Evidence-Based Interventions to Control Diabetes by Local Health Departments in the United States
Authors: TABAK RACHEL G. , PARKS RENEE G. , ALLEN PEG M. , JACOB REBEKAH R. , MAZZUCCA STEPHANIE , STAMATAKIS KATHERINE , CHIN MARSHALL , BROWNSON ROSS 
Published: June 2018

The nearly 3,000 local health departments (LHDs) nationwide are the frontline of public health, and are positioned to implement evidence-based interventions (EBIs) for diabetes control. This study used a national online survey to determine the prevalence and correlates of four CDC Community Guide recommended EBIs in LHDs. Among 240 LHDs, each EBI was delivered directly or with key partners by ≥60% (Figure 1); 96 LHDs (40%) offered all four EBIs, and 15 (7%) offered none. Diabetes prevalence in the state was positively associated with offering the Diabetes Prevention Program (OR=1.28 (95% CI: 1.02-1.62)), diabetes self-management education (OR=1.32 (95% CI: 1.04-1.67)), and identifying patients and determining treatment (OR=1.27 (95% CI: 1.05-1.54)) (Table). Implementation of these EBIs by more LHDs can help control diabetes.Table. Selected Associations between Local Health Department (LHD) Characteristics and Delivering (directly and/or with key partners) Diabetes Evidence-Based Interventions (EBIs) (odds ratio [OR] (95% confidence interval [95% CI]))DSME1DPP2Identify3CHWs4LHD and respondent characteristicsJurisdiction Population categories (&lt;50,000 = referent)1.08(0.72-1.61)1.59 (1.05-2.40)1.01(0.73-1.41)1.23(0.90-1.68)Diabetes prevalence in the state1.32 (1.04-1.67)1.28 (1.02-1.62)1.27 (1.05-1.54)1.06(0.89-1.26)Position (Top executive, health director, health officer, commissioner, or equivalent in the “office of the director” = referent)0.87(0.65-1.15)0.74(0.56-0.99)0.82(0.64-1.04)1.07(0.86-1.33)Years in current position0.94(0.66-1.34)0.93(0.66-1.33)0.88(0.66-1.17)0.62 (0.46-0.82)Age0.89(0.66-1.22)0.94(0.69-1.28)0.78(0.60-1.01)0.71 (0.55-0.91)Views on EBIsEBIs are appropriate and relevant to population (strongly agree/agree vs other)1.90(0.86-4.20)2.07(0.96-4.47)1.77(0.89-3.55)1.38(0.71-2.69)Staff are aware of evidence reviews (strongly agree/agree vs other)1.47(0.74-2.95)1.01(0.52-1.97)0.87(0.50-1.51)0.89(0.53-1.50)Implement interventions to achieve health equity (yes vs no/not sure)0.52(0.24-1.12)0.76(0.35-1.69)0.81(0.41-1.59)0.46 (0.24-0.88)Supports for use of an evidence-based process to plan, implement, and evaluate public health programs (strongly agree/agree vs other)Work group/division has resources to support use1.00(0.48-2.05)0.62(0.31-1.23)1.01(0.56-1.82)1.05(0.60-1.84)Staff have skills to carry out process1.24(0.61-2.50)0.56(0.29-1.10)1.30(0.74-2.31)0.86(0.51-1.47)Partners support use1.33(0.66-2.65)0.93(0.48-1.82)1.92 (1.08-3.42)0.85(0.50-1.44)Leadership encourages use1.35(0.69-2.63)0.99(0.51-1.93)1.42(0.82-2.47)1.20(0.71-2.03)Informational resources are available1.63(0.77-3.45)1.90(0.88-4.08)1.63(0.77-3.45)0.84(0.49-1.45)Engages diverse partners that share resources2.31 (1.10-4.86)1.75(0.86-3.56)1.30(0.74-2.27)0.82(0.48-1.38)Work group/division has access to info relevant to community needs1.90(0.94-3.83)0.77(0.40-1.49)1.69(0.97-2.95)1.15(0.68-1.93)Agency culture supports evidence-based processes0.64(0.32-1.26)0.46 (0.23-0.92)1.54(0.89-2.67)0.75(0.44-1.25)1Diabetes self-management education with persons with diabetes delivered in community gathering places (DSME)2Diet and physical activity promotion programs with people at increased risk for type 2 diabetes such as the Diabetes Prevention Program (DPP)3Diabetes management interventions identifying patients with diabetes and determining effective treatment (Identify)4Community health workers to deliver diet and physical activity promotion, and weight management to groups or individuals with increased risk for type 2 diabetes (CHW)

Disclosure
R.G. Tabak: Other Relationship; Self; Envolve PeopleCare/Centene Corporation. R.G. Parks: None. P.M. Allen: None. R.R. Jacob: None. S. Mazzucca: None. K. Stamatakis: None. M. Chin: Research Support; Self; Merck Foundation. R. Brownson: None.