207965 A model to translate evidence-based injury interventions into community practice

Wednesday, November 11, 2009: 9:15 AM

Peter M. Layde, MD, MSc , Injury Research Center, Medical College of Wisconsin, Milwaukee, WI
Ann Christiansen, MPH , Injury Research Center, Medical College of Wisconsin, Milwaukee, WI
Clare E. Guse, MS , Department of Family & Community Medicine, Medical College of Wisconsin, Milwaukee, WI
Donna J. Peterson, PhD , Injury Research Center, Medical College of Wisconsin, Milwaukee, WI
Cheryl Maurana, PhD , Public and Community Health, Medical College of Wisconsin, Milwaukee, WI
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.

Learning Objectives:
1. Describe the basic elements of the Community Health Improvement Process (CHIP)model. 2. Name 2 or more barriers to successful community implementation of evidence-based interventions. 3. Identify key elements of bottom-up community capacity building. 4. Describe modifications of the CHIP model which unite top-down and bottom-up approaches.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Assistant Director of the CDC-funded Injury Research Center at MCW and have over 10 years experience conducting community health improvement programs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.