Expanding Capacity for Evidence

What are we learning about training
in evidence-based public health
among local practitioners?
Ross Brownson
Beth Baker
Katie Duggan
Paul Erwin
Robert Fields
Carson Smith
Rodrigo Reis
Carolyn Leep (NACCHO)
Rachel Tabak
Amy Eyler
Kathleen Wojciehowski
Janet Canavese
Katie Stamatakis
Carol Brownson
Case Western PRC
Jenine Harris
Chris Casey
Beth Dodson
What is Project LEAD?
4 Aims:
1. Describe the evidence-base for local
EBPH in the United States (esp. AEBPs)
2. Test the effectiveness of local-level
EBPH capacity building in 4 states
(Train the Trainer)
3. Describe a range of local models in
4. Translate and disseminate findings to
Selected findings (Aim 1)
Administrative evidencebased practices (A-EBPS)
 Agency (health department)-level
structures and activities that are
positively associated with performance
measures (e.g., achieving core public
health functions, carrying out evidencebased interventions)
Brownson, Allen, Duggan, Stamatakis, & Erwin. Am J Prev Med,
Results, 5 EBP domains
Workforce development
Life long learning (71%), culture supports EBDM
Relationships and partnerships
Staff participation (84%) hire w/ PH degree (36%)
Organizational climate and culture
QI (82%), EBDM (59%)
Importance (92%), share resources (68%)
Financial processes
Multi funding sources (96%), QI resources (55%)
Predictors of a-EBPs
Predictors of A-EBPs in the United States, 2012 (n=317)
LHD Characteristic
OR (95% CI)
aOR (95% CI)
Population of
25,000 to 49,999
7.0 (3.3, 15.0)*
7.5 (3.3, 17.3)*
50,000 to 99,999
5.7 (2.7, 12.2)*
4.9 (2.1, 11.2)*
100,000 to
500,000 or larger
9.1 (4.3, 19.6)*
7.1 (3.0, 16.9)*
7.1 (3.0, 16.8)*
4.4 (1.6, 12.5)*
Early Results
Patterns of A-EBPs and use of EBDM vary
significantly based on:
1. Population size served by the LHD
(strongest predictors after adjustment)
a. Smaller HDs 3X more likely to be led by a
2. Governance structure (state governed)
3. Age group in the 50s
Use of resources
 26% of LHDs
reported systematic
reviews as 1 of top 3
most important
 34% were not
familiar with the
Community Guide
A tale of two worlds…
How LHDs learn about
research findings?
1. Professional associations
How researchers perceive
they most effectively reach
1. Journal articles
2. Seminars/workshops
2. Face-to-face meetings
3. Email alerts
3. Media interviews
4. Journal articles
4. Press releases
Selected findings (Aim 2)
Train the Trainer
• November 2012, St. Louis Missouri
• Recruitment of PRC’s
– Geographic distribution
– PRCs with established relationships with
– “Ready to hit the ground running”
Training Locations
• Case Western Reserve University
Prevention Research Center for Healthy Neighborhoods
and PBRN
• University of Michigan
Prevention Research Center of Michigan and Michigan
Public Health Training Center
• University of North Carolina at Chapel Hill
Center for Health Promotion and Disease Prevention
and PHTC
• University of Washington Health Promotion Research
Center and PHTC
Train the Trainer Process
• Partners from PRC came to St Louis for 3 day
training and overview of Evidence Based Public
Health course
• Conference calls with each site to set up
logistics and provide technical assistance
• EBPH slides and materials for trainings given to
each site
• PRC in conjunction with PBRN or PHTC put on
training for local health departments in their area
Train the Trainer
• Review of Module Content
• Focus on “Process” for course delivery
Recruiting participants for the
State Trainings
• Emails to various public health listservs
– PBRN, LHD commissioners, directors of
nursing, etc.
• Website postings
– PRC and PHTC
• Announcements and flyers at conferences
• Help from state health department
**Each state had waiting lists
Participants of Trainings
• 57% program manager or coordinator, 22% top
executive, administrator, or assistant director
• 2% doctoral degree, 24% public health masters,
37% other masters, 9% nursing degree, 28%
bachelors degree or less
• Mean years in current position = 5.2 years,
mean years in public health = 8.8 years
• Number of organizations represented at state
trainings in person = 101 (OH = 24, MI = 21, NC
= 26, WA = 20)
Course Format
Two locations used traditional in-person
training and two used mixed modes for
course delivery i.e. in-person and webinars
for distance learning capabilities
– WA – 3 one-hour webinars with 2 days of inperson training
– MI – 2 onsite training days, 3 modules each
day, 3 modules by webinar, 2 of which had
multiple days
11 EBPH Skills Evaluated
(pre-training course survey)
I Can…
develop a concise statement of the issue
conduct a community assessment
describe the issue in a quantitative way
discover what is known about the issue through the scientific literature
prioritize program or policy options that address the issue
understand economic evaluation to use findings from others to
assist with determining which intervention would be best suited for my community and
population of interest
understand economic evaluation to assist in the design and implementation of an
economic evaluation
develop an action plan for the program or policy
qualitatively evaluate the program or policy
quantitatively evaluate the program or policy
economically evaluate the program or policy
Pre/Post Skill Abilities
(course survey)
• Data show participants felt more capable
of all 11 skills after the training
– Differences in ability scores between pre and
post evaluations were all statistically
significant using p=.01 for sites evaluated
An Example: Skills Ability for
Case Western and NC combined
Number of responses
Number of responses
I can prioritize program or
policy options that address
the issue
I can qualitatively evaluate
the program or policy
Views Related to EBDM
(pre-training survey)
• I feel that I have the skills necessary for developing
evidence-based interventions (No. 76, 59.4%)
• I feel that I can effectively communicate information on
evidence-based strategies to policy matters (No. 54, 42.2%)
• I feel evidence-based interventions are packaged in a way
that I can use them (No. 34, 26.6%)
• I feel evidence-based interventions are designed in a way to
be self-sustaining (No. 30, 23.6%)
• I feel that I need to be an expert on many issues in order to
effectively make evidence-based decisions (No. 22, 17.2%)
• My fears about job security prevent me from using EBDM
(No. 6, 4.7%)
Which of the following would most
encourage you to utilize EBDM
in your work?
(pre-training survey)
• Placing a high priority on EBDM in your
• Trainings on EBDM
• Positive feedback for EBDM use
Which of the following would
most encourage you to utilize
EBDM in your work?
• Director’s Survey
• Trainings on EBDM
• Placing a high priority on EBDM by leaders in my agency
• Positive feedback for EBDM use
• Programmatic Survey
• Placing a high priority on EBDM in your work
• Trainings on EBDM
• Positive feedback for EBDM use
Gap between importance and
availability of skills
(pre-training survey)
Economic Evaluation 4.1
Communicating research to policy makers 3.5
Evaluation designs 3.3
Adapting interventions 3.2
Prioritizing health issues 2.7
What participants most liked
about the course
(post-training course survey)
• The breadth of the topics truly encouraged use of
evidence across all functions of a LHD, not just
• Being able to concentrate on learning and having a
systematic approach to follow
• Presents a whole new way of thinking about public
health practice
Lessons Learned
Webinars – advantages and disadvantages
• Quicker and easier for participants
• Less expensive
• Flexibility of combined format was appreciated by
• Opportunity for both formal and informal interaction
among participants and between participants and
instructors is much less
• Onsite instruction was more effective
Take away messages from Aim 2
• All surveys point to the need for more training in
• The pre/post evaluations received from the
trainings indicate that participants feel more
competent in EBPH skills after training
• EBPH trainings = improved skills, ability and
increased potential for change in local health
Ideas going forward…
Continue analyses, featuring more complex data linkage
Explore context and meaning of Aim 1 gaps
Explore new approaches for information seeking
Enhance Aim 2 additional technical assistance (beyond
the EBPH courses)
Develop new approaches for these populations (e.g., findings for
Scaling up findings from Aim 2
Use Aim 3 findings to find and test new leverage points
Link more closely with AcademyHealth for dissemination

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