Glasgow Russell E
Center for Dissemination and Implementation Research, Institute For Health Research, Kaiser Permanente Colorado, Aurora, CO 80237-8066, USA.
Ann Behav Med. 2008 Feb;35(1):19-25. doi: 10.1007/s12160-007-9008-5. Epub 2008 Feb 12.
This editorial presents a perspective on the types of evidence most needed to advance behavioral medicine given the current status of the field.
The paper argues that the types of evidence most needed at present are evidence that is contextual, practical, and robust.
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.
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.
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.
鉴于行为医学领域的现状，本社论就推进该领域发展最需要的证据类型提出了一种观点。
本文认为当前最需要的证据类型是具有情境性、实用性和可靠性的证据。
对上述每个问题进行了讨论，涉及干预措施的特点；在多个层面（环境、临床工作人员和参与者）的代表性；以及研究设计和测量方法。从科学哲学、文献现状和未来方向的角度进行了论证。
当前占主导地位的还原论研究范式主要关注使用高度同质化患者和学术环境的内部效度，这种范式现在不会也无法产生向现实世界实践和政策的理想转化。相反，需要更广泛的“实用”临床和行为试验，这些试验要解决项目实施环境的影响，纳入对决策者和社区重要的结果，并关注调节、中介和经济问题。
为了创建可传播的项目，需要更加关注外部效度和报告的透明度。我们需要认识到世界是复杂的，并接受和研究这种复杂性以取得进一步进展。这样的方法可以产生既严谨又相关的证据。
