Chronic Disease Resources

NACCHO provides resources and support to local health departments to implement disease self-management programs at the community level. NACCHO offers an extensive complement of resources regarding guidance for implementation of programs and stories of successful programs.

The following resources were developed by the NACCHO team to help prevent chronic disease in your community.

NACCHO has compiled the following articles to help your Local Health Department stay informed on chronic disease issues.

NACCHO has compiled the following resources to help your local health department prevent chronic disease in your community.

The following webinars and recordings can help your Local Health Department become more knowledgeable on chronic disease issues in your community.

The National Association of County and City Health Officials (NACCHO), with support from the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Division of Population Health/Arthritis Program, has launched a National Support Network for local Health department Chronic Disease Self-Management Programs.  This support network will enhance local health departments (LHDs) capacity to deliver effective Stanford model of Chronic Disease Self-Management Program (CDSMP) or Arthritis Self-Management Program, (Spanish - Tomando Control de su Salud) versions.  In expanding the availability of the CDSMP to additional local jurisdictions we seek to support the use of evidenced-based programs while enhancing the well-being and self-efficacy of persons with a chronic illness.

The Stanford model of CDSMP©, is a six-week educational workshop for people with chronic conditions (e.g. arthritis, diabetes, lung and heart disease). Evidenced-based, self-management education programs have been proven to significantly help people with chronic diseases. Coupled with clinical care, this program teaches participants how to exercise and eat properly, use medications appropriately, solve everyday problems relative to their medical conditions, and to communicate effectively with family, friends and health care providers. The CDSMP workshops are provided in community settings such as senior centers, churches, libraries, and hospitals.

NACCHO's National Support Network includes:

• Local Health Department-CDSMP Community of Practice (LHD-CDSMP-COP)- Peer Network Support
• NACCHO Chronic Disease Staff Technical Support/Training
• Webpage and Toolkit for Resources
• Partnerships and Collaborations in CDSMP

What Is Fidelity?

The Stanford CDSM Program is an evidence-based approach for improving health status, health behaviors, and decreasing inappropriate healthcare utilization among patients with chronic conditions. In order to achieve these outcomes, LHDs implementing CDSMP must ensure program fidelity. Program fidelity refers to the how closely staff and others (i.e. Leaders, Trainers, and evaluators) follow the steps for delivering CDSMP as the developers intended. Program delivery that is not true to the original design decreases the likelihood that you will get the desired outcomes. Poor fidelity can result in a range of unintended effects not only for participants but also for Leaders, Trainers and your organization. Fidelity monitoring should be part of your overall quality assurance plan, and NACCHO encourages LHDs to use the Stanford CDSMP Fidelity manual to ensure fidelity. 

Tips for Fidelity

NACCHO recommends LHDs use the following tips to ensure fidelity of their CDSMP delivery efforts:

• Identify a program team member to oversee and coordinate efforts to ensure fidelity
• Develop a fidelity plan to strategically plan and allocate resources toward fidelity assurance
• Review the Stanford CDSMP Fidelity Manual and use the Must Dos list to determine steps for ensuring fidelity
• Identify resources to support fidelity assurance efforts, e.g. surveys, site visits, etc.

For more information on NACCHO's CDSMP, please email us at: chronicdisease@naccho.org.

The National Association of County and City Health Officials (NACCHO) Representing the nation's 2,800 local governmental health departments (LHDs), NACCHO is advancing the nation's efforts to prevent diseases and helping American's live more healthful and productive lives. NACCHO, in conjunction with its membership  supports the achievement of the goals delineated under the National Prevention Strategy (NPS) and are is taking action along with local partners, and local communities to promote policy, systems, and environmental change strategies to address disease risk factors.

What can local health departments do to implement the National Prevention Strategy?

With the passing of the ACA and the changing dynamics in local, state, and federal levels of government, local health departments are in the unique position to aide their communities in implementing the NPS. Local health departments can engage local stakeholders including elected officials, business community, faith-based institutions, and health providers and serve as data and information experts on the impact that a healthy community will have in their local area and region. Roles that local health departments can undertake in the implementation of the NPS:

• Serve as Community Health/Health Impact Assessment experts
• Form local coalitions of stakeholders and community members to disseminate the goals, objectives, and benefits of the NPS
• Advocate for the implementation of priorities and recommendations listed in the NPS
• Advocate for the strengthening of local policies and programs that overlap with priorities and recommendations listed in the NPS
• Enhance data collection activities on chronic diseases, especially in the area of epidemiology
• Work with other partner organizations, local health departments, and the Federal government to disseminate lessons learned

For a copy of the entire National Prevention Strategy, click here

Through a cooperative agreement with the Centers for Disease Control and Prevention (CDC), NACCHO aims to improve the adoption and use of evidence-based approaches to preventive services among Local Health Departments (LHDs) by promoting the use of The Guide to Community Preventive Services (The Community Guide).

The Goal of The Community Guide

The Guide to Community Preventive Services (Community Guide), is a free resource designed to help identify evidence-based programs, practices, and policies to improve health and prevent disease, injury, and disability in the community.

The Community Guide findings and recommendations are based on systematic reviews of scientific literature by reading the Community Preventive Services Task Force (Task Force). The Task Force is an independent, nonfederal, volunteer body, appointed by the Director of the CDC, whose members represent a broad range of research, practice, and policy expertise in community preventive services, public health, health promotion, and disease prevention.

How Can State and Local Health Departments Use the Community Guide

• Promote dialogue
• Mobilize communities
• Develop policies
• Inform research priorities
• Educate
• Evaluate
• Identify successful programs

Community Guide Resources

NACCHO undertook a process and outcome evaluation to assess the effectiveness of its Framework for Evidence-Based Decision Making and Planning in increasing LHD capacity to incorporate evidence in to their decision-making and planning practices Click here to access report

2013 NACCHO Model Practices-Community Guide Crosswalk - Aligning Practice-Based Initiatives with Evidence

NACCHO's Model Practices-Community Guide Crosswalk: A Resource for Implementing Effective Public Health Strategies, can inform LHDs as they consider ways to address public health concerns with effective strategies. The crosswalk identifies Model Practices implemented by LHDs alongside related recommendations from The Community Guide to enhance practice-based initiatives with evidence, while simultaneously providing examples of ways to translate evidence into practice.

Download the Crosswalk here

Community Guide Success Stories

NACCHO funded 5 local health departments to receive capacity building assistance for implementation of evidence-based recommendations from The Community Guide. These success stories highlight the progress and accomplishments of the LHDs who received this support from NACCHO.

• Using the Community Guide to Improve Rates of Physical Activity for Older Adults in Douglas County, Kansas: Lawrence-Douglas County Health Department 
• Using the Community Guide in Workforce-Development Efforts: Boston Public Health Commission
• Using the Community Guide to Go Smoke-Free in Kentucky: Monroe County Health Department
• Using the Community Guide to Encourage Evidence-Based NACCHO Wellness Practices to Prevent Cancer in North Carolina: Worksite County Public Health
• Using the Community Guide to Create a Cross-Jurisdictional Asthma Home Visitation Protocol with an Environmental Focus: City of St. Louis Department of Health

Screencast Series: Three Ways The Community Guide Makes the LHD Worker's Job Easier

This screencast series teaches LHDs how to:

• Use Task Force recommendations from the Community Guide to quickly identify prevention approaches that work
• Access systematic review findings from the Community Guide to enhance grants
• Use resources from the Community Guide to promote dialog with multi-sector stakeholders
• Implement six steps to integrate Community Guide findings into Community Health Improvement Plan

To view the full screencast series, click here.

Promoting Accreditation Through Evidence-Based Public Health Programs

This crosswalk helps local health departments identify evidence-based interventions from The Community Guide whose implementation could help document conformity with PHAB's standards and measures. Click here to download the crosswalk.

Policy Statements Related to the Community Guide

The National Association of County and City Health Officials (NACCHO) supports evidence-based public health practice,* including the following:

• The use of analytical tools and methods for evaluating evidence to determine the effectiveness and feasibility of population-based interventions.
• The translation of data to help educate communities and to inform public policy.
• Where data does not exist, community assessment and research into public health prevention and intervention strategies to determine when and what type of public health action is recommended and evaluation, based on the condition's magnitude, severity, and preventability, of the effectiveness of such action to inform future practice.
• Broad distribution of newly recommended population-based interventions with evidence of effectiveness.
• Emerging best practices that the community has found to be legitimate and effective, which often serve as precursors to the development of evidence-based practices.

The Community Guide, through the systematic review of scientific literature, and its evaluation of the strengths and weaknesses of existing research evidence for community-based health promotion and disease prevention programs, services, and policies provides LHD with the tools necessary to:

• Assess the effectiveness of programs, services, and policies;
• Examine the applicability of these programs, services, and policies to various populations and settings; and,
• Conduct the appropriate economic and financial analyses of cost and return on investment, to provide a full complement of information to inform decision-making.

Justification

Evidence-based practice for public health involves using the best available evidence to make informed public health practice decisions.  The foundation for evidence-based public health practice is a combination of multidisciplinary empirical research and evaluation evidence, community beliefs and opinions, accumulated public health practice experience, and other local considerations. Together, these factors determine which programs are most likely to be effective in a given jurisdiction.

Adopted by NACCHO Board of Directors

November 12, 2000

Updated February 2004

Updated September 2007

Updated October 2010

References

Public Health Service, Task Force on Community Preventive Services. A Guide to Community Preventive Services. Retrieve on October 22, 2010, from http://www.thecommunityguide.org/index.html.

National Association of County and City Health Officials. (2005). Operational Definition of a Functional Local Health Department, Local Health Standard 10. Retrieved on October 22, 2010, from 

University of Massachusetts Medical School. About Evidence Based Practice for Public Health. Retrieved on September 5, 2010, from http://library.umassmed.edu/ebpph/about.cfm.

Anderson, Laurie, et al. (2005). Evidence Based Public Health Policy and Practice: Promises and Limits. American Journal of Preventive Medicine. 28(5S): 226-230.  * Evidence-based practice is defined as "the development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning including systematic uses of data and program planning models" in Brownson, Ross C., Gurney, James G., and Land, Garland H. Evidence-Based Decision Making in Public Health. Journal of Public Health Management Practice. 1999; 5(5): 86-97.

Visit NACCHO's Training and Technical Assistance site for Community Guide Users, click here