Background: Nearly 26 million people in the US?or 8.3% of the population?has diabetes. Premature death and disability can be prevented for persons with diabetes 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. Goal: This proposal seeks to reduce the burden of diabetes by increasing adoption of EBPPs among LHD practitioners. Methods: This is a two-phase study that takes a comprehensive approach to elucidate effective tactics for dissemination and implementation (D&I) of EBPPs among LHD practitioners. Phase 1: We will refine and test measures to assess the adoption of EBPPs in LHDs, building on pilot work. Phase 2: We will conduct a qualitative needs assessment of 15 LHDs in Missouri to understand factors influencing the adoption of diabetes control EBPPs. We will then conduct a pre/post, experimental (group-randomized) study of 30 LHDs in Missouri to evaluate the effectiveness of active D&I approaches. The intervention arm of this study (15 LHDs) will receive a flexible ?menu? of D&I approaches that account for local contextual and organizational factors. The control arm (15 LHDs) will receive a minimal ?usual care? intervention. We will conduct multivariate regression analyses to model the factors important to improving adoption of diabetes control EBPPs, and will conduct social network analysis to understand the relationships and contextual issues that influence EBPP adoption. We will translate and disseminate findings from Phases 1 and 2 to LHD practitioners and practice-related stakeholders in order to support the sustainable practice of diabetes control among LHDs. Innovations and Impact: This study is innovative and impactful because it will: 1) be the first to identify effective approaches for increasing the adoption of diabetes control EBPPs among LHDs in the US; 2) be the first to develop valid and reliable objective measures of EBPP adoption levels in LHDs; 3) augment Diffusion of Innovation Theory with constructs from Institutional Theory; 4) include tactics novel to US public health practice (e.g., use of knowledge brokers); 5) use social network analysis and qualitative needs assessment together with traditional statistical modeling for a comprehensive understanding of the predictors of EBPP adoption; and 6) use a stakeholder-driven, flexible ?menu? approach from which to select a set of D&I activities that have the greatest salience and feasibility among the LHDs enrolled in our D&I trial. This research is expected to result in a replicable D&I model that can significantly impact diabetes and chronic disease control among LHDs.
The proposed study is relevant to public health because it addresses diabetes and its risk factors, which have high burden and disparities in the US. Intervention knowledge on evidence-based programs and policies for diabetes control is substantial, yet not commonly applied in local health departments, where a large reduction in burden is feasible if these policies and programs are more widely adopted. A project on this scale has the potential to shift the paradigm on how research can be more effectively disseminated across the US to those in an ideal position to use the evidence (local health departments).
| Parks, Renee G; Tabak, Rachel G; Allen, Peg et al. (2017) 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. Implement Sci 12:122 |
