Local health department managers found they could support integration of evidence-based decision making into day-to-day public health practice through a variety of internal procedures.

With health departments scrutinized now more than ever, now is the time to fully integrate evidence-based decision making (EBDM) into public health practices. EBDM applies the best available research and evaluation evidence to select, adapt, implement, and evaluate policies and programs that work. While training helps individuals build skills, our earlier work found skill attainment is necessary but not enough to move EBDM forward and sustain EBDM use. Organizational supports within health departments are important as well. Use of EBDM creates informed choices, resource management, and improved ability to demonstrate positive impact. We launched a project to support local health departments (LHDs) in creating or enhancing organizational supports for EBDM, working most closely with LHD managers and staff engaged in chronic disease prevention/health promotion/community health. 

Preliminary Work 

We conducted a national survey with LHD directors and staff involved in chronic disease prevention to learn more about organizational factors related to EBDM. This and a needs assessment with employees leading or involved in chronic disease management at LHDs across Missouri informed the multiyear project with local health departments. We also had previous experience with other health departments in earlier projects.  

Multiyear EBDM Project with LHDs 

We invited 12 mid-to-large LHDs in Missouri to participate. We provided a multi-day EBDM training followed by technical assistance. After their training, LHD teams and project staff jointly developed an EBDM incorporation plan that fit health department priorities and contexts. We did regular check-ins with each LHD with discussion of successes, challenges, modifications; and provision of customized technical assistance, support, and information resources. We conducted 17 interviews with LHD staff 6-8 months after the project. This was during the early portion of the pandemic, so we kept the interview burden low by selecting staff from 4 of the participating LHDs. Here we report on what we learned. 

Management Practices LHDs Put in Place and Found Helpful 

What LHD Employees Recommend to Integrate EBDM 

Develop leadership support, which is key 

• Leaders can set an organizational culture and climate in which EBDM is talked about frequently and expected, with on-the-job learning supported 
• Leaders and managers can establish open communication for safe expression of concerns and challenges 
• “Leadership and their department heads set the bar high for themselves. They’re not going to expect anything less from us.” 

Build a foundation for EBDM through a supportive culture and ongoing training 

• “Give yourself the time, the space, the funding to make it a priority.” 
• “Having a good foundation in the beginning, making sure that everybody’s on the same page.” 
• “Realize that there is an investment that’s required with that in terms of training staff.” Given staff turnover, training needs are ongoing. 

Start small via champions; roll out new or modified procedures slowly 

Within Work Unit 

• “Starting in one program or one division and really putting in the energy…being able to find the cheerleaders or the people that are willing to take on that work and to help lead it and then just also just to continually look back at it and how do we expand.” 
• “Start small and keep moving forward.” 

Note benefits and impacts of process changes with agency staff 

• “Making sure that there’s the most bang for your buck. I think from that alone, that’s a big sell.” 
• “If they embraced more EBDM that would open them up to more diverse funding opportunities.” 

Share ideas and impacts with other LHDs 

• “More brainstorming and idea-sharing between health departments.” 
• “…that’s very helpful to build enthusiasm, to build that connection with others, and just feel like you’re not alone too, that makes it easier to implement.” 

Additional Recommendations from Our Project Team 

• Identify champions among internal team members and external partners  
• Communicate EBDM expectations in day-to-day work  
• Mentor staff as they build abilities and confidence to apply EBDM  
• Support partners’ EBDM capacity building when incorporating EBDM into community health improvement planning and implementation  
• Partner with a university in your region for support 

To learn more, see our project webpage and read our open access article in the Journal of Public Health Management and Practice.

View our project infographic here: https://prcstl.wustl.edu/items/aim-local-health/

We also recommend:  

• Sustaining organizational culture change in health systems
• Rising to Meet the Moment: What Does the Public Health Workforce Need to Modernize?
• Learning to Lead: 3 Models to Support Public Health Leadership Development 

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Peg Allen, PhD, MPH, is an Assistant Professor with the Prevention Research Center at Washington University in St. Louis. She conducts applied research with state and local health departments in support of evidence-based public health capacity building and practice, with a focus on organizational supports and collaboration.

Renee Parks, MS, is a Project Manager with the Prevention Research Center at Washington University in St. Louis. She works with coalitions to increase use of effective policies to advance health equity. She has extensive experience in developing, implementing, and evaluating health promotion initiatives at community-based organizations and university settings.