Evidence-based Public Health Practice Research Articles

Development and validation of the Information Literacy Measurement Scale (ILMS-34) in Chinese public health practitioners

BackgroundPublic health professionals (PHPs) have increasing information needs to inform evidence-based public health decisions and practice, which requires good information literacy. A comprehensive and reliable assessment tool is necessary to assess PHPs' literacy and guide future promotion programs. However, there is a lack of measurement tools specifically for the information literacy of PHPs.ObjectivesThis study aimed to develop an information literacy assessment tool for PHPs and test its psychometric properties among PHPs.MethodsA 34-item Information Literacy Measurement Scale (ILMS-34) for PHPs was developed based on an extensive literature review, the Delphi method, and pilot testing. The ILMS-34 was further validated among 526 PHPs recruited from four cities in Guangdong Province, China, using convenience sampling. The sample was randomly divided into two equal groups for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. Other psychometric testing included item analysis, Cronbach's α coefficient, three-week test–retest reliability, and known-group validity.ResultsEFA yielded four dimensions for the ILMS-34: information consciousness, information knowledge, information ability, and information ethics. Subsequent CFA showed a good model fit of the four-factor structure (χ2/df = 1.485, RMSEA = 0.043, SRMR = 0.038, TLI = 0.977, CFI = 0.979). There were significant differences in each item between the high and low-scoring groups (p < 0.001), indicating good item discrimination. The ILMS-34 demonstrated good internal consistency with a Cronbach's α coefficient of 0.97 for the total scale (four subscales: 0.92, 0.92, 0.98, and 0.91, respectively). It also showed good test–retest reliability after three weeks with an ICC coefficient of 0.67. The DSE-MS scores varied by various sample characteristics, verifying the known-group validity.ConclusionThe ILMS-34 is a multidimensional instrument with good psychometric properties and can be used as an effective tool to measure information literacy among PHPs. Further validation in other samples across various cultures is needed to test its broad application.

Assessment of the Knowledge Level of COVID-19 Vaccines and Vaccine Hesitancy amongst Final-Year Medical Students in Southeast Nigeria

Background: Despite how ravaging and deadly COVID-19 infection is, vaccine hesitancy is high among the uneducated, medical students, and health workers, who as frontline workers, should lead by example and drive COVID-19 vaccination efforts. Objectives: This research aims to assess the knowledge level of COVID-19 vaccines among final-year medical students in Southeast-Nigeria universities and determine the factors responsible for the hesitancy of this vaccine among them. Methodology: A cross-sectional study of final-year medical students in six medical schools in Southeast Nigeria using an electronically distributed structured, validated online Google form amongst final-year medical students from which 125 of them responded. Results: Out of a sample of 125 final-year medical students, 123 (98.4%) are aware of COVID-19 vaccines while 2 (1.6%) lack knowledge of COVID-19 vaccines. The demographics of the final year medical students comprised 68 (58%) males and 57 (45.6%) females, 74.4% (93/125) of the respondents do not have a preference for any vaccine while 25.6% (33/125), shows a preference for various vaccine types. 95 (76%) final year medical students have not been vaccinated as against 30 (24%) who have received the vaccine for the Covid-19 virus, this large gap in the vaccination ratio accounted for many factors ranging from safety, availability, side effects, etc. Conclusion: The level of awareness of COVID-19 vaccines is very high among final-year medical students but it is not equivalent to the level of uptake of the vaccines. Despite being future healthcare professionals, medical students' vaccination rates remain suboptimal, highlighting a significant vaccine hesitancy and a large gap between knowledge and practice. Understanding and addressing these underlying factors is crucial to improving vaccine uptake and ensuring that medical students, as future healthcare leaders, are equipped to promote evidence-based public health practice.

Public Health Professionals’ Perspectives on Research Utilization in Nigerian Health Systems

The integration of research evidence into healthcare decision-making is essential for improving health outcomes, particularly in low- and middle-income countries like Nigeria. This study investigates the perspectives of public health professionals on research utilization within the Nigerian health system, identifying barriers and facilitators to the application of evidence-based practices. Utilizing a cross-sectional descriptive design, data were collected from public health professionals and policymakers through a structured questionnaire distributed via Google Survey. The findings reveal a significant gap in the dissemination and utilization of research findings, with many professionals unaware of existing systems to facilitate this process. Despite recognizing the importance of research utilization for enhancing health and quality of life, barriers such as limited access to quality research publications and inadequate collaboration between researchers and policymakers impede effective implementation. Capacity-building initiatives, such as workshops and continuous professional development programs, were identified as key facilitators for promoting evidence-based practices. The study underscores the need for improved communication and tailored dissemination strategies to bridge the gap between research and practice, ensuring that findings are accessible and applicable to the specific needs of different professional groups. These results align with existing literature that highlights the crucial role of evidence-based practice in public health and the necessity of robust dissemination and implementation frameworks. Addressing these barriers and leveraging facilitators can significantly enhance the utilization of research findings, leading to better health outcomes and more effective healthcare policies in Nigeria.

Health Smart City towards improving Public Health and Citizen Engagement

Abstract Climate change is modifying weather patterns, producing far-reaching effects on the environment, the economy and society as a whole, endangering global livelihoods, health, food and energy security, and water resources. Europe will not escape its effects, aggravating risks and threats to public health (PH). Today cities are leading the effort to tackle climate change. Cities are embracing digitalization and establishing smart cities (SC). SC should address people mobility, but also the impact of extreme weather phenomena. The degradation of the environment will foreseeably create security and health crisis that could benefit with digital technologies. The development of urban policies should be guided by evidence-based PH practices. The inclusion of PH into the pillars of the SC will contribute toward mitigating PH crises, such as the COVID-19 pandemic. Design Science Research Methodology was used to elicit a Smart Public Health City (SPHEC) framework. A set of PH and SC experts participated in the process, using diabetes as a case study. The European Green Deal served as a blueprint toward a healthier and more sustainable city. The SPHEC framework was defined by elucidating the PH functions within a SC, with the identification of a set of digital PH services that are required to support the SPHEC framework. This allows to assess the benefits obtained with the digital PH services, and provides evidence for guiding decision-making. The role of digital PH services emerges from the analysis of the framework, through the development of proper digital PH services, strengthening capacity and resilience in future climate emergencies, and motivating policy makers to endorse this challenge. Climate change is a serious threat with impact in PH and cities need to be prepared to tackle it. The use of the SPHEC framework enable to understand the role of both digitalization and the green deal in supporting public policies to tackle chronic diseases like diabetes.

Public Health Framework for Smart Cities within the Comprehensive Approach to Sustainability in Europe: Case Study of Diabetes

European cities should address the climate change challenges, improving quality of life and reducing costs. They need potential smart and digital approaches. Public health (PH) has recognized climate change as a major challenge. The development of urban policies should be guided by evidence-based PH practices. The environmental health determinants and the climate crisis now represent a clear PH threat. The core of the Smart City is sustainability, and its basic condition is active PH. The inclusion of public health into the pillars of the Smart City concept to contribute toward mitigating PH crises, such as the COVID-19 pandemic, is a framework for action. Design Science Research Methodology (DSRM) is used to elicit a Smart Public Health City (SPHEC) framework. A set of PH and smart city experts participated in the DSRM process, using diabetes as a case study. The European Green Deal served as a blueprint for this transformational change toward a healthier and more sustainable city. The SPHEC framework was defined by elucidating clearly the several dimensions of the PH functions within a digital city, via the identification of a set of digital PH services that are required to support the SPHEC framework. This allows for an assessment of the actual benefits that are obtained with the digital health services, and provides evidence for guiding decision-making. The role of digital PH services emerges from the analysis of the SPHEC framework, through the development of proper digital health services within the smart city, strengthening capacity and resilience in future climate emergencies, and motivating policy makers to take this challenge more seriously.

Designing Multifunctional Urban Green Spaces: An Inclusive Public Health Framework.

Evidence of the wide range of health benefits associated with the use of urban green space (UGS) continues to grow. Despite this evidence, many UGS designs do not adopt a community-inclusive approach that utilizes evidence-based public health strategies to maximize potential health benefits. This research focused on testing a multidisciplinary, community-involved public health framework to drive the UGS design process. The aim of this study was to use community feedback and evidence-based public health practices to promote physical health, psychological wellbeing, and social cohesion by creating a multifunctional UGS that enhances nature therapy, natural play, and sports and recreation. Community health assessment data (236 survey responses), community forum and survey feedback (157 survey responses), local urban green space inventory assessment, and environmental assessment and impact data were analyzed to develop a design plan that maximize the greatest potential health benefits for the greatest proportion of the population. Community health data indicated a strong relationship between the availability of places to be physically active in the community and higher ratings of mental (aOR = 1.80) and physical (aOR = 1.49) health. The creation and utilization of the proposed community-inclusive and public health-focused framework resulted in a UGS design that prioritized the needs of the community and provided evidence-informed strategies to improve the health of local residents. This paper provides unique insight into the application of a framework that promotes a more health-focused and functional approach to UGS design.

Preventing Adverse Childhood Experiences: The Role of Etiological, Evaluation, and Implementation Research

Research on adverse childhood experiences is a vital part of the data-to-action link and the development of evidence-based public health and violence prevention practice. Etiological research helps to elucidate the key risk and protective factors for adverse childhood experiences and outcome research examines the consequences of exposure to them. Evaluation research is critical to building the evidence base for strategies that are likely to have a significant impact on preventing and reducing adverse experiences during childhood. Implementation research efforts inform the movement and scale-up of evidence-based findings to public health practice. The Centers for Disease Control and Prevention’s Division of Violence Prevention located in the National Center for Injury Prevention and Control is investing in a number of research initiatives that are designed to advance what is known about the causes and consequences of adverse childhood experiences (i.e., etiological research), the strategies that are effective at reducing and preventing them (i.e., evaluation research), and how to best adapt and scale effective strategies (i.e., implementation research). This article complements the other articles in this Special Supplement by briefly providing a review of reviews for each of these areas and highlighting recent research investments and strategic directions by the Centers for Disease Control and Prevention in the area of child abuse and neglect and adverse childhood experience prevention. Research investments are critical to advancing the evidence base on the prevention of adverse childhood experiences and to ensure safe, stable, and nurturing relationships and environments so that all children can live to their fullest potential.

Supporting Success: ASTHO's Strategies for Reducing Maternal Mortality and Morbidity.

Supporting Success: ASTHO's Strategies for Reducing Maternal Mortality and Morbidity.

Generation and Use of Evidence by Local Health Departments: The Role of Leader Attributes.

The purpose of this study was to examine whether certain types of leaders were associated with the degree to which local health departments (LHDs) generate and use evidence to inform their service offering. Pooled, cross-sectional analysis using 4 waves (2010, 2013, 2016, and 2019) of the National Profiles of Local Health Departments sponsored by the National Association of County and City Health Officials (NACCHO). Univariate analysis was used to assess the extent to which LHDs were generating and using evidence to improve the health of their local communities and whether this changed over time. Multinomial logistic regression models were used to examine the relationships between LHD leader attributes and the extent to which LHDs were generating and using evidence. Between 1496 and 2087 (varied by survey round) LHDs from throughout the United States. Two outcome variables pertaining to the generation of evidence: (1) how recently an LHD completed a community health assessment and (2) how recently an LHD completed a community health improvement plan. A third outcome variable reflected how extensively an LHD used the Community Guide, a compendium of evidence-based findings. In 2010, 25.1% and 41.4% of all LHDs had not completed a community health assessment or a community health improvement plan, respectively; by 2019, those figures declined significantly to 14.6% and 24.7%. Similarly, in 2010, 61.7% of all LHDs were not using the Community Guide; by 2019, that percentage declined significantly to 42.5%. Multivariable analysis revealed that leader experience was a more robust correlate of evidence generation and use by LHDs than leader education. While LHDs' generation and use of evidence have grown over the past decade, there is room for improvement. Local health department leader attributes-education and experience-highlight targeted opportunities to fill gaps in the use of evidence-based public health practices.

Public Health Strengths During the COVID-19 Response.

Public Health Strengths During the COVID-19 Response.

Training Needs and Awareness of Emerging Areas of Public Health Practice Among Epidemiologists Working in State Health Agency Central Offices in the United States, 2017.

Epidemiologists working in state health agency central offices (SHA-CO) are key professionals working to monitor population health indicators. Assessing training needs to identify gaps is critical to ensuring a competent public health workforce. The objective of this research was to identify training needs of SHA-CO epidemiologists and their awareness of emerging areas of public health practice (EAoP) using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS). SHA-CO epidemiologists were surveyed in fall 2017 using a Web-based tool. Balanced repeated replication weights were used to account for complex sample design. Differences in responses by tenure, education level, and supervisory status were assessed using multinomial logistic regression. Forty-seven state health agencies. Permanently employed SHA-CO epidemiologists. Training needs were identified by classifying skill gaps as those skills that participants self-reported as high relevance to day-to-day work but self-rated as having low proficiency. Awareness of EAoP was self-reported. Systems and strategic thinking and budget and financial management were the areas with the greatest training needs. For most skill domains, fewer participants reported skill gaps with increasing years of public health work experience. Participants with 16 or more years of work experience were less likely to be motivated by most training motivators listed by epidemiologists with 5 or fewer years of experience. The EAoP participants reported greatest awareness of evidence-based public health practice (67%), and the EAoP they reported hearing least about was Health in All Policies (14%). Stratified analyses by tenure identified important differences in training needs and motivators that employers can use to customize workforce development strategies. SHA-CO epidemiologists reported varying amounts of awareness of EAoP. Specialized training approaches may contribute to improved employee engagement and reduce skill gaps among SHA-CO epidemiologists.

Public Health Employees' Perceptions about the Impact of Emerging Public Health Trends on Their Day-to-Day Work: Effects of Organizational Climate and Culture.

Objective: The purpose of this research was to assess the workforce characteristics associated with public health employees’ perceived impact of emerging trends in public health on their day-to-day work. Methods: Multinomial logistic regression was performed to analyze data from the 2017 PH WINS, a cross-sectional survey utilizing a nationally representative sample of the United States public health workforce. Results: More than 55% of the public health workforce perceived that their day-to-day work was impacted by the emerging public health trends. Workplace environment was significantly associated with the perception of their day-to-day work being impacted by emerging public health trends such as quality improvement (QI) (AOR = 1.04, p < 0.001), and evidence-based public health practice (EBPH) (AOR = 1.04, p < 0.001). Race, ethnicity, and educational status were also positively associated with the perceived impact of the emerging public health trends. Conclusions: The organizational culture of a public health agency influences the engagement of the workforce and their perception of the meaningfulness of their work. As practitioners shift into chief health strategists, it will be imperative for them to have training in public health foundations and tools in order to efficiently serve their communities.

Building Capacity of Evidence-Based Public Health Practice at King Saud University: Perceived Challenges and Opportunities.

Implementation of evidence-based public health (EBPH) is lagging behind in Saudi Arabia and the region. Graduate-level public health curriculum at King Saud University, College of Medicine, Riyadh, is designed to equip students to integrate best available evidence in public health decision making. The objectives of this study were to explore the viewpoint of the students on the perceived challenges they faced during training and the possible opportunities to improve their learning experience of EBPH. Eighteen graduate students participated in 3 focus groups that were audio-recorded, transcribed, and de-identified before analysis. Social construction and constructivism lens using thematic analysis were adopted. Saturation was reached when similar responses were recorded. Two themes (challenges and opportunities) and 9 subthemes emerged. The lack of a national health information system, scarcity of research pertinent to the Saudi community, and deficient communication between the postgraduate programs and the Ministry of Health were the main barriers perceived by participants to affect their EBPH training. However, participants perceived opportunities for change through establishment of partnership and communication channels with the Ministry of Health and the Saudi community. In addition, participants considered building community of practice and using social media as a platform for communication between public health professionals and the community at large as a valid opportunity for professional growth and community service. Although systematic training in EBPH through postgraduate programs is effective in providing the future manpower with the needed skill and knowledge to practice EBPH, organizational and cultural barriers remain toward practicing EBPH. Reaching out to those in leadership positions and communicating with other public health professionals may facilitate spreading the culture of EBPH.

Engaging Local Health Departments in Disaster Research: A Washington State Survey.

Disaster research can inform effective, efficient, and evidence-based public health practices and decision making; identify and address knowledge gaps in current disaster preparedness and response efforts; and evaluate disaster response strategies. This study aimed to identify challenges and opportunities experienced by Washington State local health departments (LHDs) regarding engagement in disaster research activities. An online survey was disseminated to the emergency preparedness representative for the 35 LHDs in Washington State. Survey questions sought to assess familiarity and experience with disaster research, as well as identify facilitators and barriers to their involvement. The survey was first piloted with 7 local and state public health emergency preparedness practitioners. A total of 82.9% of Washington's 35 LHDs responded to our survey. Only 17.2% of respondents had previous experience with disaster research. Frequently reported barriers to engaging in disaster research included funding availability, competing everyday priorities, staff capacity, and competing priorities during disaster response. These findings can inform efforts to support disaster research partnerships with Washington State LHDs and facilitate future collaboration. Researchers and public health practitioners should develop relationships and work to incorporate disaster research into LHD planning, training, and exercises to foster practice-based disaster research capacity.

Responding to Climate and Environmental Change Impacts on Human Health via Integrated Surveillance in the Circumpolar North: A Systematic Realist Review.

Environments are shifting rapidly in the Circumpolar Arctic and Subarctic regions as a result of climate change and other external stressors, and this has a substantial impact on the health of northern populations. Thus, there is a need for integrated surveillance systems designed to monitor the impacts of climate change on human health outcomes as part of broader adaptation strategies in these regions. This review aimed to identify, describe, and synthesize literature on integrated surveillance systems in Circumpolar Arctic and Subarctic regions, that are used for research or practice. Following a systematic realist review approach, relevant articles were identified using search strings developed for MEDLINE® and Web of Science™ databases, and screened by two independent reviewers. Articles that met the inclusion criteria were retained for descriptive quantitative analysis, as well as thematic qualitative analysis, using a realist lens. Of the 3431 articles retrieved in the database searches, 85 met the inclusion criteria and were analyzed. Thematic analysis identified components of integrated surveillance systems that were categorized into three main groups: structural, processual, and relational components. These components were linked to surveillance attributes and activities that supported the operations and management of integrated surveillance. This review advances understandings of the distinct contributions of integrated surveillance systems and data to discerning the nature of changes in climate and environmental conditions that affect population health outcomes and determinants in the Circumpolar North. Findings from this review can be used to inform the planning, design, and evaluation of integrated surveillance systems that support evidence-based public health research and practice in the context of increasing climate change and the need for adaptation.

Protecting Populations from Radon in Ontario, Canada: Translating Research to Evidence-Based Public Health Practice

Protecting Populations from Radon in Ontario, Canada: Translating Research to Evidence-Based Public Health Practice

Evidence Based Public Health Practice: A Fundamental Concept

DOI: http://dx.doi.org/10.3126/hprospect.v10i0.5643Health Prospect Vol.10 2011, pp.25-26

Lessons Learned in Promoting Evidence-Based Public Health: Perspectives from Managers in State Public Health Departments

Evidence-based public health (EBPH) practice, also called evidence-informed public health, can improve population health and reduce disease burden in populations. Organizational structures and processes can facilitate capacity-building for EBPH in public health agencies. This study involved 51 structured interviews with leaders and program managers in 12 state health department chronic disease prevention units to identify factors that facilitate the implementation of EBPH. Verbatim transcripts of the de-identified interviews were consensus coded in NVIVO qualitative software. Content analyses of coded texts were used to identify themes and illustrative quotes. Facilitator themes included leadership support within the chronic disease prevention unit and division, unit processes to enhance information sharing across program areas and recruitment and retention of qualified personnel, training and technical assistance to build skills, and the ability to provide support to external partners. Chronic disease prevention leaders’ role modeling of EBPH processes and expectations for staff to justify proposed plans and approaches were key aspects of leadership support. Leaders protected staff time in order to identify and digest evidence to address the common barrier of lack of time for EBPH. Funding uncertainties or budget cuts, lack of political will for EBPH, and staff turnover remained challenges. In conclusion, leadership support is a key facilitator of EBPH capacity building and practice. Section and division leaders in public health agencies with authority and skills can institute management practices to help staff learn and apply EBPH processes and spread EBPH with partners.

CDC's Prevention Status Reports: Monitoring the Status of Public Health Policies and Practices for Improved Performance and Accountability.

Increasing the adoption and implementation of evidence-based policies and practices is a key strategy for improving public health. Although there is widespread agreement about the importance of implementing evidence-based public health policies and practices, there are gaps between what has been shown to be effective and what is implemented at the state level. The Centers for Disease Control and Prevention (CDC) developed the Prevention Status Reports (PSRs), a performance measurement system, to highlight evidence-based public health policies and practices and catalyze state performance and quality improvement efforts across the nation. CDC selected a set of 10 topics representing some of the most important public health challenges in the nation. Stakeholders, including state health departments and other partners, helped conceptualize the PSRs and informed the development of the PSR framework, which provides an organizational structure for the system. CDC subject matter experts developed criteria for selecting policies and practices, indicators for each policy and practice, and a criteria-based rating system for each indicator. The PSRs were developed for all 50 states and the District of Columbia. The PSRs were developed and serve as a performance measurement system for monitoring the adoption, reach, and implementation fidelity of evidence-based public health policies and practices nationwide. The PSRs include 33 policy and practice indicators across the 10 health topics. They use a simple 3-level rating system-green, yellow, and red-to report the extent to which each state (and the District of Columbia) has implemented the policy or practice in accordance with supporting evidence or expert recommendations. Results from aggregate analyses show positive change or improvement. The PSRs are a unique part of CDC's work to improve the performance and accountability of the public health system, serving as both a monitoring tool and a call to action to improve health outcomes. The PSRs can be used to track the reach of and fidelity to evidence-based policies and practices nationally over time, as well as inform state efforts to improve their use of evidence-based policies and practice.

Meta-analysis in evidence-based healthcare: a paradigm shift away from random effects is overdue.

Each year up to 20 000 systematic reviews and meta-analyses are published whose results influence healthcare decisions, thus making the robustness and reliability of meta-analytic methods one of the world's top clinical and public health priorities. The evidence synthesis makes use of either fixed-effect or random-effects statistical methods. The fixed-effect method has largely been replaced by the random-effects method as heterogeneity of study effects led to poor error estimation. However, despite the widespread use and acceptance of the random-effects method to correct this, it too remains unsatisfactory and continues to suffer from defective error estimation, posing a serious threat to decision-making in evidence-based clinical and public health practice. We discuss here the problem with the random-effects approach and demonstrate that there exist better estimators under the fixed-effect model framework that can achieve optimal error estimation. We argue for an urgent return to the earlier framework with updates that address these problems and conclude that doing so can markedly improve the reliability of meta-analytical findings and thus decision-making in healthcare.