Building evidence-based practice capacity at a Pacific Island jurisdiction: The experience of American Samoa Department of Health

Significance: Pacific Island health departments struggle with a fragmented health-care system, a public health workforce shortage, and a growing chronic disease burden, all of which negatively impact service delivery effectiveness. Purpose: The American Samoa Department of Health (ASDOH) received funding from the Centers for Disease Control and Prevention's National Public Health Improvement Initiative to build its capacity and implementation of evidence-based practices (EBP) as recommended by The Guide to Community Preventive Services to maximize health resources and improve workforce performance, service delivery, and community health. Methods: A 2011 assessment of EBP use by ASDOH programs found that EBPs are minimally utilized due to limited awareness and uncertainty about how to implement proven practices. In response, an Advisory Group composed of program managers was established to provide direction and actionable recommendations on EBP prioritization and implementation. Interactive skill-based trainings were developed to 1) define EBPs; 2) provide hands-on experience searching EBP databases; and 3) introduce an evidence-based public health (EBPH) framework. Using a prioritization matrix that considers magnitude of disease, departmental priorities, and feasibility of implementation, programs were selected for EBP piloting. Results: Based on preliminary training data (n=35), 89% of participants found the training very useful, 91% reported strong confidence in their ability to define EBPs, and 86% reported strong confidence to identify EBPH resources. Two chronic disease programs were selected to pilot EBPs, and coordinated planning efforts are under way. Conclusion: The cultivation of “evidence champions” at ASDOH, along with data-driven planning, prioritization, and workforce training, is a promising approach toward building public health capacity in a limited resource setting.