[Evidence-based public health: perspectives and specific implementation factors].
Ontology highlight
ABSTRACT:
SUBMITTER: Rehfuess EA
PROVIDER: S-EPMC8087605 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:ContextThere is limited research on what factors are most salient to implementation of evidence-based practices (EBPs) among public health agencies in public health emergency preparedness and response (PHPR) and under what conditions EBP implementation will occur.ObjectiveThis study assessed the conditions, barriers, and enablers affecting EBP implementation among the PHPR practice community and identified opportunities to support EBP implementation.DesignA Web-based survey gathered information from public health agencies. Data obtained from 228 participating agencies were analyzed.SettingState, local, and territorial public health agencies across the United States.ParticipantsPreparedness program officials from 228 public health agencies in the United States, including Public Health Emergency Preparedness (PHEP) cooperative agreement awardees (PHEP awardees) and a random sample of local health departments (LHDs).ResultsRespondents indicated that EBP is necessary and improves PHPR functions and tasks and that staff are interested in improving skills for EBP implementation. Top system-level barriers to EBP implementation were insufficient funding, lack of EBP, and lack of clarity regarding which practices are evidence based. PHEP awardees were significantly more likely to report a lack of EBP in the field, whereas LHDs were significantly more likely to report a lack of incentives. The top organizational-level barrier was insufficient staff. Most respondents indicated their agency culture supports EBP; however, LHDs were significantly more likely to report a lack of support from supervisors and leadership. Few respondents reported individual barriers to EBP implementation.ConclusionsFindings indicate an opportunity to improve dissemination strategies, communication efforts, and incentives to support EBP implementation in PHPR. Potential strategies include improving awareness of and accessibility to EBPs through targeted dissemination efforts; building organizational capacity to support EBP implementation, particularly staff capacity, knowledge, and skills; and identifying funding and incentives to promote EBP uptake and sustainment.
| S-EPMC7523532 | biostudies-literature
Project description:BackgroundPublic health resources are limited and best used for effective programs. This study explores associations of mis-implementation in public health (ending effective programs or continuing ineffective programs) with organizational supports for evidence-based decision making among U.S. local health departments.MethodsThe national U.S. sample for this cross-sectional study was stratified by local health department jurisdiction population size. One person was invited from each randomly selected local health department: the leader in chronic disease, or the director. Of 600 selected, 579 had valid email addresses; 376 completed the survey (64.9% response). Survey items assessed frequency of and reasons for mis-implementation. Participants indicated agreement with statements on organizational supports for evidence-based decision making (7-point Likert).ResultsThirty percent (30.0%) reported programs often or always ended that should have continued (inappropriate termination); organizational supports for evidence-based decision making were not associated with the frequency of programs ending. The main reason given for inappropriate termination was grant funding ended (86.0%). Fewer (16.4%) reported programs often or always continued that should have ended (inappropriate continuation). Higher perceived organizational supports for evidence-based decision making were associated with less frequent inappropriate continuation (odds ratio = 0.86, 95% confidence interval 0.79, 0.94). All organizational support factors were negatively associated with inappropriate continuation. Top reasons were sustained funding (55.6%) and support from policymakers (34.0%).ConclusionsOrganizational supports for evidence-based decision making may help local health departments avoid continuing programs that should end. Creative mechanisms of support are needed to avoid inappropriate termination. Understanding what influences mis-implementation can help identify supports for de-implementation of ineffective programs so resources can go towards evidence-based programs.
| S-EPMC7106610 | biostudies-literature
Project description:BackgroundEvidence-based treatments (EBTs) are critical to effectively address mental health problems among children and adolescents, but costly for mental health service agencies to implement and sustain. Financing strategies help agencies overcome cost-related barriers by obtaining financial resources to support EBT implementation and/or sustainment.AimsWe sought to (i) understand how youth mental health system decision-makers involved with EBT implementation and sustainment view key features (e.g., relevance, feasibility) that inform financing strategy selection and (ii) compare service agency, funding agency, and intermediary representative perspectives.MethodTwo surveys were disseminated to 48 representatives across U.S. youth mental health service agencies, funding agencies, and intermediaries who were participating in a larger study of financing strategies. Quantitative and qualitative data were gathered on 23 financing strategies through quantitative ratings and open-ended responses. Data were analyzed using descriptive statistics and rapid content analysis.ResultsThe financing strategies rated as most relevant include braided funding streams, contracts for EBTs, credentialing/rostering providers, fee-for-service reimbursement (regular and increased), and grant funding. All other strategies were unfamiliar to 1/3 to 1/2 of participants. The six strategies were rated between somewhat and quite available, feasible, and effective for EBT sustainment. For sustaining different EBT components (e.g., delivery, materials), the mix of financing strategies was rated as somewhat adequate. Qualitative analysis revealed challenges with strategies being non-recurring or unavailable in representatives' regions. Ratings were largely similar across participant roles, though funding agency representatives were the most familiar with financing strategies.DiscussionDespite the breadth of innovative financing strategies, expert representatives within the youth mental health services ecosystem had limited knowledge of most options. Experts relied on strategies that were familiar but often did not adequately support EBT implementation or sustainment. These findings underscore more fundamental issues with under-resourced mental health systems in the U.S.; financing strategies can help agencies navigate EBT use but must be accompanied by larger-scale system reforms. Limitations include difficulties generalizing results due to using a small sample familiar with EBTs, high agreement as a potential function of snowball recruiting, and limited responses to the open-ended survey questions.Implications for health care provision and useAlthough EBTs have been found to effectively address mental health problems in children and adolescents, available strategies for financing their implementation and sustainment in mental health systems are insufficient. This constraint prevents many children and adolescents from receiving high-quality services.Implications for health policiesFinancing strategies alone cannot solve systematic issues that prevent youth mental health service agencies from providing EBTs. Policy changes may be required, such as increased financial investment from the U.S. government into mental health services to support basic infrastructure (e.g., facility operations, measuring outcomes).Implications for further researchFuture work should examine expert perspectives on EBT financing strategies in different contexts (e.g., substance use services), gathering targeted feedback on financing strategies that are less well known, and exploring topics such as strategic planning, funding stability, and collaborative decision-making as they relate to EBT implementation and sustainment.
| S-EPMC10947519 | biostudies-literature
Project description:We developed an evidence-based continuous quality improvement (CQI) cycle for laboratory safety as a method of utilizing survey data to improve safety in a public health laboratory setting. • Expert Opinion: The CQI cycle begins with the solicitation of laboratory staff input via an annual survey addressing potential chemical, physical and radiological hazards associated with multiple laboratory activities. The survey collects frequency, severity and exposure data related to these activities in the context of the most pathogenic organisms handled at least weekly. • Gap Analysis: Step 2 of the CQI cycle used survey data to identify areas needing improvement. Typically, the traditional two-dimensional risk assessment matrix is used to prioritize mitigations. However, we added an additional dimension - frequency of exposure - to create three-dimensional risk maps to better inform and communicate risk priorities. • Mitigation Measures: Step 3 of the CQI cycle was to use these results to develop mitigations. This included evaluating the identified risks to determine what risk control measures (elimination, substitution, engineering, administrative or PPE) were needed. In the 2016 iteration of the CQI cycle described here, all mitigations were based on administrative controls. • Evaluation and Feedback: The last step of the CQI cycle was to evaluate the inferred effects of interventions through subsequent surveys, allowing for qualitative assessment of intervention effectiveness while simultaneously restarting the cycle by identifying new hazards. Here we describe the tools used to drive this CQI cycle, including the survey tool, risk analysis method, design of interventions and inference of mitigation effectiveness.
| S-EPMC6537614 | biostudies-literature
Project description:BackgroundHealth disparities, inconsistent outcomes, and underwhelming health services continue to be problems for all nurses and doctors. Studies from a variety of nations have found that doctors and nurses have little familiarity with evidence-based practice. There is a knowledge vacuum about the degree of evidence-based nursing practice and its contributing factors in Ethiopia as well as the current study region.ObjectiveThe study's objective was to evaluate how healthcare professionals working in government hospitals in the Sidama regional state of 2022 are implementing evidence-based clinical practice and to identify associated factors.MethodsFrom October 1 to December 30/2022, a cross-sectional institution-based study with a mix of quantitative and qualitative methods was carried out. A total of 422 healthcare workers were randomly selected to participate in the current study from 6 randomly selected public hospitals in the region. This study included 25 key informant interviews. The Friedman test and Funk's BARRIER scale were adapted into a semi-structured questionnaire quantitative. Multivariable logistic regression was used to assess the significance of the association between the dependent and independent variables. A pretest was conducted on 22 healthcare workers from Shashmane Hospital.ResultThis study found that more than half, 51.7%, of the participants had a total implementation of evidence-based practice score below the mean score (40.4). only Access to the internet [having smart phone] (Adjusted Odds Ratio (AOR) = 3.03: 95% Confidence Interval (CI): (1.75-5.26))., favorable Attitude toward EBP of participants. (Adjusted Odds Ratio (AOR) = 1.84Confidence Interval (1.12-2.70)), inadequate Self-efficacy of Evidence-based practice skills (Adjusted Odds Ratio (AOR) = 0.29 Confidence interval = 0.19-0.46), and Knowledge of evidence-based practice (Adjusted Odds Ratio (AOR) = 0.45 Confidence interval = 0.30-0.77)were factors significantly associated with EBP implementation.ConclusionMore than half of the participants,51.7%, do not implement evidence-based practice in the care of their clients, which is unacceptable. The use of EBP has been significantly associated with access to the internet (having a smartphone), participants' positive attitudes toward it, their level of skill efficacy in finding and accessing it, and their knowledge of it. Therefore, stakeholders ought to think about addressing these obstacles to the adoption of EBP.
| S-EPMC10956850 | biostudies-literature
Project description:More than 15 years after the publication of the sequence of the human genome, the resulting changes in health care have been modest. At the same time, some promising examples in genetic services become visible, which contribute to the prevention of chronic disease such as cancer. These are discussed to identify barriers and facilitating factors for the implementation of genetic services. Examples from oncogenetics illustrate a high risk of serious disease where prevention is possible, especially in relatives. Some 5% of breast cancers and colorectal cancers are attributable to an inherited predisposition. These cancers occur at a relatively young age. DNA testing of relatives of affected patients may facilitate primary and secondary prevention. Training of non-genetic health care workers and health technology assessment are needed, as is translational research in terms of bringing genomics to health care practice while monitoring and evaluating. Stratified screening programs could include cascade screening and risk assessment based on family history. New roles and responsibilities will emerge. A clear assessment of the values implied is needed allowing to balance the pros and cons of interventions to further the responsible innovation of genetic services.
| S-EPMC5543075 | biostudies-other
Project description:Public health agencies are responsible for implementing effective, evidence-based public health programs and policies to reduce the burden of chronic diseases. Evidence-based public health can be facilitated by modifiable administrative evidence-based practices (A-EBPs) (e.g., workforce development, organizational climate), yet little is known about how practitioners view A-EBPs. Thus, the purpose of this qualitative study was to understand state health department practitioners' perceptions about how A-EBPs are implemented and what facilitators and barriers exist to using A-EBPs. Chronic disease prevention and health promotion program staff who were members of the National Association of Chronic Disease Directors were recruited to participate in telephone interviews using a snowball sampling technique. Interviews were transcribed verbatim, and transcripts were analyzed using a common codebook and the a priori method in NVivo. Twenty seven interviews were conducted with practitioners in four states (5-8 interviews per state). All practitioners felt that their work unit culture is positive and that leadership encouraged and expected staff to use evidence-based processes. Participants discussed the provision of trainings and technical assistance as key to workforce development and how leaders communicate their expectations. Access to evidence, partnerships, and funding restrictions were the most commonly discussed barriers to the use of A-EBPs and EBDM. Results of this study highlight practitioners' perspectives on promoting evidence-based public health in their departments. Findings can inform the development and refinement of resources to improve A-EBP use and organizational and leadership capacity of state health departments.
| S-EPMC7427867 | biostudies-literature
Project description:The increase in communicable and non-communicable disease incidence and prevalence, changing population demographics, along with concerns about pandemics, natural disasters, and wars, have highlighted the challenges faced by health systems. The study aims to identify data on publicly posted public health jobs available to applicants eligible to work in India to identify the public health and allied fields workforce needs, skills, and expertise in India. A cross-sectional study was done in June-July 2021. The data was collected from eleven common job portals in India. Descriptive and content analysis was done to identify the most common job titles, educational level preferred/desired, skills, and experience required in the public health jobs in India. In total 382 unique public health and related fields jobs were analyzed. Job postings were most commonly classified as manager (n = 68), officer/lead (n = 61), analyst (n = 49), and consultant (n = 44). Around one-fifth of the jobs were based in Delhi (n = 98, 24%). About a quarter of the job postings required more than 8 years of experience (26%, n = 100). More than half of the job postings mentioned having the knowledge and understanding of data analysis and statistical approaches (n = 116, 64%). Around 15% (n = 193) of the job posting wanted the candidate to have expertise in communication. Skills were classified into various types such as software, technical, and language. Timely assessment of the curriculum should be done to impart skills related to the needs of the employers and prepare a skilled and competent public health workforce to address the 21st century public health challenges.
| S-EPMC9738109 | biostudies-literature
Project description:BackgroundEvidence-based health policy (EBHP) development is critical to the judicious use of public funds. EBHPs increase transparency, accountability, effectiveness, and efficiency of policies. Encouraging collaboration between researchers or knowledge producers and policy makers is important because both communities have distinct professional cultures, resulting in them working separately without understanding each other. Knowledge sharing is a complex process that requires understanding of cultural aspects that may reduce cultural differences and increase the use of common language. Health information technology (HIT) is a useful tool to increase knowledge translation, which may result in the transparent use of evidence and networking in developing EBHPs. Our vision is to leverage HIT tools for a better health system that includes digitalized, open source, evidence-based, and transparent ways for collaboration and development of robust mechanisms and for sharing of synthesized evidence with knowledge user-friendly forms.ObjectiveThe aim of this study is to develop a conceptual framework on Knowledge translation and health Information Technology for Transparency (KhITT) in policy making and EBHPs (ie, the KhITT framework). The framework will be informed by the views of four key stakeholder groups (ie, policy makers, knowledge producers, HIT professionals, and the public) toward EBHP. The informants may also describe practices that demonstrate the EBHP development process and suggest technology platforms to enable this process.MethodsWe propose an exploratory, descriptive qualitative study to take place in British Columbia, Canada, using in-depth semistructured interviews. To ensure data saturation and trustworthiness, we will use a nonprobability, purposive snowball sample of up to 15 eligible participants in each of the four stakeholder groups. We will analyze the data using content analysis.ResultsThe KhITT framework focuses on various stakeholders' perspectives to better understand their perceived needs and priorities in identifying issues with EBHP, in order to make informed recommendations. Ethics approval has been obtained by the harmonized Behavioural Research Ethics Board at the University of British Columbia. We anticipate that we will complete data collection and analysis by December 2020. Preliminary results will be published in summer 2021.ConclusionsOur ultimate goal of this study is to develop a conceptual framework and describe the technology platforms that would enable the EBHP process. We anticipate that our rigorous content analysis will be able to produce insights and themes that are able to address our objectives, contribute to an in-depth understanding of the EBHP process within British Columbia, highlight all influential factors, explicitly disseminate and communicate the study results, identify issues with EBHP and provide informed recommendations to address them, and enhance efforts toward transparent EBHPs.International registered report identifier (irrid)PRR1-10.2196/16268.
| S-EPMC7775201 | biostudies-literature
Project description:BACKGROUND:Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation. OBJECTIVES:Our goal was to review the literature on evidence-based public health (EBPH), to determine whether it can be applied to climate change adaptation, and to consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change. METHODS:We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders. DISCUSSION:A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors currently limit application of the framework, including a lack of higher-level evidence of intervention efficacy and a lack of guidelines for reporting climate change health impact projections. To enhance the evidence base, there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This approach has implications for funders, researchers, journal editors, practitioners, and policy makers. CONCLUSIONS:The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders.
| S-EPMC4216160 | biostudies-literature