title: Public health case studies in diabetes prevention and control: innovation, partnerships, and funding.
abstract: BACKGROUND
  In 2006, we conducted case studies of 4 North Carolina local health departments (LHDs) that scored highly on an index of diabetes prevention and control performance, to explore characteristics that may serve as barriers or facilitators of diabetes prevention and control services.
  
  
  METHODS
  Case studies involving in-depth interviews were conducted at 4 LHDs. Sites were selected on the basis of 2 variables, known external funding for diabetes services and population size, that were associated with performance in diabetes prevention and control in a 2005 survey of all North Carolina LHDs. Fourteen interviews (individual and group) were conducted among 17 participants from the 4 LHDs. The main outcome measures were LHD characteristics that facilitate or hinder the performance of diabetes programs and services.
  
  
  RESULTS
  Interviews revealed that all 4 high-performing LHDs had received some sort of funding from a source external to the LHD. Case study participants indicated that barriers to additional service delivery included low socioeconomic status of the population and lack of financial resources. Having a diabetes self-management education program that was recognized by the American Diabetes Association appeared to be a facilitator of diabetes services provision. Other facilitators were leadership and staff commitment, which appeared to facilitate the leveraging of partnerships and funding opportunities, leading to enhanced service delivery.
  
  
  CONCLUSIONS
  The small number of LHDs participating in the study and the cross-sectional study design were limitations.
  
  
  CONCLUSIONS
  Leadership, staff commitment, partnership leveraging, and funding appear to be associated with LHD performance in diabetes prevention and control services. These factors should be further studied in future public health systems and services research.
authors.affiliation: North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, North Carolina, USA.
authors.forename: Mary V
authors.initials: MV
authors.lastname: Davis
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Cannon
authors.forename: April
authors.initials: A
authors.lastname: Reese
authors.forename: Beth
authors.initials: B
authors.lastname: Lovette
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Porterfield
mesh_terms: D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy*; D005378:Financial Support; D006291:Health Policy; D006801:Humans; D009111:Local Government; D019982:Organizational Case Studies; D010353:Patient Education as Topic / Q000458:organization & administration; D011635:Public Health Administration / Q000191:economics / Q000379:methods*; D012648:Self Care; D012959:Socioeconomic Factors