Predictors of Evidence-Based Decision Making and Population Health Practice in LHDs

Research Objective : To identify the frequency with which LHDs carry out Evidence-Based Decision Making (EBDM) and population health strategies in LHDs and state-, LHD-, and community-levels predictors of LHDs' use of these strategies.

Data Sets and Sources: Harmonized PHSSR dataset consisting of 2010 NACCHO Profile of Local Health Departments Survey, Module 2 respondents, 2010 ASTHO Profile of State Health Departments, US Census data, and Area Resource File data.

Study Design: The study used multivariate analysis to identify predictors of EBDM and population health. We identified items in the 2010 NACCHO Profile Survey representing EBDM and population health strategies and constructed two composite dependent variables. Based on the PHSSR literature, we identified potential predictors at the state-, LHD-, and community levels.

Analysis: Using descriptive analyses, we determined the frequency with which LHDs carry out EBDM strategies and population health strategies. Hierarchical linear modeling (HLM) was used to identify factors that best predict LHDs' use of EBDM and population health strategies.

Principal Findings: Fourteen percent of LHDs engaged in six or seven (out of seven) EBDM strategies; and 15% used six or more (out of 10) population health strategies. Hierarchical linear modeling results will identify modifiable state health department, LHD, and community context predictors of LHDs' use of these strategies.

Conclusion: Based on data from the NACCHO Profile Survey, LHDs vary greatly in the extent to which they focus on EBDM and population health practice. The paths that lead LHDs to focus on EBDM and population health practice are complex and diverse.

Implications For The Field Of PHSSR: For PHSSR research, more precise data definitions and questions are needed in national surveys such as the NACCHO and ASTHO surveys. More research is needed to understand how LHDs use EBDM strategies (and which ones they use) as well as how they make decisions about focusing on population health practice.