Obesity prevention: a proposed framework for translating evidence into action
Obesity prevention: a proposed framework for translating evidence into action
复制标题
DOI：
10.1111/j.1467-789x.2005.00184.x
复制
发表时间：
2005-02-01
期刊：
影响因子：
8.9
通讯作者：
Kumanyika, S
中科院分区：
文献类型：
--
作者：
Swinburn, B;Gill, T;Kumanyika, S
肥胖作为一个主要的公共卫生和经济问题已成为许多国家政策和规划议程的首要问题，预防儿童肥胖提供了特别紧迫的行动任务。人们普遍认为，迫切需要采取行动，行动应该是全面和持续的，并且应该以证据为基础。虽然政策和项目资助决策不可避免地受到各种历史、社会和政治影响，但需要一个框架来定义其证据基础。本文描述了与肥胖预防特别相关的基于证据的决策框架的开发。国际肥胖工作组 (IOTF) 预防小组以公共卫生和健康促进领域的现有工作为基础，制定了一系列预防肥胖的关键问题和证据要求。这些内容在 2004 年 4 月的 IOTF 研讨会上进行了介绍和讨论，然后进一步发展为实用框架。该框架由五个关键政策和计划问题定义，构成该框架的基础。它们是：(i) 为针对肥胖问题采取行动提出理由； (ii) 确定影响因素和干预点； (iii) 确定行动机会； (iv) 评估潜在的干预措施； (v) 选择具体政策、计划和行动的组合。每个问题都有一组不同的证据要求和分析输出来支持政策和计划决策。由于相对缺乏功效和效果研究，第 4 个问题被认为是目前最有问题的问题。与临床决策以随机对照试验为主、内部效度较高的证据基础相比，肥胖预防的证据基础需要多种不同类型的证据，并且往往需要利益相关者的知情意见，以确保外部效度和情境相关性。
Obesity as a major public health and economic problem has risen to the top of policy and programme agendas in many countries, with prevention of childhood obesity providing a particularly compelling mandate for action. There is widespread agreement that action is needed urgently, that it should be comprehensive and sustained, and that it should be evidence-based. While policy and programme funding decisions are inevitably subject to a variety of historical, social, and political influences, a framework for defining their evidence base is needed. This paper describes the development of an evidence-based, decision-making framework that is particularly relevant to obesity prevention. Building upon existing work within the fields of public health and health promotion, the Prevention Group of the International Obesity Task Force (IOTF) developed a set of key issues and evidence requirements for obesity prevention. These were presented and discussed at an IOTF workshop in April 2004 and were then further developed into a practical framework. The framework is defined by five key policy and programme issues that form the basis of the framework. These are: (i) building a case for action on obesity; (ii) identifying contributing factors and points of intervention; (iii) defining the opportunities for action; (iv)evaluating potential interventions; and (v) selecting a portfolio of specific policies, programmes, and actions. Each issue has a different set of evidence requirements and analytical outputs to support policy and programme decision-making. Issue 4 was identified as currently the most problematic because of the relative lack of efficacy and effectiveness studies. Compared with clinical decision-making where the evidence base is dominated by randomized controlled trials with high internal validity, the evidence base for obesity prevention needs many different types of evidence and often needs the informed opinions of stakeholders to ensure external validity and contextual relevance.