Disseminating Public Health Evidence to Support Prevention and Control of Diabetes Among Local Health Departments

Primary Outcome Measures:

• Evidence-based decision making (EBDM) competencies [ Time Frame: 24 months post baseline ]
  Self-report Likert scale items measure perceived importance and availability of specific public health practitioner skill sets for EBDM.
  
  
• Awareness of EBDM [ Time Frame: 24 months post baseline ]
  Self-report Likert scale item measures personal awareness of opportunities to learn about EBDM among local level chronic disease control public health practitioners.
  
  
• Use of EBDM [ Time Frame: 24 months post baseline ]
  Self-report Likert scale items measure personal use of EBDM among local level chronic disease control public health practitioners.
  
  
• Supervisory Support and Expectations for EBDM use [ Time Frame: 24 months post baseline ]
  Self-report Likert scale items measure perceived direct supervisory support, value, and expectations for EBDM use by employees.
  
  
• Work group evaluation maintenance [ Time Frame: 24 months post baseline ]
  Self-report Likert scale of work units' support of community needs assessment, utilization of evaluation for pre and post program implementation use as well as for dissemination purposes.
  
  
• Work group EBDM resources maintenance [ Time Frame: 24 months post baseline ]
  Self-report Likert scale items measure perceived work unit's current skill capacity for EBDM as well as the availability of training and electronic resources to employees for EBDM.
  
  
• Work group climate for EBDM [ Time Frame: 24 months post baseline ]
  Self-report Likert scale items measure work group's perceived level of incorporation of employee and partner informational feedback into decision making.
  
  
• Agency Leadership [ Time Frame: 24 months post baseline ]
  Self-report Likert scale items measure agency leadership support for EBDM.
  
  
• Agency Relationships and Partnerships [ Time Frame: 24 months post baseline ]
  Self-report Likert scale items measure the importance of the type of agency partnerships and support they provide.
  
  

Secondary Outcome Measures:

• Intra- and inter-organization communication around evidence-based programs and policies (EBPPs) [ Time Frame: 24 months post baseline ]
  Self-report network evaluation that captures other agency work groups and community agencies in which the chronic disease work group has contact, the extent of the contact, and how the current relationship is described.
  
  

Evidence-based public health approaches to prevent and control diabetes and other chronic diseases have been identified in recent decades, and could have a profound effect on diabetes incidence and quality and length of life of those diagnosed. However, barriers to implement approaches continue because of lack of organizational support, limited resources, competing priorities, and limited skill among the public health workforce. The purpose of this study is to determine effective ways to promote the adoption of evidence based public health practice related to diabetes and chronic disease prevention and control among local health departments (LHDs). This stepped-wedge cluster randomized trial aims to evaluate active dissemination strategies on local-level public health practitioners to increase adoption and use of evidence-based programs and policies for diabetes and chronic disease prevention and control among LHDs in Missouri. Twelve LHDs will be recruited and randomly assigned to one of three groups that cross over from usual practice to receive the intervention (dissemination) strategies at 8-month intervals; the intervention duration for groups ranges from 8 to 24 months. LHD staff and the university-based study team are jointly identifying, refining and selecting dissemination strategies. Intervention strategies may include multi-day in-person training workshops, electronic information exchange modalities, and remote technical assistance. Evaluation methods include surveys at baseline and at each 8-month interval, abstraction of LHD chronic disease prevention program plans and progress reports, and social network analysis.