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.
Front Public Health. 2022 Apr 28;10:853791. doi: 10.3389/fpubh.2022.853791. eCollection 2022.
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.
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.
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, < 0.05) and climate cultivation (-0.14, 95% CI -0.27 to -0.02, < 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.
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.
美国的地方卫生部门（LHD）负责预防疾病和促进各自社区的健康。了解和解决支持 LHD 培养支持循证决策（EBDM）过程的氛围和文化的因素，可以增强有效实践和服务的提供。
我们采用阶梯式试验设计，在 12 个 LHD（美国密苏里州）中测试实施支持的交错提供，以扩大 EBDM 过程的能力。干预措施是对 EBDM 进行现场培训，并由研究团队在 24 个月（2018 年 3 月至 2020 年 2 月）内提供持续支持。我们采用混合方法评估：（1）个人的 EBDM 技能，（2）EBDM 的组织支持，以及（3）实施的循证干预措施。LHD 工作人员在 4 个时间点完成了一项衡量他们的 EBDM 技能、组织支持和循证干预措施的定量调查。我们选择了在干预期间有高接触和参与度的 4 个 LHD 对员工进行采访（n = 17），了解 EBDM 的促进因素和障碍。我们使用混合效应线性回归来检查定量调查结果。访谈逐字转录，并通过双重独立过程进行编码。
共有 519 名 LHD 工作人员符合条件并在对照期和干预期内邀请完成定量调查（控制期 593 人，干预期 593 人）。共有 434 人在对照期和 492 人在干预期完成（分别为 83.6%和 83.0%的应答率）。在两种试验模式下，一半的参与者至少拥有硕士学位（49.7-51.7%），大多数是女性（82.1-83.8%）。EBDM 技能或实施循证干预措施均未发现显著的干预效果。两个组织支持得分在干预与对照期之间下降：意识（-0.14，95%CI-0.26 至-0.01，<0.05）和气候培养（-0.14，95%CI-0.27 至-0.02，<0.05），但所有参与者的得分均随时间而提高。受访者指出，员工更替、时间有限、资源有限和动力不足是继续开展 EBDM 工作的挑战。设定期望、方案审查和现有实践被视为促进因素。
挑战（例如，人员更替、资源）可能会破坏 LHD 充分嵌入支持 EBDM 的组织流程的能力。这项研究和相关文献提供了关于如何最好地支持 LHD 建立使用和维持循证实践的能力的理解。
