Disseminating Public Health Evidence to Support Prevention and Control of Diabetes Among Local Health Departments

Enhancing Evidence-based Diabetes Control Among Local Health Departments

The purpose of this study is to identify and evaluate dissemination strategies to support the uptake of evidence-based programs and policies (EBPPs) for diabetes prevention and control among local-level public health practitioners. Dissemination strategies such as multi-day in-person training workshops, electronic information exchange modalities, and remote technical assistance are hypothesized to associate with improved access and use of public health evidence and organizational supports for program and policy decision making based on evidence-based public health.

Study Overview

• Status: Completed
• Conditions: Organizational Support for Evidence-based Public Health
• Intervention / Treatment: Other: Dissemination of public health knowledge

Detailed Description

Evidence-based public health approaches to prevent and control diabetes and other chronic diseases have been identified in recent decades, and could have a profound effect on diabetes incidence and quality and length of life of those diagnosed. However, barriers to implement approaches continue because of lack of organizational support, limited resources, competing priorities, and limited skill among the public health workforce. The purpose of this study is to determine effective ways to promote the adoption of evidence based public health practice related to diabetes and chronic disease prevention and control among local health departments (LHDs). This stepped-wedge cluster randomized trial aims to evaluate active dissemination strategies on local-level public health practitioners to increase adoption and use of evidence-based programs and policies for diabetes and chronic disease prevention and control among LHDs in Missouri. Twelve LHDs will be recruited and randomly assigned to one of three groups that cross over from usual practice to receive the intervention (dissemination) strategies at 8-month intervals; the intervention duration for groups ranges from 8 to 24 months. LHD staff and the university-based study team are jointly identifying, refining and selecting dissemination strategies. Intervention strategies may include multi-day in-person training workshops, electronic information exchange modalities, and remote technical assistance. Evaluation methods include surveys at baseline and at each 8-month interval, abstraction of LHD chronic disease prevention program plans and progress reports, and social network analysis.

• Study Type: Interventional
• Enrollment (Actual): 331
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Missouri
    • Saint Louis, Missouri, United States, 63130
      • Prevention Research Center, Brown School, Washington University in St. Louis

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Local Health Departments (LHDs, cluster) in the state of Missouri and corresponding public health workforce (individuals within cluster); screenings.

Exclusion Criteria:

• LHDs that have less than 5 employees working in or supporting diabetes or chronic disease control, which includes program areas of diabetes prevention and management, obesity prevention, physical activity, nutrition, cardiovascular health, and cancer

Study Plan

How is the study designed?

Design Details

• Primary Purpose: OTHER
• Allocation: RANDOMIZED
• Interventional Model: CROSSOVER
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
NO_INTERVENTION: Control; The control group will conduct usual public health practice.
ACTIVE_COMPARATOR: Intervention; Participating local health departments will help develop and choose several dissemination activities they prefer for their local health department to receive. Dissemination activities may include multi-day in-person training workshops, electronic information exchange modalities, remote technical assistance, and information on ways to enhance organizational climates favorable to evidence-based diabetes and chronic disease prevention and control.	Other: Dissemination of public health knowledge; Participating local health departments will help develop and choose dissemination strategies they prefer for their staff working in and supporting diabetes and chronic disease prevention and control to receive. Dissemination strategies may include multi-day in-person training workshops, electronic information exchange modalities, remote technical assistance, and information on ways to enhance organizational climates favorable to evidence-based diabetes prevention and control.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evidence-based Decision Making (EBDM) Competencies	Survey participants were asked to rate the perceived importance of each of 10 skills pertinent to evidence-based decision making on an 11-point ordered scale (possible values 0 not at all important to 10 very important for each skill), and to rate the perceived availability in the agency of each of the same skills from 0-10 (0 not at all available to 10 very available). A skill gap was calculated for each skill as perceived importance minus perceived availability (possible values -10 to +10 for each skill). An overall EBDM skill gap was created by taking the average across all 10 skill gaps (possible values -10 to +10). Higher scores indicate a worse outcome. Skill items: community assessment; quantifying the issue; prioritization; action planning; adapting interventions; evaluation designs; quantitative evaluation; qualitative evaluation; economic evaluation; and communicating evidence to decision-makers. A definition for each was provided that started with the word "understand".	24 months post baseline
Evidence-based Intervention Score	Self-reported number of evidence-based chronic disease prevention interventions implemented by the local health department from a pre-populated list of 8 evidence-based interventions to prevent diabetes and other chronic diseases (possible score 0 to 8). Higher score indicates a better outcome.	24 months post baseline
Awareness of Culture Supportive of EBDM	Self-report Likert scale items measure personal awareness of opportunities to learn about and apply EBDM among local level chronic disease control public health practitioners. Each item is measured on a 7-point Likert scale from 1 strongly disagree to 7 strongly agree. A summary score was created as an average of the items within the domain. Possible scores 1 to 7. Higher scores mean a better outcome. The items were: a) I am provided the time to identify evidence-based programs and practices; b) My direct supervisor recognizes the value of management practices that facilitate evidence-based decision-making; c) My work group/division offers employees opportunities to attend evidence-based-decision making trainings; and d) Top leadership in my agency (e.g., director, assistant directors) recognizes the value of evidence-based decision-making.	24 months post baseline
Capacity and Expectations for Evidence-based Decision Making (EBDM)	Self-report Likert scale items assess perceived supervisory expectations for EBDM use and perceived work unit/division capacity to carry out EBDM. Each item is measured on a 7-point Likert scale from 1 strongly disagree to 7 strongly agree. A summary score was created as an average of the items (possible scores 1 to 7). Higher scores mean a better outcome. Items: a) I use EBDMin my work; b) My direct supervisor expects me to use evidence-based decision making; c) My performance is partially evaluated on how well I use evidence-based decision making in my work; d) My work group/division currently has the resources (e.g. staff, facilities, partners) to support application of evidence-based decision making; e) The staff in my work group/division has the necessary skills to carry out evidence-based decision making; f) The majority of my work group/division's external partners support use of EBDM; and g) Top leadership in my agency encourages use of EBDM.	24 months post baseline
Resource Availability	Self-report Likert scale items measured perceived work unit's resource availability for evidence-based decision making. Each item is measured on a 7-point Likert scale from 1 strongly disagree to 7 strongly agree. A summary score was created as an average of the items. Possible scores 1 to 7. Higher scores mean a better outcome. The items in the scale were: a) Informational resources (e.g. academic journals, guidelines, and toolkits) are available to my work group/division to promote the use of evidence-based decision making; b) My work group/division engages a diverse external network of partners that share resources to facilitate evidence-based decision making; and c) Stable funding is available for evidence-based decision making.	24 months post baseline
Evaluation Capacity of Work Unit	Self-report Likert scale of work unit's support of community needs assessment, utilization of evaluation for pre and post program implementation as well as for dissemination purposes. Each item is measured on a 7-point Likert scale from 1 strongly disagree to 7 strongly agree. A summary score was created as an average of the items within the domain. Possible scores 1 to 7. Higher scores mean a better outcome. Items: a) My work group/division supports community needs assessments to ensure that evidence-based decision-making approaches continue to meet community needs; b) My work group/division plans for evaluation of interventions prior to implementation; c) My work group/division uses evaluation data to monitor and improve interventions; and d) My work group/division distributes intervention evaluation findings to other organizations that can use our findings.	24 months post baseline
EBDM Climate Cultivation	Self-report Likert scale assessing perceived health department culture supportive of EBDM, information sharing and participatory decision making. Each item is measured on a 7-point Likert scale from 1 strongly disagree to 7 strongly agree. A summary score was created as an average of the items within the domain. Possible scores 1 to 7. Higher scores mean a better outcome. Items: a) My work group/division has access to evidence-based decision making information that is relevant to community needs; b) When decisions are made within my work group/division, program staff members are asked for input; c) Information is widely shared in my work group/division so that everyone who makes decisions has access to all available knowledge; d) My agency is committed to hiring people with relevant training or experience in public health core disciplines (e.g., epidemiology, health education, environmental health); and e) My agency has a culture that supports the processes necessary for EBDM.	24 months post baseline
Partnerships to Support EBDM	Self-report Likert scale items assess perceived importance of partnering across sectors to share resources and address population health issues. Each item is measured on a 7-point Likert scale from 1 strongly disagree to 7 strongly agree. A summary score was created as an average of the items within the domain. Possible scores 1 to 7. Higher scores mean a better outcome. Items: a) Our collaborative partnerships have missions that align with my agency; b) It is important to my agency to have partners who share resources (money, staff time, space, materials); c) It is important to my agency to have partners in health care to address population health issues; and d) It is important to my agency to have partners in other sectors (outside of health) to address population health issues	24 months post baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Inter-agency Connectedness	The average number of links per agency is the measure of connectedness with other agencies that is reported here. The measure is from a separate self-report social network survey.	24 months post baseline

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Investigators: Principal Investigator: Ross C Brownson, PhD, Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, Division of Public Health Sciences, Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine

Publications and helpful links

General Publications

• Parks RG, Tabak RG, Allen P, Baker EA, Stamatakis KA, Poehler AR, Yan Y, Chin MH, Harris JK, Dobbins M, Brownson RC. Enhancing evidence-based diabetes and chronic disease control among local health departments: a multi-phase dissemination study with a stepped-wedge cluster randomized trial component. Implement Sci. 2017 Oct 18;12(1):122. doi: 10.1186/s13012-017-0650-4.
• Jacob RR, Parks RG, Allen P, Mazzucca S, Yan Y, Kang S, Dekker D, Brownson RC. How to "Start Small and Just Keep Moving Forward": Mixed Methods Results From a Stepped-Wedge Trial to Support Evidence-Based Processes in Local Health Departments. Front Public Health. 2022 Apr 28;10:853791. doi: 10.3389/fpubh.2022.853791. eCollection 2022.

Helpful Links

• Click here for more information about this study: Adoption and Implementation of evidence to Mobilize Local Health
• Protocol paper
• Results paper

Study record dates

Study Major Dates

• Study Start (ACTUAL): July 5, 2017
• Primary Completion (ACTUAL): August 21, 2020
• Study Completion (ACTUAL): January 21, 2021

Study Registration Dates

• First Submitted: July 6, 2017
• First Submitted That Met QC Criteria: July 6, 2017
• First Posted (ACTUAL): July 7, 2017

Study Record Updates

• Last Update Posted (ACTUAL): February 10, 2023
• Last Update Submitted That Met QC Criteria: January 27, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Keywords: Dissemination research; Public health workforce; Evidence-based public health; Public health accreditation
• Other Study ID Numbers: 201705026; 5R01DK109913 (NIH)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No