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Kaufman CE, Keane EM, Shangreau C, Arthur-Asmah R, Morse B, Whitesell NR. Dissemination and uptake of HIV/STD preventive interventions in American Indian and Alaska Native communities: a case study. ETHNICITY & HEALTH 2021; 26:352-363. [PMID: 30146899 DOI: 10.1080/13557858.2018.1514456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/23/2018] [Indexed: 06/08/2023]
Abstract
Objectives: HIV and sexually transmitted diseases (STDs) are serious health conditions among American Indian and Alaska Native (AIAN) populations, especially youth. However, few sexual risk reduction evidence-based interventions (EBIs) have been implemented by AIAN-serving organizations. This project sought to identify and assess the parameters facilitating the uptake and use of EBIs in order to strengthen opportunities for sustainability and improved sexual health among AIANs.Design: Guided by Rogers' theory of diffusion of innovation, we conducted a survey with a national sample of stakeholders involved with sexual health and well-being of AIAN youth (N = 142). We collected surveys for nine months beginning September 2010 and analyzed data in 2014 and 2015. We assessed respondents' perceptions of factors that might facilitate or hinder the use of a sexual risk reduction EBI, called RESPECT, in their communities. We regressed the scale of likely program uptake (alpha = 0.88) on each of five measures of perception of diffusion and uptake: trialability (extent new program can be altered), relative advantage (more advantageous than current program), observability (impact of program), complexity (difficulty of implementation), and compatibility (consistent with community values and practices).Results: Trialability (p = .009), observability (p = .003), and compatibility (p = .005) were found to be significantly related to program uptake in the adjusted model. Standardized betas showed that compatibility ranked highest of the three, followed by trialability and observability.Conclusions: For AIAN-serving organizations and AIAN communities, demonstrating trialability, compatibility, and observability of a sexual risk reduction EBI in specific cultural settings may increase likelihood of implementation and sustainability.
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Affiliation(s)
- Carol E Kaufman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health - Anschutz Medical Campus, Aurora, CO, USA
| | - Ellen M Keane
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health - Anschutz Medical Campus, Aurora, CO, USA
| | - Carly Shangreau
- Great Plains Tribal Epidemiology Center, Great Plains Tribal Chairmen's Health Board, Rapid City, SD, USA
| | - Ruth Arthur-Asmah
- Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Bradley Morse
- The Butler Institute, University of Denver, Denver, CO, USA
| | - Nancy R Whitesell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health - Anschutz Medical Campus, Aurora, CO, USA
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Rodriguez Weno E, Mazzucca S, Parks RG, Padek M, Allen P, Brownson RC. Use and Awareness of The Community Guide in State and Local Health Department Chronic Disease Programs. Prev Chronic Dis 2020; 17:E133. [PMID: 33092684 PMCID: PMC7587308 DOI: 10.5888/pcd17.200196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The Community Guide (Guide) is a user-friendly, systematic review system that provides information on evidence-based interventions (EBIs) in public health practice. Little is known about what predicts Guide awareness and use in state health departments (SHDs) and local health departments (LHDs). METHODS We pooled data from 3 surveys (administered in 2016, 2017, and 2018) to employees in chronic disease programs at SHDs and LHDs. Participants (n = 1,039) represented all 50 states. The surveys asked about department practices and individual, organizational, and external factors related to decisions about EBIs. We used χ2 tests of independence for analyses. RESULTS Eighty-one percent (n = 498) of SHD and 54% (n = 198) of LHD respondents reported their agency uses the Guide. Additionally, 13% of SHD participants reported not being aware of the Guide. Significant relationships were found between reporting using the Guide and academic collaboration, population size, rated importance of forming partnerships, and accreditation. CONCLUSION Awareness and use of the Guide in LHD and SHD chronic disease programs is widespread. Awareness of the Guide can be vital to implementation practice, because it enhances implementation of EBI practices. However, awareness of the Guide alone is likely not enough for health departments to implement EBIs. Changes at the organizational level, including sharing information about the Guide and providing training on how to best use it, may increase its awareness and use.
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Affiliation(s)
- Emily Rodriguez Weno
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr, Campus Box 1196, St. Louis, MO 63130.
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Renee G Parks
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Margaret Padek
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Peg Allen
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
- Department of Surgery, Division of Public Health Sciences, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
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Allen P, Mazzucca S, Parks RG, Robinson M, Tabak RG, Brownson R. Local Health Department Accreditation Is Associated With Organizational Supports for Evidence-Based Decision Making. Front Public Health 2020; 7:374. [PMID: 31921739 PMCID: PMC6928116 DOI: 10.3389/fpubh.2019.00374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/22/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction: Recent studies show that health department accreditation from the U.S. Public Health Accreditation Board (PHAB) drives performance management and quality improvement. PHAB standards call for agencies to use evidence in decision making. It is unknown whether accreditation is associated with organizational supports for evidence-based decision making (EBDM). Self-report data from a 2017 survey of U.S. local health departments were analyzed to test relationships of accreditation status with organizational supports for EBDM. Methods: A cross-sectional survey was conducted in this observational study. A total of 579 local health departments were invited to complete an online survey; 350 (60.4%) provided complete data for the present study. The dependent variables were six factors of organizational supports for EBDM previously validated through confirmatory factor analyses. Accreditation status (PHAB-accredited, preparing, not preparing) was the independent variable of interest. Logistic regression analyses controlled for governance (presence of a local board of health; state, local, or shared state and local governance) and jurisdiction population size. Results: PHAB-accredited health departments were more likely to report higher capacity for EBDM, resource availability for EBDM, and evaluation capacity than health departments that reported not yet preparing for accreditation. Health departments that reported preparing for PHAB accreditation showed a non-significant pattern of higher perceived supports for EBDM compared to departments not preparing for accreditation. Conclusion: PHAB standards and the accreditation process may help stimulate health department organizational supports for EBDM.
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Affiliation(s)
- Peg Allen
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Renee G Parks
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Mackenzie Robinson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Rachel G Tabak
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Ross Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States.,Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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Erwin PC, Parks RG, Mazzucca S, Allen P, Baker EA, Hu H, Davis-Joyce J, Brownson RC. Evidence-Based Public Health Provided Through Local Health Departments: Importance of Academic-Practice Partnerships. Am J Public Health 2019; 109:739-747. [PMID: 30896995 PMCID: PMC6459662 DOI: 10.2105/ajph.2019.304958] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the extent to which US local health departments (LHDs) are engaged in evidence-based public health and whether this is influenced by the presence of an academic health department (AHD) partnership. METHODS We surveyed a cross-sectional stratified random sample of 579 LHDs in 2017. We ascertained the extent of support for evidence-based decision-making and the use of evidence-based interventions in several chronic disease programs and whether the LHD participated in a formal, informal, or no AHD partnership. RESULTS We received 376 valid responses (response rate 64.9%). There were 192 (51.6%) LHDs with a formal, 80 (21.6%) with an informal, and 99 (26.7%) with no AHD partnership. Participants with formal AHD partnerships reported higher perceived organizational supports for evidence-based decision-making and interventions compared with either informal or no AHD partnerships. The odds of providing 1 or more chronic disease evidence-based intervention were significantly higher in LHDs with formal AHD partnerships compared with LHDs with no AHD partnerships (adjusted odds ratio = 2.3; 95% confidence interval = 1.3, 4.0). CONCLUSIONS Formal academic-practice partnerships can be important means for advancing evidence-based decision-making and for implementing evidence-based programs and policies.
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Affiliation(s)
- Paul Campbell Erwin
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Renee G Parks
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Stephanie Mazzucca
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Peg Allen
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Elizabeth A Baker
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Hengrui Hu
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Johnnetta Davis-Joyce
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Ross C Brownson
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
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Knowing Where Public Health Is Going: Levels and Determinants of Workforce Awareness of National Public Health Trends. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 21 Suppl 6:S102-10. [PMID: 26422478 DOI: 10.1097/phh.0000000000000312] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Several recent developments are trending in public health, providing an important window into the future of policy and practice in the field. The extent to which public health workforce is aware of these trends has not been assessed. OBJECTIVE This research examined the extent to which the public health workforce is familiar with 8 important developments and trends in public health and explored factors associated with variation in awareness levels. DESIGN This study characterizes an observational cross-sectional design, based on analysis of secondary data collected by the Association of State and Territorial Health Officials through the Public Health Workforce Interests and Needs Survey (PH WINS). SETTING Our study used data from those states for which representative samples for the local health department (LHD) employees were also available. PARTICIPANTS We included survey responses from employees of state health agencies' central offices and LHDs. MAIN OUTCOME MEASURE The primary outcome variable for the analysis was the level of awareness about emerging public health trends in the public health workforce. RESULTS Awareness of emerging trends was lowest for Public Health Systems and Services Research; roughly 1 in 4 employees were aware of this trend. The second least heard of trends were Health in All Policies, and cross-jurisdictional sharing. The public health trends about which the highest proportion of public health employees had heard were implementation of the Patient Protection and Affordable Care Act and evidence-based public health practice. Awareness about public health trends was generally higher among state health agency employees than among LHD employees. Work environment, supervisory status, employee education, and female gender were significantly associated with higher awareness levels for both state health agency and LHD employees. CONCLUSIONS Public health trends that are important for health agencies should be brought to the spotlight in national dialogue in order to increase practitioner involvement in those initiatives.
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Shah GH, Leider JP, Luo H, Kaur R. Interoperability of Information Systems Managed and Used by the Local Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22 Suppl 6, Public Health Informatics:S34-S43. [PMID: 27684616 PMCID: PMC5049946 DOI: 10.1097/phh.0000000000000436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the post-Affordable Care Act era marked by interorganizational collaborations and availability of large amounts of electronic data from other community partners, it is imperative to assess the interoperability of information systems used by the local health departments (LHDs). OBJECTIVES To describe the level of interoperability of LHD information systems and identify factors associated with lack of interoperability. DATA AND METHODS This mixed-methods research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, with a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling design. A total of 324 completed responses were received (50% response rate). Qualitative data were used from a key informant interview study of LHD informatics staff from across the United States. Qualitative data were independently coded by 2 researchers and analyzed thematically. Survey data were cleaned, bivariate comparisons were conducted, and a multivariable logistic regression was run to characterize factors associated with interoperability. RESULTS For 30% of LHDs, no systems were interoperable, and 38% of LHD respondents indicated some of the systems were interoperable. Significant determinants of interoperability included LHDs having leadership support (adjusted odds ratio [AOR] = 3.54), control of information technology budget allocation (AOR = 2.48), control of data systems (AOR = 2.31), having a strategic plan for information systems (AOR = 1.92), and existence of business process analysis and redesign (AOR = 1.49). CONCLUSION Interoperability of all systems may be an informatics goal, but only a small proportion of LHDs reported having interoperable systems, pointing to a substantial need among LHDs nationwide.
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Affiliation(s)
- Gulzar H. Shah
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Drs Shah and Kaur); de Beaumont Foundation, Bethesda, Maryland (Dr Leider); and Department of Public Health, Brody School of Medicine, East Carolina University, North Carolina (Dr Luo)
| | - Jonathon P. Leider
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Drs Shah and Kaur); de Beaumont Foundation, Bethesda, Maryland (Dr Leider); and Department of Public Health, Brody School of Medicine, East Carolina University, North Carolina (Dr Luo)
| | - Huabin Luo
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Drs Shah and Kaur); de Beaumont Foundation, Bethesda, Maryland (Dr Leider); and Department of Public Health, Brody School of Medicine, East Carolina University, North Carolina (Dr Luo)
| | - Ravneet Kaur
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Drs Shah and Kaur); de Beaumont Foundation, Bethesda, Maryland (Dr Leider); and Department of Public Health, Brody School of Medicine, East Carolina University, North Carolina (Dr Luo)
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Carman AL, McGladrey ML, Goodman Hoover A, Crosby RA. Organizational Variation in Implementation of an Evidence-Based Human Papillomavirus Intervention. Am J Prev Med 2015; 49:301-8. [PMID: 26190804 DOI: 10.1016/j.amepre.2015.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/06/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION "1-2-3 Pap" is a video-based intervention designed to improve human papillomavirus (HPV) vaccine adherence rates among young women in rural Eastern Kentucky. The efficacy trial for the original intervention linked video exposure with increased likelihood of vaccine series completion among the target audience. Given their historic focus on prevention, local health departments were selected as pilot sites to study implementation of 1-2-3 Pap in a public health setting and identify site-specific variations in its implementation. METHODS A mixed-method, pre- and post-comparison pilot study conducted between October 2013 and April 2014 addressed three primary research questions: (1) how specific implementation planning activities using existing organizational resources and processes affect the selection and optimization of dissemination channels for evidence-based public health interventions; (2) what organizational resources, processes, or other attributes facilitate or impede implementation of evidence-based public health interventions; and (3) how variation in dissemination channels corresponds with intervention outcomes. RESULTS Although analysis conducted in October 2014 found that the pilot study did not generate significant changes in HPV vaccine rates, data yielded from the Organizational Readiness to Change Assessment survey instrument and process evaluation interviews revealed variation in pre-study planning and in the use and coordination of staff, the adaptation of materials provided for implementation, and sites' ability to access HPV vaccine rate data throughout the study. CONCLUSIONS The mixed-method pilot study advances dissemination and implementation science through identification of variation in planning activities and use of organizational resources and processes for implementation of prevention interventions in public health settings.
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Affiliation(s)
- Angela L Carman
- College of Public Health, Public Health Practice-Based Research Networks, University of Kentucky, Lexington, Kentucky.
| | - Margaret L McGladrey
- College of Public Health, Public Health Practice-Based Research Networks, University of Kentucky, Lexington, Kentucky
| | - Anna Goodman Hoover
- College of Public Health, Public Health Practice-Based Research Networks, University of Kentucky, Lexington, Kentucky; National Coordinating Center, Public Health Practice-Based Research Networks, University of Kentucky, Lexington, Kentucky; Public Health Services and Systems Research, Public Health Practice-Based Research Networks, University of Kentucky, Lexington, Kentucky
| | - Richard A Crosby
- College of Public Health, Public Health Practice-Based Research Networks, University of Kentucky, Lexington, Kentucky
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Winterbauer NL, Bridger CM, Tucker A, Rafferty AP, Luo H. Adoption of Evidence-Based Interventions in Local Health Departments: "1-2-3 Pap NC". Am J Prev Med 2015; 49:309-16. [PMID: 26190805 DOI: 10.1016/j.amepre.2015.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/23/2015] [Accepted: 03/05/2015] [Indexed: 11/28/2022]
Abstract
Descriptions of barriers and facilitators to adoption of evidence-based interventions in local health departments (LHDs) are limited. This study was conducted by the North Carolina Public Health Practice-Based Research Network to identify factors associated with adoption of an evidence-based human papillomavirus video intervention, "1-2-3 Pap NC," in North Carolina LHDs. A sequential mixed-method study design was used. Data from the 2013 National Profile of Local Health Departments were used to test associations between LHD characteristics and adoption of the intervention. Qualitative, key stakeholder interviews with LHD directors provided the context for quantitative data. Data collection and analysis continued from March 3, 2014, to September 15, 2014. Overall, 28% of North Carolina health jurisdictions (33 of 100 counties) implemented the intervention. Of the three channels used to deliver the intervention to clients, most LHDs opted to show the video in the exam room (42%), followed by website/other social media (36%) and video loop in the lobby/waiting room (22%). In logistic regression, gender of the director (female) was significantly and positively associated with adoption of the intervention (AOR=4.44, p<0.05). Being a first-time director was marginally significant (AOR=0.28, p=0.074), suggesting first-time directors were less likely to adopt. Qualitative results suggested that aspects of communication (awareness and positive attitudes) and agency directors' evaluation of resources, balanced against intervention complexity and flexibility, competing priorities, and mandates, influenced adoption. Adoption of evidence-based interventions by LHDs is critical to improve population health. Practice-based research can contribute to understanding facilitators and modifying barriers to this process.
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Affiliation(s)
- Nancy L Winterbauer
- Department of Public Health, East Carolina University, Brody School of Medicine, Greenville, North Carolina.
| | | | - Ashley Tucker
- Department of Public Health, East Carolina University, Brody School of Medicine, Greenville, North Carolina
| | - Ann P Rafferty
- Department of Public Health, East Carolina University, Brody School of Medicine, Greenville, North Carolina
| | - Huabin Luo
- Department of Public Health, East Carolina University, Brody School of Medicine, Greenville, North Carolina
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