Preparing Public Health Professionals to Make Evidence-Based Decisions: A Comparison of Training Delivery Methods in the United States

Hybridity enabled: A research synthesis of the enabling conditions for hybrid professionalism in healthcare

Hybrid professionals in healthcare organizations play a critical role, the characteristics, processes and implications of which have been thoroughly studied by scholars in the field. However, not as much attention has been paid to the conditions under which such roles might be taken by professionals entering the ground of management. This gap results into a lack of conceptual clarity and eventually ends being an obstacle in framing and ameliorating the tools needed to act such a role in its different phases. This is a research area worthy of a finer-grained understanding: the ability of organizations to effectively support role hybridization, in fact, is a requisite for professionals-managers' willingness to stay in the role and cope with the complexity that such a two-fold position entails, no matter what. Based on the results of a scoping literature review, this paper presents the enabling conditions for hybrid professionalism in healthcare, and proposes a classification of them into categories corresponding to different facets of hybrid role-taking: opportunities for interaction with management, tools supporting sense-making, and provision of delegation and autonomy. For each of these categories, organizational and management tools discussed in the literature are presented. The results of the study provide a road-map of the enabling conditions for hybrid professionalism that aims to be of practical convenience for managers and policy-makers in health care. Eventually, suggestions for organizational design and personnel management, as well as directions for further research, are highlighted.

Challenges of using evidence in managerial decision-making of the primary health care system

BACKGROUND

Managerial Evidence-Based Decision-Making [EBDM] in the primary is a systematic approach that directs the decision-maker in a conscientious, explicit, and judicious utilization of reliable and best evidence based on the professional experiences and preferences of stakeholders and patients from various sources. This study aimed to investigate the challenges primary healthcare managers encounter while undertaking decision-making processes.

METHOD

A systematic review was conducted in 2022 with the aim of identifying and collecting all qualitative articles pertaining to evidence-based decision-making in the primary healthcare system. To achieve this, a meticulous search was conducted using the relevant keywords, including primary health care and evidence-based decision making, as well as their corresponding synonyms, across the databases Web of Science, Scopus, and Pubmed. Importantly, there were no limitations imposed on the timeframe for the search. To carefully analyze and consolidate the findings of this systematic review, the meta-synthesis approach was employed.

RESULTS

A total of 22 articles were assessed in this systematic review study. The results revealed the main categories including evidence nature, EBDM barriers, utilizing evidence, decision-makers ability, organizational structure, evidence-based, EBDM support, communication for EBDM, evidence sides, EBDM skill development, public health promotion, and health system performance improvement.

CONCLUSION

The primary healthcare system is crucial in improving health outcomes and ensuring access to healthcare services for all individuals. This study explored the utilization of evidence-based EBDM within the primary healthcare system. We identified five key dimensions: causal, contextual, and intervening conditions, strategies, and consequences of EBDM as a core phenomenon. The findings will help policymakers and administrators comprehend the importance of evidence-based decision-making, ultimately leading to enhanced decision quality, community well-being, and efficiency within the healthcare system. EBDM entails considering the best reliable evidence, and incorporating community preferences while also exploiting the professional expertise and experiences of decision-makers. This systematic review has the potential to provide guidance for future reforms and enhance the quality of decision-making at the managerial level in primary healthcare.

Assessment of undergraduate health students' perception and satisfaction on training and participation in community health outreach

Aim

The need to improve training of health professionals has increased in recent years due to increasing frequencies of public health events. Consequently, a descriptive cross-sectional survey was carried out to determine the level of satisfaction and knowledge acquired by undergraduate students in the health sciences during a community health outreach program.

Subject and methods

Students were invited to complete an online-administered questionnaire (consisting of both open- and closed-ended questions) to assess their perceptions and experiences on the community health outreach program. Additionally, the survey was carried out to assess the quality of training provided and obtain suggestions for further improvements. Responses were collected and analysed using Microsoft Excel.

Results

Most respondents (>83%) reported satisfaction with the community diagnosis and community intervention briefing and training sessions. All respondents reported familiarity with standard community health outreach instruments and were capable of identifying environmental health risk factors that may contribute to the spread of communicable diseases. Interestingly, respondents reported greater appreciation of health challenges faced by rural communities. However, respondents expressed dissatisfaction with the duration of the outreach program (24%) and funding (15%).

Conclusion

Although respondents reported overall satisfaction with the organization and execution of the health outreach program, certain aspects of the program were deemed unsatisfactory. Despite the shortcomings, we believe that our student-centred learning strategy is readily adaptable for training future healthcare professionals and improving health literacy of rural communities, particularly in sub-Saharan Africa.

Evaluation of a Virtual Training to Enhance Public Health Capacity for COVID-19 Infection Prevention and Control in Nursing Homes

CONTEXT

Between April 2020 and May 2021, the Centers for Disease Control and Prevention (CDC) awarded more than $40 billion to health departments nationwide for COVID-19 prevention and response activities. One of the identified priorities for this investment was improving infection prevention and control (IPC) in nursing homes.

PROGRAM

CDC developed a virtual course to train new and less experienced public health staff in core healthcare IPC principles and in the application of CDC COVID-19 healthcare IPC guidance for nursing homes.

IMPLEMENTATION

From October 2020 to August 2021, the CDC led training sessions for 12 cohorts of public health staff using pretraining reading materials, case-based scenarios, didactic presentations, peer-learning opportunities, and subject matter expert-led discussions. Multiple electronic assessments were distributed to learners over time to measure changes in self-reported knowledge and confidence and to collect feedback on the course. Participating public health programs were also assessed to measure overall course impact.

EVALUATION

Among 182 enrolled learners, 94% completed the training. Most learners were infection preventionists (42%) or epidemiologists (38%), had less than 1 year of experience in their health department role (75%), and had less than 1 year of subject matter experience (54%). After training, learners reported increased knowledge and confidence in applying the CDC COVID-19 healthcare IPC guidance for nursing homes (≥81%) with the greatest increase in performing COVID-19 IPC consultations and assessments (87%). The majority of participating programs agreed that the course provided an overall benefit (88%) and reduced training burden (72%).

DISCUSSION

The CDC's virtual course was effective in increasing public health capacity for COVID-19 healthcare IPC in nursing homes and provides a possible model to increase IPC capacity for other infectious diseases and other healthcare settings. Future virtual healthcare IPC courses could be enhanced by tailoring materials to health department needs, reinforcing training through applied learning experiences, and supporting mechanisms to retain trained staff.

How to "Start Small and Just Keep Moving Forward": Mixed Methods Results From a Stepped-Wedge Trial to Support Evidence-Based Processes in Local Health Departments

Background

Local health departments (LHDs) in the United States are charged with preventing disease and promoting health in their respective communities. Understanding and addressing what supports LHD's need to foster a climate and culture supportive of evidence-based decision making (EBDM) processes can enhance delivery of effective practices and services.

Methods

We employed a stepped-wedge trial design to test staggered delivery of implementation supports in 12 LHDs (Missouri, USA) to expand capacity for EBDM processes. The intervention was an in-person training in EBDM and continued support by the research team over 24 months (March 2018-February 2020). We used a mixed-methods approach to evaluate: (1) individuals' EBDM skills, (2) organizational supports for EBDM, and (3) administered evidence-based interventions. LHD staff completed a quantitative survey at 4 time points measuring their EBDM skills, organizational supports, and evidence-based interventions. We selected 4 LHDs with high contact and engagement during the intervention period to interview staff (n = 17) about facilitators and barriers to EBDM. We used mixed-effects linear regression to examine quantitative survey outcomes. Interviews were transcribed verbatim and coded through a dual independent process.

Results

Overall, 519 LHD staff were eligible and invited to complete quantitative surveys during control periods and 593 during intervention (365 unique individuals). A total of 434 completed during control and 492 during intervention (83.6 and 83.0% response, respectively). In both trial modes, half the participants had at least a master's degree (49.7-51.7%) and most were female (82.1-83.8%). No significant intervention effects were found in EBDM skills or in implementing evidence-based interventions. Two organizational supports scores decreased in intervention vs. control periods: awareness (-0.14, 95% CI -0.26 to -0.01, p < 0.05) and climate cultivation (-0.14, 95% CI -0.27 to -0.02, p < 0.05) but improved over time among all participants. Interviewees noted staff turnover, limited time, resources and momentum as challenges to continue EBDM work. Setting expectations, programmatic reviews, and pre-existing practices were seen as facilitators.

Conclusions

Challenges (e.g., turnover, resources) may disrupt LHDs' abilities to fully embed organizational processes which support EBDM. This study and related literature provides understanding on how best to support LHDs in building capacity to use and sustain evidence-based practices.

Toward Optimized Effectiveness of Employee Training Programs

Abstract. Although organizations invest heavily on employee training, the effectiveness of employee training programs has not been well-established. In the current study, we examine the training delivery features of employee training programs to derive a better understanding of features that may be of best benefit in the improvement of employee affective outcomes. Specifically, and via the use of meta-analysis ( k = 79 studies totaling 107 independent effect sizes), we focus on two broad classes of affective employee training outcomes including attitudinal and motivational outcomes. Results evidence support for the effectiveness of employee workplace training interventions and indicate that employee training programs associated with attitudinal versus motivational outcomes require different features while being delivered to reach optimal effectiveness.

The Association Between Evidence-Based Decision Making and Accreditation of State Health Departments

OBJECTIVE

To assess the association between evidence-based decision making, including implementation of evidence-based interventions (EBIs), with accreditation of state health departments through the Public Health Accreditation Board (PHAB).

DESIGN

This was a cross-sectional, electronic survey of state health department practitioners. We utilized a survey instrument focused on evidence-based public health, de-implementation, and sustainability of public health programs. Survey questions were organized into 6 domains: (1) demographic information; (2) individual-level skills; (3) decision making on programs ending; (4) decision making on programs continuing; (5) organization/agency capacity; and (6) external influences.

PARTICIPANTS

The targeted practitioners were randomly selected from the 3000-person membership of National Association of Chronic Disease Directors and program manager lists from key Centers for Disease Control and Prevention-supported programs in cancer and cancer risk factors. The final target audience for the survey totaled 1329 practitioners, representing all 50 states.

MAIN OUTCOME MEASURE(S)

The main outcome measures included the strength of association between a state's PHAB accreditation status and variables related to evidence-based public health and use of EBIs that fell within the individual participant skills, organization/agency capacity, and external influences domains.

RESULTS

We received 643 valid responses (response rate = 48.4%), representing all 50 states, with 35 states being PHAB accredited. There was a statistically significant association between PHAB accreditation and state health department use of quality improvement processes (P = .002), leadership plans to implement EBIs (P = .009), and leadership reactions to EBI implementation issues (P = .004). Respondents from PHAB-accredited states were significantly more likely than participants from nonaccredited states to report greater engagement with legislators and governors regarding EBIs and 14% less likely to report the inappropriate termination of programs in their work unit (P = .05).

CONCLUSIONS

The importance of accreditation relates to both internally focused functions and externally focused activities, especially regarding policy-related impact.

Long-Term Evaluation of a Course on Evidence-Based Public Health in the U.S. and Europe

The evidence-based public health course equips public health professionals with skills and tools for applying evidence-based frameworks and processes in public health practice. To date, training has included participants from all the 50 U.S. states, 2 U.S. territories, and multiple other countries besides the U.S. This study pooled follow-up efforts (5 surveys, with 723 course participants, 2005-2019) to explore the benefits, application, and barriers to applying the evidence-based public health course content. All analyses were completed in 2020. The most common benefits (reported by >80% of all participants) were identifying ways to apply knowledge in their work, acquiring new knowledge, and becoming a better leader who promotes evidence-based approaches. Participants most frequently applied course content to searching the scientific literature (72.9%) and least frequently to writing grants (42.7%). Lack of funds for continued training (35.3%), not having enough time to implement evidence-based public health approaches (33.8%), and not having coworkers trained in evidence-based public health (33.1%) were common barriers to applying the content from the course. Mean scores were calculated for benefits, application, and barriers to explore subgroup differences. European participants generally reported higher benefits from the course (mean difference=0.12, 95% CI=0.00, 0.23) and higher frequency of application of the course content to their job (mean difference=0.17, 95% CI=0.06, 0.28) than U.S. participants. Participants from later cohorts (2012-2019) reported more overall barriers to applying course content in their work (mean difference=0.15, 95% CI=0.05, 0.24). The evidence-based public health course represents an important strategy for increasing the capacity (individual skills) for evidence-based processes within public health practice. Organization-level methods are also needed to scale up and sustain capacity-building efforts.

The University of California San Francisco (UCSF) Training Program in Implementation Science: Program Experiences and Outcomes

Purpose: We evaluated outcomes of trainees who have completed the Certificate program in Implementation Science at the University of California San Francisco.

Methods: All students who completed the in-person Certificate Program between 2008 and 2015 (n = 71), or the online Certificate Program between 2016 and 2017 (n = 13), were eligible for our study. We assessed the potential impact of the Certificate Program on the professional development of trainees, through participant surveys on their self-reported level of comfort with pre-defined competencies, and on academic productivity.

Results: Of eligible trainees, 54 in-person (77%) and 13 online (100%) Certificate Program participants completed surveys. In-person trainees reported a total of 147 implementation science-related publications in peer-reviewed journals (median 3 publications/trainee, IQR 1–15). Thirty-four trainees (63%) reported being a Principal Investigator (PI) of 64 funded implementation science-related grants (median 2 grants/trainee, IQR 1–4). Fifteen percent (15%, n = 8) of participants reported receiving an NIH grant on which they were the PI, including R01 or P01 level funding (n = 4, 7%) and K awards (n = 3, 6%). Both in-person and online trainees reported median high to moderate confidence for all 12 competencies assessed. Confidence waned in skills aligning with later stages of implementation research for all trainees.

Conclusion: The moderate to high confidence in all competencies assessed and reported high level of academic productivity support the benefits of intensive, graduate-level training focused on applied methods to support career development of implementation scientists.

The Public Health Leadership and Implementation Academy for Noncommunicable Diseases

Purpose and Objectives

Low‐ and middle‐income countries (LMICs) have a large burden of noncommunicable diseases and confront leadership capacity challenges and gaps in implementation of proven interventions. To address these issues, we designed the Public Health Leadership and Implementation Academy (PH-LEADER) for noncommunicable diseases. The objective of this program evaluation was to assess the quality and effectiveness of PH-LEADER.

Intervention Approach

PH-LEADER was directed at midcareer public health professionals, researchers, and government public health workers from LMICs who were involved in prevention and control of noncommunicable diseases. The 1-year program focused on building implementation research and leadership capacity to address noncommunicable diseases and included 3 complementary components: a 2-month online preparation period, a 2-week summer course in the United States, and a 9-month, in-country, mentored project.

Evaluation Methods

Four trainee groups participated from 2013 through 2016. We collected demographic information on all trainees and monitored project and program outputs. Among the 2015 and 2016 trainees, we assessed program satisfaction and pre–post program changes in leadership practices and the perceived competence of trainees for performing implementation research.

Results

Ninety professionals (mean age 38.8 years; 57% male) from 12 countries were trained over 4 years. Of these trainees, 50% were from India and 29% from Mexico. Trainees developed 53 projects and 9 publications. Among 2015 and 2016 trainees who completed evaluation surveys (n = 46 of 55), we saw pre–post training improvements in the frequency with which they acted as role models (Cohen’s d = 0.62, P <.001), inspired a shared vision (d = 0.43, P =.005), challenged current processes (d = 0.60, P <.001), enabled others to act (d = 0.51, P =.001), and encouraged others by recognizing or celebrating their contributions and accomplishments (d = 0.49, P =.002). Through short on-site evaluation forms (scale of 1–10), trainees rated summer course sessions as useful (mean, 7.5; SD = 0.2), with very good content (mean, 8.5; SD = 0.6) and delivered by very good professors (mean, 8.6; SD = 0.6), though they highlighted areas for improvement.

Implications for Public Health

The PH-LEADER program is a promising strategy to build implementation research and leadership capacity to address noncommunicable diseases in LMICs.