Abstract
BackgroundLittle is known about the contextual factors affecting the uptake of evidence-based chronic disease interventions in the United States and in other countries. This study sought to better understand the contextual similarities and differences influencing the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) in Australia, Brazil, China, and the United States.MethodsBetween February and July 2015, investigators in each country conducted qualitative, semi-structured interviews (total N = 50) with chronic disease prevention practitioners, using interview guides that covered multiple domains (e.g., use of and access to EBCDP interventions, barriers and facilitators to the implementation of EBCDP interventions).ResultsPractitioners across the four countries reported only a few programmatic areas in which repositories of EBCDP interventions were used within their workplace. Across countries, academic journals were the most frequently cited channels for accessing EBCDP interventions, though peers were commonly cited as the most useful. Lack of time and heavy workload were salient personal barriers among practitioners in Australia and the United States, while lack of expertise in developing and implementing EBCDP interventions was more pertinent among practitioners from Brazil and China. Practitioners in all four countries described an organizational culture that was unsupportive of EBCDP. Practitioners in Brazil, China and the United States cited an inadequate number of staff support to implement EBCDP interventions. A few practitioners in Australia and China cited lack of access to evidence. Partnerships were emphasized as key facilitators to implementing EBCDP interventions across all countries.ConclusionsThis study is novel in its cross-country qualitative exploration of multilevel constructs of EBCDP dissemination and implementation. The interviews produced rich findings about many contextual similarities and differences with EBCDP that can inform both cross-country and country-specific research and practice to address barriers and improve EBCDP implementation among the four countries long-term.
Highlights
Little is known about the contextual factors affecting the uptake of evidence-based chronic disease interventions in the United States and in other countries
Despite a global need for evidence-based chronic disease prevention (EBCDP), and several studies calling for an action plan to better address the burden of chronic disease around the world [24,25,26], little is currently known about how access to EBCDP interventions, as well as personal and organizational-level barriers and facilitators of EBCDP vary by middle- and high-income countries and how these differences might affect the transfer and translation of evidence-based interventions within and across countries [24, 26,27,28]
Most practitioners from Australia, Brazil, and the United States worked as public health educators, managers, or program coordinators, whereas the largest contingents of practitioners from China were physicians or refused to disclose their employment title
Summary
Little is known about the contextual factors affecting the uptake of evidence-based chronic disease interventions in the United States and in other countries. Despite a global need for EBCDP, and several studies calling for an action plan to better address the burden of chronic disease around the world [24,25,26], little is currently known about how access to EBCDP interventions, as well as personal and organizational-level barriers and facilitators of EBCDP vary by middle- and high-income countries and how these differences might affect the transfer and translation of evidence-based interventions within and across countries [24, 26,27,28] The objective of this qualitative study is to explore the channels chronic disease practitioners in Australia, Brazil, China, and the United States use to access EBCDP in addition to, personal and organizational-level barriers and facilitators that they perceive influence the dissemination and implementation (D&I) of EBCDP
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