The Makings of an Evidence-Based Local Health Department: Identifying Administrative and Management Practices

There is a gap in knowledge about how to best organize and administer practice in local health departments to implement sustained evidence-based policies, programs, and interventions. This report identifies administrative and management evidence-based practices to inform ongoing initiatives in local public health system quality improvement, accreditation processes, and performance. The article presents administrative elements in workforce development, leadership, organizational climate and culture, relationships and partnerships, and financial processes that local health departments can address at modest cost within a few years or less. Local public health systems can further identify, implement and evaluate evidence-based administrative practices

Implementing administrative evidence based practices: Lessons from the field in six local health departments across the United States

BACKGROUND: Administrative evidence based practices (A-EBPs) are agency level structures and activities positively associated with performance measures (e.g., achieving core public health functions, carrying out evidence-based interventions). The objectives of this study were to examine the contextual conditions and explore differences in local health department (LHD) characteristics that influence the implementation of A-EBPs. METHODS: Qualitative case studies were conducted based on data from 35 practitioners in six LHDs across the United States. The sample was chosen using an A-EBP score from our 2012 national survey and was linked to secondary data from the National Public Health Performance Standards Program. Three LHDs that scored high and three LHDs that scored low on both measures were selected as case study sites. The 37-question interview guide explored LHD use of an evidence based decision making process, including A-EBPs and evidence-based programs and policies. Each interview took 30–60 min. Standard qualitative methodology was used for data coding and analysis using NVivo software. RESULTS: As might be expected, high-capacity LHDs were more likely to have strong leadership, partnerships, financial flexibility, workforce development activities, and an organizational culture supportive of evidence based decision making and implementation of A-EBPs. They were also more likely to describe having strong or important relationships with universities and other educational resources, increasing their access to resources and allowing them to more easily share knowledge and expertise. CONCLUSIONS: Differences between high- and low-capacity LHDs in A-EBP domains highlight the importance of investments in these areas and the potential those investments have to contribute to overall efficiency and performance. Further research may identify avenues to enhance resources in these domains to create an organizational culture supportive of A-EBPs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-0891-3) contains supplementary material, which is available to authorized users

Vortex Lattice Symmetry and Electronic Structure in YBa₂Cu₃O₇

We report a small angle neutron scattering study of the vortex lattice in YBa2Cu3O7 in magnetic fields of 0.5≤H≤5 T applied along and close to the c axis. Over the entire field range, the vortices form an oblique lattice with two nearly equal lattice constants and an angle of 73°between primitive vectors. Numerical calculations suggest that variations of the superconducting order parameter near the vortex core are important in stabilizing this structure. An analysis that accounts for the fourfold symmetry of the vortex core qualitatively explains both the symmetry and the orientation of the observed vortex lattice. A quantitative explanation of our data will require calculations based on a realistic gap equation

Vortex Structures in YBa₂Cu₃O₇ (Invited)

Extensive small angle neutron scattering experiments have been conducted on the vortex system in YBa2Cu3O7 in a magnetic field range of 0.5 T≤H≤5 T, and with various orientations of the magnetic field with respect to the crystallographic axes. For H parallel to the c axis, the vortex lattice is oblique with two nearly equal lattice constants and an angle of 73°between primitive vectors. One principal axis of the vortex lattice coincides with the (110) direction of the crystal lattice. It is shown that this structure cannot be explained in the framework of a purely electrodynamic (London) model, and that it is intimately related to the in-plane anisotropy of the superconducting coherence length. When the field is inclined with respect to the c axis, the uniaxial anisotropy due to the layered crystal structure of YBa2Cu3O7 becomes relevant. The interplay between the square in-plane anisotropy and the uniaxial anisotropy leads to both a continous structural transition and a reorientation of the vortex lattice as a function of inclination angle. For the largest inclination angles, the vortex lattice decomposes into independent chains

Developing a Tool to Assess Administrative Evidence-Based Practices in Local Health Departments

There is need for assessing the practices undertaken by local health departments in order to improve the implementation of evidence-based actions. This paper describes the development and testing of a survey instrument for assessing Administrative Evidence-Based Practices (A-EBPs) in Local Health Departments. A-EBPs identified through a review of the literature were used to develop a survey composed of nine sections and tested in a sample of local health department practitioners. The resulting tool showed adequate test-retest reliability and internal consistency. Practitioners and researchers may apply this tool in practice-based and evaluation research

Patterns of Information Behavior and Prostate Cancer Knowledge Among African-American Men

The purposes of this study are to explore cancer information acquisition patterns among African-American men and to evaluate relationships between information acquisition patterns and prostate cancer prevention and control knowledge. A random sample of 268 men participated in a statewide interviewer-administered, telephone survey. Men classified as non-seekers, non-medical source seekers, and medical source seekers of prostate cancer information differed on household income, level of education, and beliefs about personal risk for developing prostate cancer. Results from multiple regression analysis indicated that age, education, and information-seeking status were associated with overall levels of prostate cancer knowledge. Results from logistic regression analyses indicated that men who included physicians as one of many information resources (medical source seekers) had superior knowledge over non-seekers and non-medical source seekers on 33% of individual knowledge details. The findings emphasize the need to connect lower-income and lower-educated African-American men to physicians as a source of prostate cancer control information

What Influences the Use of Administrative Evidence-Based Practices in Local Health Departments?

Evidence based public health (EBPH) in local health departments (LHDs) is a process that involves translating the best available scientific evidence into practice. However, EBPH and implementation of evidence based programs and policies in LHDs are not widespread. This report outlines the patterns and predictors of the use of administrative evidence based practices (A-EBPs) in a national sample of LHD directors. LHDs can improve performance, prepare for accreditation and ultimately improve community health by utilizing an administrative evidence based process

Understanding misimplementation in U.S. state health departments: An agent-based model

INTRODUCTION: The research goal of this study is to explore why misimplementation occurs in public health agencies and how it can be reduced. Misimplementation is ending effective activities prematurely or continuing ineffective ones, which contributes to wasted resources and suboptimal health outcomes. METHODS: The study team created an agent-based model that represents how information flow, filtered through organizational structure, capacity, culture, and leadership priorities, shapes continuation decisions. This agent-based model used survey data and interviews with state health department personnel across the U.S. between 2014 and 2020; model design and analyses were conducted with substantial input from stakeholders between 2019 and 2021. The model was used experimentally to identify potential approaches for reducing misimplementation. RESULTS: Simulations showed that increasing either organizational evidence-based decision-making capacity or information sharing could reduce misimplementation. Shifting leadership priorities to emphasize effectiveness resulted in the largest reduction, whereas organizational restructuring did not reduce misimplementation. CONCLUSIONS: The model identifies for the first time a specific set of factors and dynamic pathways most likely driving misimplementation and suggests a number of actionable strategies for reducing it. Priorities for training the public health workforce include evidence-based decision making and effective communication. Organizations will also benefit from an intentional shift in leadership decision-making processes. On the basis of this initial, successful application of agent-based model to misimplementation, this work provides a framework for further analyses

Information-Seeking Behaviors and Other Factors Contributing to Successful Implementation of Evidence-Based Practices in Local Health Departments

The objective of this article is to describe factors which contribute to successful translation of science into evidence-based practices and their implementation in public health practice agencies, based on a review of the literature and evidence from a series of case studies. The case studies involved structured interviews with key informants in four health departments and with four corresponding partners from academic institutions. Interviews were recorded and transcribed, coded by two independent, trained coders, using a standard codebook. A thematic analysis of codes was conducted. Coding was entered into Atlas TI software for further analysis