Leveraging Implementation Science for Cardiovascular Health Equity: A Scientific Statement From the American Heart Association.

Reducing cardiovascular disease disparities will require a concerted, focused effort to better adopt evidence-based interventions, in particular, those that address social determinants of health, in historically marginalized populations (ie, communities excluded on the basis of social identifiers like race, ethnicity, and social class and subject to inequitable distribution of social, economic, physical, and psychological resources). Implementation science is centered around stakeholder engagement and, by virtue of its reliance on theoretical frameworks, is custom built for addressing research-to-practice gaps. However, little guidance exists for how best to leverage implementation science to promote cardiovascular health equity. This American Heart Association scientific statement was commissioned to define implementation science with a cardiovascular health equity lens and to evaluate implementation research that targets cardiovascular inequities. We provide a 4-step roadmap and checklist with critical equity considerations for selecting/adapting evidence-based practices, assessing barriers and facilitators to implementation, selecting/using/adapting implementation strategies, and evaluating implementation success. Informed by our roadmap, we examine several organizational, community, policy, and multisetting interventions and implementation strategies developed to reduce cardiovascular disparities. We highlight gaps in implementation science research to date aimed at achieving cardiovascular health equity, including lack of stakeholder engagement, rigorous mixed methods, and equity-informed theoretical frameworks. We provide several key suggestions, including the need for improved conceptualization and inclusion of social and structural determinants of health in implementation science, and the use of adaptive, hybrid effectiveness designs. In addition, we call for more rigorous examination of multilevel interventions and implementation strategies with the greatest potential for reducing both primary and secondary cardiovascular disparities.

Developing Priorities to Alleviate the Long-Term Impact of the COVID-19 Pandemic on Women Engaged in Diabetes Research, Education, and Care: A Concept Mapping Study.

Objective: The aim of this study was to develop priorities through stakeholder engagement to alleviate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the professional careers of women engaged in diabetes research, education, and care. Research Design and Methods: This study used concept mapping, a mixed-methods, multistep process, to generate a conceptual map of recommendations through the following steps: 1) identify stakeholders and develop the focus prompt, 2) generate ideas through brainstorming, 3) structure ideas through sorting and rating on priority and likelihood, 4) analyze the data and create a cluster map, and 5) interpret and use results. Results: Fifty-two participants completed the brainstorming phase, and 24 participated in sorting and rating. The final concept map included seven clusters. Those rated as highest priority were to ensure supportive workplace culture (µ = 4.43); promote practices to achieve gender parity in hiring, workload, and promotion (µ = 4.37); and increase funding opportunities and allow extensions (µ = 4.36). Conclusion: This study identified recommendations for institutions to better support women engaged in diabetes-related work to alleviate the long-term impact of the COVID-19 pandemic on their careers. Some areas were rated as high in priority and high in likelihood, such as ensuring a supportive workplace culture. In contrast, family-friendly benefits and policies were rated as high in priority but low in likelihood of being implemented; these may take more effort to address, including coordinated efforts within institutions (e.g., women's academic networks) and professional societies to promote standards and programs that advance gender equity in medicine.

Does the neighborhood built environment moderate the effectiveness of a weight-loss intervention for mothers with overweight or obesity? Findings from the Healthy Eating and Active Living Taught at Home (HEALTH) study.

BACKGROUND: Women of childbearing age are vulnerable to weight gain and experience a high prevalence of obesity due to pregnancy and stressors of parenthood. Lifestyle interventions such as the Healthy Eating and Active Living Taught at Home (HEALTH) study have been effective for weight loss; however, little is known about how the built environment (parks, transit, grocery stores, fast food, walkability etc.), where participants live might modify intervention effectiveness. This study examined whether characteristics of the neighborhood built environment modified effectiveness of the HEALTH study on weight loss.  METHODS: Secondary data analysis was conducted using data from HEALTH. Using GIS, buffers were built around participant addresses to capture distance to and availability of food (grocery store, convenience store, fast food) and urban design and transit (parks, street connectivity, transit) built environment characteristics. Built environment characteristics were dichotomized into low and high density and distance. Likelihood ratio tests for interaction were conducted to determine if built environment characteristics modified intervention effectiveness on Body mass index (BMI) and waist circumference (WC). Mixed effects linear regression models were then run to estimate the effect of the HEALTH intervention on weight outcomes at 24-months across both strata of built environment characteristics.  RESULTS: The analytic sample (n = 151) had baseline mean BMI 34.9 (SD = 5.8) and mean WC 46.0 cm (SD4.9). All urban design and transit and all food environment characteristics modified HEALTH effectiveness on one or both weight outcomes. The built environment modified the HEALTH intervention such that it was mostly effective for mothers residing in neighborhoods with low transit access, low street connectivity, high park access, and low access to grocery stores, convenience stores, and fast food. CONCLUSIONS: Result show the HEALTH was most effective for women residing neighborhoods with built environment characteristics suggestive of suburban neighborhood typology. To maximize impact for mothers residing in all types of neighborhoods, future research should explore scaling up HEALTH in suburban settings, while adapting HEALTH to maximize effectiveness in compact neighborhoods most likely, urban core neighborhoods.

Expanding Implementation Research to Prevent Chronic Diseases in Community Settings.

Chronic disease prevention continues to be inadequate, overall and in achieving health equity, in spite of the many evidence-based practices and policies (EBPPs) available to address risk behaviors such as unhealthful eating, lack of physical activity, and tobacco use. Although clinical settings are needed for EBPPs that involve medical procedures such as immunization or early detection, dissemination of EBPPs can be effective in a variety of settings such as schools and childcare centers, worksites, social service organizations, and religious organizations. More implementation research is needed to meet challenges of effective application of EBPPs in such community settings, in which primary missions, capacity, cultures, and values do not focus on health services delivery. To address health equity, consideration of social and economic contexts of people reached in these settings is essential. This review presents lessons learned from past studies to guide future implementation research and practice across diverse settings and geographies.

Applying RE-AIM to Evaluate the External Validity of Weight Gain Prevention Interventions in Young Adults: A Systematic Review.

OBJECTIVES: The purpose of this review was to use RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to assess the extent to which weight gain prevention studies targeting young adults reported on elements of external validity. DESIGN: Systematic review. ELIGIBILITY CRITERIA: Articles of interest included a lifestyle/behavioral intervention targeting weight gain prevention. Eligibility criteria included the following: study design of randomized controlled trials, quasi-randomized control trials, or natural experiments; average participant age between 18 and 35 years; study duration of at least 12 months; and published in English between January 2008 and May 2018. Studies had to report weight or body mass index as a measured outcome and were excluded if they were paired with smoking cessation programs, were conducted in specific groups (ie, pregnant women, breast cancer survivors), or were follow-ups to weight loss studies. STUDY SELECTION: After removing duplicates, the search yielded 11426 articles. Titles and abstracts were screened by 1 reviewer; 144 articles were assessed in a full-text review by 2 reviewers. Discrepancies were resolved by consensus. Nine studies (13 articles) were included in the review. MAIN OUTCOMES MEASURES: Reported elements of the RE-AIM framework. RESULTS: A total of 9 studies met the selection criteria. All studies lacked full reporting on external validity elements. Of the total of 60 RE-AIM reporting criteria, 8 were reported by all 9 studies, 26 criteria were reported by fewer than 4 studies, and 22 criteria were not reported by any of the studies. DISCUSSION: There remains inadequate reporting of elements of external validity and generalizability in weight gain prevention studies. This is a significant scientific constraint that limits the information required to disseminate and implement prevention of weight gain interventions for population impact. Standardized reporting may be needed to ensure results that demonstrate not only internal validity but also external validity and generalizability are needed to promote public health impact.

Low rates of cascade genetic testing among families with hereditary gynecologic cancer: An opportunity to improve cancer prevention.

OBJECTIVE: Cascade genetic testing (CGT) of hereditary breast and ovarian cancer (HBOC) or Lynch Syndrome (LS) patients' relatives offers opportunities to prevent cancer, but CGT rates are not well described. We aimed to measure reported disclosure of genetic testing results and CGT rates in these families and evaluate patients' views of educational media. METHODS: Patients with HBOC or LS identified from germline genetic testing at an academic institution between 2011 and 2016 were surveyed regarding disclosure, testing among relatives, and perceptions of educational materials. Medical records and pedigrees provided numbers of total and first-degree relatives. RESULTS: Of 103 mutation carriers consented, 64 (63%) completed the survey an average of 38 months after receiving genetic testing results. Participants' mean age was 53 years, and thirty-one (48%) had a cancer diagnosis. The majority (86%) felt extremely or very comfortable sharing health information. Participants disclosed results to 87% of first-degree relatives, but reported that only 40% of first-degree relatives underwent testing. First-degree female relatives had significantly higher CGT rates than first-degree male relatives (59% versus 21%, P < 0.001). Participants with HBOC reported higher CGT rates than those with LS (49% versus 33%, P = 0.02). Participants did not identify any one educational medium as more helpful than the others for disclosing results. CONCLUSION: Disclosure rates are high among HBOC and LS mutation carriers, but reported CGT rates are low. Gender- and mutation-specific barriers prevent patients' family members from undergoing CGT. Future studies should implement materials to address these barriers and improve CGT rates.

Factors Facilitating or Hindering Use of Evidence-Based Diabetes Interventions Among Local Health Departments.

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.

Belief, Confidence, and Motivation to Use the Paretic Upper Limb in Daily Life Over the First 24 Weeks After Stroke.

BACKGROUND AND PURPOSE: The recovery patterns of upper limb (UL) impairment after stroke are established. Psychosocial factors such as belief that paretic UL recovery is possible, confidence, and motivation to use the paretic UL in everyday tasks are unexplored early after stroke. The purpose of this exploratory study was to characterize belief, confidence, and motivation to use the paretic UL in daily life, and self-perceived barriers to UL recovery over the first 24 weeks after stroke. METHODS: This was a longitudinal cohort study (N = 30) with 8 assessment sessions over the first 24 weeks after stroke. Belief, confidence, and motivation to use the paretic UL and self-perceived barriers were quantified via survey and analyzed using descriptive statistics. Change in the number of self-perceived barriers between weeks 2 and 24 was tested using a paired-samples t test. The relationship between UL capacity, depressive symptomatology, cognition, and each psychosocial factor was examined using Spearman rank-order correlation analyses. RESULTS: Twenty-two participants completed all study assessments. Belief, confidence, and motivation were high across the 24 weeks, with little variation. There was no difference between the average number of barriers from weeks 2 to 24. There was no relationship between the clinical measures and psychosocial factors at week 2, 12, or 24. DISCUSSION AND CONCLUSIONS: High levels of belief, confidence, and motivation appear consistent over the first 6 months after stroke. The lack of correlations between psychosocial factors and clinical measures suggests belief, confidence, and motivation may not be vulnerable to functional status early after stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A283).

A multilevel approach for promoting physical activity in rural communities: a cluster randomized controlled trial.

BACKGROUND: Physical activity (PA) has demonstrated a decreased risk in various cancers and other chronic diseases; however, rural residents are less likely to attain recommended levels of PA compared to urban and suburban counterparts. Given rural residents make up 15% of the United States population, there is a need for novel approaches to increase PA among this population. The goal of the present study is to investigate the effectiveness of a multilevel intervention to increase PA rates among rural residents. METHODS/DESIGN: Guided by an ecological framework, a group-randomized design will be used to evaluate the effects of a three-level intervention for increasing PA among adult residents residing in 6 rural communities (n = 600) along with 6 control communities (n = 600). The intervention includes components at the individual (short message service [SMS] text messages), interpersonal (social support in walking groups), and community levels (events at existing trails). Innovative methods to encourage participation will be employed as well as a focus on life priorities (family, recreation, hobbies) other than health. Aim 1 includes a literature review and key informant interviews to determine the local contexts for intervention adaptation. Aim 2 will employ a set of interventions at the individual, interpersonal, and community-levels to evaluate their impact on moderate-to-vigorous PA as measured by self-reported (telephone survey) and objectively assessed (accelerometry) measures. These data are supplemented by location based on Global Positioning System and community audits, which provide information on recreational amenities, programs/policies, and street segments. DISCUSSION: This study is among the first of its kind to test a multilevel intervention in a rural setting, address life priorities that compliment health outcomes, and examine moderation between behavioral interventions and the natural environments where people are physically active. Our results will influence the field by enhancing the ability to scale-up innovative, PA interventions with the potential to reach high-risk, rural populations. TRIAL REGISTRATION: Clinical Trials NCT03683173 , September 25, 2018.

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.

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.

A formative study to understand perspectives of families eligible for a pediatric obesity program: a qualitative study.

BACKGROUND: Raising Well® (RW) was initiated in 2015 by Envolve PeopleCare™ at the request of health plans seeking a solution to work with families on Medicaid that have a child with overweight or obesity. RW uses expert clinical coaches via phone contact to deliver an educational intervention promoting lifestyle change to families with at least one overweight or obese child in an eligible Medicaid health plan. This gives RW significant potential for reach and population impact. This project aimed to understand how to maximize this impact by exploring perspectives of RW, using a conceptual framework informed by the Conceptual Model of Implementation Research, including assessment of the feasibility, acceptability, and appropriateness of RW; determining satisfaction among those experiencing coaching; identifying reasons individuals do not participate; and developing recommendations to enhance interest and participation. METHODS: Semi-structured interviews were conducted with 70 RW-eligible families across four states, who were described as: active participants, respondents who dropped or stopped RW, and RW non-participants. Following the interviews, the transcripts were coded inductively and deductively using a grounded theory approach, considering themes from the conceptual framework; themes also emerged from the data. RESULTS: From this sample, 19 families reported to be active coaching participants, 24 had dropped coaching, and 27 were RW non-participants. A number of themes were identified. Feasibility themes included coaches' flexibility and willingness to work with the family's schedule. Acceptability themes suggest providing actionable strategies tailored to the family's context and needs, beyond just nutrition information and tips, early in the coaching relationship so the family perceives a benefit for continued participation. With regard to appropriateness, families were also interested in other methods of communication including email, texting, and in person visits. Access to resources for activity and healthy eating in their local community was also recommended. CONCLUSIONS: RW has the potential to improve health and promote wellness. To enhance the impact of this program, RW could incorporate these findings to promote feasibility, acceptability, and appropriateness and improve program implementation. Strategies may include modifying the information provided or the mode of delivering the information.

Development of a scalable weight loss intervention for low-income workers through adaptation of interactive obesity treatment approach (iOTA).

BACKGROUND: Describing how and why an evidence-based intervention is adapted for a new population and setting using a formal evaluation and an adaptation framework can inform others seeking to modify evidence-based weight management interventions for different populations or settings. The Working for You intervention was adapted, to fit a workplace environment, from Be Fit Be Well, an evidence-based intervention that targets weight-control and hypertension in patients at an outpatient clinic. Workplace-based efforts that promote diet and activity behavior change among low-income employees have potential to address the obesity epidemic. This paper aims to explicitly describe how Be Fit Be Well was adapted for this new setting and population. METHODS: To describe and understand the worksite culture, environment, and policies that support or constrain healthy eating and activity in the target population, we used qualitative and quantitative methods including key informant interviews, focus groups, and a worker survey; these data informed intervention adaptation. We organized the adaptations made to Be Fit Be Well using an adaptation framework from implementation science. RESULTS: The adapted intervention, Working for You, maintains the theoretical premise and evidence-base underpinning Be Fit Be Well. However, it was modified in terms of the means of delivery (i.e., rather than using interactive voice response, Working for You employs automated SMS text messaging), defined as a modification to context by the adaptation framework. The adaptation framework also includes modifications to content; in this case the behavioral goals were modified for the target population based on updated science related to weight loss and to target a workplace population (e.g., a goal to avoiding free food at work). CONCLUSIONS: If effective, this scalable and relatively inexpensive intervention can be translated to other work settings to reduce obesity and diabetes risk among low-SES workers, a group with a higher prevalence of these conditions. Using a formal evaluation and framework to guide and organize how and why an evidence-based intervention is adapted for a new population and setting can push the field of intervention research forward. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02934113 ; Received: October 12, 2016; Updated: November 7, 2017.

Getting the Word Out: New Approaches for Disseminating Public Health Science.

The gap between discovery of public health knowledge and application in practice settings and policy development is due in part to ineffective dissemination. This article describes (1) lessons related to dissemination from related disciplines (eg, communication, agriculture, social marketing, political science), (2) current practices among researchers, (3) key audience characteristics, (4) available tools for dissemination, and (5) measures of impact. Dissemination efforts need to take into account the message, source, audience, and channel. Practitioners and policy makers can be more effectively reached via news media, social media, issue or policy briefs, one-on-one meetings, and workshops and seminars. Numerous "upstream" and "midstream" indicators of impact include changes in public perception or awareness, greater use of evidence-based interventions, and changes in policy. By employing ideas outlined in this article, scientific discoveries are more likely to be applied in public health agencies and policy-making bodies.

An Overview of Research and Evaluation Designs for Dissemination and Implementation.

The wide variety of dissemination and implementation designs now being used to evaluate and improve health systems and outcomes warrants review of the scope, features, and limitations of these designs. This article is one product of a design workgroup that was formed in 2013 by the National Institutes of Health to address dissemination and implementation research, and whose members represented diverse methodologic backgrounds, content focus areas, and health sectors. These experts integrated their collective knowledge on dissemination and implementation designs with searches of published evaluations strategies. This article emphasizes randomized and nonrandomized designs for the traditional translational research continuum or pipeline, which builds on existing efficacy and effectiveness trials to examine how one or more evidence-based clinical/prevention interventions are adopted, scaled up, and sustained in community or service delivery systems. We also mention other designs, including hybrid designs that combine effectiveness and implementation research, quality improvement designs for local knowledge, and designs that use simulation modeling.

Mixed methods analysis of eighteen worksite policies, programs, and environments for physical activity.

BACKGROUND: This study examined whether specific worksite supports for physical activity (PA) were associated with total and domain-specific PA. METHODS: A cross-sectional, telephone-based study was conducted in four Missouri, USA, metropolitan areas in 2012 and 2013. Outcome variables included total PA and sub-domains (leisure, work, travel) measured using the International Physical Activity Questionnaire. Logistic regression determined odds of meeting PA recommendations, given access to and use of 18 unique PA worksite supports. A subsample of 119 participants also wore hip accelerometry for seven consecutive days and maintained a wear-time diary. Access to worksite supports were associated with odds of meeting objective moderate and vigorous (MV) PA above 150 min per week. RESULTS: Among 2013 survey participants, meeting PA recommendations while performing work-related tasks was significantly associated with several supports (e.g., walking maps, stair prompts), as was meeting recommendations during travel (e.g., flextime for PA, incentives for public transportation, walking/bicycling to work). Access to 11 worksite supports increased odds of meeting PA recommendations through leisure-time PA; five supports were associated with total PA. There were significant differences between access to and use of supports. Using objective MVPA, access to worksite challenges and bike storage were significantly associated with five and three times greater odds of meeting 150 min of MVPA per week, respectively. CONCLUSIONS: Worksite wellness plans are increasing across the US and employers are eager for evidence-based supports for increasing PA. This study provides insights into the utility of multiple worksite supports for PA to increase odds that employees meet PA recommendations.

Comparison of Research Framing Preferences and Information Use of State Legislators and Advocates Involved in Cancer Control, United States, 2012-2013.

INTRODUCTION: Evidence-based policy plays an important role in prevention of cancer and other chronic diseases. The needs of actors involved in policy decision-making should inform knowledge translation strategies. This study examines the differences between state legislators and advocates in how they seek and use information and what their preferences are for how research information is framed. METHODS: We conducted a cross-sectional comparison of survey responses by US advocates (n = 77) and state legislators (n = 265) working on issues related to cancer control. RESULTS: Advocates differed significantly from legislators on all demographic characteristics. Advocates reported seeking and using information more frequently than legislators, though legislators used legislative research bureaus more often (0.45 point difference, P = .004). Both legislators and advocates prioritized the presentation and timeliness of research information similarly but reported different preferences for source (information bias, information relevance, delivery of information by trusted person) of research information. Several differences between advocates and legislators were modified by participant age. CONCLUSION: Our study provides insights for development of knowledge translation strategies to enhance evidence-based policy making for cancer control that are tailored to state-level legislators and advocates. Additional research efforts should evaluate the effectiveness of such knowledge translation strategies, particularly among advocates.

The role of researchers in disseminating evidence to public health practice settings: a cross-sectional study.

BACKGROUND: Evidence-based public health interventions, which research has demonstrated offer the most promise for improving the population's health, are not always utilized in practice settings. The extent to which dissemination from researchers to public health practice settings occurs is not widely understood. This study examines the extent to which public health researchers in the United States are disseminating their research findings to local and state public health departments. METHODS: In a 2012, nationwide study, an online questionnaire was administered to 266 researchers from the National Institutes of Health, the Centers for Disease Control and Prevention, and universities to determine dissemination practices. Logistic regression analyses were used to examine the association between dissemination to state and/or local health departments and respondent characteristics, facilitators, and barriers to dissemination. RESULTS: Slightly over half of the respondents (58%) disseminated their findings to local and/or state health departments. After adjusting for other respondent characteristics, respondents were more likely to disseminate their findings to health departments if they worked for a university Prevention Research Center or the Centers for Disease Control and Prevention, or received their degree more than 20 years ago. Those who had ever worked in a practice or policy setting, those who thought dissemination was important to their own research and/or to the work of their unit/department, and those who had expectations set by their employers and/or funding agencies were more likely to disseminate after adjusting for work place, graduate degree and/or fellowship in public health, and the year the highest academic degree was received. CONCLUSIONS: There is still room for improvement in strengthening dissemination ties between researchers and public health practice settings, and decreasing the barriers researchers face during the dissemination process. Researchers could better utilize national programs or workshops, knowledge brokers, or opportunities provided through academic institutions to become more proficient in dissemination practices.

Assessing Capacity for Sustainability of Effective Programs and Policies in Local Health Departments.

CONTEXT: 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 and is important in local health departments (LHDs) to retain the benefits of effective programs. OBJECTIVE: Explore the applicability of the Program Sustainability Framework in high- and low-capacity LHDs as defined by national performance standards. DESIGN: Case study interviews from June to July 2013. Standard qualitative methodology was used to code transcripts; codes were developed inductively and deductively. SETTING: Six geographically diverse LHD's (selected from 3 of high and 3 of low capacity) PARTICIPANTS: : 35 LHD practitioners. MAIN OUTCOME MEASURES: Thematic reports explored the 8 domains (Organizational Capacity, Program Adaptation, Program Evaluation, Communications, Strategic Planning, Funding Stability, Environmental Support, and Partnerships) of the Program Sustainability Framework. RESULTS: High-capacity LHDs described having environmental support, while low-capacity LHDs reported this was lacking. Both high- and low-capacity LHDs described limited funding; however, high-capacity LHDs reported greater funding flexibility. Partnerships were important to high- and low-capacity LHDs, and both described building partnerships to sustain programming. Regarding organizational capacity, high-capacity LHDs reported better access to and support for adequate staff and staff training when compared with low-capacity LHDs. While high-capacity LHDs described integration of program evaluation into implementation and sustainability, low-capacity LHDs reported limited capacity for measurement specifically and evaluation generally. When high-capacity LHDs described program adoption, they discussed an opportunity to adapt and evaluate. Low-capacity LHDs struggled with programs requiring adaptation. High-capacity LHDs described higher quality communication than low-capacity LHDs. High- and low-capacity LHDs described strategic planning, but high-capacity LHDs reported efforts to integrate evidence-based public health. CONCLUSIONS: Investments in leadership support for improving organizational capacity, improvements in communication from the top of the organization, integrating program evaluation into implementation, and greater funding flexibility may enhance sustainability of evidence-based public health in LHDs.

Which worksite supports for healthy weight do employees use?

This paper explores factors associated with employee use of available supports for improving nutrition and activity behaviors. A cross-sectional telephone-survey assessed presence and use of available program, facility, and policy supports. Logistic regression was used to explore associations between job characteristics (e.g., supervising others) and use of available supports, adjusting for demographic characteristics. After adjustment, most supports were associated with at least one job-related factor. Participants supervising others were more likely to utilize eight supports including personal services for fitness, indoor exercise and shower facilities, and flextime for physical activity. The programs and facilities associated with the most factors were health fairs (e.g., increased likelihood with increased hours worked/week) and indoor exercise and shower facilities (e.g., increased likelihood with increased flexibility at work), respectively. Policies were associated with fewer factors. Since use of many programs and facilities differed based on job-related factors, employers might target supports based on job-related factors.

Implementing administrative evidence based practices: lessons from the field in six local health departments across the United States.

BACKGROUND: Administrative evidence based practices (A-EBPs) are agency level structures and activities positively associated with performance measures (e.g., achieving core public health functions, carrying out evidence-based interventions). The objectives of this study were to examine the contextual conditions and explore differences in local health department (LHD) characteristics that influence the implementation of A-EBPs. METHODS: Qualitative case studies were conducted based on data from 35 practitioners in six LHDs across the United States. The sample was chosen using an A-EBP score from our 2012 national survey and was linked to secondary data from the National Public Health Performance Standards Program. Three LHDs that scored high and three LHDs that scored low on both measures were selected as case study sites. The 37-question interview guide explored LHD use of an evidence based decision making process, including A-EBPs and evidence-based programs and policies. Each interview took 30-60 min. Standard qualitative methodology was used for data coding and analysis using NVivo software. RESULTS: As might be expected, high-capacity LHDs were more likely to have strong leadership, partnerships, financial flexibility, workforce development activities, and an organizational culture supportive of evidence based decision making and implementation of A-EBPs. They were also more likely to describe having strong or important relationships with universities and other educational resources, increasing their access to resources and allowing them to more easily share knowledge and expertise. CONCLUSIONS: Differences between high- and low-capacity LHDs in A-EBP domains highlight the importance of investments in these areas and the potential those investments have to contribute to overall efficiency and performance. Further research may identify avenues to enhance resources in these domains to create an organizational culture supportive of A-EBPs.