title: Barriers to evidence-based decision making in public health: a national survey of chronic disease practitioners.
abstract: OBJECTIVE
  Existing knowledge of evidence-based chronic disease prevention is not systematically disseminated or applied. This study investigated state and territorial chronic disease practitioners' self-reported barriers to evidence-based decision making (EBDM).
  
  
  METHODS
  In a nationwide survey, participants indicated the extent to which they agreed with statements reflecting four personal and five organizational barriers to EBDM. Responses were measured on a Likert scale from 0 to 10, with higher scores indicating a larger barrier to EBDM. We analyzed mean levels of barriers and calculated adjusted odds ratios for barriers that were considered modifiable through interventions.
  
  
  RESULTS
  Overall, survey participants (n=447) reported higher scores for organizational barriers than for personal barriers. The largest reported barriers to EBDM were lack of incentives/rewards, inadequate funding, a perception of state legislators not supporting evidence-based interventions and policies, and feeling the need to be an expert on many issues. In adjusted models, women were more likely to report a lack of skills in developing evidence-based programs and in communicating with policy makers. Participants with a bachelor's degree as their highest degree were more likely than those with public health master's degrees to report lacking skills in developing evidence-based programs. Men, specialists, and individuals with doctoral degrees were all more likely to feel the need to be an expert on many issues to effectively make evidence-based decisions.
  
  
  CONCLUSIONS
  Approaches must be developed to address organizational barriers to EBDM. Focused skills development is needed to address personal barriers, particularly for chronic disease practitioners without graduate-level training.
authors.affiliation: Prevention Research Center in St. Louis, Saint Louis University School of Public Health, St. Louis, MO, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Jacobs
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Dodson
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Baker
authors.forename: Anjali D
authors.initials: AD
authors.lastname: Deshpande
authors.forename: Ross C
authors.initials: RC
authors.lastname: Brownson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000517:prevention & control*; D002983:Clinical Competence; D003657:Decision Making; D004522:Educational Status; D055317:Evidence-Based Practice; D005260:Female; D019538:Health Care Surveys; D006284:Health Plan Implementation; D006801:Humans; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D015980:Public Health Practice; D012944:Social Support; D014481:United States