Enhancing evidence-based diabetes and chronic disease control among local health departments: a multi-phase dissemination study with a stepped-wedge cluster randomized trial component

Abstract

BackgroundThe rates of diabetes and prediabetes in the USA are growing, significantly impacting the quality and length of life of those diagnosed and financially burdening society. Premature death and disability can be prevented through implementation of evidence-based programs and policies (EBPPs). Local health departments (LHDs) are uniquely positioned to implement diabetes control EBPPs because of their knowledge of, and focus on, community-level needs, contexts, and resources. There is a significant gap, however, between known diabetes control EBPPs and actual diabetes control activities conducted by LHDs. The purpose of this study is to determine how best to support the use of evidence-based public health for diabetes (and related chronic diseases) control among local-level public health practitioners.Methods/designThis paper describes the methods for a two-phase study with a stepped-wedge cluster randomized trial that will evaluate dissemination strategies to increase the uptake of public health knowledge and EBPPs for diabetes control among LHDs. Phase 1 includes development of measures to assess practitioner views on and organizational supports for evidence-based public health, data collection using a national online survey of LHD chronic disease practitioners, and a needs assessment of factors influencing the uptake of diabetes control EBPPs among LHDs within one state in the USA. Phase 2 involves conducting a stepped-wedge cluster randomized trial to assess effectiveness of dissemination strategies with local-level practitioners at LHDs to enhance capacity and organizational support for evidence-based diabetes prevention and control. Twelve LHDs will be selected and randomly assigned to one of the 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. Intervention (dissemination) strategies may include multi-day in-person workshops, electronic information exchange methods, technical assistance through a knowledge broker, and organizational changes to support evidence-based public health approaches. Evaluation methods comprise surveys at baseline and the three crossover time points, abstraction of local-level diabetes and chronic disease control program plans and progress reports, and social network analysis to understand the relationships and contextual issues that influence EBPP adoption.Trial registrationClinicalTrial.gov, NCT03211832Electronic supplementary materialThe online version of this article (10.1186/s13012-017-0650-4) contains supplementary material, which is available to authorized users.

Perspectives on program mis-implementation among U.S. local public health departments

“…This national cross-sectional study was part of a larger study that used a stratified random sampling design to invite one individual from each included US LHD to complete an online survey [41]. Eligible LHDs were those that screened for diabetes or body mass index, or conducted or contracted for population-based nutrition and physical activity efforts, according to the 2016 National Association of County and City Health Officials (NACCHO) National Profile survey.…”

“…The survey included sections on mis-implementation (frequency and reasons), LHD and participant characteristics, skills for EBDM, and organizational supports. After three rounds of study team input and cognitive response testing with 10 chronic disease prevention practitioners, the survey demonstrated acceptable test-retest reliability [41].…”

“…As described in detail elsewhere, the study team drew from measures developed and tested in its previous national health department studies and other existing instruments identified by the study team [32,[41][42][43]. The survey included sections on mis-implementation (frequency and reasons), LHD and participant characteristics, skills for EBDM, and organizational supports.…”

Knowledge translation

“…14 A scoping review by Wilson et al 15 identified that the steps in KT frameworks relating to adapting knowledge to the local context, assessing barriers to knowledge use and implementing interventions to promote knowledge use (referred to as dissemination in his review) were generally underpinned by at least one of the following theories: persuasive communication, diffusion of innovations theory or social marketing. Parks et al 16 provide a detailed methodology for enhancing the dissemination and update of programs and policies to enhance diabetes-related care in local health departments using some of these frameworks. Kastner and Straus illustrate how the knowledge to action framework was used to create a clinical support tool to enhance osteoporosis disease management by primary care providers.…”

General Practitioners’ Perceptions of their Practice of Evidence-based Chronic Disease Prevention Interventions: A Quantitative Study in Shanghai, China

“…The efficient global prevention and control of chronic disease has gradually become a focus for scholars [1][2]. Evidence-based chronic disease prevention (EBCDP) has emerged and become popularized as a scientific tool to increase the efficiency of preventing and controlling diseases in developed countries [3].…”