American Journal of Preventive Medicine, December 2013

Authors: Collette D. Sosnowy, PhD, Linda J. Weiss, PhD, Christopher M. Maylahn, MPH,
Sylvia J. Pirani, MS, MPH, Nancy J. Katagiri, MPH, CPH

Background: Data indicating the extent to which evidence-based decision making (EBDM) is used
in local health departments (LHDs) are limited.
Purpose: This study aims to determine use of decision-making processes by New York State LHD
leaders and upper-level staff and identify facilitators and barriers to the use of EBDM in LHDs.
Methods: The New York Public Health Practice-Based Research Network implemented a mixed  methods study in 31 LHDs. There were 20 individual interviews; five small-group interviews (two or
three participants each); and two focus groups (eight participants each) conducted with people who
had decision-making authority. Information was obtained about each person’s background and
position, decision-making responsibilities, how decisions are made within their LHD, knowledge
and experience with EBDM, use of each step of the EBDM process, and barriers and facilitators to
EBDM implementation. Data were collected from June to November 2010 and analyzed in 2011.
Results: Overall, participants supported EBDM and expressed a desire to increase their department’s
use of it. Although most people understood the concept, a relatively small number had
substantial expertise and experience with its practice. Many indicated that they applied EBDM
unevenly. Factors associated with use of EBDM included strong leadership; workforce capacity
(number and skills); resources; funding and program mandates; political support; and access to data
and program models suitable to community conditions.
Conclusions: EBDM is used inconsistently in LHDs in New York. Despite knowledge and interest
among LHD leadership, the LHD capacity, resources, appropriate programming, and other issues
serve as impediments to EBDM and optimal implementation of evidence-based strategies.