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

Renee G Parks, Rachel G Tabak, Peg Allen, Elizabeth A Baker, Katherine A Stamatakis, Allison R Poehler, Yan Yan, Marshall H Chin, Jenine K Harris, Maureen Dobbins, Ross C Brownson, Renee G Parks, Rachel G Tabak, Peg Allen, Elizabeth A Baker, Katherine A Stamatakis, Allison R Poehler, Yan Yan, Marshall H Chin, Jenine K Harris, Maureen Dobbins, Ross C Brownson

Abstract

Background: The rates of diabetes and prediabetes in the USA are growing, significantly impacting the quality and length of life of those diagnosed and financially burdening society. Premature death and disability can be prevented through implementation of evidence-based programs and policies (EBPPs). Local health departments (LHDs) are uniquely positioned to implement diabetes control EBPPs because of their knowledge of, and focus on, community-level needs, contexts, and resources. There is a significant gap, however, between known diabetes control EBPPs and actual diabetes control activities conducted by LHDs. The purpose of this study is to determine how best to support the use of evidence-based public health for diabetes (and related chronic diseases) control among local-level public health practitioners.

Methods/design: This paper describes the methods for a two-phase study with a stepped-wedge cluster randomized trial that will evaluate dissemination strategies to increase the uptake of public health knowledge and EBPPs for diabetes control among LHDs. Phase 1 includes development of measures to assess practitioner views on and organizational supports for evidence-based public health, data collection using a national online survey of LHD chronic disease practitioners, and a needs assessment of factors influencing the uptake of diabetes control EBPPs among LHDs within one state in the USA. Phase 2 involves conducting a stepped-wedge cluster randomized trial to assess effectiveness of dissemination strategies with local-level practitioners at LHDs to enhance capacity and organizational support for evidence-based diabetes prevention and control. Twelve LHDs will be selected and randomly assigned to one of the 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. Intervention (dissemination) strategies may include multi-day in-person workshops, electronic information exchange methods, technical assistance through a knowledge broker, and organizational changes to support evidence-based public health approaches. Evaluation methods comprise surveys at baseline and the three crossover time points, abstraction of local-level diabetes and chronic disease control program plans and progress reports, and social network analysis to understand the relationships and contextual issues that influence EBPP adoption.

Trial registration: ClinicalTrial.gov, NCT03211832.

Keywords: Chronic disease prevention; Diabetes control; Dissemination research; Evidence-based public health; Public health workforce.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the institutional review board of Washington University in St. Louis (reference number: 201705026).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Conceptual framework of dissemination of EBPPs in LHDs
Fig. 2
Fig. 2
Phase 1 national survey selection of LHD lead practitioners working in chronic disease control
Fig. 3
Fig. 3
a Phase 2 stepped wedge study design. b Stepped wedge implementation during study

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