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The Diffusion of Evidence-Based Decision Making Among Local Health Department Practitioners in the United States

Harris, Jenine K. PhD; Erwin, Paul C. MD, DrPH; Smith, Carson MPA; Brownson, Ross C. PhD

Journal of Public Health Management and Practice: March/April 2015 - Volume 21 - Issue 2 - p 134–140
doi: 10.1097/PHH.0000000000000129
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Objectives: Evidence-based decision making (EBDM) is the process, in local health departments (LHDs) and other settings, of translating the best available scientific evidence into practice. Local health departments are more likely to be successful if they use evidence-based strategies. However, EBDM and use of evidence-based strategies by LHDs are not widespread. Drawing on diffusion of innovations theory, we sought to understand how LHD directors and program managers perceive the relative advantage, compatibility, simplicity, and testability of EBDM.

Design, Setting, and Participants: Directors and managers of programs in chronic disease, environmental health, and infectious disease from LHDs nationwide completed a survey including demographic information and questions about diffusion attributes (advantage, compatibility, simplicity, and testability) related to EBDM. Bivariate inferential tests were used to compare responses between directors and managers and to examine associations between participant characteristics and diffusion attributes.

Results: Relative advantage and compatibility scores were high for directors and managers, whereas simplicity and testability scores were lower. Although health department directors and managers of programs in chronic disease generally had higher scores than other groups, there were few significant or large differences between directors and managers across the diffusion attributes. Larger jurisdiction population size was associated with higher relative advantage and compatibility scores for both directors and managers.

Conclusions: Overall, directors and managers were in strong agreement on the relative advantage of an LHD using EBDM, with directors in stronger agreement than managers. Perceived relative advantage has been demonstrated to be the most important factor in the rate of innovation adoption, suggesting an opportunity for directors to speed EBDM adoption. However, lower average scores across all groups for simplicity and testability may be hindering EBDM adoption. Recommended strategies for increasing perceived EBDM simplicity and testability are provided.

This article describes diffusion of evidence-based decision making (EBDM) among local health department practitioners. Recommended strategies for increasing perceived EBDM simplicity and testability are also provided.

Prevention Research Center in St Louis (Ms Smith and Dr Brownson), Brown School (Dr Harris), Washington University in St Louis, St Louis, Missouri; and Department of Public Health, University of Tennessee, Knoxville (Dr Erwin).

Correspondence: Jenine K. Harris, PhD, Brown School, Washington University in St Louis, One Brookings Dr, St Louis, MO 63130 (harrisj@wustl.edu).

This study was supported in part by Robert Wood Johnson Foundation's grant no. 69964 (Public Health Services and Systems Research). This article is a product of the Prevention Research Center and was also supported by Cooperative Agreement no. U48/DP001903 from the Centers for Disease Control and Prevention. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors thank members of their research team, Peg Allen, Beth Dodson, Katie Duggan, Carolyn Leep, Robert Fields, Katie Stamatakis, and Drs Glen Mays and Douglas Scutchfield of the National Coordinating Center for Public Health Services and Systems Research, University of Kentucky College of Public Health.

The authors declare no conflicts of interest.

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