BACKGROUND: Established in 2012, Tennessee’s Primary Prevention Initiative (PPI) engages all local health departments (LHDs) in efforts to decrease chronic disease incidence in their communities through reduction of unhealthy or unsafe behaviors, removal of causative risk factors, health promotion and education, and implementation of health-conscious policy changes. Statewide emphasis has been placed on Tennessee’s “Big Three Plus One”, comprised of tobacco and nicotine addiction, obesity, physical inactivity, and substance abuse. LHDs design projects in their communities around any topic of their choice. All staff devote approximately 5% of their time to PPI projects. Each project team submits proposed activities, outcome measures, partnership development and contributions, facilitating factors and barriers, and success stories.
METHODS: A mixed methods approach is applied for this evaluation, yielding a combination of qualitative and quantitative data. Aspects of the evaluation include determination of the evaluation’s role in population health improvement and program structure, application of Suchman’s evaluative criteria (1967) and evidence-based public health principles (Brownson et al., 2011), assessment of its role in departmental transformational change, and utilization of cyclical learning. Data resources incorporate both primary and secondary data sources, including but not limited to the PPI reporting tool, key informant interviews, case studies, surveillance and monitoring systems, and vital records databases.
RESULTS: To date, there have been 1,581 projects submitted by all 95 Tennessee counties, 65% of which have been completed. Approximately 60% projects focus on Tennessee’s “Big Three Plus One”; other topic areas include immunizations (13%), infant mortality (9%), teen pregnancy (4%), and suicide prevention (1%). Projects categorized as “other” represent the remaining 13% of projects. Nearly a quarter of completed projects are considered short-term (lasting less than 30 days) while 66% were non-comprehensive (only one activity). Initial findings clearly demonstrate a need for further evaluation, which is to be completed in collaboration with the National Association of Chronic Disease Directors (NACDD) Epidemiology Mentoring Program. Extensive evaluation findings will be made available during the 2016 CSTE Annual Conference.
CONCLUSIONS: Critical evaluation products include a well-described understanding of the implementation process and adoption of the Primary Prevention Initiative, quantifiable determination of project ‘success’, categorical assessment of strategies/activities, review of staff roles and alignment of skills, and justifiable, evidence-based recommendations for the PPI model going forward.