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

Background: There is a tension between two alternative approaches to implementing community-based injury interventions. Top-down approaches like the Evidence-Based Public Health (EBPH) movement emphasize the scientific basis of prevention by disseminating rigorously evaluated interventions from academic and governmental agencies into local communities. Bottom-up approaches like the Community Health Improvement Process (CHIP) emphasize community leadership in identifying priority health problems and in developing and implementing health improvement strategies. Each approach has limitations: the EBPH approach may suffer from a lack of community ownership of the process which may jeopardize implementation and sustainability, while the CHIP approach may suffer by implementing unproven programs which address community priorities ineffectively.

Objectives: In a 3 year community-academic collaboration, the Injury Research Center at the Medical College of Wisconsin collaborated with five county health departments in Wisconsin to implement evidence-driven, community-based injury prevention programs. The PRECEDE-PROCEED model was used to evaluate the progress of communities in identifying, implementing, and evaluating evidenced-based interventions to address community priorities.

Results: There was substantial variability in the success in implementing evidence-based interventions. In less successful communities, progress stalled at different phases reflecting differences in preexisting community capacity, local project leadership, and successful functioning of community coalitions.

Conclusions: Barriers to implementation of evidence-based injury interventions vary widely among communities. With modification, CHIP can serve as a useful framework for uniting top-down and bottom-up approaches to implementing evidence-based interventions while emphasizing community ownership, priorities, and wisdom.