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Building an Evidence-Based Health Department

Posted By Margaret G. Ritchie, Thursday, April 19, 2018
Updated: Thursday, April 19, 2018

Experience has shown that evidence-based public health (EBPH) training gives chronic disease practitioners the tools they need to make decisions based on the best available evidence. Public health practitioners working within health systems studied and developed administrative evidence-based practices (A-EBPs) that can help facilitate the health departments’ roles in supporting the application of evidence-based decision making (i.e. how to become an evidence-based health department). A-EBPs consist of five major domains: workforce development, leadership, organizational culture and climate, relationships and partnerships, and financial processes.

In 2016, the National Association of Chronic Disease Directors (NACDD), and the Centers for Disease Control and Prevention (CDC), in collaboration with the Prevention Research Center at Washington University in St. Louis issued a national survey including a subset of questions on A-EBPs. There were four workforce development questions assessing perceptions of the respondent’s work unit as a whole; 11 leadership questions related to quality of leaders, evidence-based decision making, management, and unit capacity; 10 statements that assessed perceptions of organizational culture and climate; and four questions to assess perceptions of financial transparency, type and structure of funding sources, and economic evaluation.

571 chronic disease practitioners responded to a national survey.

What did we learn?

 • In the leadership category, the highest percentage of respondents agreed with the presence of quality leadership (63%). The items with the lowest percentage of agreement were related to the future workforce in public health. Only 12.4% agreed that their department had a replacement plan for those who retire or move to another job.

• Within the culture and climate construct, 68% of respondents reported working in a department that encourages communication and collaboration. Respondents used a likert scale (from strongly disagree to strongly agree) as to whether their department "adequately represents the cultural needs of the communities in my state." 34% agreed or strongly agreed with the statement. Of all the questions in the climate and culture category, this had the fewest number/ lowest percent who agreed or strongly agreed.

• Within relationships and partners, only two items had agreement percentages less than 50%. Only 30% agreed that their health department collaborates with health plans, and 42% agreed that they collaborate with sectors outside of public health. The vast majority (87%) agreed that partnership development with both health and other sectors is needed to address health issues within their state.

• In the financial practices group of questions, less than one-third agreed that economic evaluation is included in decision making about programs and policies, and only 28% reported that their organization had a variety of stable and flexible funding sources. In addition to the use of evidence-based interventions, administrative best practices can help ensure the quality and sustainability of initiatives within state health departments.

The data from this study can be used to target training and to inform practice in a number of ways. They suggest a need for: 1) succession planning, particularly in light of the aging workforce; 2) continued development of leadership capacity; and 3) stronger collaborations, i,e. more integration of primary care and public health, and more partnering with other sectors outside of health. Enhancing awareness of A-EBPs within public health leadership and highlighting their importance to practice may lead to increased use of these practices.

For more on the findings, read the full article: Eyler, A. A., Valko, C., Ramadas, R., Macchi, M., Fershteyn, Z., & Brownson, R. C. (2017). Administrative Evidence-Based Practices in State Chronic Disease Practitioners. American Journal of Preventive Medicine, 54(2), 275–283. 

 View the assessment tool online.

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