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Hu Y, Yin X, Gong E, Liu J, Liu X, Shao R, Zhang J, Brownson RC. Are public health researchers designing for dissemination? Findings from a national survey in China. Implement Sci Commun 2023; 4:110. [PMID: 37670371 PMCID: PMC10478366 DOI: 10.1186/s43058-023-00451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 06/03/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Research findings are not always disseminated in ways preferred by audiences, and research dissemination is not always considered a priority by researchers. While designing for dissemination (D4D) provides an active process to facilitate effective dissemination, use of these practices in China is largely unknown. We aimed to describe the designing for dissemination activities and practices among public health researchers in China. METHODS In January 2022, we conducted a cross-sectional survey in 61 sub-committees of four national academic societies which include a wide range of health disciplines. The sample mainly involved researchers at universities or research institutions, the Centers for Disease Control and Prevention at national or regional levels, and hospitals. Participants completed a 42-item online questionnaire. Respondent characteristics, dissemination routes, dissemination barriers, organizational support, and personal practice of D4D were examined with descriptive analyses. RESULTS Of 956 respondents, 737 were researchers. Among these researchers, 58.1% had disseminated their research findings. Although there were some variation in the commonly used routes among different groups, academic journals (82.2%) and academic conferences (73.4%) were the most frequently used routes. Barriers to dissemination to non-research audiences existed at both organizational level (e.g., a lack of financial resources, platforms, and collaboration mechanisms) and individual level (e.g., a lack of time, knowledge, and skills, and uncertainty on how to disseminate). About a quarter of respondents (26.7%) had a dedicated person or team for dissemination in their unit or organization, with university researchers reporting a significantly higher proportion than their counterparts (P < 0.05). Only 14.2% of respondents always or usually used frameworks or theories to plan dissemination activities, 26.2% planned dissemination activities early, and 27.1% always or usually involved stakeholders in the research and dissemination process. Respondents with working experience in a practice or policy setting or dissemination and implementation training experience were more likely to apply these D4D strategies (P < 0.05). CONCLUSION Considerable room exists for improvement in using impactful dissemination routes, tackling multiple barriers, providing organizational support, and applying D4D strategies among Chinese public health researchers. Our findings have implications for structural changes in academic incentive systems, collaborations and partnerships, funding priorities, and training opportunities.
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Affiliation(s)
- Yiluan Hu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Enying Gong
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
| | - Jing Liu
- Chinese Preventive Medicine Association, Beijing, 100021, China
| | - Xia Liu
- Chinese Preventive Medicine Association, Beijing, 100021, China
| | - Ruitai Shao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China.
| | - Juan Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China.
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, 5000, Oulu, Finland.
| | - Ross C Brownson
- Prevention Research Center, Brown School at 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, 63130, USA
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Allen P, Parks RG, Kang SJ, Dekker D, Jacob RR, Mazzucca-Ragan S, Brownson RC. Practices Among Local Public Health Agencies to Support Evidence-Based Decision Making: A Qualitative Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:213-225. [PMID: 36240510 PMCID: PMC9892206 DOI: 10.1097/phh.0000000000001653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Evidence-based decision making (EBDM) capacity in local public health departments is foundational to meeting both organizational and individual competencies and fulfilling expanded roles. In addition to on-the-job training, organizational supports are needed to prepare staff; yet, less is known in this area. This qualitative study explores supportive management practices instituted as part of a training and technical assistance intervention. DESIGN This qualitative study used a semistructured interview guide to elicit participants' descriptions and perceptions via key informant interviews. Verbatim transcripts were coded and thematic analyses were conducted. SETTING Local public health departments in a US Midwestern state participated in the project. PARTICIPANTS Seventeen middle managers and staff from 4 local health departments participated in remote, audio-recorded interviews. INTERVENTION Following delivery of a 3½-day in-person training, the study team met with health department leadership teams for department selection of supportive agency policies and procedures to revise or newly create. Periodic remote meetings included collaborative problem-solving, sharing of informational resources, and encouragement. MAIN OUTCOME MEASURES Included management practices instituted to support EBDM and impact on day-to-day work as described by the interview participants. RESULTS Leadership and middle management practices deemed most helpful included dedicating staff; creating specific guidelines; setting expectations; and providing trainings, resources, and guidance. Health departments with a preexisting supportive organizational culture and climat e were able to move more quickly and fully to integrate supportive management practices. Workforce development included creation of locally tailored overviews for all staff members and onboarding of new staff. Staff wanted additional hands-on skill-building trainings. Several worked with partners to incorporate evidence-based processes into community health improvement plans. CONCLUSIONS Ongoing on-the-job experiential learning is needed to integrate EBDM principles into day-to-day public health practice. Management practices established by leadership teams and middle managers can create supportive work environments for EBDM integration.
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Affiliation(s)
- Peg Allen
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Renee G. Parks
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Sarah J. Kang
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Debra Dekker
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Rebekah R. Jacob
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Stephanie Mazzucca-Ragan
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Ross C. Brownson
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
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Jacob RR, Parks RG, Allen P, Mazzucca S, Yan Y, Kang S, Dekker D, Brownson RC. How to "Start Small and Just Keep Moving Forward": Mixed Methods Results From a Stepped-Wedge Trial to Support Evidence-Based Processes in Local Health Departments. Front Public Health 2022; 10:853791. [PMID: 35570955 PMCID: PMC9096224 DOI: 10.3389/fpubh.2022.853791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Local health departments (LHDs) in the United States are charged with preventing disease and promoting health in their respective communities. Understanding and addressing what supports LHD's need to foster a climate and culture supportive of evidence-based decision making (EBDM) processes can enhance delivery of effective practices and services. Methods We employed a stepped-wedge trial design to test staggered delivery of implementation supports in 12 LHDs (Missouri, USA) to expand capacity for EBDM processes. The intervention was an in-person training in EBDM and continued support by the research team over 24 months (March 2018-February 2020). We used a mixed-methods approach to evaluate: (1) individuals' EBDM skills, (2) organizational supports for EBDM, and (3) administered evidence-based interventions. LHD staff completed a quantitative survey at 4 time points measuring their EBDM skills, organizational supports, and evidence-based interventions. We selected 4 LHDs with high contact and engagement during the intervention period to interview staff (n = 17) about facilitators and barriers to EBDM. We used mixed-effects linear regression to examine quantitative survey outcomes. Interviews were transcribed verbatim and coded through a dual independent process. Results Overall, 519 LHD staff were eligible and invited to complete quantitative surveys during control periods and 593 during intervention (365 unique individuals). A total of 434 completed during control and 492 during intervention (83.6 and 83.0% response, respectively). In both trial modes, half the participants had at least a master's degree (49.7-51.7%) and most were female (82.1-83.8%). No significant intervention effects were found in EBDM skills or in implementing evidence-based interventions. Two organizational supports scores decreased in intervention vs. control periods: awareness (-0.14, 95% CI -0.26 to -0.01, p < 0.05) and climate cultivation (-0.14, 95% CI -0.27 to -0.02, p < 0.05) but improved over time among all participants. Interviewees noted staff turnover, limited time, resources and momentum as challenges to continue EBDM work. Setting expectations, programmatic reviews, and pre-existing practices were seen as facilitators. Conclusions Challenges (e.g., turnover, resources) may disrupt LHDs' abilities to fully embed organizational processes which support EBDM. This study and related literature provides understanding on how best to support LHDs in building capacity to use and sustain evidence-based practices.
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Affiliation(s)
- Rebekah R. Jacob
- 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
| | - 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
| | - Yan Yan
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Sarah Kang
- Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, CA, United States
| | - Debra Dekker
- National Association of County and City Health Officials, Washington, DC, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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Hoover AG, Zephyr PD. Classifying Community Organizational Health Communication Networks: Local Health Department Recognition of Public Information-Sharing Partners Across Sectors. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:513-520. [PMID: 32956298 DOI: 10.1097/phh.0000000000001265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Local health departments (LHDs) operate within complex, multisectoral organizational communication networks. Network composition may affect priorities, processes, and the reach of health information to key stakeholders. This study seeks to elucidate variation in local network structures to examine how different constellations may affect information sharing across audiences. DESIGN This study analyzes data from a 2016 US survey of 491 metropolitan LHDs and 556 nonmetropolitan LHDs. Researchers first conducted social network analysis of network density, defined as the total number of potential organizations contributing to a jurisdiction's health communication activities. Researchers then conducted logistic regression to compare the relationship between network density and reported health communication activities targeting 3 specific audiences: policy makers, lay publics, and mass media. RESULTS Three network types emerged on the basis of the number of organizations that contribute to health communication activities, with low-density Minimal networks more common in nonmetropolitan jurisdictions and higher-density Expanded and Robust networks more common in metropolitan jurisdictions. LHDs in Minimal networks were significantly less likely to communicate with policy makers, lay publics, and mass media than their counterparts in higher-density networks (P < .05). CONCLUSIONS LHDs are embedded in organizational communication networks that vary in both the number of communication partners and the types of audiences reached. Examining their own local organizational communication networks may provide insights into LHDs that wish to improve the effectiveness of public health messaging. By adding organizational communication partners and reaching new audiences, LHDs in Minimal networks can expand the reach of messages designed to help policy makers, communities, and individuals promote health and prevent disease.
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Affiliation(s)
- Anna Goodman Hoover
- Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, Kentucky (Dr Hoover); and Department of Statistics, University of Kentucky, Lexington, Kentucky (Mr Zephyr)
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Factors Facilitating or Hindering Use of Evidence-Based Diabetes Interventions Among Local Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 26:443-450. [PMID: 32732717 PMCID: PMC7196444 DOI: 10.1097/phh.0000000000001094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess facilitators, barriers, and capacities to use of evidence-based programs and policies (EBPPs) in local health departments (LHDs). DESIGN A qualitative study design was used to elicit a contextual understanding of factors. One-hour interviews were conducted among directors and diabetes/chronic disease practitioners from LHDs. A consensus coding approach was used to identify themes. SETTING AND PARTICIPANTS Twenty-four participants from 14 Missouri LHDs completed interviews. RESULTS Themes were identified as facilitators, barriers, or capacities that enhance EBPP use. Facilitators included awareness of EBPPs, leadership and supervisor support of EBPP use, and facilitators to increase capacity to implement EBPPs. Skills development, targeted messaging, and understanding of evidence-based decision-making (EBDM) terminology were needed. Barriers to EBPPs use were described at the individual, organizational, and interorganizational levels and included community buy-in, limited resources, relevance to partners, and time scarcity. Capacities included the ways LHDs learn about EBPPs, methods that influence the use of EBPPs, and resources needed to sustain EBPPs. Top ways to learn about EBPPs were in-person interactions. Staff meetings, meetings with decision makers, and relevant evidence influenced decision making. Resources needed were funding, organizational capacity, and partnerships. Directors' and practitioners' views differed on type of agency culture that promoted EBPP use, preferences for learning about EBPPs, ways to influence decisions, needs, and barriers to EBPPs. CONCLUSIONS These findings can inform future strategies to support uptake of EBPPs in diabetes and chronic disease control in LHDs. LHDs have a good understanding of EBPPs, but subtle differences in perception of EBPPs and needs exist between directors and practitioners. Investment in capacity building and fostering an organizational culture supportive of EBDM were key implications for practice. By investing in employee skill development, LHDs may increase agency capacity. Researchers should use preferred channels and targeted messaging to disseminate findings.
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Fan F, Wang Z, Yu D, Chen C, Shen D, Yu Z, Liu X, Zhou H, Shi J. General practitioners' perceptions of their practice of evidence-based chronic disease prevention interventions: a quantitative study in Shanghai, China. BMC FAMILY PRACTICE 2020; 21:147. [PMID: 32698768 PMCID: PMC7375034 DOI: 10.1186/s12875-020-01212-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/07/2020] [Indexed: 11/25/2022]
Abstract
Background Epidemic chronic diseases pose significant challenges to the improvement of healthcare in China and worldwide. Despite increasing international calls for the inclusion of evidence-based decision-making (EBDM) processes in chronic disease prevention and control programming as well as policymaking, there is relatively little research that assesses the current capacity of physicians and the factors that influence that capacity in China. Method This cross-sectional study was conducted in community health centres (CHCs) in Shanghai, China, using multistage cluster sampling. An evidence-based chronic disease prevention (EBCDP) evaluation tool was employed to assess physician EBCDP awareness, adoption, implementation and maintenance based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and using a 7-point Likert scale. Linear regression analysis was used to assess associations between each EBCDP aspect and overall EBCDP status with participant characteristics or organizational factors. Result A total of 892 physicians from CHCs in Shanghai, China, were assessed. The physicians perceived their awareness (mean = 4.90, SD = 1.02) and maintenance (mean = 4.71, SD = 1.07) of EBCDP to be relatively low. Physicians with relatively lower job titles and monthly incomes (> 9000 RMB) tended to have relatively higher scores for the awareness, adoption, and implementation of EBCDP (P < 0.05). Those who had participated in one program for chronic disease prevention and control were less likely to adopt (b = − 0.284, P = 0.007), implement (b = − 0.292, P = 0.004), and maintain (b = − 0.225, P = 0.025) EBCDP than those who had participated in more programs. Physicians in general practice (Western medicine) had a lower level of awareness of EBCDP than those in other departments (P < 0.0001). Physician from CHCs located in suburban areas had lower scores for awareness (b = − 0.150, P = 0.047), implementation (b = − 0.171, P = 0.029), and maintenance (b = − 0.237, P = 0.002) that those from urban CHCs. Physicians in CHCs affiliated with universities had higher scores on all four EBCDP aspects that those in CHCs not affiliated with a university. Conclusions This study provides quantitative evidence illustrating EBCDP practices among physicians in CHCs with various personal and organizational characteristics, respectively. More methods should be provided to increase the awareness of such physicians regarding EBCDP to stimulate the use of EBCDP for their patients and in connection with other public health priorities.
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Affiliation(s)
- Feng Fan
- Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, Shanghai, 200090, China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.,General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, 528244, China
| | - Dehua Yu
- Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China
| | - Chen Chen
- Shanghai Jing'an District Jiangning Road Community Health Service Center, Shanghai, 200041, China
| | - Delei Shen
- Shanghai Fenglin Community Health Service Center, Shanghai, 200000, China
| | - Zhaohu Yu
- Navy 971 Hospital, Qingdao, 266071, China
| | - Xin Liu
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Huining Zhou
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Jianwei Shi
- Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, 200090, China. .,School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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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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Allen P, Jacob RR, Parks RG, Mazzucca S, Hu H, Robinson M, Dobbins M, Dekker D, Padek M, Brownson RC. Perspectives on program mis-implementation among U.S. local public health departments. BMC Health Serv Res 2020; 20:258. [PMID: 32228688 PMCID: PMC7106610 DOI: 10.1186/s12913-020-05141-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health resources are limited and best used for effective programs. This study explores associations of mis-implementation in public health (ending effective programs or continuing ineffective programs) with organizational supports for evidence-based decision making among U.S. local health departments. METHODS The national U.S. sample for this cross-sectional study was stratified by local health department jurisdiction population size. One person was invited from each randomly selected local health department: the leader in chronic disease, or the director. Of 600 selected, 579 had valid email addresses; 376 completed the survey (64.9% response). Survey items assessed frequency of and reasons for mis-implementation. Participants indicated agreement with statements on organizational supports for evidence-based decision making (7-point Likert). RESULTS Thirty percent (30.0%) reported programs often or always ended that should have continued (inappropriate termination); organizational supports for evidence-based decision making were not associated with the frequency of programs ending. The main reason given for inappropriate termination was grant funding ended (86.0%). Fewer (16.4%) reported programs often or always continued that should have ended (inappropriate continuation). Higher perceived organizational supports for evidence-based decision making were associated with less frequent inappropriate continuation (odds ratio = 0.86, 95% confidence interval 0.79, 0.94). All organizational support factors were negatively associated with inappropriate continuation. Top reasons were sustained funding (55.6%) and support from policymakers (34.0%). CONCLUSIONS Organizational supports for evidence-based decision making may help local health departments avoid continuing programs that should end. Creative mechanisms of support are needed to avoid inappropriate termination. Understanding what influences mis-implementation can help identify supports for de-implementation of ineffective programs so resources can go towards evidence-based programs.
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Affiliation(s)
- Peg Allen
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA.
| | - Rebekah R Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Renee G Parks
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Stephanie Mazzucca
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Hengrui Hu
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Mackenzie Robinson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, USA
| | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park (MIP), 175 Longwood Road South, Suite 210a, Hamilton, Ontario, L8P 0A1, Canada
| | - Debra Dekker
- National Association of County and City Health Officials (NACCHO), 1201 Eye Street, NW, 4th Floor, Washington, DC, 20005, USA
| | - Margaret Padek
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130-4838, 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, 63130-4838, 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, 4921 Parkview Place, St. Louis, MO, 63110, USA
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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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10
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Thirsk J. Knowledge translation. Nutr Diet 2019; 75:341-344. [PMID: 30240105 DOI: 10.1111/1747-0080.12466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 11/29/2022]
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11
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Porter KJ, Brock DJ, Estabrooks PA, Perzynski KM, Hecht ER, Ray P, Kruzliakova N, Cantrell ES, Zoellner JM. SIPsmartER delivered through rural, local health districts: adoption and implementation outcomes. BMC Public Health 2019; 19:1273. [PMID: 31533683 PMCID: PMC6751747 DOI: 10.1186/s12889-019-7567-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/29/2019] [Indexed: 11/16/2022] Open
Abstract
Background SIPsmartER is a 6-month evidenced-based, multi-component behavioral intervention that targets sugar-sweetened beverages among adults. It consists of three in-person group classes, one teach-back call, and 11 automated phone calls. Given SIPsmartER’s previously demonstrated effectiveness, understanding its adoption, implementation, and potential for integration within a system that reaches health disparate communities is important to enhance its public health impact. During this pilot dissemination and implementation trial, SIPsmartER was delivered by trained staff from local health districts (delivery agents) in rural, Appalachian Virginia. SIPsmartER’s execution was supported by consultee-centered implementation strategies. Methods In this mixed-methods process evaluation, adoption and implementation indicators of the program and its implementation strategy (e.g., fidelity, feasibility, appropriateness, acceptability) were measured using tracking logs, delivery agent surveys and interviews, and fidelity checklists. Quantitative data were analyzed with descriptive statistics. Qualitative data were inductively coded. Results Delivery agents implemented SIPsmartER to the expected number of cohorts (n = 12), recruited 89% of cohorts, and taught 86% of expected small group classes with > 90% fidelity. The planned implementation strategies were also executed with high fidelity. Delivery agents completing the two-day training, pre-lesson meetings, fidelity checklists, and post-lesson meetings at rates of 86, 75, 100, and 100%, respectively. Additionally, delivery agents completed 5% (n = 3 of 66) and 10% (n = 6 of 59) of teach-back and missed class calls, respectively. On survey items using 6-point scales, delivery agents reported, on average, higher feasibility, appropriateness, and acceptability related to delivering the group classes (range 4.3 to 5.6) than executing missed class and teach-back calls (range 2.6 to 4.6). They also, on average, found the implementation strategy activities to be helpful (range 4.9 to 6.0). Delivery agents identified strengths and weakness related to recruitment, lesson delivery, call completion, and the implementation strategy. Conclusions In-person classes and the consultee-centered implementation strategies were viewed as acceptable, appropriate, and feasible and were executed with high fidelity. However, implementation outcomes for teach-back and missed class calls and recruitment were not as strong. Findings will inform the future full-scale dissemination and implementation of SIPsmartER, as well as other evidence-based interventions, into rural health districts as a means to improve population health. Electronic supplementary material The online version of this article (10.1186/s12889-019-7567-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathleen J Porter
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA.
| | - Donna Jean Brock
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Paul A Estabrooks
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA
| | - Katelynn M Perzynski
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Erin R Hecht
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Pamela Ray
- Virginia Department of Health, New River Health District, 212 3rd Avenue, Radford, VA, 24141, USA
| | - Natalie Kruzliakova
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA
| | - Eleanor S Cantrell
- Virginia Department of Health, Lenowisco Health District, 134 Roberts Street SW, Wise, VA, 24293, USA
| | - Jamie M Zoellner
- Department of Public Health Sciences, University of Virginia, School of Medicine, 16 East Main Street, Christiansburg, VA, 24073, USA
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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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Green Tea Consumption and Risk of Breast Cancer and Recurrence-A Systematic Review and Meta-Analysis of Observational Studies. Nutrients 2018; 10:nu10121886. [PMID: 30513889 PMCID: PMC6316745 DOI: 10.3390/nu10121886] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 01/01/2023] Open
Abstract
Breast cancer (BC) is the most common cancer in women and several factors are involved in its onset. Green tea (GT) has been shown to have potential beneficial effects on different types of cancer. The aim of this review was to evaluate the association between GT regular consumption and risk of BC in women. The risk of BC recurrence and risk of BC in relation to menopausal status were also evaluated. A literature search of PubMed, Scopus, and Web of Science was conducted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to perform the systematic review and meta-analysis. Full texts were downloaded for 40 studies; however, only 13 records were included in the meta-analysis. Eight were cohort studies and five were case-control studies. The pooled sample consisted of 163,810 people. An inverse statistically significant relationship between GT and BC risk, with an Odds Ratio (OR) = 0.85 ((95% CI = 0.80–0.92), p = 0.000)), was found. Egger’s linear regression test did not show a potential publication bias (intercept 0.33, t = 0.40, p = 0.695), which was also confirmed by the symmetry of the funnel plot. Moreover, no high statistical heterogeneity (Chi2 = 31.55, df = 13, I2 = 58.79%, p = 0.003) was found. The results of this meta-analysis showed a potential protective effect of GT consumption on BC, especially for BC recurrence.
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Tabak RG, Parks RG, Allen P, Jacob RR, Mazzucca S, Stamatakis KA, Poehler AR, Chin MH, Dobbins M, Dekker D, Brownson RC. Patterns and correlates of use of evidence-based interventions to control diabetes by local health departments across the USA. BMJ Open Diabetes Res Care 2018; 6:e000558. [PMID: 30233805 PMCID: PMC6135437 DOI: 10.1136/bmjdrc-2018-000558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/11/2018] [Accepted: 07/24/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The nearly 3000 local health departments (LHDs) nationwide are the front line of public health and are positioned to implement evidence-based interventions (EBIs) for diabetes control. Yet little is currently known about use of diabetes-related EBIs among LHDs. This study used a national online survey to determine the patterns and correlates of the Centers for Disease Control and Prevention Community Guide-recommended EBIs for diabetes control in LHDs. RESEARCH DESIGN AND METHODS A cross-sectional study was conducted to survey a stratified random sample of LHDs regarding department characteristics, respondent characteristics, evidence-based decision making within the LHD, and delivery of EBIs (directly or in collaboration) within five categories (diabetes-related, nutrition, physical activity, obesity, and tobacco). Associations between delivering EBIs and respondent and LHD characteristics and evidence-based decision making were explored using logistic regression models. RESULTS Among 240 LHDs there was considerable variation among the EBIs delivered. Diabetes prevalence in the state was positively associated with offering the Diabetes Prevention Program (OR=1.28 (95% CI 1.02 to 1.62)), diabetes self-management education (OR=1.32 (95% CI 1.04 to 1.67)), and identifying patients and determining treatment (OR=1.27 (95% CI 1.05 to 1.54)). Although all organizational supports for evidence-based decision making factors were related in a positive direction, the only significant association was between evaluation capacity and identifying patients with diabetes and determining effective treatment (OR=1.54 (95% CI 1.08 to 2.19)). CONCLUSION Supporting evidence-based decision making and increasing the implementation of these EBIs by more LHDs can help control diabetes nationwide.
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Affiliation(s)
- Rachel G Tabak
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Renee G Parks
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Peg Allen
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Rebekah R Jacob
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Stephanie Mazzucca
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Katherine A Stamatakis
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA
| | - Allison R Poehler
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
| | - Marshall H Chin
- Department of Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, Illinois, USA
| | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Hamilton, Ontario, Canada
| | - Debra Dekker
- National Association of County and City Health Officials (NACCHO), District of Columbia, Washington, USA
| | - Ross C Brownson
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J Siteman Cancer Center, Washington University School of Medicine, Washington University, St Louis, Missouri, USA
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