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Am J Prev Med. 2014 Jan;46(1):49-57. doi: 10.1016/j.amepre.2013.08.013.

Understanding administrative evidence-based practices: findings from a survey of local health department leaders.

Author information

Prevention Research Center in St. Louis, Brown School, St. Louis, Missouri; Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri. Electronic address:
Pontifical Catholic University of Parana, School of Health and Biosciencesand the Federal University of Parana, Department of Physical Education, Curitiba, Brazil.
Prevention Research Center in St. Louis, Brown School, St. Louis, Missouri.
College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri.
Department of Public Health, University of Tennessee, Knoxville, Tennessee.



There are sparse data showing the extent to which evidence-based public health is occurring among local health departments.


The purpose of the study was to describe the patterns and predictors of administrative evidence-based practices (structures and activities that are associated with performance measures) in a representative sample of local health departments in the U.S.


A cross-sectional study of 517 local health department directors was conducted from October through December 2012 (analysis in January-March 2013). The questions on administrative evidence-based practices included 19 items based on a recent literature review (five broad domains: workforce development, leadership, organizational climate and culture, relationships and partnerships, financial processes).


There was a wide range in performance among the 19 individual administrative evidence-based practices, ranging from 35% for providing access to current information on evidence-based practices to 96% for funding via a variety of sources Among the five domains, values were generally lowest for organizational climate and culture (mean for the domain=49.9%) and highest for relationships and partnerships (mean for the domain=77.1%). Variables associated with attaining the highest tertile of administrative evidence-based practices included having a population jurisdiction of 25,000 or larger (adjusted ORs [aORs] ranging from 4.4 to 7.5) and state governance structure (aOR=3.1).


This research on the patterns and predictors of administrative evidence-based practices in health departments provides information on gaps and areas for improvement that can be linked with ongoing quality improvement processes.

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