Wednesday, December 6, 2023
| Characteristic | SHD Survey Participants (n = 663) | LHD Survey Participants (n = 376) |
|---|---|---|
| Population size | ||
| Small (SHD <2.5 million, LHD <50,000) | 181 (27) | 119 (32) |
| Medium (SHD 2.5–6.4 million, LHD 50,000–200,000) | 225 (34) | 129 (34) |
| Large (SHD >6.4 million, LHD >200,000) | 233 (35) | 128 (34) |
| Regionb | ||
| New England | 106 (17) | 38 (10) |
| South | 147 (23) | 102 (27) |
| West | 104 (16) | 37 (10) |
| Mountains/Midwest | 149 (23) | 67 (18) |
| Mid-Atlantic and Great Lakes | 137 (21) | 132 (35) |
| Program areac | ||
| Obesity | 80 (12) | 0 |
| Tobacco | 68 (11) | 10 (3) |
| Cancer | 91 (14) | |
| Diabetes | 38 (6) | 4 (1) |
| Cardiovascular disease | 45 (7) | |
| Physical activity or nutrition | 4 (1) | |
| Multiple areas | 172 (27) | 319 (95) |
| Other areas | 149 (23) | |
| Sex | ||
| Female | 528 (80) | 312 (83) |
| Other gender identity | 3 (1) | 0 |
| Male | 131 (20) | 59 (17) |
| Race/ethnicity | ||
| Non-Hispanic White | 527 (80) | 321 (85) |
| Non-Hispanic Black or African American | 74 (11) | 27 (7) |
| Asian | 37 (6) | 9 (2) |
| Hispanic | 27 (4) | 8 (2) |
| American Indian or Alaska Native | 14 (2) | 6 (2) |
| Hawaiian or Pacific Islander | 6 (1) | 2 (1) |
| Other | 14 (2) | 6 (2) |
| Any public health educationd | 244 (37) | 118 (31) |
| Years in public health (mean, SD)e | 14.8 (9.4) | 16.4 (9.7) |
| Public health job position | ||
| Director, over multiple programs | 90 (14) | 174 (46) |
| Program manager | 326 (51) | 171 (45) |
| Specialist | 214 (33) | 22 (6) |
| Other | 11 (2) | 8 (2) |
| SHD use of the Guide in work unitf | ||
| No | 39 (6) | |
| Yes, often | 273 (44) | |
| Yes, sometimes | 225 (37) | |
| I am not familiar with the Community Guide | 78 (13) | |
| LHD use of the Guide across agency for decision makingg | ||
| Not used | 87 (24) | |
| Used in some programs | 181 (49) | |
| Used consistently across programs | 17 (5) | |
| Do not know the extent of use of Community Guide in the LHD | 86 (23) | |
Table 1. Demographic Characteristics of State Health Department and Local Health Department Participants (N = 1,039), Study on Use and Awareness of The Community Guide, United States, 2016–2018a
Abbreviations: — , not applicable; ASTHO, Association of State and Territorial Health Officials; CDC, Centers for Disease Control and Prevention; Guide, The Community Guide; LHD, local health department; NACCHO, National Association of County and City Health Officials; SD, standard deviation; SHD, state health department.
a Values are no. (%) unless otherwise indicated. Not all data sum to total values for n because of missing responses.
b ASTHO-defined state regions.
c SHD participants were asked to select 1 area they worked in from a list of chronic disease areas or indicate that they worked in multiple areas. LHD participants were asked to select all areas they worked in, including diabetes, obesity, physical activity, nutrition, and tobacco.
d Any public health education means that the participant reported having an MPH/MSPH or PhD, DrPH, or ScD in public health.
e Participants were asked to report the overall number of years they had been working in public health.
f SHD participants were asked, “Does your work unit use The CDC Community Guide in its work?” Response options were no, “yes, sometimes,” “yes, always,” and “I am not familiar with The Community Guide.”
g The question about the Guide is from the NACCHO 2016 profile. The survey asked representatives from LHDs, “Which of the following best describes the extent to which The Guide to Community Preventive Services has been used to support or enhance decision making in your LHD over the past 12 months?” The responses included “LHD staff in some programmatic areas have used the Community Guide,” “LHD staff consistently use the Community Guide in all relevant programmatic areas,” “LHD staff have not used the Community Guide,” and “Do not know the extent of use of Community Guide within LHD.”
| Characteristic | State Health Departments | |||||
|---|---|---|---|---|---|---|
| Use the Guidea | Aware of the Guideb | |||||
| Yes (n = 498), n (%) | No (n = 117), n (%) | χ2 (P Value) | Yes (n = 537) n (%) | No (n = 78) n (%) | χ2 (P Value) | |
| Positionsc | ||||||
| Program managers | 265 (84) | 49 (16) | 21.2 (.002) | 281 (90) | 32 (10) | 15.1 (.004) |
| Specialists | 148 (73) | 54 (27) | 162 (80) | 40 (20) | ||
| Directors, overseeing multiple programs | 78 (90) | 9 (10) | 82 (94) | 5 (6) | ||
| Other | 6 (54.5) | 5 (43.5) | 10 (91) | 1 (9) | ||
| Program area | ||||||
| Obesity | 65 (84) | 12 (16) | 45.5 (<.001) | 70 (91) | 7 (9) | 26.0 (<.001) |
| Tobacco | 62 (94) | 4 (6) | 62 (94) | 4 (6) | ||
| Cancer | 77 (89) | 9 (11) | 78 (91) | 8 (9) | ||
| Diabetes | 65 (84) | 12 (16) | 30 (86) | 5 (14) | ||
| Cardiovascular | 38 (86) | 6 (14) | 41 (93) | 3 (7) | ||
| Multiple areas | 140 (84) | 26 (16) | 150 (90) | 16 (10) | ||
| Other areas | 88 (62) | 53 (38) | 106 (75) | 35 (25) | ||
| Jurisdiction sized | ||||||
| Small (<2.5 million residents) | 146 (84) | 27 (16) | 2.3 (.52) | 155 (90) | 18 (10) | 1.6 (.65) |
| Medium (2.5–6.4 million) | 174 (81) | 41 (19) | 188 (87) | 27 (13) | ||
| Large (>6.4 million) | 159 (78) | 44 (22) | 174 (86) | 29 (14) | ||
| Regione | ||||||
| New England | 80 (79) | 21 (18) | 12.7 (.01) | 86 (85) | 15 (15) | 7.9 (.09) |
| South | 113 (83) | 23 (17) | 121 (89) | 15 (11) | ||
| West | 85 (84) | 16 (16) | 91 (90) | 10 (10) | ||
| Mountains/Midwest | 126 (87) | 19 (13) | 132 (91) | 13 (9) | ||
| Mid-Atlantic and Great Lakes | 94 (71) | 38 (29) | 107 (81) | 25 (16) | ||
| Governance of SHDsf | ||||||
| Shared | 64 (74) | 23 (26) | 6.6 (.04) | 72 (83) | 15 (17) | 4.4 (.65) |
| Local | 307 (80) | 75 (20) | 331 (87) | 51(13) | ||
| State | 127 (87) | 19 (13) | 134 (92) | 12 (8) | ||
| Health department is accreditedg | ||||||
| Yes | 341 (83) | 71 (17) | 2.6 (.10) | 363 (88) | 49 (12) | 0.7 (.40) |
| No | 157 (77) | 46 (23) | 174 (86) | 29 (14) | ||
| Health department is academich | ||||||
| Yes | 78 (73) | 29 (27) | 5.7 (.02) | 84 (79) | 23 (22) | 9.4 (.002) |
| No or unsure | 412 (83) | 85 (17) | 444 (89) | 53 (11) | ||
| Important for work unit to form partnershipsi | ||||||
| Yes | 482 (82) | 108 (18) | 4.9 (.03) | 519 (88) | 71 (12) | 5.5 (.02) |
| No | 16 (64) | 9 (36) | 18 (72) | 7 (28) | ||
| Programs that should have continued endedj | ||||||
| Frequently | 40 (83) | 8 (17) | 0.1 (.76) | 44 (92) | 4 (8) | 0.7 (.42) |
| Infrequently | 450 (82) | 102 (19) | 484 (92) | 68 (12) | ||
| Programs continue that should have endedk | ||||||
| Frequently | 45 (82) | 10 (18) | 0.0 (.998) | 49 (89) | 6 (11) | 0.1 (.82) |
| Infrequently | 445 (82) | 99 (18) | 479 (88) | 65 (12) | ||
Table 2. Characteristics of Participants (N = 615) from State Health Departments (SHDs) in the United States that Use and Are Aware of The Community Guide, United States, 2016–2018
Abbreviations: CDC, Centers for Disease Control and Prevention; Guide, The Community Guide; PHAB, Public Health Accreditation Board; SHD, state health department.
a SHD participants were asked, “Does your work unit use The CDC Community Guide in its work?” Response options were no, “yes, sometimes,” “yes, always,” and “I am not familiar with The Community Guide.” “Yes, sometimes” and “yes, always” were coded as “yes, use the Guide”; all other responses were coded as no.
b SHD participants were asked, “Does your work unit use The CDC Community Guide in its work?” Response options were “no,” “yes, sometimes,” “yes, always,” and “I am not familiar with The Community Guide.” “I am not familiar with The Community Guide” was coded as “no, not aware of the Guide”; all other responses were coded as “yes, aware of the Guide.”
c SHD participants self-reported their position. “Specialist” includes epidemiologists and health educators, for example.
d State population in 2012.
e ASTHO-defined state regions.
f Governance type comes from ASTHO classifications.
g Participant’s SHD has PHAB accreditation. Data point is from PHAB.
h This variable comes from the Public Health Foundation. An academic health department is one with a formal affiliation of a health department and an academic institution that trains future health professionals.
i SHD participants were asked to rate the following statement on a scale from 1 (“strongly disagree”) to 5 (“strongly agree”): “It is important for my work unit to develop partnerships with both health and other work sectors to address our state’s health issues.” Strongly agree and agree were coded as yes, and all other responses were coded as no.
j SHD participants were asked to rate the following statement on a scale from 1 (“never”) to 5 (“always”): “How often do ineffective programs, overseen by your work unit, continue when they should have ended?” “Often” and “always” were coded as “frequently,” and all other responses were coded as “infrequently.”
k SHD participants were asked to rate the following statement on a scale from 1 (“never”) to 5 (“always”): “How often do effective programs, overseen by your work unit, end when they should have continued?” “Often” and “always” were coded as “frequently,” and all other responses were coded as “infrequently.”
| Characteristic | Local Health Departments | |||||
|---|---|---|---|---|---|---|
| Use the Guidea | Aware of Use of the Guide in Their Health Departmentb | |||||
| Yes (n = 198), n (%) | No (n = 173), n (%) | χ2 (P Value) | Yes (n = 285), n (%) | No (n = 86), n (%) | χ2 (P Value) | |
| Jurisdiction sizec | ||||||
| Small (<50,000 residents) | 43 (36) | 75 (64) | 24.8 (<.001) | 86 (73) | 32 (27) | 1.5 (.47) |
| Medium (50,000–200,000 residents) | 69 (54) | 58 (46) | 100 (79) | 27 (21) | ||
| Large (>200,000 residents) | 86 (68) | 40 (32) | 99 (79) | 27 (21) | ||
| Regiond | ||||||
| New England | 15 (41) | 22 (59) | 4.1 (.39) | 30 (81) | 7 (19) | 3.2 (.53) |
| South | 59 (58) | 42 (42) | 75 (74) | 30 (26) | ||
| West | 21 (57) | 16 (43) | 26 (70) | 11 (30) | ||
| Mountains/Midwest | 32 (49) | 33 (51) | 48 (74) | 17 (26) | ||
| Mid-Atlantic and Great Lakes | 71 (54) | 60 (46) | 106 (81) | 25 (29) | ||
| Governance of LHDse | ||||||
| Shared | 22 (61) | 14 (39) | 1.6 (.45) | 30 (83) | 6 (16.7) | 2.6 (.27) |
| Local | 146 (52) | 137 (48) | 219 (77) | 64 (23) | ||
| State | 30 (58) | 22 (42) | 36 (69) | 16 (31) | ||
| Health department is accreditedf | ||||||
| Yes | 73 (65) | 40 (32) | 8.4 (.004) | 89 (79) | 24 (21) | 0.4 (.55) |
| No | 124 (48) | 133 (52) | 195 (76) | 62 (24) | ||
| Health department is academicg | ||||||
| Yes | 152 (57) | 117 (44) | 5.8 (.02) | 214 (80) | 55 (20) | 5.3 (.02) |
| No or unsure | 41 (42) | 56 (58) | 66 (68) | 31 (32) | ||
| Important for work unit to form partnershipsh | ||||||
| Yes | 174 (54) | 151 (47) | 0.1 (.76) | 253 (78) | 72 (22) | 1.8 (.18) |
| No | 23 (51) | 22 (49) | 31 (69) | 14 (31) | ||
| Programs that should have continued endedi | ||||||
| Frequently | 56 (54) | 47 (46) | 0.0 (>.99) | 83 (81) | 20 (19) | 0.9 (.34) |
| Infrequently | 133 (54) | 112 (46) | 186 (76) | 59 (24) | ||
| Programs continue that should have endedj | ||||||
| Frequently | 33 (58) | 24 (42) | 0.4 (.53) | 45 (79) | 12 (21) | 0.1 (.73) |
| Infrequently | 152 (53) | 133 (47) | 219 (77) | 66 (23) | ||
Table 3. Characteristics of Survey Participants (N = 371) From Local Health Departments (LHDs) in the United States That Use and Are Aware of The Community Guide, United States, 2016–2018
Abbreviations: Guide, The Community Guide; LHD, local health department; NACCHO, National Association of County and City Health Officials; PHAB, Public Health Accreditation Board.
a The question about the Guide is from the NACCHO 2016 Profile. The survey asked representatives from LHDs, “Which of the following best describes the extent to which The Guide to Community Preventive Services has been used to support or enhance decision making in your LHD over the past 12 months?” The responses included “LHD staff in some programmatic areas have used the Community Guide,” “LHD staff consistently use The Community Guide in all relevant programmatic areas,” “LHD staff have not used The Community Guide,” and “Do not know the extent of use of Community Guide within LHD.” The first 2 responses were coded as “yes, use the Guide” and the other 2 responses were coded as no.
b The question about the Guide is from the NACCHO 2016 Profile. The survey asked representatives from LHDs, “Which of the following best describes the extent to which The Guide to Community Preventive Services has been used to support or enhance decision making in your LHD over the past 12 months?” The responses included “LHD staff in some programmatic areas have used The Community Guide,” “LHD staff consistently use The Community Guide in all relevant programmatic areas,” “LHD staff have not used The Community Guide,” and “Do not know the extent of use of Community Guide within LHD.” The last response was coded as “no, not aware of the use of the Guide” and the other 3 responses were coded as “yes, aware of the use of the Guide.”
c Population from NACCHO 2016 Profile.
d ASTHO-defined state regions.
e From NACCHO 2016 Profile.
f LHD participants were asked, “Is your health department accredited or preparing to apply for accreditation through the Public Health Accreditation Board (PHAB)?” Participants could select from responses “We are currently accredited,” “Yes, and we have recently applied but are not yet accredited,” “Yes, but we have not yet applied,” no, or “Unsure.” “We are currently accredited” was coded as yes, and all other responses were coded as no.
g LHD participants were asked, “Does your agency currently participate in any academic partnerships (arrangement between an academic institution and a governmental public health agency that provides mutual benefits in teaching, research, and service)?” Participants could respond yes, no, or “unsure.”
h LHD participants were asked how much they agree with the statements, on a scale of 1 to 7, from strongly disagree to strongly agree, “It is important to my agency to have partners in health care to address population health issues” and “It is important to my agency to have partners in other sectors (outside of health) to address population health issues.” If they indicated on one or both of the items a 6 or 7, then the item was coded as yes. If the participant did not select a 6 or 7 for either question, the item was coded as no.
i LHD participants were asked “In your opinion, how often do programs end that should have continued (ie, end without being warranted)?” They could select “never,” “rarely,” “sometimes,” “often,” “always,” “I do not know,” or “not applicable.” “Often” and “always” were coded as “frequently,” and all other options were coded as “infrequently.”
j LHD participants were asked, “In your opinion, how often do programs continue that should have ended (ie, continue without being warranted)?” They could select “never,” “rarely,” “sometimes,” “often,” “always,” “I do not know,” or “not applicable.” “Often” and “always” were coded as “frequently,” and all other options were coded as “infrequently.”
This activity is intended for public health officials, healthcare providers, researchers, and decision makers in state and local communities who are or should be using The Community Guide (Guide), a free online resource that summarizes systematic review evidence and offers recommendations on effective community preventive services, programs, and policies.
The goal of this activity is to describe characteristics related to use and awareness of the Guide to inform strategies to increase uptake of the Guide in local (LHDs) and state health departments (SHDs). Using self-report data from 3 surveys administered in 2016, 2017, and 2018 to LHD and SHD employees in chronic disease programs, this pooled analysis assessed the prevalence of use of and awareness of the Guide among 1039 US public health practitioners representing all 50 states along with potentially related factors.
Upon completion of this activity, participants will be able to:
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The Community Guide (Guide) is a user-friendly, systematic review system that provides information on evidence-based interventions (EBIs) in public health practice. Little is known about what predicts Guide awareness and use in state health departments (SHDs) and local health departments (LHDs).
We pooled data from 3 surveys (administered in 2016, 2017, and 2018) to employees in chronic disease programs at SHDs and LHDs. Participants (n = 1,039) represented all 50 states. The surveys asked about department practices and individual, organizational, and external factors related to decisions about EBIs. We used χ2 tests of independence for analyses.
Eighty-one percent (n = 498) of SHD and 54% (n = 198) of LHD respondents reported their agency uses the Guide. Additionally, 13% of SHD participants reported not being aware of the Guide. Significant relationships were found between reporting using the Guide and academic collaboration, population size, rated importance of forming partnerships, and accreditation.
Awareness and use of the Guide in LHD and SHD chronic disease programs is widespread. Awareness of the Guide can be vital to implementation practice, because it enhances implementation of EBI practices. However, awareness of the Guide alone is likely not enough for health departments to implement EBIs. Changes at the organizational level, including sharing information about the Guide and providing training on how to best use it, may increase its awareness and use.
Chronic diseases account for most death and disability in the United States [1]. Evidence-based interventions (EBIs) are available to prevent or lessen disease burden. Using interventions supported by evidence improves likelihood of program success, increases productivity, is ethical, and encourages efficient use of resources [2].
The more than 3,000 local health departments (LHDs) and 50 state health departments (SHDs) in the United States are well placed to implement EBIs for chronic disease prevention. However, public health practitioners reported that only 58% of previous programs were evidence-based [3]. Health departments have experienced multiple challenges in implementing EBIs [4] and vary widely in the use of EBIs [5], especially those requiring clinical collaborations [6] or policy and environmental changes [7]. The availability of scientific information about effective policies and programs is one of the first steps to making public health practice and agencies more evidence-based [8]. One resource for this information is The Community Guide (Guide).
The Guide is a free online resource that summarizes systematic review evidence and provides recommendations on effective community preventive services, programs, and policies. It includes recommendations from a Centers for Disease Control and Prevention (CDC)–appointed task force of health experts on more than 230 interventions in 21 topics areas [9]. The Guide is intended to be a tool used by public health professionals, health care providers, researchers, and decision makers in state and local communities to improve community health. The Guide is a tool that agencies can use to become more evidence-based in their practice.
The aim of this pooled analysis was to better understand characteristics related to the use and awareness of the Guide to inform strategies to increase the use of the Guide in LHDs and SHDs. The aim was accomplished by examining the prevalence of, use of, and awareness of the Guide among US public health practitioners and related factors, using self-reported data from 3 recent national surveys.
