title: Effectiveness of public health quality improvement training approaches:  application, application, application.
abstract: BACKGROUND
  Quality improvement (QI) has been identified as a key strategy to improve the performance of state and local public health agencies. Quality improvement training effectiveness has received little attention in the literature.
  
  
  OBJECTIVE
  To evaluate the effectiveness of 3 QI training types: webinars, workshops, and demonstration site activities on improving participant knowledge, skill, and ability to conduct QI through a questionnaire conducted after training participation.
  
  
  METHODS
  We used a natural experimental design hypothesizing that demonstration site participants would have the greatest gains on outcomes of interest compared with webinar and workshop participants. Bivariate and multivariate models were used to examine outcome differences between questionnaire respondents who participated in various training types.
  
  
  METHODS
  Local health department employees who participated in the 3 training strategies.
  
  
  METHODS
  Measures included knowledge and skill gain, skill application, QI receptivity, and ability to successfully participate in a QI project.
  
  
  RESULTS
  Two hundred eighty-four unique individuals who work in 143 health departments completed the questionnaire for a 59% response rate. The majority of these health departments serve midsize populations. Demonstration site respondents had significantly greater gains in knowledge and skills, skill application, and ability to successfully participate in a QI project. Webcast training participants had significantly higher QI receptivity in adjusted models. Respondents who participated in both webcast and demonstration site trainings had higher mean scores on all outcomes when compared with demonstration site single training participants, these differences were significant in unadjusted models.
  
  
  CONCLUSIONS
  Our findings suggest that QI training for public health agency employees should include both didactic training on QI content and opportunities for QI application. Future research should examine if this approach can effectively increase successful participation in QI projects for staff in LHDs of all sizes.
authors.affiliation: North Carolina Institute for Public Health, Department of Health Behavior and Health Education, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. mary_davis@unc.edu
authors.forename: Mary V
authors.initials: MV
authors.lastname: Davis
authors.forename: Amy
authors.initials: A
authors.lastname: Vincus
authors.forename: Matthew
authors.initials: M
authors.lastname: Eggers
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mahanna
authors.forename: William
authors.initials: W
authors.lastname: Riley
authors.forename: Brenda
authors.initials: B
authors.lastname: Joly
authors.forename: Jessica Solomon
authors.initials: JS
authors.lastname: Fisher
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bowling
mesh_terms: D004493:Education; D040381:Education, Public Health Professional; D006801:Humans; D015980:Public Health Practice; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D014481:United States