SESSION 1C: Workforce-Evidence-Based Decision Making
Room: Thoroughbred 3
Tuesday, April 8, 2014, 2-3:15 pm
Back to Conference Agenda
AUDIO
KC14 Session 1C on Workforce: Evidence-Based Decision Making by NCC for PHSSR
MODERATOR
Christopher Maylahn, M.P.H.
PRESENTERS
Rebekah R. Jacob, M.P.H., M.S.W.
Training needs and supports for evidence-based decision making among the public health workforce
Co-Investigators: Elizabeth A. Baker, Ph.D., Peg Allen, Ph.D., M.P.H., Elizabeth A. Dodson, Ph.D., Katie Duggan, M.P.H, M.S., Robert Fields, M.P.H., Sonia Sequeira, M.P.H, M.S.W., Ross C. Brownson, Ph.D.
Background: Preparing the public health workforce to practice evidence-based decision making (EBDM) is necessary to improve practice. Despite growing supports for EBDM competencies and processes, there are remaining training needs and barriers for effective translation to practice and policy.
Research Objective: To identify and compare EBDM competency gaps among the U.S. public health workforce and identify strategies for reducing these gaps.
Data Sets and Sources: This study combines self-reported data from four nationally representative online surveys about EBDM with state and local health departments between 2008 and 2013. Survey participants were asked to rate perceived importance and availability of EBDM competencies. Additionally, participants in the state level 2013 survey ranked three items that “would most encourage you to utilize EBDM in your work” and items that “would be most useful to you in applying EBDM in your work” from a list of response options.
Study Design: Cross-sectional Analysis: A competency “gap” score was calculated by subtracting the Likert scale rated availability of the EBDM competency from rated importance. Independent sample t-tests were used to compare state-level practitioners’ competency gaps. Mean gaps were aggregated.
Principal Findings: The largest competency gap areas were consistent across the four samples: economic evaluation, communicating research to policy makers, evaluation designs, and adapting interventions. State level participants in 2013 reported significantly smaller mean gaps than those in 2008 (p< 0.01). Leaders prioritizing EBDM was most often ranked by participants to help encourage them to practice EBDM (67.9%). EBDM training for specific areas was most commonly ranked by participants to help them apply EBDM in their work (64.3%).
Conclusion: The findings suggest gaps in EBDM competencies may be narrowing. However, the largest competency gaps remain consistent over time and across local and state public health practitioners. Leadership support for EBDM and more tailored EBDM training may improve the practice of EBDM within health departments.
Implications for Public Health Practice and Policy: More EBDM capacity building efforts are needed, especially where the largest gaps are noted. These activities may include focused trainings along with ways to improve organizational practices (e.g. leadership support).
Dayna Maniccia, Dr.P.H., M.S.
Evidence Based Decision Making by Local Health Departments in New York State
Co-Investigators: Collette Sosnowy, Ph.D., M.A., Nancy Katagiri, M.P.H, CHES, Christopher Maylahn, M.P.H., Sylvia Pirani, M.P.H, M.S.
Background: Evidence-based decision making (EBDM) is a valuable public health tool. The extent to which local health departments (LHDs) participate in EBDM is unknown. The New York State (NYS) Public Health Practice-Based Research Network developed a multi-part mixed-method study to assess EBDM in NYS LHDs.
Research Objective: To determine the use of EBDM by LHD programs and assess whether EBDM varied across programmatic areas and LHD characteristics.
Data Sets and Sources: Information about EBDM activities was collected from three program areas present in all NYS LHDs. LHD characteristics were obtained from the NACCHO 2010 Profile of LHDs survey.
Study Design: Staff responsible for childhood lead poisoning prevention, immunization, and physical activity and nutrition programs, program area common to all LHDs in NYS, were surveyed. Survey questions pertained to the decision-making processes used when developing or modifying a program or deciding which program to implement.
Analysis: Descriptive statistics of LHDs were calculated and responding and non-responding LHDs compared with chi-square analyses. A modified factor analysis approach was used to create an overall EBDM score. Frequency of use of EBDM steps was calculated and compared across program areas using Fisher’s exact test. Overall EBDM scores by program area were compared using ANOVA.
Principal Findings: Most respondents reported their program conducted many EBDM activities. However, none reported using all activities at all times. Most frequently occurring activities included setting short-term objectives, identifying stakeholders, searching governmental websites for information, and identifying target populations; least frequently occurring included consulting The Community Guide, working with academic researchers, and publishing in academic or practice journals. EBDM facilitators included valuing community input, encouragement for using existing interventions, and collaborative decision making processes. Insufficient knowledge about evaluation methods was the most frequently cited barrier.
Conclusions: Routine EBDM should be encouraged and supported. Using all EBDM steps, especially evaluation and dissemination, should be emphasized. To facilitate EBDM and increase implementation of evidence-based strategies, program evaluation, and dissemination, linkages with academic researchers and other resources should be encouraged.
Implications for Public Health Practice and Policy: These findings can help policy-makers strengthen the capacity of LHDs to become ‘’evidence-based health departments.”
Julie Jacobs, M.P.H.
Building Evidence-Based Decision Making Capacity in Local Health Departments: an Evaluation of Training and Technical Assistance Efforts in Four U.S. States
Co-Investigators: Ross Brownson, Ph.D., Carson Smith, M.P.A., Robert Fields, M.P.H., Kathleen Duggan, M.P.H., M.S.
Background: Public health practitioners face increasing calls to 1) use the best available evidence in developing programs/policies and 2) contribute to the body of evidence. Evidence-based decision making (EBDM) training courses have been recommended to build practitioners’ capacity to achieve these goals.
Research Objective: To test local-level EBDM capacity-building efforts in four states (Michigan, North Carolina, Ohio, Washington) with a quasi-experimental study design. The main capacity-building activity was an EBDM training course. States also received technical assistance in the form of grant writing, community needs assessment, intervention and evaluation design, and economic evaluation.
Data Sets and Sources: An online survey was delivered to a national sample of local health department directors, administrators and practitioners (n=849, 57% response rate). A subsample (n=228, 76% response rate) was retested 8 to 14 months later to serve as the control group. Course participants completed pre-test surveys prior to training and were retested 6 months after the course (n=112, 89% response rate). All survey respondents rated the importance and availability of 10 EBDM competencies. Course participants assessed how frequently they used EBDM skills, and they rated benefits and barriers to using course content.
Study Design: Quasi-experimental
Analysis: Simple and multiple linear regression models assessed the difference between pre-test and post-test scores. EBDM skills were analyzed with descriptive statistics and Pearson’s chi-square tests.
Principal Findings: Course participants reported greater increases in the availability of EBDM competencies at post-test, compared to the control group. Significant differences (p
Conclusions: This training course increased practitioners’ perception of the availability of EBDM competencies, and participants identified many benefits of the training.
Implications for Public Health Practice and Policy: EBDM training courses can be used to build practitioners’ capacity to both use and create evidence. Further research is needed on how best to scale up these approaches.
Kay Lovelace, Ph.D., M.P.H., B.A.
LHDs increase their use of EBDM practices from 2010 to 2013
Co-Investigators: Gulzar Shah, Ph.D., M.S., Carolyn Leep, M.P.H, M.S., Robert Aronson, Dr.P.H., M.P.H
Background: An evidence-based approach is needed to effectively address the gap between population health goals in the United States and current morbidity and mortality rates. Recently, the authors developed an index to allow researchers to assess the frequency of evidence-based decision making (EBDM) practice in LHDs. The first descriptive analysis was conducted with data from the NACCHO 2010 Profile Study of Local Health Departments (LHDs). The current research was designed to assess changes in the percentage of LHDs using EBDM practices from 2010 to 2013.
Research Objective: To identify changes in the frequency with which LHDs carried out EBDM practices from 2010 to 2013. Data sets and sources: 2010 NACCHO Profile of LHDs Survey, 2013 NACCHO Profile of LHDs Survey. The NACCHO Profile Surveys are conducted every 2-3 years. All LHDs in the country are invited to respond.
Study Design: Cross-sectional survey
Analysis: The research reported here used an index of EBDM practices previously developed by the authors. Descriptive analysis was used to identify the frequency with which LHDs used each EBDM practice comprising the index and the frequency of the total number of practices they used in both 2010 and 2013.
Principal Findings: Overall, the percentage of LHDs using EBDM practices increased from 2010 to 2013. Specifically, in 2010, forty-five percent of LHDs used three EBDM practices or fewer; 41.5% used four or five EBDM practices; and 13.5% used six or seven practices. In 2013, thirty-seven percent of LHDs used three EBDM practices or fewer; 39% used four or five practices; and 23.7% used six or seven practices. The overall increase in numbers of EBDM practices used by LHDs was largely driven by increases in percentages of LHDs that use the County Health Rankings (37.8% to 66.5%) and that use The Guide to Community Preventive Services (26% to 41.2%)(Table 1).
Implications for PH Policy and Practice: The results reveal that there is an increase in the use of EBDM practices in LHDs from 2010 to 2013. More research is needed to understand details of how LHDs implement EBDM strategies and use them to innovate the practice of public health.