domingo, 12 de julio de 2015

Promoting Evidence-Based Decision Making in a Local Health Department, Pueblo City–County, Colorado

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Promoting Evidence-Based Decision Making in a Local Health Department, Pueblo City–County, Colorado

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Anna K. Hardy, RN, MPH; Christine Nevin-Woods, DO, MPH; Sylvia Proud, MS; Ross C. Brownson, PhD

Suggested citation for this article: Hardy AK, Nevin-Woods C, Proud S, Brownson RC. Promoting Evidence-Based Decision Making in a Local Health Department, Pueblo City–County, Colorado. Prev Chronic Dis 2015;12:140507. DOI:


Evidence-based decision making (EBDM) is an effective strategy for addressing population health needs. Assessing and reducing barriers to using EBDM in local health departments may improve practice and provide insight into disseminating EBDM principles among public health practitioners.
Community Context
Administrative leaders at the Pueblo City–County Health Department, Pueblo, Colorado, used a systematic approach for implementing EBDM. Research partners engaged staff to understand factors that increase or deter its use.
A survey was distributed to staff members at baseline to identify gaps in administrative and individual practice of EBDM. In-depth interviews were also conducted with 11 randomly selected staff members. Results were shared with staff and administration, after which activities were implemented to improve application of EBDM. A follow up survey was administered 1 year after the initial assessment.
Survey data showed evidence of progress in engaging and educating staff members, and data showed improved attitudes toward EBDM (ie, several items showed significant improvement from baseline to follow-up). For example, staff members reported having the necessary skills to develop evidence-based interventions (73.9%), the ability to effectively communicate information on evidence-based strategies to policy makers (63.0%), access to current information on improving EBDM processes (65.2%), and a belief that evidence-based interventions are designed to be self-sustaining (43.5%).
Within a local health department in which leaders have made EBDM a priority, addressing the culture and climate of the department may build EBDM. Future research may provide insight into tailoring EBDM within and across local health departments.


Evidence-based decision making (EBDM) provides a framework to address many critical challenges (eg, setting priorities, making efficient use of resources) facing the public health system (1). EBDM is a process used to determine the best intervention for a population; it is rooted in community needs, practitioner experience, and existing evidence (2). EBDM produces high-quality information on what works in populations, resulting in implementation of successful programs and policies, greater workforce productivity, and more efficient use of funding (1). Public Health Accreditation Board Standard 10 requires the use and dissemination of evidence (3), which contributes to the momentum for EBDM.
Although the key tenets of EBDM are now well established (1,4,5), information is sparse on how to implement EBDM concepts in day-to-day public health practice. Research shows that EBDM practice does not happen organically (5); there are common barriers to engaging local health departments in EBDM. These include philosophical differences between practitioners and researchers; lack of time, money, or incentives; and insufficient organizational support (5). One survey of 447 state and territorial health care practitioners treating chronic disease showed that the strongest barriers to using EBDM were organizational factors (6). Other national data show the importance of agency size and make-up (ie, types of staff members and their qualifications) in EBDM (7,8).
Organizational structures and activities associated with EBDM performance, called administrative evidence-based practices (AEBPs) (5), fall into 5 domains: workforce development, leadership, organizational culture and climate, relationships and partners, and financial characteristics of the agency (7). This article describes an assessment of AEBPs and individual staff-member factors in a local health department involved in adopting EBDM, the activities related to promoting EBDM that took place over 1 year, and the impact of those activities on staff attitudes and perceptions toward EBDM.


This project was funded in part by contract no. U48/DP000060 (Prevention Research Centers Program) and the Evidence-Based Public Health training program supported in part by the National Association of Chronic Disease Directors, contract no. 482012. This article is a product of a Prevention Research Center and was also supported by cooperative agreement no. U48/DP001903 from the Centers for Disease Control and Prevention.
The authors and Kathleen Duggan conceived and designed this study. We thank Laurie Schneider, Janna West-Kowalski, the Colorado Department of Public Health and Environment, and the Colorado School of Public Health for consulting on and providing EBPH training to research staff and PCCHD staff; Rachel John at the Washington University Brown School Fieldworks Office; Mary Adams and Linda Dix at the Prevention Research Center in St. Louis for coordinating logistics of the fieldwork; Robert Fields, Carson Smith, and Rebekah Jacob for assistance with data analysis and Qualtrics; Beth Dodson for reviewing early manuscript drafts; Carol Brownson for reviewing the full manuscript; and the PCCHD staff and all local board of health members for their participation and support.

Author Information

Corresponding Author: Anna K. Hardy, RN, MPH, Saint Louis University, 1312 Carr Lane Ave, Education Union, Rm 110, St Louis, MO 63014. Telephone: 314-915-4404. Email:
Author Affiliations: Christine Nevin-Woods, Sylvia Proud, Pueblo City–County Health Department, Pueblo, Colorado; Ross C. Brownson, Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, Missouri.


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