Skip to main content
Erschienen in: Annals of Behavioral Medicine 1/2008

01.02.2008 | Editorial

What Types of Evidence are Most Needed to Advance Behavioral Medicine?

verfasst von: Russell E. Glasgow, Ph.D.

Erschienen in: Annals of Behavioral Medicine | Ausgabe 1/2008

Einloggen, um Zugang zu erhalten

Abstract

Background

This editorial presents a perspective on the types of evidence most needed to advance behavioral medicine given the current status of the field.

Purpose

The paper argues that the types of evidence most needed at present are evidence that is contextual, practical, and robust.

Methods

Each of the above issues is discussed with attention to characteristics of interventions; representativeness at the multiple levels of setting, clinical staff, and participants; and research design and measures. Arguments are made from philosophy of science, status of the literature, and future directions perspectives.

Results

The current dominant paradigm of reductionistic studies focused predominantly on internal validity using highly homogenous patients and academic settings is not and will not produce the desired translation to real-world practice and policy. Instead, broader “practical” clinical and behavioral trials are needed that address the influence of the context in which programs are conducted, that include outcomes important to decision makers and communities, and that focus on moderating, mediating, and economic issues.

Conclusions

To create programs that will be disseminable, a greater focus is needed on external validity and transparency of reporting. We need to realize that the world is complex and embrace and study this complexity to produce further progress. Such an approach can produce evidence that is both rigorous and relevant.
Literatur
1.
Zurück zum Zitat Kuhn TS. The Structure of Scientific Revolutions. 2nd ed. Chicago: University of Chicago Press; 1962. Kuhn TS. The Structure of Scientific Revolutions. 2nd ed. Chicago: University of Chicago Press; 1962.
2.
Zurück zum Zitat Biglan A. Changing Cultural Practices: A Contextualist Framework for Intervention Research. Reno, NV: Context Press; 1995. Biglan A. Changing Cultural Practices: A Contextualist Framework for Intervention Research. Reno, NV: Context Press; 1995.
3.
Zurück zum Zitat Thomas P. Integrating Primary Health Care. Oxford, England: Radcliffe Publishing; 2006. Thomas P. Integrating Primary Health Care. Oxford, England: Radcliffe Publishing; 2006.
4.
Zurück zum Zitat Gharajedaghi J. Systems Thinking: Managing Chaos and Complexity. 2nd ed. Boston: Elsevier; 2006. Gharajedaghi J. Systems Thinking: Managing Chaos and Complexity. 2nd ed. Boston: Elsevier; 2006.
5.
Zurück zum Zitat McNulty T, Ferlie E. Reengineering Health Care: The Complexities of Organizational Transformation. Oxford, UK: Oxford University Press; 2002. McNulty T, Ferlie E. Reengineering Health Care: The Complexities of Organizational Transformation. Oxford, UK: Oxford University Press; 2002.
6.
Zurück zum Zitat Shadish WR, Cook TD, Campbell DT. Experimental and Quasi-experimental Design for Generalized Causal Inference. Boston: Houghton Mifflin; 2002. Shadish WR, Cook TD, Campbell DT. Experimental and Quasi-experimental Design for Generalized Causal Inference. Boston: Houghton Mifflin; 2002.
7.
Zurück zum Zitat Glasgow RE, Magid DJ, Beck A, Ritzwoller D, Estabrooks PA. Practical clinical trials for translating research to practice Design and measurement recommendations. Med Care. 2005; 43(6): 551–557.PubMedCrossRef Glasgow RE, Magid DJ, Beck A, Ritzwoller D, Estabrooks PA. Practical clinical trials for translating research to practice Design and measurement recommendations. Med Care. 2005; 43(6): 551–557.PubMedCrossRef
8.
Zurück zum Zitat Tunis SR, Stryer DB, Clancey CM. Practical clinical trials. Increasing the value of clinical research for decision making in clinical and health policy. J Am Med Assoc. 2003; 290: 1624–1632.CrossRef Tunis SR, Stryer DB, Clancey CM. Practical clinical trials. Increasing the value of clinical research for decision making in clinical and health policy. J Am Med Assoc. 2003; 290: 1624–1632.CrossRef
9.
Zurück zum Zitat Glasgow RE, Davidson KW, Dobkin PL, Ockene J, Spring B. Practical behavioral trials to advance evidence-based behavioral medicine. Ann Behav Med. 2006; 31(1): 5–13.PubMedCrossRef Glasgow RE, Davidson KW, Dobkin PL, Ockene J, Spring B. Practical behavioral trials to advance evidence-based behavioral medicine. Ann Behav Med. 2006; 31(1): 5–13.PubMedCrossRef
10.
Zurück zum Zitat Glasgow RE, Emmons KM. How can we increase translation of research into practice? Ann Rev Pub Health. 2007; 28(1): 413–433.CrossRef Glasgow RE, Emmons KM. How can we increase translation of research into practice? Ann Rev Pub Health. 2007; 28(1): 413–433.CrossRef
11.
Zurück zum Zitat Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review: A new method of systematic review designed for complex policy interventions. J Health Serv Res Pol. 2005; 10(S1): S21–S39.CrossRef Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review: A new method of systematic review designed for complex policy interventions. J Health Serv Res Pol. 2005; 10(S1): S21–S39.CrossRef
12.
Zurück zum Zitat Paul GL. Behavior modification research: Design and tactics. In Franks CM, ed. Behavior Therapy: Appraisal and Status. New York: McGraw-Hill; 1969: 29–62. Paul GL. Behavior modification research: Design and tactics. In Franks CM, ed. Behavior Therapy: Appraisal and Status. New York: McGraw-Hill; 1969: 29–62.
13.
Zurück zum Zitat Glass TA, McAtee MJ. Behavioral science at the crossroads in public health: Extending horizons, envisioning the future. Soc Sci Med. 2006; 62(7): 1650–1671.PubMedCrossRef Glass TA, McAtee MJ. Behavioral science at the crossroads in public health: Extending horizons, envisioning the future. Soc Sci Med. 2006; 62(7): 1650–1671.PubMedCrossRef
14.
Zurück zum Zitat Stokols D. Social ecology and behavioral medicine: Implications for training, practice, and policy. Behav Med. 2000; 26: 129–138.PubMedCrossRef Stokols D. Social ecology and behavioral medicine: Implications for training, practice, and policy. Behav Med. 2000; 26: 129–138.PubMedCrossRef
15.
Zurück zum Zitat Cohen J, Cohen P, West SG, Aiken LS. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. 3rd ed. London: Erlbaum; 2003. Cohen J, Cohen P, West SG, Aiken LS. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. 3rd ed. London: Erlbaum; 2003.
16.
Zurück zum Zitat Murray DM. Statistical models appropriate for designs often used in group-randomized trials. Stat Med. 2001;20(9–10): 1373–1385.PubMedCrossRef Murray DM. Statistical models appropriate for designs often used in group-randomized trials. Stat Med. 2001;20(9–10): 1373–1385.PubMedCrossRef
17.
Zurück zum Zitat Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P. Framework for design and evaluation of complex interventions to improve health. B Med J.. 2000; 321: 694–696.CrossRef Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P. Framework for design and evaluation of complex interventions to improve health. B Med J.. 2000; 321: 694–696.CrossRef
18.
Zurück zum Zitat Goodman A. Storytelling as best practice: How stories strengthen your organization, engage your audience, and advance your mission. Andy Goodman; 2003. Goodman A. Storytelling as best practice: How stories strengthen your organization, engage your audience, and advance your mission. Andy Goodman; 2003.
19.
Zurück zum Zitat Klesges LM, Dzewaltowski DA, Glasgow RE. Childhood obesity prevention: Reviewing the translation potential of intervention evidence. Am J Prev Med. 2008; in press. Klesges LM, Dzewaltowski DA, Glasgow RE. Childhood obesity prevention: Reviewing the translation potential of intervention evidence. Am J Prev Med. 2008; in press.
20.
Zurück zum Zitat Oldenburg B, Ffrench BF, Sallis JF. Health behavior research: The quality of the evidence base. Am J Health Promot. 2000; 14(4): 253–257.PubMed Oldenburg B, Ffrench BF, Sallis JF. Health behavior research: The quality of the evidence base. Am J Health Promot. 2000; 14(4): 253–257.PubMed
21.
Zurück zum Zitat Glasgow RE, Klesges LM, Dzewaltowski DA, Bull SS, Estabrooks P. The future of health behavior change research: What is needed to improve translation of research into health promotion practice? Ann Behav Med. 2004; 27(1): 3–12.PubMedCrossRef Glasgow RE, Klesges LM, Dzewaltowski DA, Bull SS, Estabrooks P. The future of health behavior change research: What is needed to improve translation of research into health promotion practice? Ann Behav Med. 2004; 27(1): 3–12.PubMedCrossRef
22.
Zurück zum Zitat Green LW, Glasgow RE. Evaluating the relevance, generalization, and applicability of research: Issues in external validity and translation methodology. Eval Health Prof. 2006; 29(1): 126–153.PubMedCrossRef Green LW, Glasgow RE. Evaluating the relevance, generalization, and applicability of research: Issues in external validity and translation methodology. Eval Health Prof. 2006; 29(1): 126–153.PubMedCrossRef
23.
Zurück zum Zitat Glasgow RE, Green LW, Klesges LM, et al. External validity: We need to do more. Ann Behav Med. 2006; 31(2): 105–108.PubMedCrossRef Glasgow RE, Green LW, Klesges LM, et al. External validity: We need to do more. Ann Behav Med. 2006; 31(2): 105–108.PubMedCrossRef
24.
Zurück zum Zitat Holmes D, Murray S, Perron A, Rail G. Deconstructing the evidence-based discourse in health sciences: Truth, power and fascism. International Journal of Evidence-Based Healthcare. 2006; 4: 180–186.CrossRef Holmes D, Murray S, Perron A, Rail G. Deconstructing the evidence-based discourse in health sciences: Truth, power and fascism. International Journal of Evidence-Based Healthcare. 2006; 4: 180–186.CrossRef
25.
Zurück zum Zitat Mohrer D, Schulz KF, Altman DG, Lepage L. The CONSORT statement: Revised recommendations for improving the quality of reports. JAMA. 2001; 285: 1987–1991.CrossRef Mohrer D, Schulz KF, Altman DG, Lepage L. The CONSORT statement: Revised recommendations for improving the quality of reports. JAMA. 2001; 285: 1987–1991.CrossRef
26.
Zurück zum Zitat Rothwell PM. External validity of randomised controlled trials: To whom do the results of this trial apply? Lancet. 2005; 365: 82–93.PubMedCrossRef Rothwell PM. External validity of randomised controlled trials: To whom do the results of this trial apply? Lancet. 2005; 365: 82–93.PubMedCrossRef
27.
Zurück zum Zitat Glasgow RE, Green LW, Ammerman A. A focus on external validity. Eval Health Prof. 2007; 30(2): 115–117.CrossRef Glasgow RE, Green LW, Ammerman A. A focus on external validity. Eval Health Prof. 2007; 30(2): 115–117.CrossRef
28.
Zurück zum Zitat Castro FG, Barrera M, Jr., Martinez CR, Jr. The cultural adaptation of prevention interventions: Resolving tensions between fidelity and fit. Prev Sci. 2004; 5: 41–45.PubMedCrossRef Castro FG, Barrera M, Jr., Martinez CR, Jr. The cultural adaptation of prevention interventions: Resolving tensions between fidelity and fit. Prev Sci. 2004; 5: 41–45.PubMedCrossRef
29.
Zurück zum Zitat Rotheram-Borus MJ, Flannery D, Duan N. Interventions that are CURRES: Cost-effective, useful, realistic, robust, evolving, and sustainable. In Rehmschmidt H, et al, eds., Facilitating Pathways: Care, Treatment, and Prevention in Child and Adolescent Health. New York: Springer; 2004; 235–244. Rotheram-Borus MJ, Flannery D, Duan N. Interventions that are CURRES: Cost-effective, useful, realistic, robust, evolving, and sustainable. In Rehmschmidt H, et al, eds., Facilitating Pathways: Care, Treatment, and Prevention in Child and Adolescent Health. New York: Springer; 2004; 235–244.
30.
Zurück zum Zitat Goodman RM, McLeroy KR, Steckler A, Hoyle R. Development of level of institutionalization scales for health promotion programs. Health Ed Q. 1993; 20: 161–178. Goodman RM, McLeroy KR, Steckler A, Hoyle R. Development of level of institutionalization scales for health promotion programs. Health Ed Q. 1993; 20: 161–178.
31.
Zurück zum Zitat Kaplan RM. The significance of quality of life in health care. Q Life Res. 2003; 12(Suppl 1): 3–16.CrossRef Kaplan RM. The significance of quality of life in health care. Q Life Res. 2003; 12(Suppl 1): 3–16.CrossRef
32.
Zurück zum Zitat Glasgow RE, Lichtenstein E, Marcus AC. Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy to effectiveness transition. Am J Publ Health. 2003; 93(8): 1261–1267.CrossRef Glasgow RE, Lichtenstein E, Marcus AC. Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy to effectiveness transition. Am J Publ Health. 2003; 93(8): 1261–1267.CrossRef
33.
Zurück zum Zitat Berwick DM. A user’s manual for the IOM’s “Quality Chasm” report: Patients’ experience should be the fundamental source of the definition of “quality”. Health Aff. 2002; 21: 80–90.CrossRef Berwick DM. A user’s manual for the IOM’s “Quality Chasm” report: Patients’ experience should be the fundamental source of the definition of “quality”. Health Aff. 2002; 21: 80–90.CrossRef
34.
Zurück zum Zitat Institute of Medicine, Committee on Quality Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2003. Institute of Medicine, Committee on Quality Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2003.
35.
Zurück zum Zitat McGlynn EA. An evidence-based national quality measurement and reporting system. Med Care. 2003; 41(1 Supp): I8–I15.PubMed McGlynn EA. An evidence-based national quality measurement and reporting system. Med Care. 2003; 41(1 Supp): I8–I15.PubMed
36.
Zurück zum Zitat Bandura A. Self-efficacy: The Exercise of Control. New York: W.H. Freeman; 1997. Bandura A. Self-efficacy: The Exercise of Control. New York: W.H. Freeman; 1997.
37.
Zurück zum Zitat Green LW, Ottosen JM. From efficacy to effectiveness to community and back: Evidence-based practice vs. practice-based evidence. Proceedings from conference: From Clinical Trials to Community: The Science of Translating Diabetes and Obesity Research. National Institutes of Diabetes, Digestive and Kidney Diseases; 2004. Green LW, Ottosen JM. From efficacy to effectiveness to community and back: Evidence-based practice vs. practice-based evidence. Proceedings from conference: From Clinical Trials to Community: The Science of Translating Diabetes and Obesity Research. National Institutes of Diabetes, Digestive and Kidney Diseases; 2004.
38.
Zurück zum Zitat Greenwald P, Cullen JW. The new emphasis in cancer control. J Natl Cancer Inst. 1985; 74(3): 543–551.PubMed Greenwald P, Cullen JW. The new emphasis in cancer control. J Natl Cancer Inst. 1985; 74(3): 543–551.PubMed
39.
Zurück zum Zitat Flay BR. Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Prev Med. 1986; 15: 451–474.PubMedCrossRef Flay BR. Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Prev Med. 1986; 15: 451–474.PubMedCrossRef
40.
Zurück zum Zitat Stevens VJ, Glasgow RE, Hollis JF, Lichtenstein E, Vogt TM. A smoking cessation intervention for hospitalized patients. Med Care. 1993; 31: 65–72.PubMedCrossRef Stevens VJ, Glasgow RE, Hollis JF, Lichtenstein E, Vogt TM. A smoking cessation intervention for hospitalized patients. Med Care. 1993; 31: 65–72.PubMedCrossRef
41.
Zurück zum Zitat Stevens VJ, Glasgow RE, Toobert DJ, Karanja N, Smith KS. One-year results from a brief, computer-assisted intervention to decrease consumption of fat and increase consumption of fruits and vegetables. Prev Med. 2003; 36(5): 594–600.PubMedCrossRef Stevens VJ, Glasgow RE, Toobert DJ, Karanja N, Smith KS. One-year results from a brief, computer-assisted intervention to decrease consumption of fat and increase consumption of fruits and vegetables. Prev Med. 2003; 36(5): 594–600.PubMedCrossRef
42.
Zurück zum Zitat Hallfors D, Cho H, Sanchez V, Khatapoush D, Kim HM, Bauer D. Efficacy vs. effectiveness trial results of an indicated “model” substance abuse program: Implications for public health. Am J Publ Health. 2006; 96(12): 2254–2259.CrossRef Hallfors D, Cho H, Sanchez V, Khatapoush D, Kim HM, Bauer D. Efficacy vs. effectiveness trial results of an indicated “model” substance abuse program: Implications for public health. Am J Publ Health. 2006; 96(12): 2254–2259.CrossRef
43.
Zurück zum Zitat Estabrooks PA, Glasgow RE. Dissemination, knowledge exchange, or knowledge integration: Explaining the gap between medical office-based physical activity intervention research and practice. Am J Pub Health. 2005; 31(4 Suppl): S45–S56. Estabrooks PA, Glasgow RE. Dissemination, knowledge exchange, or knowledge integration: Explaining the gap between medical office-based physical activity intervention research and practice. Am J Pub Health. 2005; 31(4 Suppl): S45–S56.
44.
Zurück zum Zitat Stange KC. One size doesn’t fit all. Multimethod research yields new insights into interventions to increase prevention in family practice. J Fam Pract. 1996; 43(4): 358–360.PubMed Stange KC. One size doesn’t fit all. Multimethod research yields new insights into interventions to increase prevention in family practice. J Fam Pract. 1996; 43(4): 358–360.PubMed
45.
Zurück zum Zitat Curry L, Shield R, Wetle T, eds. Improving Aging and Public Health Research: Qualitative and Mixed Methods. Washington, DC: Public Health Association; 2006. Curry L, Shield R, Wetle T, eds. Improving Aging and Public Health Research: Qualitative and Mixed Methods. Washington, DC: Public Health Association; 2006.
46.
Zurück zum Zitat Sterman J. All models are wrong: Reflections on becoming a systems scientist. Syst Dyn. 2002; 18: 501–531.CrossRef Sterman J. All models are wrong: Reflections on becoming a systems scientist. Syst Dyn. 2002; 18: 501–531.CrossRef
Metadaten
Titel
What Types of Evidence are Most Needed to Advance Behavioral Medicine?
verfasst von
Russell E. Glasgow, Ph.D.
Publikationsdatum
01.02.2008
Verlag
Springer-Verlag
Erschienen in
Annals of Behavioral Medicine / Ausgabe 1/2008
Print ISSN: 0883-6612
Elektronische ISSN: 1532-4796
DOI
https://doi.org/10.1007/s12160-007-9008-5

Weitere Artikel der Ausgabe 1/2008

Annals of Behavioral Medicine 1/2008 Zur Ausgabe

Neu in den Fachgebieten Neurologie und Psychiatrie

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.