH (Psychological Advocacy Toward Healing) intervention delivered by specialist psychological advocates. The trail was open, conducted in "real world" circumstances, and included two parallel groups individually. This control trail was implemented over a year and had a wide variety of participants. The outcomes were favorable for the eight-week intervention (Ferrari et al., 2018). The main objective of RCTs is to assess the average efficacy of an intervention in a group of patients. In clinical practice, RTCs are the foundation for deciding how to treat individuals. However, RCTs were not developed for the purpose of determining individual treatment. RCTs reflect the average results observed in the population, not the individual treatment or prevention methods (Sacristán, 2011).
Evaluate effective research methods used in prevention program research.
Modern research is confronted with the challenge of placing individuals at the focus of the clinical experience. Patient centered care and comparative effectiveness research are two of the most important movements to have arisen in the field of medicine in recent years. As part of reviewing clinical observations as a research technique it is made clear that individual observations play a central role in “personalized clinical research.” In Sacristan’s 2011 article he notes that “Bradford Hill, considered the father of modern RCTs, cautioned that blind faith in experimentation and the loss of credibility of clinical observations would lead to a loss of significant knowledge.” RCTs assist primarily to create a hypothesis, while observations would test the validity of the hypothesis for the individual patient (Sacristán, 2011). Qualitative research for health services has been on the rise. Many practitioners and stakeholders have questions about value of different outcomes based on individuals, additional questions, the acceptability and probability of different interventions and the impacts of these interventions on equity and human rights. Evidence from qualitative research can help address these questions (Lewin & Glenton, 2018). Qualitative research has several advantages. Qualitative methodology recognizes the importance of the views of the participants along with the researchers. Qualitative research offers participants choice over what they want to share, and how they articulate it. In relationship to research, it may be respectful and responsive to participants’ experience to include qualitative research and process-outcome studies. Qualitative research also tends to be more flexible. This allows for research to become more in line with real world practice (Raczynski, Waldo, Schwartz, & Horne, 2013).
This information is important to know for anyone in the health care field, leadership, administration or school.
Helpful resources include:
For Washington State Practitioners HealWa.org provides access to online journals, CINHAL, PubMed, DynaMed, Natural Medicine and multiple continuing education opportunities. This is free for licensed practitioners in Wa state (Well, your license fees cover it).
For a National site the NCSBN is a Nursing Regulatory leader and provides exam and continuing education support.
References
Ferrari, G., Feder, G., Agnew-Davies, R., Bailey, J., Hollinghurst, S., Howard, L., . . . Peters, T. J. (2018). Psychological advocacy towards healing (PATH): A randomized controlled trial of a psychological intervention in a domestic violence service setting. PLoS ONE, (11), e0205485. doi:10.1371/journal.pone.0205485
Lewin, S., & Glenton, C. (2018). Are we entering a new era for qualitative research? using qualitative evidence to support guidance and guideline development by the world health organization. International Journal for Equity in Health, (1) doi:10.1186/s12939-018-0841-
Psychological advocacy towards healing (PATH): A randomized controlled trial of a psychological intervention in a domestic violence service setting. (2018). PLoS ONE, (11), e0205485. doi:10.1371/journal.pone.0205485
Raczynski, K., Waldo, M., Schwartz, J. P., & Horne, A. M. (Eds.). (2013). Evidence-based prevention. Thousand Oaks, California: SAGE Publications. Retrieved from http://sk.sagepub.com/books/evidence-based-prevention
Sacristán, J. A. (2011). Exploratory trials, confirmatory observations: A new reasoning model in the era of patient-centered medicine. BMC Medical Research Methodology, 11(1), 57-62. doi:10.1186/1471-2288-11-57