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Brownson RC, Mazzucca-Ragan S, Jacob RR, Brownson CA, Hohman KH, Alongi J, Macchi M, Valko C, Eyler AA. Understanding Health Equity in Public Health Practice in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:691-700. [PMID: 37290132 PMCID: PMC10373837 DOI: 10.1097/phh.0000000000001763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CONTEXT Understanding the extent to which equity-focused work is occurring in public health departments (eg, in chronic disease programs) can identify areas of success and what is needed to move the needle on health equity. OBJECTIVE The study objective was to characterize the patterns and correlates of equity-related practices in US state and territorial public health practice. DESIGN The design was a multimethod (quantitative and qualitative), cross-sectional study. SETTING The setting included US state and territorial public health departments. PARTICIPANTS Chronic disease prevention practitioners (N = 600) completed self-report surveys in July 2022 through August 2022 (analyzed in September 2022 through December 2022). MAIN OUTCOME MEASURES Health equity data were obtained across 4 domains: (1) staff skills, (2) work unit practices, (3) organizational priorities and values, and (4) partnerships and networks. RESULTS There was a wide range in self-reported performance across the health equity variables. The highest values (those agreeing and strongly agreeing) were related to staff skills (eg, the ability to describe the causes of inequities [82%]). Low agreement was reported for multiple items, indicating the lack of systems for tracking progress on health equity (32%), the lack of hiring of staff members who represent disadvantaged communities (33%), and limited use of principles for community engagement (eg, sharing decision-making authority with partners [34%]). Qualitative data provided tangible examples showing how practitioners and their agencies are turning an array of health equity concepts into actions. CONCLUSIONS There is urgency in addressing health equity and our data suggest considerable room for enhancing health equity practices in state and territorial public health. To support these activities, our findings provide some of the first information on areas of progress, gaps in practice, and where to target technical assistance, capacity building efforts, and accreditation planning.
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Affiliation(s)
- Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St Louis, St Louis, Missouri (Drs Brownson, Mazzucca-Ragan, and Eyler and Mss Jacob, Brownson, and Valko); Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson) National Association of Chronic Disease Directors, Decatur, Georgia (Drs Hohman and Alongi, and Ms Macchi)
| | - Stephanie Mazzucca-Ragan
- Prevention Research Center, Brown School at Washington University in St Louis, St Louis, Missouri (Drs Brownson, Mazzucca-Ragan, and Eyler and Mss Jacob, Brownson, and Valko); Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson) National Association of Chronic Disease Directors, Decatur, Georgia (Drs Hohman and Alongi, and Ms Macchi)
| | - Rebekah R. Jacob
- Prevention Research Center, Brown School at Washington University in St Louis, St Louis, Missouri (Drs Brownson, Mazzucca-Ragan, and Eyler and Mss Jacob, Brownson, and Valko); Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson) National Association of Chronic Disease Directors, Decatur, Georgia (Drs Hohman and Alongi, and Ms Macchi)
| | - Carol A. Brownson
- Prevention Research Center, Brown School at Washington University in St Louis, St Louis, Missouri (Drs Brownson, Mazzucca-Ragan, and Eyler and Mss Jacob, Brownson, and Valko); Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson) National Association of Chronic Disease Directors, Decatur, Georgia (Drs Hohman and Alongi, and Ms Macchi)
| | - Katherine H. Hohman
- Prevention Research Center, Brown School at Washington University in St Louis, St Louis, Missouri (Drs Brownson, Mazzucca-Ragan, and Eyler and Mss Jacob, Brownson, and Valko); Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson) National Association of Chronic Disease Directors, Decatur, Georgia (Drs Hohman and Alongi, and Ms Macchi)
| | - Jeanne Alongi
- Prevention Research Center, Brown School at Washington University in St Louis, St Louis, Missouri (Drs Brownson, Mazzucca-Ragan, and Eyler and Mss Jacob, Brownson, and Valko); Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson) National Association of Chronic Disease Directors, Decatur, Georgia (Drs Hohman and Alongi, and Ms Macchi)
| | - Marti Macchi
- Prevention Research Center, Brown School at Washington University in St Louis, St Louis, Missouri (Drs Brownson, Mazzucca-Ragan, and Eyler and Mss Jacob, Brownson, and Valko); Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson) National Association of Chronic Disease Directors, Decatur, Georgia (Drs Hohman and Alongi, and Ms Macchi)
| | - Cheryl Valko
- Prevention Research Center, Brown School at Washington University in St Louis, St Louis, Missouri (Drs Brownson, Mazzucca-Ragan, and Eyler and Mss Jacob, Brownson, and Valko); Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson) National Association of Chronic Disease Directors, Decatur, Georgia (Drs Hohman and Alongi, and Ms Macchi)
| | - Amy A. Eyler
- Prevention Research Center, Brown School at Washington University in St Louis, St Louis, Missouri (Drs Brownson, Mazzucca-Ragan, and Eyler and Mss Jacob, Brownson, and Valko); Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson) National Association of Chronic Disease Directors, Decatur, Georgia (Drs Hohman and Alongi, and Ms Macchi)
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Kasman M, Hammond RA, Purcell R, Saliba LF, Mazzucca-Ragan S, Padek M, Allen P, Luke DA, Moreland-Russell S, Erwin PC, Brownson RC. Understanding Misimplementation in U.S. State Health Departments: An Agent-Based Model. Am J Prev Med 2023; 64:525-534. [PMID: 36509634 PMCID: PMC10033358 DOI: 10.1016/j.amepre.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The research goal of this study is to explore why misimplementation occurs in public health agencies and how it can be reduced. Misimplementation is ending effective activities prematurely or continuing ineffective ones, which contributes to wasted resources and suboptimal health outcomes. METHODS The study team created an agent-based model that represents how information flow, filtered through organizational structure, capacity, culture, and leadership priorities, shapes continuation decisions. This agent-based model used survey data and interviews with state health department personnel across the U.S. between 2014 and 2020; model design and analyses were conducted with substantial input from stakeholders between 2019 and 2021. The model was used experimentally to identify potential approaches for reducing misimplementation. RESULTS Simulations showed that increasing either organizational evidence-based decision-making capacity or information sharing could reduce misimplementation. Shifting leadership priorities to emphasize effectiveness resulted in the largest reduction, whereas organizational restructuring did not reduce misimplementation. CONCLUSIONS The model identifies for the first time a specific set of factors and dynamic pathways most likely driving misimplementation and suggests a number of actionable strategies for reducing it. Priorities for training the public health workforce include evidence-based decision making and effective communication. Organizations will also benefit from an intentional shift in leadership decision-making processes. On the basis of this initial, successful application of agent-based model to misimplementation, this work provides a framework for further analyses.
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Affiliation(s)
- Matt Kasman
- Center on Social Dynamics and Policy, The Brookings Institution, Washington, District of Columbia.
| | - Ross A Hammond
- Center on Social Dynamics and Policy, The Brookings Institution, Washington, District of Columbia; Brown School, Washington University in St. Louis, St. Louis, Missouri; Santa Fe Institute, Santa Fe, New Mexico
| | - Rob Purcell
- Center on Social Dynamics and Policy, The Brookings Institution, Washington, District of Columbia
| | - Louise Farah Saliba
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Stephanie Mazzucca-Ragan
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Margaret Padek
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Peg Allen
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Douglas A Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Sarah Moreland-Russell
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Paul C Erwin
- School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Ross C Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri; Public Health Sciences Division, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Duda-Sikuła M, Kurpas D. Barriers and Facilitators in the Implementation of Prevention Strategies for Chronic Disease Patients-Best Practice GuideLines and Policies' Systematic Review. J Pers Med 2023; 13:jpm13020288. [PMID: 36836522 PMCID: PMC9959826 DOI: 10.3390/jpm13020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Visits of chronically ill patients account for 80% of primary care consultations. Approximately 15-38% of patients have three or more chronic diseases, and 30% of hospitalisations result from the deteriorating clinical condition of these patients. The burden of chronic disease and multimorbidity is increasing in combination with the growing population of elderly people. However, many interventions found to be effective in health service studies fail to translate into meaningful patient care outcomes across multiple contexts. With the growing burden of chronic diseases, healthcare providers, health policymakers, and other healthcare system stakeholders are re-examining their strategies and opportunities for more effective prevention and clinical interventions. The study aimed to find the best practice guidelines and policies influencing effective intervention and making it possible to personalize prevention strategies. Apart from clinical treatment, it is essential to increase the effectiveness of non-clinical interventions that could empower chronic patients to increase their involvement in therapy. The review focuses on the best practice guidelines and policies in non-medical interventions and the barriers to and facilitators of their implementation into everyday practice. A systematic review of practice guidelines and policies was conducted to answer the research question. The authors screened databases and included 47 full-text recent studies in the qualitative synthesis.
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Affiliation(s)
- Marta Duda-Sikuła
- Clinical Trial Department, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Correspondence:
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
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Woodruff K, Berglas N, Herold S, Roberts SCM. Disseminating Evidence on Abortion Facilities to Health Departments: A Randomized Study of E-mail Strategies. HEALTH COMMUNICATION 2023; 38:61-70. [PMID: 34061693 DOI: 10.1080/10410236.2021.1932109] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Given the politicization of abortion, professionals working in U.S. health departments (HDs) may not be receptive to communications about abortion, despite often regulating abortion facilities. This paper reports results of a randomized, prospective, observational study to test the effects of e-mail language when disseminating evidence on abortion to HD professionals. Our sample was 302 HD employees who oversee healthcare facilities inspection/regulation in all 50 U.S. state HDs, clustered by HD and randomized into two study groups. In November-December 2019, we sent biweekly e-mails containing links to a website summarizing evidence on abortion facility regulation. E-mails/headers sent to one group emphasized public health values and did not include the word abortion; e-mails/headers to the other group used the word abortion. Primary outcome measures were e-mail open rates and click-through rates. Among 221 participants to whom e-mails were deliverable, the overall open rate was 36%. Open rate was 25% for PH values and 46% for abortion groups (p < .05). Effects were moderated by state abortion policy environment: in both supportive and restrictive environments, participants in the abortion messaging group were statistically more likely to open e-mails than those in the PH values group. There was no difference between groups in states with middle-ground abortion policy environments. Among participants opening at least one e-mail, 19% clicked through to the website, with no significant difference by group. This study demonstrates that repeated targeted e-mail campaigns can reach HD professionals with research summaries. Concerns that communications to HDs should avoid the word abortion are unsupported.
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Affiliation(s)
- Katie Woodruff
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
| | - Nancy Berglas
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
| | - Stephanie Herold
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
| | - Sarah C M Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences; University of California, San Francisco
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Mazzucca S, Jacob RR, Valko CA, Macchi M, Brownson RC. The Relationships Between State Health Department Practitioners' Perceptions of Organizational Supports and Evidence-Based Decision-Making Skills. Public Health Rep 2021; 136:710-718. [PMID: 33593131 PMCID: PMC8579394 DOI: 10.1177/0033354920984159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Evidence-based decision making (EBDM) allows public health practitioners to implement effective programs and policies fitting the preferences of their communities. To engage in EBDM, practitioners must have skills themselves, their agencies must engage in administrative evidence-based practices (A-EBPs), and leaders must encourage the use of EBDM. We conducted this longitudinal study to quantify perceptions of individual EBDM skills and A-EBPs, as well as the longitudinal associations between the 2. METHODS An online survey completed among US state health department practitioners in 2016 and 2018 assessed perceptions of respondents' skills in EBDM and A-EBPs. We used χ2 tests, t tests, and linear regressions to quantify changes over time, differences by demographic characteristics, and longitudinal associations between individual skills and A-EBPs among respondents who completed both surveys (N = 336). RESULTS Means of most individual EBDM skills and A-EBPs did not change significantly from 2016 to 2018. We found significant positive associations between changes in A-EBPs and changes in EBDM skill gaps: for example, a 1-point increase in the relationships and partnerships score was associated with a narrowing of the EBDM skill gap (β estimate = 0.38; 95% CI, 0.15-0.61). At both time points, perceived skills and A-EBPs related to financial practices were low. CONCLUSIONS Findings from this study can guide the development and dissemination of initiatives designed to simultaneously improve individual and organizational capacity for EBDM in public health settings. Future studies should focus on types of strategies most effective to build capacity in particular types of agencies and practitioners, to ultimately improve public health practice.
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Affiliation(s)
- Stephanie Mazzucca
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Rebekah R. Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Cheryl A. Valko
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Marti Macchi
- National Association of Chronic Disease Directors, Atlanta, GA, USA
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine; Washington University in St. Louis, St. Louis, MO, USA
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Mazzucca S, Parks RG, Tabak RG, Allen P, Dobbins M, Stamatakis KA, Brownson RC. Assessing Organizational Supports for Evidence-Based Decision Making in Local Public Health Departments in the United States: Development and Psychometric Properties of a New Measure. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:454-463. [PMID: 31348160 PMCID: PMC6614014 DOI: 10.1097/phh.0000000000000952] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
CONTEXT Fostering evidence-based decision making (EBDM) within local public health departments and among local health department (LHD) practitioners is crucial for the successful translation of research into public health practice to prevent and control chronic disease. OBJECTIVE The purpose of this study was to identify organizational supports for EBDM within LHDs and determine psychometric properties of a measure of organizational supports for EBDM in LHDs. DESIGN Cross-sectional, observation study. SETTING Local public health departments in the United States. PARTICIPANTS Local health department practitioners (N = 376) across the United States participated in the study. MAIN OUTCOME MEASURES Local health department practitioners completed a survey containing 27 items about organizational supports for EBDM. Most items were adapted from previously developed surveys, and input from researchers and practitioners guided survey development. Confirmatory factor analysis was used to test and refine the psychometric properties of the measure. RESULTS The final solution included 6 factors of 22 items: awareness of EBDM (3 items), capacity for EBDM (7 items), resources availability (3 items), evaluation capacity (3 items), EBDM climate cultivation (3 items), and partnerships to support EBDM (3 items). This factor solution achieved acceptable fit (eg, Comparative Fit Index = 0.965). Logistic regression models showed positive relationships between the 6 factors and the number of evidence-based interventions delivered. CONCLUSIONS This study identified important organizational supports for EBDM within LHDs. Results of this study can be used to understand and enhance organizational processes and structures to support EBDM to improve LHD performance and population health. Strong measures are important for understanding how LHDs support EBDM, evaluating interventions to improve LHD capacity, and to guide programmatic and policy efforts within LHDs.
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Affiliation(s)
- Stephanie Mazzucca
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri (Drs Mazzucca, Tabak, Allen, and Brownson and Ms Parks); National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Ontario, Canada (Dr Dobbins); Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, St Louis, Missouri (Dr Stamatakis); and Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson)
| | - Renee G. Parks
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri (Drs Mazzucca, Tabak, Allen, and Brownson and Ms Parks); National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Ontario, Canada (Dr Dobbins); Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, St Louis, Missouri (Dr Stamatakis); and Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson)
| | - Rachel G. Tabak
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri (Drs Mazzucca, Tabak, Allen, and Brownson and Ms Parks); National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Ontario, Canada (Dr Dobbins); Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, St Louis, Missouri (Dr Stamatakis); and Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson)
| | - Peg Allen
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri (Drs Mazzucca, Tabak, Allen, and Brownson and Ms Parks); National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Ontario, Canada (Dr Dobbins); Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, St Louis, Missouri (Dr Stamatakis); and Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson)
| | - Maureen Dobbins
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri (Drs Mazzucca, Tabak, Allen, and Brownson and Ms Parks); National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Ontario, Canada (Dr Dobbins); Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, St Louis, Missouri (Dr Stamatakis); and Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson)
| | - Katherine A. Stamatakis
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri (Drs Mazzucca, Tabak, Allen, and Brownson and Ms Parks); National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Ontario, Canada (Dr Dobbins); Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, St Louis, Missouri (Dr Stamatakis); and Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson)
| | - Ross C. Brownson
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri (Drs Mazzucca, Tabak, Allen, and Brownson and Ms Parks); National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Ontario, Canada (Dr Dobbins); Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, St Louis, Missouri (Dr Stamatakis); and Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Brownson)
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Mazzucca S, Valko CA, Eyler AA, Macchi M, Lau A, Alongi J, Robitscher J, Brownson RC. Practitioner perspectives on building capacity for evidence-based public health in state health departments in the United States: a qualitative case study. Implement Sci Commun 2020; 1:34. [PMID: 32856021 PMCID: PMC7427867 DOI: 10.1186/s43058-020-00003-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/08/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Public health agencies are responsible for implementing effective, evidence-based public health programs and policies to reduce the burden of chronic diseases. Evidence-based public health can be facilitated by modifiable administrative evidence-based practices (A-EBPs) (e.g., workforce development, organizational climate), yet little is known about how practitioners view A-EBPs. Thus, the purpose of this qualitative study was to understand state health department practitioners' perceptions about how A-EBPs are implemented and what facilitators and barriers exist to using A-EBPs. METHODS Chronic disease prevention and health promotion program staff who were members of the National Association of Chronic Disease Directors were recruited to participate in telephone interviews using a snowball sampling technique. Interviews were transcribed verbatim, and transcripts were analyzed using a common codebook and the a priori method in NVivo. RESULTS Twenty seven interviews were conducted with practitioners in four states (5-8 interviews per state). All practitioners felt that their work unit culture is positive and that leadership encouraged and expected staff to use evidence-based processes. Participants discussed the provision of trainings and technical assistance as key to workforce development and how leaders communicate their expectations. Access to evidence, partnerships, and funding restrictions were the most commonly discussed barriers to the use of A-EBPs and EBDM. CONCLUSIONS Results of this study highlight practitioners' perspectives on promoting evidence-based public health in their departments. Findings can inform the development and refinement of resources to improve A-EBP use and organizational and leadership capacity of state health departments.
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Affiliation(s)
- Stephanie Mazzucca
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Cheryl A Valko
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Amy A Eyler
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Marti Macchi
- National Association of Chronic Disease Directors, Decatur, GA, USA
| | | | - Jeanne Alongi
- National Association of Chronic Disease Directors, Decatur, GA, USA
| | - John Robitscher
- National Association of Chronic Disease Directors, Decatur, GA, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Lessons Learned in Promoting Evidence-Based Public Health: Perspectives from Managers in State Public Health Departments. J Community Health 2019; 43:856-863. [PMID: 29500725 PMCID: PMC6119481 DOI: 10.1007/s10900-018-0494-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Evidence-based public health (EBPH) practice, also called evidence-informed public health, can improve population health and reduce disease burden in populations. Organizational structures and processes can facilitate capacity-building for EBPH in public health agencies. This study involved 51 structured interviews with leaders and program managers in 12 state health department chronic disease prevention units to identify factors that facilitate the implementation of EBPH. Verbatim transcripts of the de-identified interviews were consensus coded in NVIVO qualitative software. Content analyses of coded texts were used to identify themes and illustrative quotes. Facilitator themes included leadership support within the chronic disease prevention unit and division, unit processes to enhance information sharing across program areas and recruitment and retention of qualified personnel, training and technical assistance to build skills, and the ability to provide support to external partners. Chronic disease prevention leaders’ role modeling of EBPH processes and expectations for staff to justify proposed plans and approaches were key aspects of leadership support. Leaders protected staff time in order to identify and digest evidence to address the common barrier of lack of time for EBPH. Funding uncertainties or budget cuts, lack of political will for EBPH, and staff turnover remained challenges. In conclusion, leadership support is a key facilitator of EBPH capacity building and practice. Section and division leaders in public health agencies with authority and skills can institute management practices to help staff learn and apply EBPH processes and spread EBPH with partners.
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