Factors affecting evidence-based decision making in local health departments.
BACKGROUND
Data indicating the extent to which evidence-based decision making (EBDM) is used in local health departments (LHDs) are limited.


OBJECTIVE
This study aims to determine use of decision-making processes by New York State LHD leaders and upper-level staff and identify facilitators and barriers to the use of EBDM in LHDs.


METHODS
The New York Public Health Practice-Based Research Network implemented a mixed-methods study in 31 LHDs. There were 20 individual interviews; five small-group interviews (two or three participants each); and two focus groups (eight participants each) conducted with people who had decision-making authority. Information was obtained about each person's background and position, decision-making responsibilities, how decisions are made within their LHD, knowledge and experience with EBDM, use of each step of the EBDM process, and barriers and facilitators to EBDM implementation. Data were collected from June to November 2010 and analyzed in 2011.


RESULTS
Overall, participants supported EBDM and expressed a desire to increase their department's use of it. Although most people understood the concept, a relatively small number had substantial expertise and experience with its practice. Many indicated that they applied EBDM unevenly. Factors associated with use of EBDM included strong leadership; workforce capacity (number and skills); resources; funding and program mandates; political support; and access to data and program models suitable to community conditions.


CONCLUSIONS
EBDM is used inconsistently in LHDs in New York. Despite knowledge and interest among LHD leadership, the LHD capacity, resources, appropriate programming, and other issues serve as impediments to EBDM and optimal implementation of evidence-based strategies.
Graduate Center of the City University of New York, Albany; New York State Department of Health, Albany.
Collette D
CD
Sosnowy
Linda J
LJ
Weiss
Christopher M
CM
Maylahn
Sylvia J
SJ
Pirani
Nancy J
NJ
Katagiri
D003657:Decision Making; D019317:Evidence-Based Medicine / Q000379:methods*; D017144:Focus Groups; D006801:Humans; D007857:Leadership; D009111:Local Government; D009518:New York; D011634:Public Health; D015980:Public Health Practice