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

01-02-2008 | Editorial

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

Author: Russell E. Glasgow, Ph.D.

Published in: Annals of Behavioral Medicine | Issue 1/2008

Login to get access

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.
Literature
1.
go back to reference 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.
go back to reference 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.
go back to reference Thomas P. Integrating Primary Health Care. Oxford, England: Radcliffe Publishing; 2006. Thomas P. Integrating Primary Health Care. Oxford, England: Radcliffe Publishing; 2006.
4.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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
Metadata
Title
What Types of Evidence are Most Needed to Advance Behavioral Medicine?
Author
Russell E. Glasgow, Ph.D.
Publication date
01-02-2008
Publisher
Springer-Verlag
Published in
Annals of Behavioral Medicine / Issue 1/2008
Print ISSN: 0883-6612
Electronic ISSN: 1532-4796
DOI
https://doi.org/10.1007/s12160-007-9008-5

Other articles of this Issue 1/2008

Annals of Behavioral Medicine 1/2008 Go to the issue