Background
Methods
Data collection
Analysis
Results
Australia N = 13 | Brazil N = 9 | China N = 16 | United States N = 12 | |
---|---|---|---|---|
Gender | ||||
Female | 92% (12) | 55% (5) | 81% (13) | 100% (12) |
Male | 8% (1) | 45% (4) | 19% (3) | 0% (0) |
Age | ||||
21–29 | 8% (1) | 0% (0) | 0% (0) | 8% (1) |
30–39 | 23% (3) | 56% (5) | 44% (4) | 33% (4) |
40–49 | 23% (3) | 22% (2) | 25% (4) | 42% (5) |
50+ | 31% (4) | 22% (2) | 25% (4) | 16% (2) |
Refused | 15% (2) | 0% (0) | 6% (1) | 0%(0) |
Education | ||||
High School or Less | 0% (0) | 0% (0) | 6% (1) | 0% (0) |
Some college | 0% (0) | 0% (0) | 6% (1) | 0% (0) |
College degree | 23% (3) | 33% (3) | 25% (5) | 8% (1) |
Graduate degree | 69% (9) | 67% (6) | 30% (6) | 92% (11) |
Missing | 8% (1) | 0% (0) | 12% (2) | 0% (0) |
Employment title | ||||
Clinical Management | 0% (0) | 0% (0) | 12% (2) | 0% (0) |
Community health nurse | 0% (0) | 11% (1) | 0% (0) | 0% (0) |
Department head | 0% (0) | 11% (1) | 12% (2) | 16% (2) |
Physician | 0% (0) | 0% (0) | 30% (6) | 0% (0) |
Program Manager/ Coordinator/Health Educator | 64% (8) | 67% (6) | 12% (2) | 72% (9) |
Statistician | 0% (0) | 11% (1) | 0% (0) | 0% (0) |
Other | 23% (3) | 0% (0) | 0% (0) | 8% (1) |
Missing | 15% (2) | 0% (0) | 24% (4) | 0% (0) |
Australia N = 13 | Brazil N = 9 | China N = 16 | United States N = 12 | |
---|---|---|---|---|
The most commonly cited channels for obtaining information on EBCDP interventions | ||||
Academic journals | x | x | ||
Conferences | x | x | ||
Networks | x | x | x | |
Professional associations | x | x | x | |
The most useful channel for accessing EBCDP interventions was their peers | x | x | x | x |
Reported only a few programmatic areas in which evidence-based repositories were being used within their organizations of employment | x | x | x | x |
Perceived personal-level barriers to the implementation of EBCDP interventions | ||||
Lack of time | x | x | x | |
Heavy workload | x | x | ||
Lack of expertise with developing and implementing EBCDP interventions | x | x | ||
Optimism and versatility in overcoming barriers | x | |||
Perceived organizational-level barriers to the implementation of EBCDP interventions | ||||
Unsupportive workplace cultures | x | x | x | x |
Perceived lack of support for EBCDP from the organization’s leadership | x | |||
Lack of communication across various groups | x | x | ||
Lack of a workplace policy, mechanism, or incentive to promote and/or keep staff members accountable for making evidence-based decisions in their work | x | x | ||
Presence of workplace policies that limit personal authority to select the best interventions or to make other changes necessary to incorporate EBCDP | x | x | ||
Inadequate number of staff to implement EBCDP interventions | x | x | x | |
Lack of access to evidence | x | x | ||
Lack of evidence relevant to rural communities | x | |||
Facilitators to implementing evidence-based interventions | x | |||
Funding agencies that require EBCDP interventions | ||||
Having an education/degree | x | x | x | |
Partnerships/support from others | x | x | x | x |
Channels for learning about evidence-based interventions
“Networks are most useful because they are a way to hear about research that's been conducted long before it's reported in the peer reviewed literature.” [Australia]
“Communication between peers, which basically takes place through trainings and academic conferences.” [China]
Personal barriers to implementing evidence-based interventions
“It’s just that we have too much work to do. Doctors and other staff in the community-based health centers are overwhelmed. So, we don’t have extra time to get to learn about new evidence or knowledge. What we read, at most, are those articles related to our routine work.” [China]
“…the lack of ability to develop strategies based on evidence.” [Brazil]
“[Personal barriers include] lack of skills to effectively communicate evidence-based strategies to policy makers, lack of skills to effectively develop evidence-based chronic disease programs, and let me see, and lack of decision-making authority to select evidence-based chronic disease programs.” [China]
“That’s why I think there is not a barrier, right? I think everything is possible…I think the main thing is you’re always studying, seeking knowledge, exchanging experiences with someone who has implemented effective practices. That worked, succeeded. You will have no problem in developing this type of process.” [Brazil]
“I do not see obstacles there…any questions I do not know or skills I do not have, at this point I do not have the answer, but I will seek the answer, either by phone or by email, or the next meeting. One is not without answers.” [Brazil]
Organizational barriers to implementing evidence-based interventions
“There might sometimes be organizational cultures that are not so strongly evidence driven.” [Australia]
“Yes, especially the resistance of the workers themselves who do not want to change their working processes.” [Brazil]
“I would say that they (administrators) are supportive, but you still have to set it within your work, so it’s not to the point where that is the… evidence-based programing would not be the driving force, it would be getting your other work done, that it’s funded, and then if you have time, you can do these other types (evidence-based) of program.” [United States]
“Medical staff actually care about what kind of interventions work and what don’t work. But the administrators care more about getting the work done and achieving their goals. If they can’t get what they want from a certain intervention, they won’t be interested. The leaders have their term in office and want to get things done.” [China]
“And under the current national health insurance policy, we [in mainland China] lack a chronic disease management system that’s similar to the diabetes management system in Taiwan. To set up such a system, we first need to establish something like an effective information exchange platform or should we say, become more information-based. At present, inadequate informatization [sharing of patient information] is the biggest obstacle.” [China]
“You know… something there…something that we are trying to work on a lot, we do this well, and we know we need to improve is working with partners on those policy change efforts and some of the other things that we cannot necessarily do ourselves. A lot of things are not things that local public health can do, I cannot, you know, raise alcohol taxes or…you know there are a lot of things I can do, but I can work with partners to do that and to promote them.” [United States]
Organizational policies
“The lack of incentive or reward for using evidence-based decision making is definitely one. We need incentives to do our work.” [China]
“I would say one of the most challenging aspects is that you can have evidence coming in at the work level that requires an adaptation that hierarchically needs to go through an approval process, and sometimes the process is so convoluted and slow that it really limits your ability to respond to the context in which you are working.” [Australia]
“The issue is the lack of authority to select the best programs. Despite having a specific sector of health surveillance for chronic disease we do not have a lot of autonomy.” [Brazil]
Lack of organizational resources
“Chronic disease management and prevention requires a lot of work, especially for China that has a large population. First, the personnel and money that we can invest in this work are limited. Chronic disease management mainly requires a change of lifestyle and health behavior; this is going to take a long time. The follow-up work, health education, things like these also require a lot of staff-time investment.” [China]
“I think some of it is tied back to my earlier comment, which is the resources because if we had more staff, I would have more time to be able to better integrate it.” [United States]
“…we are, again, a very small, rural community. Some of our towns have less than 1,000 people living in them, so you know it does make it a little bit difficult when looking at the various interventions--is it going to fit the needs of our population?” [United States]
Facilitators to implementing evidence-based interventions
Education/experience
“At a personal level for myself, I've been very fortunate to be supportive and just finished a master’s in public health. I had quite a strong grounding in the social epidemiology.” [Australia]
“If I don't know, I seek the information through articles, websites, Google and I seek knowledge from the health department.” [Brazil]
“Yea, I would say confidence, experience, I also have a great support system with creating healthy communities.” [United States]
Partnerships
“We have our Creating Healthy Communities coalition and Safer Schools is a part of that coalition. There were not any mandates for Creating Healthy Communities or Safe Schools, but everyone who was involved in both of those had a lot of experience and knowledge.” [United States]
“Yes, and my whole job is about partnerships and networks and how we support and it is about working about policy practice and research and that's part of what my role was trying to do I guess. It's working with the policymakers that count, so it's working with researchers at different universities and it's working with practitioners…” [Australia]
“The federal government finances these processes and the State Department send financing for Municipality Department that implement the programs. Another option is creating partnerships between public and private sectors, but responsibility lies with the Municipality Department.” [Brazil]
“It [a particular program] used partnerships as the basis for the intervention and that allowed us to achieve more collaborative and coordinated actions. I think there is a strong evidence-base for that.” [Australia]
“The support comes from all three levels of government (municipal, state, and federal). One helps with financing (federal), one with structure (state), and the other with work team (municipal).” [Brazil]
“Support from administrators/managers within our health department and partnerships or coalitions with other organizations are the primary pieces.” [China]
“Partnerships and coalitions, so we have both some support and some barriers from elected officials. And having a partnership and doing this in a way that is in a coalition and having partners that aren’t just the public health department make it much easier to put forward more progressive campaigns. And by campaigns, whether it’s an actual awareness campaign or a campaign to move a policy forward or the movement in general, the larger campaign to reduce sugary drink consumption. It’s absolutely, absolutely, 100% vital to do this in a partnership with people from the community who are impacted as well as other professional organizations.” [United States]