LEAD: Local Evidence for Affecting Decisions about Public Health

Project Dates: 2012-2013

The LEAD-Public Health Project (Local Evidence for Affecting Decisions about Public Health) and LEAD 2 Scale-Up Project (Scaling-Up Capacity for Evidence-Based Public Health) examine the use of, barriers to, and methods for enhancing Evidence Based Programs and Policies (EBPP) in local health departments.

The practice of evidence-based public health (EBPH) is an integration of science-based interventions with community preferences to improve population health. Using both quantitative and qualitative methods to achieve its four goals, this study will increase the knowledge of EBPH and the use of EBPPs in local health department decisions.

​​​​​Project Goals:

  • Describe the evidence base for local evidence based public health EBPH in the United States using available literature and the data from a nationwide survey of local EBPH use by public health practitioners.
  • Test the effectiveness of local-level EBPH capacity building in four states using data from the national survey as a base-line to compare to surveys completed after training and technical assistance has been conducted for local health departments by local prevention research centers.
  • Conduct case studies to understand the contextual conditions such as political climate and partnerships that affect the implementation of EBPPs.  Use data on internal and external relationships within the local health departments chosen for case studies to map a network that will show differences in partner types and activity types between low and high evidence health departments.
  • Translate and disseminate findings to a wide variety of stakeholders using traditional and non-traditional dissemination activities to best reach the target audience.

Implications for Research and Practice

Few of the existing studies examining Evidence Based Public Health were conducted in local health departments.  This study will inform the development of guidance for effective public health administration and will provide the evidence base for what should be implemented at local levels.  It will identify administrative evidence based programs and policies, beginning to address the gaps in knowledge seen in EBPH at a local level.

Project Contact

Katie Duggankduggan@wustl.edu

Project Staff

Workgroup for Aim 1: Katie Stamatakis (Team Lead), Rodrigo Reis,Beth Dodson, Katie Duggan, Paul Erwin, Peg AllenRoss Brownson, Jenine Harris, Robert Fields, Carson Smith

Workgroup for Aim 2:  Ross Brownson (Team Lead), Beth Baker, Katie Stamatakis, Paul Erwin, Katie Duggan, Rodrigo ReisRobert Fields, Carson Smith

Workgroup for Aim 3:  Rachel Tabak (Team Lead), Jenine Harris, Amy Eyler, Beth Dodson, Katie Duggan, Ross Brownson, Dorothy Cilenti, Robert Fields, Carson Smith

Workgroup for Aim 4: Ross Brownson, Katie Duggan (Team Leads), Chris Casey, Jenine Harris, Amy Eyler, Paul Erwin,Robert Fields, Carson Smith

Project Partners

Aim 1: Carolyn Leep, National Association of County and City Health Officials (NACCHO)

Aim 2: Janet Canavese, Missouri Institute for Community Health (MICH); National network of PRCs; Practice Based Research Networks; and Public Health Training Centers

Aim 3: Janet Canavese, Kathleen Wojciehowski (MICH)

Aim 4: Kathleen Wojciehowski (MICH), Carolyn Leeep (NACCHO)

Project Partner Organizations

Robert Wood Johnson FoundationPHSSR National Coordinating center (Public Health Systems and Services Research), NACCHO (National Association of County and City Health Officials)MICH (Missouri Institute for Community HealthUniversity of Washington Health Promotion Research CenterCase Western Reserve University Prevention Research Center for Healthy NeighborhoodsUniversity of Michigan Prevention Research Center of MichiganUniversity of North Carolina at Chapel Hill, Center for Health Promotion and Disease Prevention

Funding Source

Robert Wood Johnson Foundation, Grant No. 69964


Related Resources

Duggan K, Smith C, Tabak R, Erwin, P., Aiska K, Brownson R. Implementing Administrative Evidence Based Practices: Lessons from the field in six LHDs across the US. BMC Health Services Research 06/2015; 15. DOI:10.1186/s12913-015-0891-3.

Brownson R, Allen P, Jacob, R, Harris, J, Duggan K, Hipp, P, Erwin P. Understanding mis-implementation in public health practice. Am J Prev Med, 2015;48(5):543-561.. DOI: 10.1016/j.amepre.2014.11.015

Fields R. P., Stamatakis K.A., Duggan K, Brownson R.C. Importance of scientific resources among local public health practitioners. American Journal of Public Health. 02/2015; DOI: 10.2105/AJPH.2014.302323.

Tabak R, Duggan K, Smith C, Aiska K, Moreland-Russell, S., Brownson R. Assessing capacity for sustainability of effective programs and policies in local health departments. Public Health Management and Practice, 2015. DOI: 10.1097/PHH.0000000000000254

Duggan K, Allen P, Brownson R.C., Erwin P.C., Fields R, Reis R.S., Smith C, Stamatakis K. What Influences the Use of Administrative Evidence Based Practices in Local Health Departments? Frontiers in Public Health Services and Systems Research. 2014; i3(4):1. Available at: http://uknowledge.uky.edu/frontiersinphssr/vol3/iss4/

Harris J.K., Erwin P.C., Smith C., Brownson R.C. The diffusion of evidence-based decision making among local health department practitioners in the United States. Journal of Public Health Management and Practice,2014.

Jacobs J.A., Duggan K, Erwin P, Smith C, Borawski E, Compton J, D’Ambrosio L, Frank S, Frazier-Kouassi S, Hannon P.A., Leeman J, Mainor A, Brownson R.C. Capacity Building for Evidence-Based Decision Making in Local Health Departments: scaling up an effective training approach. Implementation Science 2014.

Jacob R. R., Baker E. A., Allen P, Dodson E.A., Duggan K, Fields R, Sequeira S, Brownson R.C. Training needs and supports for evidence-based decision making among the public health workforce in the United States. BMC Health Services Research, 2014.

Allen P, Brownson RC, Duggan K, Stamatakis KA, Erwin PC. The makings of an evidence-based local health department: identifying administrative and management practices. Frontiers in Public Health Services & Systems Research. 2012: June, in press.

Brownson RC, Allen P, Duggan K, Stamatakis KA, Erwin PC. Fostering more effective public health by identifying administrative evidence-based practices.  American Journal of Preventive Medicine 2012: September, in press.

Brownson R, Reis R, Allen P, Duggan K, Fields R, Stamatakis K, Erwin, P. Understanding the process of evidence-based public health: Findings from a national survey of local health department leaders. Am J Prev Med. 2013: in press.

Erwin P, Harris J, Smith C, Leep C, Duggan K, Brownson R. Evidence-based public health practice among program managers in local public health departments. J Public Health Manag Pract. (in press).

Reis R, Duggan K, Allen P, Stamatakis K, Erwin P, Brownson R. Developing a tool to assess administrative evidence-based practices in local health departments. Frontiers in PHSSR. In press.

Aisaka, K, Duggan, K, Tabak, R, Smith, C, Erwin, P, Brownson, R. Development of an Administrative Evidence-Based Practices Assessment Tool for Health Departments. Washington University in St. Louis, Siteman Cancer Center Prevention & Control Fall Symposium poster presentation. September 30, 2015.

Duggan, K, Aisaka, K, Tabak, R, Smith, C, Erwin, P, Brownson, R. Dissemination and Implementation of an On-line Administrative Evidence-Based Practices Assessment Tool for Health Departments. Washington University in St. Louis, Institute for Public Health’s 8th Annual Conference poster presentation, November 19, 2015.

Brownson, R. The makings of an evidence-based health department. National Association of Chronic Disease Directors, Science, Epidemiology and Evaluation Committee Webinar. November 24, 2015.

Aiska, K, Duggan, K, Tabak, R, Erwin, P, Smith, C. “What influences implementation of Administrative Evidence Based Practices in LHD’s? Research Without Walls Student Symposium. Brown School, Washington University in St Louis, April 2015.

Brownson, R, Allen P, Jacob, R, Harris, J, Duggan K, Hipp, P, Erwin P. Understanding mis-implementation in public health practice. PHSSR 2015 Keeneland Conference, Lexington KY, April 2015.

Duggan, K, Smith C, Tabak R, Erwin, P., Aiska K, Brownson R. “What influences implementation of Administrative Evidence Based Practices in LHD’s? Lessons from the field in six LHDs across the US” PHSSR 2015 Keeneland Conference, Lexington KY (voted best poster presentation), April 2015.

Tabak, R. Duggan K, Smith C, Aiska K, Moreland-Russell, S., Brownson R. “Capacity for sustainability in local public health departments” PHSSR 2015 Keeneland Conference, Lexington KY, April 2015.

Brownson, RC. “Translating the Evidence,” presented at Annual PHSSR Keeneland Conference, April 8-10, 2013, Lexington, KY.

Duggan, K. Expanding Capacity for Evidence-Based Local Public Health. National Institutes of Health: National Library of Medicine Webinar. October 2, 2013.

Duggan, K., Cilenti, D., Erwin, P., Brownson, R., Smith, C., Fields, R., Reis, R. (2013) Using the Evidence-Base to Improve Local Public Health Practice.  Accepted for presentation at NACCHO Annual Conference 2013, July 10-12, 2013, Dallas, Texas.

Fields, R.P., Smith, C.E., Duggan, K., Reis, R., Stamatakis, K., Erwin, P., Leep, C., Allen, P., & Brownson, R.C. (2013). Examining Agency-level Conditions and Practices to Improve Decision-making in Public Health. Presented at the Public Health Systems and Services Research Keeneland Conference, April 8-11, 2013, Lexington, KY.

Smith, C.E., Fields, R.P., Duggan, K., Reis, R., Stamatakis, K., Erwin, P., Leep, C., Harris, J., & Brownson, R.C. (2013).Factors Influencing the Spread of Evidence-based Decision Making in Local Health Departments in the United States. Presented at the Public Health Systems and Services Research Keeneland Conference, April 8-11, 2013, Lexington, KY.

Stamatakis, K, Duggan, K., Smith, C., Fields  R., Brownson, R.C. (2013). Resources for best practices in decision making in US local health departments: Variation across program area. Submitted for presentation at the 141st American Public Health Association [APHA] Annual Meeting, November 2- 6, 2013, Boston, MA.​​​

THE IMPORTANCE OF SCIENTIFIC RESOURCES AMONG LOCAL PUBLIC HEALTH PRACTITIONERS

Local health department (LHDs) practitioners develop evidence-based programs and policies by means of a evidence-based decision making. To inform efforts aimed at boosting performance of public health agencies, there should be a clearer understanding of decision making patterns in LHDs, particularly those that are based on scientific information.

ASSESSING CAPACITY FOR SUSTAINABILITY IN LOCAL HEALTH DEPARTMENTS

Sustainability has been defined as the existence of structures and processes that allow a program to leverage resources to effectively implement and maintain evidence-based public health. The Sustainability Framework, which includes 8 domains, is a useful tool for assessing public health program capacity for sustainability among local health departments.

CAPACITY BUILDING FOR EVIDENCE-BASED DECISION MAKING: SCALING UP AN EFFECTIVE TRAINING APPROACH

This study tested local-level evidence-based decision making (EBDM) capacity-building efforts, specifically the curriculum of an evidence-based public health training course. It demonstrates the potential for improving EBDM capacity, while allowing for local tailoring of strategies.

IMPLEMENTING ADMINISTRATIVE EVIDENCE-BASED PRACTICES: LESSONS FROM SIX LOCAL HEALTH DEPARTMENTS

Administrative evidence based practices (A-EBPs) are agency level structures and activities positively associated with performance measures. A-EBPs have been shown to be effective in boosting performance and contributing to accreditation efforts, ultimately leading to improved population health.

UNDERSTANDING MIS-IMPLEMENTATION IN PUBLIC HEALTH PRACTICE​

Mis-implementation in public health practice refers to ending effective programs and interventions that should continue, or continuing ineffective programs that should end. Public health resources are limited; therefore better understanding the reasons for mis-implementation can help practitioners use resources wisely.

OVERVIEW

First Issue brief in a series of briefs that are being used to disseminate information about administrative evidence based practices that can be implemented in local health departments to help improve performance. The series of issue briefs will provide practical solutions that can be put into practice within a short time period.

WORKFORCE DEVELOPMENT

This brief provides information on workplace development including administrative practices, core competencies, tools, and resources.

LEADERSHIP

This brief provides information on enhancing leadership, including values and expectations to promote and participatory decision making.

ORGANIZATIONAL CULTURE

This brief provides information on organizational culture, including tips regarding innovation, flow of information, and orientation towards learning.

RELATIONSHIPS AND PARTNERSHIPS

This brief provides information on relationships and partners, including building partnerships with other organizations and establishing clear visions.

FINANCIAL PRACTICES

This brief provides information on financial practices including allocating resources, obtaining funding, and outcomes-based contracting.

LEAD-PH NATIONAL SURVEY

Survey instrument used to conduct national survey of local health department directors to gather information about the current evidence base for evidence based public health in local health departments across the nation.

CASE STUDY QUALITATIVE SURVEY GUIDE

Survey instrument used to conduct interviews with local health department employees to gather information about the current evidence base for evidence based public health in local health departments in six different local health departments across the nation.

RESOURCES AND TOOLKITS

A list of external workshops, resources, and toolkits related to evidence based public health.

 ADMINISTRATIVE EVIDENCE-BASED PRACTICES ASSESSMENT TOOL

This online survey tool helps managers and practitioners at local and state public health departments assess the extent to which their departments utilize administrative evidence-based practices (A-EBPs), leading to improved efficiency and public health outcomes, and building competency for accreditation.