The goal of the proposed research is to reduce the number of obesity-related cancers by advancing our understanding of organizational processes that influence implementation of evidence-based practice (EBP) in obesity prevention in U.S. public health settings. Local health departments (LHD) are governmental agencies responsible for delivering public health services in communities across the US, including policies and programs related to obesity prevention, and will provide the setting for this study. The growing movement in public health around continuous quality improvement (documented through accreditation) offers an opportunity to study the potential impact on organizational processes related to the uptake of EBP. Implementation climate is a characteristic of organizations that facilitates EBP implementation and has been documented to change in response to targeted strategies. There are currently no instruments to measure implementation climate developed for use in LHDs, whose structure differs in meaningful ways from health care service organizations for which such measures have been developed.
The aims of the proposed study are 1) to determine the feasibility of collecting and merging existing data related to public health organizational structure and context from multiple sources and 2) to pilot-test a new measure of implementation climate. The new measure of implementation climate will be based on a framework from implementation research, which was developed from a comprehensive review of other published measures. Scales developed for this new measure will be assessed for test-retest reliability. In order to better manage the scope of this pilot study we will focus this workon Missouri LHDs. Missouri is an ideal laboratory for this pilot work, with the only voluntary, state-based accreditation program mirroring the national program. The recently launched national program provides a future opportunity for widespread public health impact, and offers the potential to scale up the measures and methods developed in this pilot work, which could enhance our understanding of how to improve implementation of EBP in obesity and cancer prevention across a broad range of communities. Our methods and approach will be informed by practitioner input through our linkages with the Missouri Institute for Community Health and the Missouri Public Health Practice-Based Research Network. We plan to use the methods and measures developed from this pilot study for a larger study which will be powered to test the hypothesis that accreditation is associated with improvements in organizational climate for EBP, as well as study the potential moderating effects of organizational structure and climate. Data from the larger study will also be used to conduct more rigorous psychometric assessment of the scales developed to measure implementation climate. Ultimately, these findings will inform the design of a trial to test the effectiveness of an implementation strategy with the goal of improving implementation of EBP in obesity and cancer prevention in LHDs across the US.
There is a large body of research knowledge that could contribute to reducing the number of obesity-related cancers in the US if it was more widely applied in practice. Local health departments, which carry out public health functions in communities across the US, provide a key setting for scaling up the translation of knowledge into practice. The proposed project aims to develop a measure of implementation climate to advance our understanding of how to improve organizational processes in LHDs such that practice in obesity and cancer prevention is ultimately more effective.