"Admissible Evidence": the nature of evidence in Public Health and Medicine

Article type
Rychetik L
Introduction/Objective: This study explores the understanding and use of the concept of 'evidence' among those involved in teaching medicine or public health at the Faculty of Medicine, University of Sydney, Australia. This research is being carried out within the context of introducing 'evidence-based medicine' into a new four-year graduate medical program and a restructured Masters of Public Health. Formerly discipline-based formats are replaced by integrated and problem-based approaches. Collaboration and understanding between disciplines is crucial, yet 'evidence' can have quite different interpretations, depending on the person, their background, current discipline and the context in which it is used.

Methods: This is a qualitative study using a grounded theory approach. The data collected are in the form of one-to-one in-depth interviews, which are taped, transcribed and organised for analysis using the NUDIST computer program. The aim is to explore meaning and the richness, depth and variety of ideas held by Faculty about evidence. Each participant nominates two others for the next interview (snowball sampling), one who will enrich and build on their ideas and a second who has different views to their own. Other data sources are discourses within the public health and medical literature (articles, editorials and letters to the editor) and discussions on the Internet. Triangulation improves study rigour and sets the findings within a broader historical context.

Results: The 'evidence-based' approach to health care has been called a 'movement', a 'religion' and a new 'paradigm'. These terms have been used both positively, with excitement and vigour, as well as deprecatingly, and with some concern and cynicism. Analysis is in progress. Key themes emerging to date include: criteria for the believability and quality of evidence, utility and application, basic science evidence vs. evidence of outcomes, evidence as 'power', science vs lobbying.

Discussion: This is the first study of its type and is a contribution to (he examination of the concept of a scientific/evidence basis for health services. It challenges notions of 'evidence' and facilitates the exchange of ideas among those of us working towards 'evidence-based' decision making within a multi-disciplinary health care and tertiary education setting.