Department of Public Health, Section for Health Services Research, University of Copenhagen, Denmark.
Danish Society of Public Health, Denmark.
Scand J Public Health. 2022 Nov;50(7):1012-1017. doi: 10.1177/14034948221125341.
Traditionally, evidence in public health has been founded in health sciences using the hierarchy of evidence. In this Commentary, we argue that we need a combination of evidence based on a broad range of scientific disciplines and methodologies to best translate research into improved public health.
Using existing concepts of evidence such as the hierarchy of evidence and the evidence typology, we discuss their pitfalls in public health science and suggest a way forward. We use the case of the MAMAACT intervention to exemplify our claims.
Public health does not apply an either/or perspective, but an integrated, theoretically informed approach based on mixed and multiple methods to understand complex health problems and how to tackle them. Ideally, public health decisions should always incorporate scientific evidence, although we need to fully acknowledge that the quality of evidence is defined by more than just being placed highest in the hierarchy of evidence. No method or study design is superior in obtaining evidence, but we need the combined and supplemented contributions from a range of scientific approaches to form a whole. Thus, we propose an integrated, multidisciplinary concept of evidence in the form of cogwheels, where the public health problem followed by the research question(s) will guide the components to be studied and the use of method(s) in an interplay with the decisions of the scientific perspective(s) that include choice of theories.
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传统上，公共卫生领域的证据是基于健康科学和证据层级来建立的。在本述评中，我们认为，我们需要结合基于广泛科学学科和方法的证据，以最佳地将研究转化为改善公共卫生。
我们使用现有的证据概念，如证据层级和证据类型学，讨论其在公共卫生科学中的缺陷，并提出一种前进的方法。我们使用 MAMAACT 干预措施的案例来说明我们的观点。
公共卫生不采用非此即彼的观点，而是采用基于混合和多种方法的综合、理论化的方法，以理解复杂的健康问题及其解决方式。理想情况下，公共卫生决策应始终纳入科学证据，尽管我们需要充分认识到，证据的质量不仅仅取决于在证据层级中处于最高位置。没有哪种方法或研究设计在获取证据方面具有优势，但我们需要结合和补充来自各种科学方法的贡献，形成一个整体。因此，我们提出了一种综合的、多学科的证据概念，以齿轮的形式呈现，公共卫生问题以及随后的研究问题将指导要研究的组件以及方法的使用，与包括理论选择在内的科学观点的决策相互作用。
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