Diffusion of practice-based research in local public health: what differentiates adopters from nonadopters?

OBJECTIVE To examine the level of involvement by local health departments (LHDs) in practice-based research (PBR) activities, and determine factors associated with variation in such involvement. DESIGN A total of 625 LHDs in a nationally representative stratified random sample of LHDs were administered questions about their participation in PBR activities along with the core instrument in the 2010 National Profile of Local Health Departments Study. Using the Profile data set, zero-inflated negative binomial regression is used to examine the relationships among the variables in the model. MAIN OUTCOME MEASURE The dependent variable was a count variable about the number of PBR activities performed by LHDs. RESULTS About 62% of LHDs participated in at least one research activity. Participating in research activities was significantly associated with the following characteristics of LHDs: serving a population of 500 000 to 999 999, local governance, having a full-time top executive, having heard of the county health rankings, and having performed a Community Health Assessment in the last 5 years. Of LHDs performing at least one research activity, only LHD jurisdiction size predicted the number of research activities in which LHDs participated. Among these LHDs, the range in participation was from about 12% of research plans developed by LHDs to 37% collected data. CONCLUSIONS AND IMPLICATIONS Large public health agencies may be overrepresented, raising the risk that research results may not adequately address the needs, uncertainties, and innovations arising in smaller settings. Correcting this imbalance may require mechanisms for greater involvement of low-resource LHDs in PBR and expanded federal support for such activities through PBR networks.