Promoting state health department evidence-based cancer and chronic disease prevention

16 Pages·2017·0.63 MB·English

WWaasshhiinnggttoonn UUnniivveerrssiittyy SScchhooooll ooff MMeeddiicciinnee
DDiiggiittaall CCoommmmoonnss@@BBeecckkeerr
Open Access Publications
2013
PPrroommoottiinngg ssttaattee hheeaalltthh ddeeppaarrttmmeenntt eevviiddeennccee--bbaasseedd ccaanncceerr aanndd
cchhrroonniicc ddiisseeaassee pprreevveennttiioonn:: AA mmuullttii--pphhaassee ddiisssseemmiinnaattiioonn ssttuuddyy
wwiitthh aa cclluusstteerr rraannddoommiizzeedd ttrriiaall ccoommppoonneenntt
Peg Allen
Washington University in St Louis
Sonia Sequeira
Washington University in St Louis
Rebekah R. Jacob
Washington University in St Louis
Adriano Akira Hino
Washington University in St Louis
Katherine A. Stamatakis
Saint Louis University
See next page for additional authors
Follow this and additional works at: https://digitalcommons.wustl.edu/open_access_pubs
Please let us know how this document benefits you.
RReeccoommmmeennddeedd CCiittaattiioonn
Allen, Peg; Sequeira, Sonia; Jacob, Rebekah R.; Hino, Adriano Akira; Stamatakis, Katherine A.; Harris,
Jenine K.; Elliott, Lindsay; Kerner, Jon F.; Jones, Ellen; Dobbins, Maureen; Baker, Elizabeth A.; and
Brownson, Ross C., "Promoting state health department evidence-based cancer and chronic disease
prevention: A multi-phase dissemination study with a cluster randomized trial component."
Implementation Science. 8, 1. 141. (2013).
https://digitalcommons.wustl.edu/open_access_pubs/2055
This Open Access Publication is brought to you for free and open access by Digital Commons@Becker. It has been
accepted for inclusion in Open Access Publications by an authorized administrator of Digital Commons@Becker.
For more information, please contact [email protected].
AAuutthhoorrss
Peg Allen, Sonia Sequeira, Rebekah R. Jacob, Adriano Akira Hino, Katherine A. Stamatakis, Jenine K.
Harris, Lindsay Elliott, Jon F. Kerner, Ellen Jones, Maureen Dobbins, Elizabeth A. Baker, and Ross C.
Brownson
This open access publication is available at Digital Commons@Becker: https://digitalcommons.wustl.edu/
open_access_pubs/2055
Allenetal.ImplementationScience2013,8:141
http://www.implementationscience.com/content/8/1/141
Implementation
Science
STUDY PROTOCOL Open Access
Promoting state health department
evidence-based cancer and chronic disease
prevention: a multi-phase dissemination study
with a cluster randomized trial component
Peg Allen1*, Sonia Sequeira1, Rebekah R Jacob1, Adriano Akira Ferreira Hino1,2,3, Katherine A Stamatakis4,
Jenine K Harris1, Lindsay Elliott1, Jon F Kerner5, Ellen Jones6, Maureen Dobbins7, Elizabeth A Baker8
and Ross C Brownson1,9
Abstract
Background: Cancer and otherchronicdiseasesreduce quality and length oflife and productivity, and represent a
significant financial burdento society.Evidence-based public health approaches to prevent cancer and other
chronic diseases have been identifiedin recent decades and have thepotentialfor high impact. Yet,barriers to
implement prevention approaches persistas a resultofmultiple factors including lack of organizational support,
limited resources, competingemergingprioritiesand crises, and limited skill among thepublic health workforce.
The purpose of this study is to learn how best to promote theadoptionof evidence based publichealth practice
related to chronic disease prevention.
Methods/design: Thispaperdescribesthemethodsforamulti-phasedisseminationstudywithaclusterrandomized
trialcomponentthatwillevaluatethedisseminationofpublichealthknowledgeaboutevidence-basedpreventionof
cancerandotherchronicdiseases.Phaseoneinvolvesdevelopmentofmeasuresofpractitionerviewsonand
organizationalsupportsforevidence-basedpublichealthanddatacollectionusinganationalonlinesurveyinvolving
statehealthdepartmentchronicdiseasepractitioners.Inphasetwo,aclusterrandomizedtrialdesignwillbeconducted
totestreceptivityandusefulnessofdisseminationstrategiesdirectedtowardstatehealthdepartmentchronicdisease
practitionerstoenhancecapacityandorganizationalsupportforevidence-basedchronicdiseaseprevention.Twelve
statehealthdepartmentchronicdiseaseunitswillberandomlyselectedandassignedtointerventionorcontrol.State
healthdepartmentstaffandtheuniversity-basedstudyteamwill jointly identify, refine, and select dissemination
strategies within intervention units. Intervention (dissemination) strategies may include multi-day in-person
training workshops, electronic information exchange modalities, and remote technical assistance. Evaluation
methods include pre-post surveys, structured qualitative phone interviews, and abstraction of state-level
chronic disease prevention program plans and progress reports.
Trial registration: clinicaltrials.gov: NCT01978054.
Keywords: Information dissemination, Innovation diffusion, Dissemination research, Public health workforce,
Chronic disease prevention, Cancer prevention and control, Evidence-based public health, Public health
accreditation
*Correspondence:[email protected]
1PreventionResearchCenterinSt.Louis,BrownSchool,Washington
UniversityinSt.Louis,621SkinkerBlvd.,St.Louis,MO63130-4838,USA
Fulllistofauthorinformationisavailableattheendofthearticle
©2013Allenetal.;licenseeBioMedCentralLtd.ThisisanOpenAccessarticledistributedunderthetermsoftheCreative
CommonsAttributionLicense(http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,and
reproductioninanymedium,providedtheoriginalworkisproperlycited.TheCreativeCommonsPublicDomainDedication
waiver(http://creativecommons.org/publicdomain/zero/1.0/)appliestothedatamadeavailableinthisarticle,unlessotherwise
stated.
Allenetal.ImplementationScience2013,8:141 Page2of14
http://www.implementationscience.com/content/8/1/141
Background interventions[20-27].Despitegreatprogressinidentifying
The burden to individuals, families, communities, and effective interventions, challenges to implementing these
society from tobacco use, poor nutrition, inadequate interventions remain. These include reaching large popu-
physical activity, obesity, and related cancers, cardiovas- lationsandaddressingbarriersassociatedwithimplement-
cular diseases, and diabetes is staggering and has been ing and adapting interventions across multiple settings
well-documented [1]. With the aging of the population, and populations, including low income and minority
growth in healthcare costs to manage chronic diseases populations [28].
threatens state and national economies. In 2010, overall An additional barrier to evidence-based chronic dis-
costs for cancer alone were over $124 billion [2]. Mul- ease prevention is the challenge of keeping up-to-date
tiple chronic diseases are common, with 21% of those the knowledge and skills of the public health work-
aged 45 – 64 years old in the U.S. having two or more force. Even today, only a small portion of the public
chronic diseases, and 62% of those aged 65 years and health workforce has formal academic training in public
older [3,4]. Low income and minority populations carry health[19,29,30].Evidence-based policies and programs
an excess burden due to early onset, later diagnosis, and (EBPPs) for chronic disease prevention are complex
poorer disease management outcomes [5-7]. Health- and implemented across multiple settings and levels
enhancing behaviors, including physical activity, healthy of society. This, compounded by high staff turnover
eating, and avoiding tobacco, can delay or prevent in public health agencies, adds to the challenge of main-
chronicdisease[8-12].Inaddition,managementofexist- taining knowledge and skill to practice in an evidence-
ing conditions through health-enhancing behaviors has informedway[29].
been found to improve quality of life and reduce health- Evidence-based public health requires knowledge of
care costs[13]. processes as well as specific intervention evidence con-
In the past two decades, environmental and policy ap- tent knowledge and a complex set of skills. Such process
proaches to prevent cancer and other chronic diseases knowledge is a key part of evidence-based decision mak-
have been identified that provide the potential to reach ing (EBDM), which involves the integration of science-
entire communities and populations statewide [14-18]. based interventions with community preferences to
Because tobacco use, physical activity, and poor nutri- improve the health of populations [31]. EBDM involves
tion are major risk factors not only for some cancers, multiple processes, including making decisions based on
but also for cardiovascular diseases and other chronic thebestavailablescientificorrigorousprogramevaluation
conditions [19], this study addresses prevention of mul- evidence,applyingprogramplanningandqualityimprove-
tiplechronicdiseasesincludingcancer(hereafterreferred mentframeworks,engagingthecommunityinassessment
to as chronic disease prevention) (see Table 1). While and decision-making, adapting and implementing EBPPs
effective interventions in the areas of tobacco, phys- forspecificpopulationsorsettings,andconductingsound
ical activity, and cancer screening are well-established, evaluation [32-34]. To select and implement EBPPS with
more recent evidence is building for effective nutrition diversepopulationsandsettings,advancedknowledgeand
Table1Interrelationshipsamongvariouschronicdiseasesandmodifiableriskfactors,UnitedStates
Cardiovascular Cancer Chroniclung Diabetes Cirrhosis Musculoskeletal Neurologic
disease disease diseases disorders
Tobaccouse + + + + +
Alcoholuse + + + + +
Highcholesterol +
Highbloodpressure + +
Diet + + + + ?
Physicalinactivity + + + + +
Obesity + + + + +
Stress + ?
Environmentaltobaccosmoke + + + ?
Occupation + + + ? + ?
Pollution + + + +
Lowsocioeconomicstatus + + + + + +
ReprintedwithpermissionfromRemingtonRL,BrownsonRC,WegnerMV,eds.ChronicDiseaseEpidemiologyandControl,ThirdEdition.2010:AmericanPublic
HealthAssociation,Washington,DC[19].
Allenetal.ImplementationScience2013,8:141 Page3of14
http://www.implementationscience.com/content/8/1/141
skillisneededininterventionadaptationandimplementa- DivisionofCancerPreventionandControl,withcollabor-
tionprocesses. ation with other units at CDC as well. The study was ap-
Therefore, in order to increase use of EBDM and proved by the institutional review board of Washington
EBPPs it is important to determine how best to dissem- University in St. Louis. Some aspects of phase one have
inatepublichealthknowledgeandevolvingscientificevi- beencompleted,whilephasetwoisintheplanningphase.
dence to build public health agency workforce capacity Phasetwoisregisteredasaclusterrandomizedtrial(clini-
and organizational support for evidence-based chronic caltrials.govNCT01978054).
disease prevention. The National Cancer Institute (NCI) The dissemination conceptual framework for the study
has acknowledged the need for more effective dissemin- is depicted in Figure 1. It is adapted with permission
ation by making effective dissemination and application from Kramer and Cole’s [36]. Conceptual Framework for
of cancer researchfindings a major themein its strategic ResearchKnowledgeTransferandUtilization[37,38].The
plan [35]. Thus, public health agency level interventions study model is also informed by Diffusion of Innovations
where dissemination strategies can be evaluated at the [39] and Institutional Theory [40-42]. Dissemination in
organizational (orcluster) levelarenecessary. this study is the process of enhancing the capacity of
The goals of this multi-phase dissemination study are the target audience of state-level practitioners to apply
to determine how best to increase individual awareness EBDMprocessestopromotestatewideandlocalplanning,
and capacity of state-level public health practitioners to adaptation, implementation, and evaluation of specific
apply EBDMprocessesandEBPPsfor preventionofcan- EBPPsforchronicdiseaseprevention[43].Theworkplace
cer and otherchronic diseases; increase agency and indi- context is hypothesized as a key determinant of how
vidual level application of EBDM processes to prevent knowledgeisreceived,used,andincorporatedintotheor-
cancerandotherchronicdiseasesinapplicableworkunits ganization’s usual day-to-day operations. In knowledge
withinstatehealthdepartments;andincreaseagencylevel transferand knowledge exchange, there isa flow ofinfor-
promotion of effective approaches and EBPPs with local mation that affects not only the target audience of practi-
publichealthagenciesandpartneringorganizations. tioners but also the researchers. Researchers use the
terms knowledge translation and exchange or knowledge
Methods/design exchange to denote an interactive process in which practi-
Studydesign tioners and researchers together problem solve how to
This is a multi-phase dissemination study funded by the applyresearchknowledgeinspecificcontexts[36,37,44-48].
NCItolearn which dissemination strategies best support As in this study’s framework (Figure 1), some researchers
uptake and application of EBDM processes among state make a distinction between knowledge transfer that is
health department practitioners and their key partners largely unidirectional from researcher to practitioner and
that work in cancer and other chronic disease preven- knowledge transfer and exchange that involves a social
tion program areas. This multi-phase study is guided by interactive process dependent on the quality of researcher-
an international advisory group of university-based re- practitioner relationships [45,46]. In this study, researchers
searchers, former public health practitioners from state will learn from practitioners about key contexts that affect
health departments, as well as collaborators from Canada application of research knowledge, such as organizational
with experience in dissemination research. The two study climate and political influences. Practitioners will learn
phasesoverlapandcomplementeachother.Phaseonein- knowledge, skills, and evidence-based organizational prac-
volvesdevelopmentandtestingofaself-reportsurveyand ticesfromresearchers.Skilldevelopmentmayaddresscom-
archival report abstraction instrument. Phase one also in- monpublichealthworkforceskillgaps,suchasuseofdata
cludescollectionofself-reportdatafromanationalrepre- includingeconomicdataforplanningandevaluation,inter-
sentative sample of state health department practitioners pretation of intervention research findings, collaboration
working in chronic disease prevention. Phase two is a across disciplines for environmental changes, communica-
group randomized evaluation study. Phase two involves tion of evidence to policy-makers, and documentation of
stratified random selection of six dissemination and six use of evidence-based approaches [49]. Together, practi-
pair-matchedcomparisonstatehealthdepartmentstotest tionersandresearcherswilldeterminehowbesttoenhance
acceptance and usefulness of the identified dissemin- modifiable contextual elements to support evidence-based
ation strategies to state-level practitioners working in statelevelchronicdiseaseprevention.
chronic disease prevention. Dissemination strategies may Thestudyteamwillworkinpartnershipwithstate-level
includetraininginevidence-basedpublichealth,technical practitioners from the dissemination states to develop
assistance, and provision of brief user-friendly evidence user-friendly evidence materials and EBDM trainings; as-
summaries. Study collaborators include the National sessorganizationalandotherfactorsthatinfluenceaccept-
Association of Chronic Disease Directors (NACDD) and anceofEBDM;supportstate-levelpractitionerapplication
the Centers for Disease Control and Prevention (CDC) of EBDM processes to enhance evidence-based chronic
Allenetal.ImplementationScience2013,8:141 Page4of14
http://www.implementationscience.com/content/8/1/141
Figure1Conceptualframeworkfordisseminationofevidencebasedpublichealth.Frameworkadaptedfrom:KramerDM,ColeDC.Sci
Commun.2003;25(1):56-82[36].KramerDM,ColeDC,LeithwoodK.BSciTechnolSoc.2004;24(4):316-330[37].KramerDM,WellsRP,CarlanN,
AversaT,BigelowPP,DixonSM,McMillanK.JOSE.2013;19(1):41-62[38].
diseaseprevention;anddesignstrategiestoembedEBDM nationally.Inaddition,thestudyteamwilldevelopatool
processeswithinongoingpractices.Evaluationwillinclude to abstract archival state health department plans and
process evaluation in dissemination states, and pre-post progress reports as an objective source of data on plan-
evaluationindisseminationandcomparisonstates[38,43]. ning and implementation of EBPPs in chronic disease
(SeeFigure2). prevention.
Studyaudience Surveyinstrument
The target audience is state health department practi- The main objective of the self-report online survey are
tioners working in comprehensive cancer prevention to obtain a national snapshot of practitioner views on
and control, cancer screening, tobacco control, physical EBDM, training and informational needs for EBDM,
activity, nutrition, obesity prevention, school health, dia- organizational support for EBDM, barriers to the appli-
betes prevention, and cardiovascular health. State health cation of EBDM, and EBPP implementation among state
departments typically provide funding, informational re- healthdepartmentmid-levelprogrammanagersandstaff
sources, and guidance for the implementation of EBPPs working in chronic disease prevention across the United
by state and local coalitions, local public health depart- States.
ments, and other agencies more than directly imple-
menting policies and programs. The study involves the Measures
provision of several EBDM dissemination strategies, The survey was developed from previous research con-
identified by the study team targeted to participating ducted byDr.Brownsonet al.[32,49],aliterature review
state healthdepartmentchronicdiseaseunits[35,43]. [50], and five rounds of study advisory group input from
August-November 2012. The 68-item survey contains
Phaseone:developmentofmeasures eight sections and was designed for completion in about
In phase one the study team has developed and tested a 15 minutes. Table 2 describes the survey domains and
survey instrument and collected self-report survey data types of items included in the survey, as well as their
Allenetal.ImplementationScience2013,8:141 Page5of14
http://www.implementationscience.com/content/8/1/141
Figure2Statehealthdepartmentselectionprocessforphasetwo.
sources. A state-level global score for EBPPs being im- Surveyinstrumenttesting
plemented in the state was developed for use as either a Cognitiveresponsetesting
dependent or independent variable. From the EBDM Items from the instrument were revised through cogni-
skill importance and availability scales, a gap score sub- tive response testing, which has been shown to improve
tracts perceived availability from perceived importance survey development [51]. Eleven former state health de-
[49]. Two items on perceived benefits and challenges of partmentchronic disease directors orprogram managers
coordinated chronic disease prevention were pilot tested identified byapartnerorganization completed hour long
by 10 Missouri state department of health coordinated interviews in December 2012, in which they reviewed
chronic disease committee members and revised based the survey instrument with a research assistant and pro-
on feedback received. The survey instrument was pro- ject manager. Participants provided feedback about what
grammed inQualtrics online survey softwareand under- they thought the questions were asking, question word-
went several periods of trial and refinement internally ing that might be unclear to others, and questions that
with research staff prior to cognitive response and reli- were clear but still difficult to answer. Participants also
ability testing. provided additional response options on a number of
hA
ttp://wllenet
w a
w l.
.im Im
ple plem
m
Table2Surveymeasures e en
Surveysection Numberofitems Typeofvariables Subscalesorsampleitems Itemsources ntatio tation
Biographical 14 cYhees/cnkoo,nneu,mchbeecrkoaflyletharast,apply PYoeasirtsioant,sptarotegrhaemaltahredaepartment RJaecisob(isn2p0r1e0ss) nscience Science
EpBaItsteimrnpbleamseednotendp(rsoeglercatmionarea) Vasakreieddbytopic Yes/no/don’tknow AYacestkaievrsdityin1,nptouutb2riltioicofnh6,esatcolthphoicosl:hcaenalctehrscreening,skincancerprevention,tobacco,physical CNoumtrimtiounnistyystgeumidaetic .com/conte2013,8:141
reviews n
t/8
YourviewsonEBPPs 9 Likert7-point Icaneffectivelycommunicateinformationonevidence-basedinterventionstoelected Jacobs2010 /1
officials. /1
Reis(inpress) 4
1
EBDMdefinitionsandincentives 2 Ranktop3 WhichofthefollowingwouldmostencourageyoutoutilizeEBDM? Jacobs2012
Reis(inpress)
Importanceandavailabilityof 20 Likert11-point(0-10) Importance(10items Jacobs2012
EBDMelements
Availability(10items) Reis(inpress)
UseofEBDM 1 Likert7-point IuseEBDMinmywork New
Workplacecontext 17 Likert7-point Supervisorysupportandexpectations(3items) Brownson2012
Reis(inpress)
Workunitresources(5items) Stamatakis2012
Workunitknowledgeexchange(2items)
Workunitevaluation(3items)
Agencyleadership(2items)
Useofinformationalevidence 5 Yes/no,howoften (cid:129)Useofcommunityguide Jacobs2012
resources
Ranktop3 (cid:129)Whatmethodsallowyoutolearnaboutthecurrentfindingsinpublichealthresearch? Reis(inpress)
(Ranktop3)
Checkallthatapply
Coordinationofchronicdisease 2 Ranktop3 Perceivedbenefits New
programs
Perceivedchallenges
P
a
g
e
6
o
f
1
4
Allenetal.ImplementationScience2013,8:141 Page7of14
http://www.implementationscience.com/content/8/1/141
items. Interview participants were offered a $40 Amazon. State health department practitioners working in pri-
comgiftcardforcompletionofcognitiveresponsetesting. mary and secondary cancer prevention and screening,
Recordedinterviewswerereviewedtoidentifythemesthat physical activity, nutrition, tobacco, obesity, diabetes,
occurred in two or more interviews and reviewed by the cardiovascular health, healthy aging, and general chronic
studyadvisorygroupwhorefinedquestionwording. diseasepreventionintheUSoraUSterritorywereinvited
to participate in the survey. State health department em-
Reliabilitytest-retest ployees of all ages, genders and educational backgrounds
We randomly selected 150 practitioners from contact were included. Administrative assistant staff members
lists collected from NACDD, CDC, and the Tobacco were excluded. Invitations containing information on the
Technical Assistance Consortium. The 106 respondents surveyandasurveylinkwereemailedtostatehealthprac-
that completed the survey the first time were each titioners in March 2013. Pre-invitations informing survey
emailed an invitation to take the survey again within 14 respondents about the purpose of the study were sent
to 24 days after their initial survey. Efforts were made to one week prior to invitations. Initial non-respondents
distribute the sample across states and program areas received two follow-up calls and three email reminders,
and all 50 states were represented in the reliability sam- which resulted in a response rate of 75.5%. Respondents
ple. Replacement sampling was done as needed to get were offered an optional $20 Amazon.com gift card for
150 eligible invitees. Of the 150 eligible practitioners completionofthesurvey.
invited, 106 (70.7%) completed test one, and 75 com- National survey data collection resulted in a total of
pletedtesttwo(70.8%oftestone).Respondentscompleted 923 completed surveys from state health department
the second survey 10 to 30 days after the first survey. employees in all 50 states, the District of Columbia, and
Among those that kept the online survey open less than five of the eight US territories. Of the 1,443 invited into
40 minutes, the median time to complete the survey was the survey, 221 were ineligible because they no longer
18.5minutes,withameantimeof19.4(SD=7.3)minutes. worked at a state health department, were on an ex-
Test-retest statistical analyses included calculating tended leave of absence, or now worked outside of
intra-class correlation coefficients (ICC) for Likert scale chronic disease prevention. Of the 1,222 eligible invitees,
items, and percent agreement and Cohen’s kappa statis- 923 completed the survey for a response rate of 75.5%.
tic for dichotomized Likert-scale items (strongly agree The 19 surveys from health department staff from the
and agree vs. other responses) [52,53]. To test internal U.S. territories will be excluded from initial analyses, be-
consistency of the domain and influence of individual cause three of the eight territories did not participate,
items on a domain, for each continuous variable, the and only 36.5% (19 of 52) eligible invitees from the terri-
Cronbach’s alpha was calculated. For ranking items, the tories completed the survey. Therefore, a total of 904
percent agreement of the three items chosen in the top completed surveys will be included in data analyses.
threeinTest1andTest2wascalculated.LandisandKoch Amongthe50states,the response rate was77.3%.
[52] kappa categories of almost perfect (1.0 – 0.8), sub-
stantial (0.8 – 0.6), moderate (0.6 – 0.4), fair (0.4 – 0.2), Programrecordreviewtooldevelopment
and low (0.2 – 0.0) were used as qualifiers for interpret- Phase one includes development of an abstract tool and
ation of results. For ICCs and percent agreement, >0.70 codebook for archival record abstraction. The purpose
were considered desirable and >0.80 were best [53]. Test- of abstracting state health department plans and reports
retest results showed that overall the percent agree- for various program areas in chronic disease prevention
ments were typically ≥0.70 and ICCs, the appropriate is to corroborate with and expand on self-report infor-
statistic for most sections and items, were mostly ≥0.70. mation on EBPPs being planned and implemented in
The majority of kappa coefficients were in the moderate chronic disease prevention in the twelve participating
range (0.40 – 0.60). Most of the scales showed adequate states. The study team will abstract health department
internal consistency (Cronbach’s alpha ≥0.70). Two ques- progress reports and plans, as well as statewide coalition
tions were deleted after review of test-retest results and strategic plans, in cancer prevention and control, to-
thewordingofthreeitemswasmodified.Becausethesur- bacco control, obesity prevention, physical activity, nu-
veywasonlyslightlymodified,testonecompletedsurveys trition, cardiovascular health, and diabetes before and
will be combined with the full survey sample data de- after dissemination strategies are applied. This will pro-
scribedbelowfornearlyallitems. vide an objective gage of EBPP uptake before and after
dissemination strategies are applied. The record abstrac-
Surveyparticipantrecruitment tion tool will also be made available to other users online
The study team created a list of eligible individuals upon finalization. The Community Guide [54] will be the
through exhaustive searching of US state health depart- basis for EBPP inclusion on the tool for most program
ment websites and updated lists from NACDD and CDC. areas, while systematic reviews not yet incorporated
Allenetal.ImplementationScience2013,8:141 Page8of14
http://www.implementationscience.com/content/8/1/141
into The Community Guide will be utilized to identify Disseminationstrategies
evidence-based nutrition EBPPs. To draft the record ab- In each dissemination state, a core group of chronic dis-
straction tool and codebook, the study team initially ab- ease unit members and study team members will work
stracted 32 state health department plans and program together to identify, select, and refine dissemination
reports from 10 states. Additional interventions in up- strategies pertinent to the work unit’s situations, priority
datedCommunityGuidesystematicreviewswillbeadded topics, and broader agency and state government con-
astheybecomeavailable. texts. The purpose is to enhance capacity of state-level
Study staff then documented types of plans and reports public health practitioners and work units to plan, pro-
publicly available from state health department websites mote, and evaluate local and statewide implementation
in a random sample of six states. Publicly available infor- of EBDM and EBPPs for the prevention of chronic dis-
mation contained mostly plans forfuturestrategiesrather eases. Dissemination strategies will emphasize electronic
than information on what was currently being imple- modes of knowledge transfer and interactive knowledge
mented. Of 84 documents found, 57 contained future exchange among each state’s core group. Knowledge
plansonly,and27containedfutureplansplussomeinfor- transfer and exchange strategies will be informed by les-
mation about implementation of current plans. From sons learned from Canadian research with the help of
thesefindingsalongwithprofessionalconsult,phasetwo’s the Canadian consulting investigators [44,55-59]. Key
abstraction form will be completed using state progress principles for dissemination strategy selection are the
reports from the participating chronic disease prevention strategy will build chronic disease prevention practi-
programs. tioner and work unit capacity for EBDM; the strategy
will be sustainable by state health departments to main-
Phasetwo:disseminationwithstatehealthdepartments tain after this grant-funded study ends; and the strategy
Overview will be developed and applied through participatory en-
Phase two will be a paired, cluster randomized evaluation gagement [48,60-62]. Content will be targeted to the
study to determine effective ways to disseminate public chronic disease risk factor prevalence and disease bur-
health knowledge about EBDM and chronic disease pre- den in each state and priority topic areas selected by the
vention EBPPs with mid- to senior-level state health de- chronic disease unit [63,64]. Priority topic areas may in-
partment employees working in prevention of cancer and clude tobacco control, obesity prevention, physical activ-
other chronic diseases. Clusters are state health depart- ity,nutrition,cancerscreening, skincancerprevention,or
ment chronic disease units (hereafter called states) made coordinated chronic disease prevention. The initial dis-
up of their respective individual employees. There will be semination strategy in each of the six states will be a tar-
two parallel study arms with six dissemination (interven- geted multi-day in-person dissemination workshop [63].
tion arm) and six pair-matched comparison(control arm) Potentialadditionaldisseminationstrategiesinclude:
stateswillberandomlyselectedfromthe33eligiblestates
(seeFigure2)andinvitedtoparticipateina staggereden- 1. Targetedelectronicmessaging acrosssites choosing
rollmentscheduleinyearstwoandthreeofthestudy.The similar topicareas;
main purpose of the dissemination strategies is to build 2. Onlinediscussiongroupsacrosssites;
capacityand toexploreoptimalwaystopackage informa- 3. Webinars;
tion for timeliness, relevance, and usefulness to public 4. Providing linkstopre-existingevidencesourcesfor
healthpractitioners.Participatingdisseminationstateswill easyaccess;
helpdevelopand choosethreetofivedisseminationstrat- 5. Conductingspecificevidencesearchesinresponseto
egiestheypreferfortheirstatehealthdepartmentchronic staterequestsand teachingstatestaff howto dothis
disease units to receive. Dissemination strategies may in- themselves;
clude training in EBDM targeted to priority risk factors 6. Electronically-deliveredissuebriefsthatprovide
andprogramareas,issuebriefswithuser-friendlyevidence public health evidenceinuser-friendly,onetotwo
summaries, targeted messaging, and information on ways page formats with a combination of statistical
to enhance organizational climates favorable to evidence- information and narrative examples, which public
based chronic disease prevention. In comparison states, healthpractitionerscansharewithstateagency
the study team will provide links to pre-existing sources leaders,electedofficials,andprivatefunders[65-67];
of evidence-based information such as the Community 7. Technicalassistanceonhowtodocumentuseof
Guide, Cancer Control P.L.A.N.E.T. (Plan, Link, Act, EBDM andEBPPimplementation;
Network, with Evidence-based Tools), and Research to 8. Strategiestofosteragencysupportforevidence-based
Practice. Pre- and post- evaluation measures will include chronicdiseasepreventioninpartnershipwithpublic
thesurveyandrecordabstractiontooldevelopedinphase healthpractitioners.Examplesincludefindingwaysto
one,qualitativeinterviews,andsocialnetworkanalyses. helpagencyleadersprioritizeEBPPs,findingwaysto