title: Adoption of Evidence-Based Interventions in Local Health Departments: "1-2-3 Pap NC".
abstract: Descriptions of barriers and facilitators to adoption of evidence-based interventions in local health departments (LHDs) are limited. This study was conducted by the North Carolina Public Health Practice-Based Research Network to identify factors associated with adoption of an evidence-based human papillomavirus video intervention, "1-2-3 Pap NC," in North Carolina LHDs. A sequential mixed-method study design was used. Data from the 2013 National Profile of Local Health Departments were used to test associations between LHD characteristics and adoption of the intervention. Qualitative, key stakeholder interviews with LHD directors provided the context for quantitative data. Data collection and analysis continued from March 3, 2014, to September 15, 2014. Overall, 28% of North Carolina health jurisdictions (33 of 100 counties) implemented the intervention. Of the three channels used to deliver the intervention to clients, most LHDs opted to show the video in the exam room (42%), followed by website/other social media (36%) and video loop in the lobby/waiting room (22%). In logistic regression, gender of the director (female) was significantly and positively associated with adoption of the intervention (AOR=4.44, p<0.05). Being a first-time director was marginally significant (AOR=0.28, p=0.074), suggesting first-time directors were less likely to adopt. Qualitative results suggested that aspects of communication (awareness and positive attitudes) and agency directors' evaluation of resources, balanced against intervention complexity and flexibility, competing priorities, and mandates, influenced adoption. Adoption of evidence-based interventions by LHDs is critical to improve population health. Practice-based research can contribute to understanding facilitators and modifying barriers to this process.
authors.affiliation: Department of Public Health, East Carolina University, Brody School of Medicine, Greenville, North Carolina. Electronic address: winterbauern@ecu.edu.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Winterbauer
authors.affiliation: Orange County Health Department, Hillsborough, North Carolina.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Bridger
authors.affiliation: Department of Public Health, East Carolina University, Brody School of Medicine, Greenville, North Carolina.
authors.forename: Ashley
authors.initials: A
authors.lastname: Tucker
authors.affiliation: Department of Public Health, East Carolina University, Brody School of Medicine, Greenville, North Carolina.
authors.forename: Ann P
authors.initials: AP
authors.lastname: Rafferty
authors.affiliation: Department of Public Health, East Carolina University, Brody School of Medicine, Greenville, North Carolina.
authors.forename: Huabin
authors.initials: H
authors.lastname: Luo
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009657:North Carolina; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D015980:Public Health Practice; D012737:Sex Factors; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D014741:Video Recording
chemical_list: D053918:Papillomavirus Vaccines