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For the initial instance, the Prevention Research Center (PRC) at Washington University in St. Louis has transported its hallmark Evidence-Based Public Health training initiative (EBPH) to a U.S. territory. This summer, the EBPH faculty conducted the course over three and a half days in Caguas, Puerto Rico.

The EBPH program has served as a fundamental element of the PRC’s endeavors for over twenty years, impacting more than 4,000 public health professionals who have participated in the course online or in person. Structured around 10 interactive modules, the training reflects many of the essential components of a master of public health curriculum, emphasizing practical tools that are directly applicable to the field. The program assists public health practitioners in identifying issues, prioritizing concerns, assessing programs, and demonstrating return on investment.

This initiative is crucial since only 14% of the U.S. public health workforce possesses a public health degree. Numerous professionals enter the domain from various disciplines and might be deficient in systematic training in evidence-based approaches.

“We’ve crafted this course to furnish practitioners with skills they can implement immediately — systems thinking to tackle intricate challenges, communication abilities to translate scientific data into real-world narratives, and resilience to endure uncertainty,” remarked Ross C. Brownson, the Steven H. and Susan U. Lipstein Distinguished Professor at the School of Public Health and PRC director. “It’s about empowering frontline program implementers with the confidence and capability to execute evidence-based practices that enhance health outcomes.”

Customizing training

The connection between Puerto Rico and the EBPH commenced in 2023 when a small group from its Department of Health participated in the in-person course in St. Louis. Impressed by its significance, they advocated for broader involvement. Subsequently, the Department of Health applied to host the program and was chosen.

Twenty-eight representatives from the Puerto Rico Department of Health attended the EBPH course. This group encompassed both experienced practitioners and those without formal health training. To guarantee accessibility, the course was conducted with simultaneous translation — a first for the program.

“The training was an exceptional experience, offering immense utility and benefit to all of us,” stated Marianne Cartagena Colón, manager of the Center for the Coordination of Services for Individuals Impacted by Alzheimer’s Disease and assistant secretary for comprehensive health services at the Puerto Rico Department of Health.

The course was anchored in Puerto Rico’s recent adversities — Hurricane Maria in 2017, earthquakes in 2020, the COVID-19 pandemic, and ongoing pressures on the island’s electrical infrastructure. By grounding exercises in these real-life experiences, abstract theories became concrete and applicable.

Cartagena Colón’s team found the modules on prioritization strategies and return on investment (ROI) particularly pertinent.

“For a jurisdiction with limited resources, understanding how to pinpoint and prioritize health challenges and subsequently illustrate the value of our programs in ROI terms is absolutely vital,” she remarked. “It enables us to build a stronger case for funding and ensures we maximize the impact we can achieve with our resources.”

Her team has already begun utilizing training tools to enhance support programs for Alzheimer’s caregivers — a critical necessity in Puerto Rico, where studies indicate elevated rates of Alzheimer’s and mortality compared to the broader U.S. The island has one of the oldest demographics in the Americas, with a median age of approximately 45 years, contrasted with 39 in the U.S.

“The most significant public health challenges we confront include the increasing demand for access to health services for a populace with escalating rates of Alzheimer’s and other chronic illnesses, alongside the continuous need to optimize our available resources to address these challenges,” Cartagena Colón remarked. “This is an especially challenging situation for caregivers, who encounter considerable barriers in attending to their self-care while also managing the complexities surrounding their family member’s diagnosis.”

Her team utilized the interview guides module to establish an organized method of communication with caregivers and health professionals. This approach provided a clearer understanding of caregivers’ specific challenges and priorities. By employing the course’s prioritization and evaluation techniques, they then ranked these needs, affirming that respite care and caregiver support were the most urgent.

“We are applying these insights to enhance our services to be more evidence-based and responsive,” she stated. “We can transition from merely responding to challenges to proactively designing programs that are both effective and justifiable from a resource perspective.”

The PRC conducted the course in its train-the-trainer format, which prepares participants to customize the training to local requirements, replicate the course, and expand its impact.

“We now possess the capability to disseminate this knowledge to colleagues throughout the island, cultivating a broader network of public health professionals equipped with these essential skills,” Cartagena Colón noted. “I believe this will generate a ripple effect, enhancing public health not only within our department but across the whole island.”

Brownson underscored that the model is built upon several fundamental implementation science strategies: enhancing capacity through training, scaling successful initiatives, and establishing a learning collaborative.

“We’ve conducted extensive evaluations of this program,” he stated. “It cultivates skills, alters practices, and fortifies public health systems. By training trainers, we’re facilitating the dissemination of these advantages far beyond a single course.”

Cartagena Colón expressed appreciation for WashU’s investment in Puerto Rico’s workforce.

“The initiative to offer an in-person, bilingual course signifies a sincere commitment to supporting our public health professionals,” she remarked. “The course was genuinely a transformative experience for our team and for public health professionals within the Puerto Rico Department of Health.”

The EBPH training team comprises faculty members Brownson, Stephanie Mazzucca-Ragan from the WashU School of Public Health, Anjali Deshpande from the University of Iowa College of Public Health, and Kathleen Gillespie from the College for Public Health and Social Justice at Saint Louis University. Carol Brownson and Linda Dix serve as training coordinators. The course received support from the National Association of Chronic Disease Directors, the Centers for Disease Control and Prevention, and the Foundation for Barnes-Jewish Hospital.

This month, the PRC is also collaborating with the Austrian Society for Public Health to introduce the program in Austria.

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