Ann L. Christiansen

A model to translate evidence-based interventions into community practice.

There is a tension between 2 alternative approaches to implementing community-based interventions. The evidence-based public health movement emphasizes the scientific basis of prevention by disseminating rigorously evaluated interventions from academic and governmental agencies to local communities. Models used by local health departments to incorporate community input into their planning, such as the community health improvement process (CHIP), emphasize community leadership in identifying health problems and developing and implementing health improvement strategies. Each approach has limitations. Modifying CHIP to formally include consideration of evidence-based interventions in both the planning and evaluation phases leads to an evidence-driven community health improvement process that can serve as a useful framework for uniting the different approaches while emphasizing community ownership, priorities, and wisdom.

Translating a Fall Prevention Intervention Into Practice: A Randomized Community Trial.

OBJECTIVES We examined whether community translation of an effective evidence-based fall prevention program via standard monetary support can produce a community-wide reduction in fall injuries in older adults and evaluated whether an enhanced version with added technical support and capacity building amplified the fall reduction effect. METHODS We completed a randomized controlled community trial among adults aged 65 and older in (1) 10 control communities receiving no special resources or guidance on fall prevention, (2) 5 standard support communities receiving modest funding to implement Stepping On, and (3) 5 enhanced support communities receiving funding and technical support. The primary outcome was hospital inpatient and emergency department discharges for falls, examined with Poisson regression. RESULTS Compared with control communities, standard and enhanced support communities showed significantly higher community-wide reductions (9% and 8%, respectively) in fall injuries from baseline (2007-2008) to follow-up (2010-2011). No significant difference was found between enhanced and standard support communities. CONCLUSIONS Population-based fall prevention interventions can be effective when implemented in community settings. More research is needed to identify the barriers and facilitators that influence the successful adoption and implementation of fall prevention interventions into broad community practice.

Research on the Translation and Implementation of Stepping On in Three Wisconsin Communities

Objective Falls are a leading cause of injury death. Stepping On is a fall prevention program developed in Australia and shown to reduce falls by up to 31%. The original program was implemented in a community setting, by an occupational therapist, and included a home visit. The purpose of this study was to examine aspects of the translation and implementation of Stepping On in three community settings in Wisconsin. Methods The investigative team identified four research questions to understand the spread and use of the program, as well as to determine whether critical components of the program could be modified to maximize use in community practice. The team evaluated program uptake, participant reach, program feasibility, program acceptability, and program fidelity by varying the implementation setting and components of Stepping On. Implementation setting included type of host organization, rural versus urban location, health versus non-health background of leaders, and whether a phone call could replace the home visit. A mixed methodology of surveys and interviews completed by site managers, leaders, guest experts, participants, and content expert observations for program fidelity during classes was used. Results The study identified implementation challenges that varied by setting, including securing a physical therapist for the class and needing more time to recruit participants. There were no implementation differences between rural and urban locations. Potential differences emerged in program fidelity between health and non-health professional leaders, although fidelity was high overall with both. Home visits identified more home hazards than did phone calls and were perceived as of greater benefit to participants, but at 1 year no differences were apparent in uptake of strategies discussed in home versus phone visits. Conclusion Adaptations to the program to increase implementation include using a leader who is a non-health professional, and omitting the home visit. Our research demonstrated that a non-health professional leader can conduct Stepping On with adequate fidelity, however non-health professional leaders may benefit from increased training in certain aspects of Stepping On. A phone call may be substituted for the home visit, although short-term benefits are greater with the home visit.

Addressing the burden of gun violence

Gun violence in the U.S. is a significant public health burden, accounting for over 30,000 deaths and an estimated 73,000 injures each year. Like other disease burdens with complex interactions between the host (individuals), agents (firearms) and the environment, epidemiological principles can identify patterns in the determinants and distribution of firearm injuries to develop, implement and evaluate evidence-based interventions (programs, policies, technologies). The National Violent Death Reporting System (NVDRS) was formed in 2002 with funding from the Centers for Disease Control and Prevention to link information on violent deaths from medical examiners and coroners to data on circumstances and weapons from law enforcement and crime laboratories. Involvement of forensic pathologists, medical examiners and coroners is critically important for a complete National Violent Death Reporting System and vital for the systematic collection, analysis, and dissemination of data on all violent deaths in the United States.

Developing a global research agenda on violence and injury prevention: a modest proposal.

The need for the development of a global injury prevention research agenda is examined. Literature was reviewed in public health and selected policy strategies outside of public health that address the development of research agendas both for specific injury topics as well as for other health related areas; the benefits of creating a global research agenda are highlighted. There are examples of successful strategies where the development of a global research agenda on an injury specific topic has improved knowledge and prevention activities in that subfield. There are also examples that consolidate larger health topics and follow an agenda. Such efforts can benefit from wider governmental and institutional support. It is concluded that the development of a global injury prevention research agenda focused on collaborative efforts and with emphasis in implementation and dissemination research could be a useful tool to improve the quantity and quality of research in the field.

Implementing effective injury interventions in local communities

Community-based injury interventions that have been shown to be effective in controlled trials are often not widely implemented, resulting in unnecessary injuries. One reason for the failure to implement effective interventions is the gulf between researchers and local health authorities. Research-driven approaches to translation into practice emphasise the scientific basis of prevention by disseminating rigorously evaluated interventions from academic and governmental agencies into local communities but may suffer from a lack of community ownership which may jeopardize implementation and sustainability. Bottom-up approaches to community health improvement emphasize community leadership in identifying and developing and implementing health improvement strategies but may suffer by implementing unproven programs which address community priorities ineffectively. In this presentation we propose a model to unite the two approaches to injury intervention at the community level. To develop this Evidence-Driven Community Health Improvement Process (EDCHIP) model we started with the framework of Community Health Improvement Process, developed by the Institute of Medicine, and added explicit steps for incorporating scientific evidence into planning, implementing and evaluating community injury interventions. We discuss the model in the context of a randomised community trial of a multi-factorial intervention to reduce fall injuries in older adults. In the trial, the intervention communities are using the EDCHIP model to implement the fall prevention program while the standard communities are the traditional approach. Emergency department visits and inpatient hospitalisations for fall injuries in adults 65 years and older are the primary outcome variables.