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.

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.

Preparing Public Health Professionals to Make Evidence-Based Decisions: A Comparison of Training Delivery Methods in the United States.

Background: Evidence-based decision making (EBDM) in health programs and policies can reduce population disease burden. Training in EBDM for the public health workforce is necessary to continue capacity building efforts. While in-person training for EBDM is established and effective, gaps in skills for practicing EBDM remain. Distance and blended learning (a combination of distance and in-person) have the potential to increase reach and reduce costs for training in EBDM. However, evaluations to-date have focused primarily on in-person training. Here we examine effectiveness of in-person trainings compared to distance and blended learning. Methods: A quasi-experimental pre-post design was used to compare gaps in skills for EBDM among public health practitioners who received in-person training, distance and blended learning, and controls. Nine training sites agreed to replicate a course in EBDM with public health professionals in their state or region. Courses were conducted either in-person (n = 6) or via distance or blended learning (n = 3). All training participants, along with controls, were asked to complete a survey before the training and 6 months post-training. Paired surveys were used in linear mixed models to compare effectiveness of training compared to controls. Results: Response rates for pre and post-surveys were 63.9 and 48.8% for controls and 81.6 and 62.0% for training groups. Participants who completed both pre and post-surveys (n = 272; 84 in-person, 67 distance or blended, and 121 controls) were mostly female (89.0%) and about two-thirds (65.3%) were from local health departments. In comparison to controls, overall gaps in skills for EBDM were reduced for participants of both in-person training (ß = -0.55, SE = 0.27, p = 0.041) and distance or blended training (ß = -0.64, SE = 0.29, p = 0.026). Conclusions: This study highlights the importance of using diverse methods of learning (including distance or blended in-person approaches) for scaling up capacity building in EBDM. Further exploration into effective implementation strategies for EBDM trainings specific to course delivery type and understanding delivery preferences are important next steps.