摘要：Objectives. We explored the effect of disseminating evidence-based guidelines that promote physical activity on US health department organizational practices in the United States. Methods. We implemented a quasi-experimental design to examine changes in the dissemination of suggested guidelines to promote physical activity ( The Guide to Community Preventive Services ) in 8 study states; the remaining states and the Virgin Islands served as the comparison group. Guidelines were disseminated through workshops, ongoing technical assistance, and the distribution of an instructional CD-ROM. The main evaluation tool was a pre- and postdissemination survey administered to state and local health department staffs (baseline n=154; follow-up n=124). Results. After guidelines were disseminated through workshops, knowledge of and skill in 11 intervention-related characteristics increased from baseline to follow-up. Awareness-related characteristics tended to increase more among local respondents than among state participants. Intervention adoption and implementation showed a pattern of increase among state practitioners but findings were mixed among local respondents. Conclusions. Our exploratory study provides several dissemination approaches that should be considered by practitioners as they seek to promote physical activity in the populations they serve. Lack of physical activity is closely linked with the incidence of several chronic diseases and a lower quality of life. 1 , 2 There is now an array of physical activity interventions that have been proven to be effective across a variety of populations and geographic settings. For example, the Task Force on Community Preventive Services has produced a set of evidence-based guidelines for promoting physical activity titled The Guide to Community Preventive Services: What Works to Promote Health? (hereafter Community Guide ). 3 , 4 In the Community Guide , intervention strategies that show evidence of increased physical activity in targeted populations are grouped into 3 categories: (1) informational approaches to change the knowledge and attitudes regarding the benefits of and opportunities for physical activity within a community among populations that state and local public health workers serve; (2) behavioral and social approaches to teach the targeted populations the behavioral management skills necessary for successful adoption and maintenance of behavior change and for creating social environments that facilitate and enhance behavioral change; and (3) environmental and policy approaches to change the structure of physical and organizational environments to provide safe, attractive, and convenient places for physical activity. Across these 3 categories, 8 specific intervention strategies were found to have sufficient or strong evidence of effectiveness. 3 , 4 Effective intervention strategies, such as those in the Community Guide , can be implemented in community settings through the efforts of numerous agencies, organizations, and individuals. State and local health departments are key to promoting physical activity interventions, because of the ability to assess public health problems, develop appropriate programs and policies, and ensure that the programs and policies are effectively delivered and implemented. 5 , 6 However, data are lacking for effective methods of disseminating suggested physical activity interventions in community settings through public health agencies. Even the most innovative scientific discoveries (e.g., a new and effective intervention strategy in the Community Guide ) do not become a standard of professional practice unless targeted and sustained efforts are used to enhance their dissemination. 7 – 11 Three reviews show the limited extent to which effective interventions were disseminated and institutionalized. In a content analysis of 1210 articles from 12 prominent public health journals, Oldenburg et al. 12 classified 89% of published studies as basic research and development. They classified another 5% as innovation development studies, less than 1% as diffusion studies (close to our use of the term dissemination) , and 5% as institutionalization studies. Similarly, Sallis et al. 13 conducted a content analysis of 4 journals and found that 2% to 20% of articles fell in a category defined as “translate research to practice.” A recent systematic review of 31 dissemination studies in cancer control found no strong evidence to recommend any 1 dissemination strategy as effective for promoting the uptake of interventions. 14 A variety of organizational factors are likely to influence readiness to change and dissemination (e.g., resources, organizational capacity, time frame). 15 We sought to better understand the dissemination of information regarding physical activity guidelines across the United States in state and local health departments. We focused particularly on the evidence-based guidelines in the Community Guide . We describe the extent of awareness and adoption of evidence-based physical activity guidelines in state and local public health departments and examine the effectiveness of active dissemination efforts among state and local public health practitioners.
