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]))

 DSME1 DPP2 Identify3 CHWs4  
LHD and respondent characteristics      
Jurisdiction Population categories (<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 state 1.32 
(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 position 0.94
(0.66-1.34) 		0.93
(0.66-1.33) 		0.88
(0.66-1.17) 		0.62 
(0.46-0.82) 		 
Age 0.89
(0.66-1.22) 		0.94
(0.69-1.28) 		0.78
(0.60-1.01) 		0.71 
(0.55-0.91) 		 
Views on EBIs      
EBIs 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 use 1.00
(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 process 1.24
(0.61-2.50) 		0.56
(0.29-1.10) 		1.30
(0.74-2.31) 		0.86
(0.51-1.47) 		 
Partners support use 1.33
(0.66-2.65) 		0.93
(0.48-1.82) 		1.92 
(1.08-3.42) 		0.85
(0.50-1.44) 		 
Leadership encourages use 1.35
(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 available 1.63
(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 resources 2.31 
(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 needs 1.90
(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 processes 0.64
(0.32-1.26) 		0.46 
(0.23-0.92) 		1.54
(0.89-2.67) 		0.75
(0.44-1.25) 		 
 DSME1 DPP2 Identify3 CHWs4  
LHD and respondent characteristics      
Jurisdiction Population categories (<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 state 1.32 
(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 position 0.94
(0.66-1.34) 		0.93
(0.66-1.33) 		0.88
(0.66-1.17) 		0.62 
(0.46-0.82) 		 
Age 0.89
(0.66-1.22) 		0.94
(0.69-1.28) 		0.78
(0.60-1.01) 		0.71 
(0.55-0.91) 		 
Views on EBIs      
EBIs 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 use 1.00
(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 process 1.24
(0.61-2.50) 		0.56
(0.29-1.10) 		1.30
(0.74-2.31) 		0.86
(0.51-1.47) 		 
Partners support use 1.33
(0.66-2.65) 		0.93
(0.48-1.82) 		1.92 
(1.08-3.42) 		0.85
(0.50-1.44) 		 
Leadership encourages use 1.35
(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 available 1.63
(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 resources 2.31 
(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 needs 1.90
(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 processes 0.64
(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)

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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.

© 2018 by the American Diabetes Association.
2018
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