Public health and health services research provide communities and decision makers with useful evidence about intervention approaches that are effective, equitable, and economically sound in specific situations and populations. The Community Guide is a collection of evidence-based recommendations and findings from the Community Preventive Services Task Force (CPSTF), an independent, nonpartisan, nonfederal panel of public health and prevention experts. The CPSTF makes recommendations on the effectiveness of systematically reviewed public health programs, services, and policies that aim to address 22 different public health topics, including chronic conditions, infectious diseases, and injuries. It also routinely examines the economic merits of interventions found to be effective, and issues finding statements based on the assessment of not only the overall studies, but the reported economic estimates as well.
The CPSTF has issued recommendations and findings for more than 250 intervention approaches based on rigorous systematic reviews conducted by a team of scientists and subject matter experts in the Community Guide Office of the Centers for Disease Control and Prevention (CDC), CPSTF members and liaisons, and other experts in research, practice, and policy.
This blog describes The Community Guide and demonstrates how the health services research community can use the information for effective, economically sound, health promotion interventions and research agendas.
Guidance Provided on Evidence Generation
The CPSTF, mandated by the Public Health Service Act (Sec. 399U), develops recommendations and findings based on rigorous and replicable systematic review methods. The Community Guide reviews include the following steps:
Step 1: Prioritize Topic Areas and Intervention Approaches
The CPSTF uses a multi-stage process to identify and prioritize review topics every five years. Using the list of prioritized topic areas, the CPSTF approves a portfolio of intervention approaches within a topic area.
Step 2: Conduct Systematic Reviews
Systematic reviews are conducted in accordance with the highest international standards, using a transparent and replicable methodology that accounts for the complexities of real-world public health interventions. Review teams evaluate the strengths and limitations of all relevant, high-quality evidence to assess whether programs, services, and policies are effective in improving health at the population level. The teams also determine whether findings are applicable to different U.S. population groups and settings; highlight possible harms, potential benefits, and implementation considerations; and identify evidence gaps and areas for future research. The CPSTF is then able to make recommendations for the interventions based on these findings.
Examples of these include:
- Tailored pharmacy-based interventions to improve medication adherence for cardiovascular disease prevention.
- Interventions engaging community health workers to increase cancer screening.
- Permanent supportive housing with housing first programs to promote health equity for people who are experiencing homelessness and have a disability.
For all effective interventions, the teams consider the economics of conducting such interventions. They look at costs, economic benefits, cost-effectiveness, and cost benefits of the interventions in order to provide evidence for resource-based decisions and allocation of funds. The quality of reported economic estimates is critically assessed in a systematic way, and the evidence informs the CPSTF finding statements. For example, the economic review of interventions engaging community health workers to increase cancer screening, found that these interventions were cost-effective for both cervical and colorectal cancer screenings, and in the case of colorectal cancer screenings, net cost savings were likely.
Identified evidence gaps in the effectiveness and economic reviews give scientists areas of focus for their research agendas. The CPSTF considerations for implementation may also inform implementation science agendas.
Moving Evidence into Action
Community Guide staff work with CDC programs and CPSTF Liaisons to develop and disseminate materials designed to help target audiences’ use of CPSTF recommendations and findings.
Community Guide in Action stories highlight how decision makers, program planners, employers, and leaders in the U.S. have used CPSTF recommendations and findings to make people safer and healthier. For example, AMIGAS: Promoting Cervical Cancer Screening among Hispanic Women, speaks to the intersection of health care and population health. The story features the successes of the AMIGAS program in Texas and Washington where cervical cancer screenings increased among Hispanic women through the use of community health workers, or promotoras.
The Community Guide offers decision makers, program planners, funders, educators, and researchers access to all of the CPSTF recommendations and findings and the evidence on which they are based. Health services researchers can use The Community Guide as an initial source to identify available evidence on health topics; gain an understanding of the applicable population; determine any economic evidence on health promotion efforts; and use the evidence gaps to frame research questions, and objectives.
Visit www.thecommunityguide.org, to identify evidence gaps and implementation considerations that can guide your research agenda and learn how others have used The Community Guide. Subscribe through the website to get updates on CPSTF recommendations, such as recent evidence on engaging community health workers in cancer screenings, implementation resources, and other news. Consider sharing this national resource with your colleagues, policy-makers, and other decision makers.