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Managing community engagement initiatives in health and social care: lessons learned from Italy and the United Kingdom. Health Care Manage Rev 2023; 48:2-13. [PMID: 36413650 PMCID: PMC9704808 DOI: 10.1097/hmr.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Determining the different features and potential impacts of community initiatives aimed at health-related outcomes poses challenges for both researchers and policy makers. PURPOSE This article explores the nature of heterogeneous "community engagement initiatives" (CEIs) considering both their social and organizational features in order to understand the managerial and policy implications to maximize their potential local health and social care-related impacts. METHODOLOGY A threefold qualitative analysis was conducted: (a) Three frameworks were developed to classify and analyze different CEIs features, building upon the current literature debate; (b) primary data were collected from Italian CEIs; and (c) a comparative cross-case analysis of a total of 79 CEIs in Italy and the United Kingdom was implemented. FINDINGS The results show two types of strategic policy and management implications: (a) CEI portfolios are very broad and differentiated; (b) different social networks have diversified social constructs, internal cultures, and organizational features; and (c) there is a consequent need to contextualize relational and steering approaches in order to maximize their potential community added value. CONCLUSION CEIs are fundamental pillars of contemporary welfare systems because of both the changing demography and epidemiology and the disruptive impact of platform economy models. This challenging scenario and the related CEIs involve a complex social mechanism, which requires a new awareness and strengthened competences for public administrations' steering. PRACTICE IMPLICATIONS It is crucial for policy makers and managers to become familiar with all the different CEIs available in order to choose which solution to implement, depending on their potential impacts related to local public health and social care priorities. They also need to select the related effective steering logic.
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Spieldenner A, Santella AJ, Cooper SC, Rosales K, Goedel WC, Jones HE. Knowledge, Attitudes, and Practices towards PrEP from Cisgender Men and Transgender Women Who Have Sex with Men in the Largest Suburban HIV Epidemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11640. [PMID: 36141901 PMCID: PMC9517439 DOI: 10.3390/ijerph191811640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
We conducted a cross-sectional web-based study to assess attitudes and experiences with HIV pre-exposure prophylaxis (PrEP) amongst a multiracial cohort of gay, bisexual, and other men who have sex with men (MSM) and transgender women in Long Island, New York. Participants were recruited through clinical providers and community-based organizations. The survey assessed knowledge and attitudes toward PrEP and factors that facilitate willingness to take it. Of the 189 respondents, most participants were Latinx/Hispanic (57.1%; n = 105), gay-identifying (81.2%; n = 151), and cisgender men (88.7%; n = 165). One in five participants completed high school or lower (19.4%; n = 36). Among those who had never used PrEP (53.4%; n = 101), nearly all participants were willing to use it if it were free or covered as part of their insurance (89.4%; n = 84). The most common barriers to not using PrEP was not knowing where to obtain it (68.3%; n = 69), concerns about side effects (42.1%; n = 35), and concerns about affordability (38.5%; n = 25). This study discusses specific nuances to the suburbs, including cultural norms and structural barriers that should be incorporated in health promotion initiatives in addressing these factors.
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Affiliation(s)
- Andrew Spieldenner
- Department of Communication and Media Studies, California State University, San Marcos, CA 92096, USA
| | - Anthony J. Santella
- Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT 06824, USA
| | - Spring C. Cooper
- Department of Community and Social Sciences, City University of New York School of Public Health, New York, NY 10027, USA
| | - Kathleen Rosales
- Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY 10027, USA
| | - William C. Goedel
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02903, USA
| | - Heidi E. Jones
- Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY 10027, USA
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Swann WL, DiNardi M, Schreiber TL. Association Between Interorganizational Collaboration in Opioid Response and Treatment Capacity for Opioid Use Disorder in Counties of Five States: A Cross-Sectional Study. Subst Abuse 2022; 16:11782218221111949. [PMID: 35845967 PMCID: PMC9284196 DOI: 10.1177/11782218221111949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/20/2022] [Indexed: 11/22/2022]
Abstract
Background: Local governments on the front lines of the opioid epidemic often collaborate
across organizations to achieve a more comprehensive opioid response.
Collaboration is especially important in rural communities, which can lack
capacity for addressing health crises, yet little is known about how local
collaboration in opioid response relates to key outputs like treatment
capacity. Purpose: This cross-sectional study examined the association between local
governments’ interorganizational collaboration activity and agonist
treatment capacity for opioid use disorder (OUD), and whether this
association was stronger for rural than for metropolitan communities. Methods: Data on the location of facilities providing buprenorphine and methadone were
merged with a 2019 survey of all 358 counties in 5 states (CO, NC, OH, PA,
and WA) that inquired about their collaboration activity for opioid
response. Regression analysis was used to estimate the effect of a
collaboration activity index and its constituent items on the capacity to
provide buprenorphine or methadone in a county and whether this differed by
urbanicity. Results: A response rate of 47.8% yielded an analytic sample of n = 171 counties,
including 77 metropolitan, 50 micropolitan, and 44 rural counties.
Controlling for covariates, a 1-unit increase in the collaboration activity
index was associated with 0.155 (95% CI = 0.005, 0.304) more methadone
facilities, ie, opioid treatment programs (OTPs), per 100 000 population. An
interaction model indicated this association was stronger for rural (average
marginal effect = 0.354, 95% CI = 0.110, 0.599) than for non-rural counties.
Separate models revealed intergovernmental data and information sharing,
formal agreements, and organizational reforms were driving the above
associations. Collaboration activity did not vary with the capacity to
provide buprenorphine at non-OTP facilities. Spatial models used to account
for spatial dependence occurring with OUD treatment capacity showed similar
results. Conclusion: Rural communities may be able to leverage collaborations in opioid response
to expand treatment capacity through OTPs.
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Affiliation(s)
- William L Swann
- School of Public Affairs, University of Colorado Denver, Denver, CO, USA
| | - Michael DiNardi
- Department of Economics, University of Rhode Island, Kingston, RI, USA
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Harrington RA, Califf RM, Balamurugan A, Brown N, Benjamin RM, Braund WE, Hipp J, Konig M, Sanchez E, Joynt Maddox KE. Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association. Circulation 2020; 141:e615-e644. [PMID: 32078375 DOI: 10.1161/cir.0000000000000753] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Understanding and addressing the unique health needs of people residing in rural America is critical to the American Heart Association's pursuit of a world with longer, healthier lives. Improving the health of rural populations is consistent with the American Heart Association's commitment to health equity and its focus on social determinants of health to reduce and ideally to eliminate health disparities. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders to make rural populations a priority in programming, research, and policy. This advisory first summarizes existing data on rural populations, communities, and health outcomes; explores 3 major groups of factors underlying urban-rural disparities in health outcomes, including individual factors, social determinants of health, and health delivery system factors; and then proposes a set of solutions spanning health system innovation, policy, and research aimed at improving rural health.
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What Are the Challenges Faced by Village Doctors in Provision of Basic Public Health Services in Shandong, China? A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142519. [PMID: 31311072 PMCID: PMC6679320 DOI: 10.3390/ijerph16142519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/26/2019] [Accepted: 07/10/2019] [Indexed: 12/14/2022]
Abstract
Background: Village doctors, as gatekeepers for the health of rural residents in China, are confronted with adversity in providing the basic public health services (BPHS), which has significantly impeded them from providing high quality BPHS. This study aimed to explore the obstacles and difficulties faced by village doctors in order to improve the quality and efficiency of BPHS provision and increase the health level of the population. Methods: In-depth interviews were employed to conduct this qualitative study. A total of 51 village doctors in four cities of Shandong Province were interviewed. The interviews were transcribed, anonymized, and imported into NVivo11.0 to facilitate management. Thematic framework analysis employing the constant comparison method was applied to the data analysis. Results: The main challenges faced by village doctors comprised the shortage, gender imbalance, and poor education of village doctors; older village doctors in some villages; low income; lack of social security; inappropriate performance assessment; inadequate professional BPHS training; heavy workload; and insufficient cooperation from rural residents, which have exacerbated the quality, efficiency, and accessibility of BPHS to some extent. Conclusions: Village doctors, as the important BPHS providers in rural Shandong, are facing a wide range of challenges. It is urgent for government officials and policy makers to consider these challenges and concentrate on improving the quality of BPHS provision by developing relevant and practical strategies.
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Guo L, Bao Y, Li S, Ma J, Sun W. Quality analysis and policy recommendations on the utilization of community basic public health services in urban and suburban Shanghai from 2009 to 2014. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:28206-28215. [PMID: 30073596 DOI: 10.1007/s11356-018-2811-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
Disparities in quality of basic public health services exist between urban and rural populations, but there is no data about these disparities between urban and suburban populations in Shanghai. The study aims to analyze and compare the quality of basic public health service utilization of community health service centers in Shanghai urban and suburban areas between 2009 and 2014. This was a cross-sectional study. Using a two-stage random sampling method, 80 community health service centers were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistical analysis, principal component analysis, and forecast analysis were used to compare and analyze basic health services utilization quality between urban and suburban centers. During the 6 years, there has been an increasing trend of the basic public health service effectiveness of prevention services, health care services, rehabilitation services, health education services, and health indexes in Shanghai urban and suburban areas. Prevention services, health care services, health education services, and population health index indicators of urban areas were better than those of the suburbs, while effectiveness indicators of rehabilitation services were lower than that of the suburbs. The urban areas had four principal component scores lower than the suburbs (P < 0.001, P = 0.006, P < 0.001, and P = 0.015). During the 6 years, with the strengthening of national support, basic public health service utilization has increased rapidly, and effectiveness of services has improved obviously. Nevertheless, there is an imbalance of basic public health service utilization between urban and suburban areas.
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Affiliation(s)
- Lijun Guo
- Shanghai University of Medicine & Health Sciences, College of Health Information Technology and Management, Shanghai, 201318, China
| | - Yong Bao
- Shanghai Jiao Tong University School of Public Health, No. 227 Chongqing South Road, Shanghai, 200025, China.
- Hongqiao International Institute of Medicine, Shanghai Jiao Tong University School of Medicine, No. 1111 XianXia Road, Changning District, Shanghai, 200336, China.
| | - Shujun Li
- Zhengzhou Fifteenth People's Hospital, Zhengzhou, 450041, Henan, China
| | - Jun Ma
- Shanghai Tongren Hospital, Shanghai, 200336, China
| | - Wei Sun
- Shanghai Jiao Tong University School of Public Health, No. 227 Chongqing South Road, Shanghai, 200025, China
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Guo L, Bao Y, Ma J, Li S, Cai Y, Sun W, Liu Q. Quality of community basic medical service utilization in urban and suburban areas in Shanghai from 2009 to 2014. PLoS One 2018; 13:e0195987. [PMID: 29791470 PMCID: PMC5965823 DOI: 10.1371/journal.pone.0195987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/20/2018] [Indexed: 11/18/2022] Open
Abstract
Urban areas usually display better health care services than rural areas, but data about suburban areas in China are lacking. Hence, this cross-sectional study compared the utilization of community basic medical services in Shanghai urban and suburban areas between 2009 and 2014. These data were used to improve the efficiency of community health service utilization and to provide a reference for solving the main health problems of the residents in urban and suburban areas of Shanghai. Using a two-stage random sampling method, questionnaires were completed by 73 community health service centers that were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistics, principal component analysis, and forecast analysis were used to complete a gap analysis of basic health services utilization quality between urban and suburban areas. During the 6-year study period, there was an increasing trend toward greater efficiency of basic medical service provision, benefits of basic medical service provision, effectiveness of common chronic disease management, overall satisfaction of community residents, and two-way referral effects. In addition to the implementation effect of hypertension management and two-way referral, the remaining indicators showed a superior effect in urban areas compared with the suburbs (P<0.001). In addition, among the seven principal components, four principal component scores were better in urban areas than in suburban areas (P = <0.001, 0.004, 0.036, and 0.022). The urban comprehensive score also exceeded that of the suburbs (P<0.001). In summary, over the 6-year period, there was a rapidly increasing trend in basic medical service utilization. Comprehensive satisfaction clearly improved as well. Nevertheless, there was an imbalance in health service utilization between urban and suburban areas. There is a need for the health administrative department to address this imbalance between urban and suburban institutions and to provide the required support to underdeveloped areas to improve resident satisfaction.
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Affiliation(s)
- Lijun Guo
- Shanghai University of Medicine & Health Sciences, College of Health Information Technology and Management, Pudong New District, Shanghai, China
| | - Yong Bao
- Shanghai Jiao Tong University School of Public Health, Shanghai, China
- Hongqiao International Institute of Medicine, Shanghai Jiao Tong University School of Medicine, Changning District, Shanghai, China
- * E-mail:
| | - Jun Ma
- Shanghai Tongren Hospital, Changning District, Shanghai, China
| | - Shujun Li
- Zhengzhou Fifteenth People’s Hospital, Shangjie District, Zhengzhou City, Henan Province, China
| | - Yuyang Cai
- Shanghai Jiao Tong University School of Public Health, Shanghai, China
| | - Wei Sun
- Shanghai Jiao Tong University School of Public Health, Shanghai, China
| | - Qiaohong Liu
- Shanghai University of Medicine & Health Sciences, College of Health Information Technology and Management, Pudong New District, Shanghai, China
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Barriers and facilitators to intraorganizational collaboration in public health: Relational coordination across public health services targeting individuals and populations. Health Care Manage Rev 2018; 45:60-72. [PMID: 29742523 DOI: 10.1097/hmr.0000000000000203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Modern public health emphasizes population-focused services, which may require collaborative work both across and within organizations. Studies have explored interorganizational collaborations, but there are little data regarding collaborations within public health organizations. PURPOSE We measured intraorganizational collaboration and identified barriers and facilitators to collaboration within a large public health department through a mixed-methods study. METHODOLOGY/APPROACH Our study occurred at the Maricopa County (Arizona) Department of Public Health, the third largest local public health jurisdiction in the United States. To measure collaboration, we surveyed staff using the relational coordination tool. To identify barriers and facilitators to collaboration, we performed key informant interviews with department personnel. RESULTS Relational coordination scores varied according to the focus of the service; clinical services had significantly lower levels of relational coordination than population-focused services (p < .01). We found high levels of mutual respect and lower levels of shared knowledge across services. Facilitators to collaboration included purposive cross-program meetings around specific topics, the organization's structure and culture, and individuals' social identities. Barriers included raised expectations for collaboration, low slack resources, member's self-interest, and trust. CONCLUSION The relational coordination of services varied significantly according to the focus of the service. Population-focused public health services had higher levels of relational coordination than individually focused services. Collaboration was facilitated and impeded by both well-known and potentially emergent factors, such as purposive cross-service meetings and organizational culture. PRACTICE IMPLICATIONS Population-focused services possessed higher levels of collaboration than individually focused services. Intraorganizational collaboration for improved population health relies on deliberate support from senior management and structured activities to increase shared knowledge and mutual respect.
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Accredited Health Department Partnerships to Improve Health: An Analysis of Community Health Assessments and Improvement Plans. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 24 Suppl 3:S35-S43. [DOI: 10.1097/phh.0000000000000735] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kwan K, Do-Reynoso V, Zarate-Gonzalez G, Goldman-Mellor S. Development and implementation of a community health survey for public health accreditation: Case study from a rural county in California. EVALUATION AND PROGRAM PLANNING 2018; 67:47-52. [PMID: 29197222 DOI: 10.1016/j.evalprogplan.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 09/16/2017] [Accepted: 11/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To describe the planning, development, pilot testing, fielding, and outcomes of a community health survey in a rural California county pursuing public health accreditation. DESIGN Community partners helped the local health department develop the community health survey. Extensive English- and Spanish-language pilot testing was conducted over a period of four months. Final survey fielding was conducted online and at 20 community sites. RESULTS 2189 completed surveys were collected. Total costs for developing and fielding the survey were approximately $25,000. Survey results indicated that alcoholism/drug abuse, breathing problems, and obesity were the primary health concerns of county residents. Benefits of conducting the community survey included strengthening inter-organizational partnerships between community partners, engaging a large and diverse respondent sample, and gathering information on a nuanced set of health indicators. Challenges included an unexpectedly high number of respondents and managing the needs of respondents with disabilities or poor literacy. CONCLUSION The information gathered from the community health survey was used in the implementation of a county-wide multi-agency strategic plan to address health priorities identified in the CHA. Engaging a broad set of community partners throughout the survey process was critical for ensuring the project's relevance and long-term regional impact.
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Affiliation(s)
- Kevin Kwan
- Department of Public Health, University of California, Merced, Merced, CA, United States.
| | - Van Do-Reynoso
- Department of Public Health, University of California, Merced, Merced, CA, United States; Madera County Public Health Department, Madera, CA, United States
| | | | - Sidra Goldman-Mellor
- Department of Public Health, University of California, Merced, Merced, CA, United States
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Abstract
CONTEXT Local health departments (LHDs) have historically not prioritized policy development, although it is one of the 3 core areas they address. One strategy that may influence policy in LHD jurisdictions is the formation of partnerships across sectors to work together on local public health policy. DESIGN We used a network approach to examine LHD local health policy partnerships across 15 large cities from the Big Cities Health Coalition. SETTING/PARTICIPANTS We surveyed the health departments and their partners about their working relationships in 5 policy areas: core local funding, tobacco control, obesity and chronic disease, violence and injury prevention, and infant mortality. OUTCOME MEASURES Drawing on prior literature linking network structures with performance, we examined network density, transitivity, centralization and centrality, member diversity, and assortativity of ties. RESULTS Networks included an average of 21.8 organizations. Nonprofits and government agencies made up the largest proportions of the networks, with 28.8% and 21.7% of network members, whereas for-profits and foundations made up the smallest proportions in all of the networks, with just 1.2% and 2.4% on average. Mean values of density, transitivity, diversity, assortativity, centralization, and centrality showed similarity across policy areas and most LHDs. The tobacco control and obesity/chronic disease networks were densest and most diverse, whereas the infant mortality policy networks were the most centralized and had the highest assortativity. Core local funding policy networks had lower scores than other policy area networks by most network measures. CONCLUSION Urban LHDs partner with organizations from diverse sectors to conduct local public health policy work. Network structures are similar across policy areas jurisdictions. Obesity and chronic disease, tobacco control, and infant mortality networks had structures consistent with higher performing networks, whereas core local funding networks had structures consistent with lower performing networks.
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Factors Driving Local Health Departments' Partnerships With Other Organizations in Maternal and Child Health, Communicable Disease Prevention, and Chronic Disease Control. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 22:E21-8. [PMID: 26480282 DOI: 10.1097/phh.0000000000000353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe levels of partnership between local health departments (LHDs) and other community organizations in maternal and child health (MCH), communicable disease prevention, and chronic disease control and to assess LHD organizational characteristics and community factors that contribute to partnerships. DATA SOURCES Data were drawn from the National Association of County & City Health Officials' 2013 National Profile Study (Profile Study) and the Area Health Resources File. LHDs that received module 1 of the Profile Study were asked to describe the level of partnership in MCH, communicable disease prevention, and chronic disease control. Levels of partnership included "not involved," "networking," "coordinating," "cooperating," and "collaborating," with "collaborating" as the highest level of partnership. Covariates included both LHD organizational and community factors. Data analyses were conducted using Stata 13 SVY procedures to account for the Profile Study's survey design. RESULTS About 82%, 92%, and 80% of LHDs partnered with other organizations in MCH, communicable disease prevention, and chronic disease control programs, respectively. LHDs having a public health physician on staff were more likely to partner in chronic disease control programs (adjusted odds ratio [AOR] = 2.33; 95% confidence interval [CI], 1.03-5.25). Larger per capita expenditure was also associated with partnerships in MCH (AOR = 2.43; 95% CI, 1.22-4.86) and chronic disease prevention programs (AOR = 1.76; 95% CI, 1.09-2.86). Completion of a community health assessment was associated with partnership in MCH (AOR = 7.26; 95% CI, 2.90-18.18), and chronic disease prevention (AOR = 5.10; 95% CI, 2.28-11.39). CONCLUSION About 1 in 5 LHDs did not have any partnerships in chronic disease control. LHD partnerships should be promoted to improve care coordination and utilization of limited health care resources. Factors that might promote LHDs' partnerships include having a public health physician on staff, higher per capita expenditure, and completion of a community health assessment. Community context likely influences types and levels of partnerships. A better understanding of these contextual factors may lead to more complete and effective LHD partnerships.
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Parks RG, Tabak RG, Allen P, Baker EA, Stamatakis KA, Poehler AR, Yan Y, Chin MH, Harris JK, Dobbins M, Brownson RC. Enhancing evidence-based diabetes and chronic disease control among local health departments: a multi-phase dissemination study with a stepped-wedge cluster randomized trial component. Implement Sci 2017; 12:122. [PMID: 29047384 PMCID: PMC5648488 DOI: 10.1186/s13012-017-0650-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/28/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The rates of diabetes and prediabetes in the USA are growing, significantly impacting the quality and length of life of those diagnosed and financially burdening society. Premature death and disability can be prevented through implementation of evidence-based programs and policies (EBPPs). Local health departments (LHDs) are uniquely positioned to implement diabetes control EBPPs because of their knowledge of, and focus on, community-level needs, contexts, and resources. There is a significant gap, however, between known diabetes control EBPPs and actual diabetes control activities conducted by LHDs. The purpose of this study is to determine how best to support the use of evidence-based public health for diabetes (and related chronic diseases) control among local-level public health practitioners. METHODS/DESIGN This paper describes the methods for a two-phase study with a stepped-wedge cluster randomized trial that will evaluate dissemination strategies to increase the uptake of public health knowledge and EBPPs for diabetes control among LHDs. Phase 1 includes development of measures to assess practitioner views on and organizational supports for evidence-based public health, data collection using a national online survey of LHD chronic disease practitioners, and a needs assessment of factors influencing the uptake of diabetes control EBPPs among LHDs within one state in the USA. Phase 2 involves conducting a stepped-wedge cluster randomized trial to assess effectiveness of dissemination strategies with local-level practitioners at LHDs to enhance capacity and organizational support for evidence-based diabetes prevention and control. Twelve LHDs will be selected and randomly assigned to one of the three groups that cross over from usual practice to receive the intervention (dissemination) strategies at 8-month intervals; the intervention duration for groups ranges from 8 to 24 months. Intervention (dissemination) strategies may include multi-day in-person workshops, electronic information exchange methods, technical assistance through a knowledge broker, and organizational changes to support evidence-based public health approaches. Evaluation methods comprise surveys at baseline and the three crossover time points, abstraction of local-level diabetes and chronic disease control program plans and progress reports, and social network analysis to understand the relationships and contextual issues that influence EBPP adoption. TRIAL REGISTRATION ClinicalTrial.gov, NCT03211832.
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Affiliation(s)
- Renee G Parks
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Rachel G Tabak
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Peg Allen
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Elizabeth A Baker
- Department of Behavioral Science & Health Education, College for Public Health & Social Justice, Saint Louis University, St. Louis, USA
| | - Katherine A Stamatakis
- Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, St. Louis, USA
| | - Allison R Poehler
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Yan Yan
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Marshall H Chin
- Department of Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, USA
| | - Jenine K Harris
- Brown School, Washington University in St. Louis, St. Louis, USA
| | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools and Health Evidence, McMaster University, Hamilton, Ontario, Canada
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
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Rose RA, Evans CBR, Smokowski PR, Howard MO, Stalker KL. Polysubstance Use Among Adolescents in a Low Income, Rural Community: Latent Classes for Middle- and High-School Students. J Rural Health 2017; 34:227-235. [PMID: 28921667 DOI: 10.1111/jrh.12268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/26/2017] [Accepted: 07/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Rural communities are currently being impacted by a nationwide epidemic of prescription opioid misuse. Rural adolescent substance users may be at substantial risk for later addiction to these and other drugs. METHODS This study uses Latent Class Analysis to identify subtypes of polysubstance users among a sample of 7,074 rural adolescents. Separate models were estimated for middle- and high-school youth. Predictive validity was estimated using cumulative ordinal logistic regression of the classes on a set of youth and family characteristics. FINDINGS We identified a 4-class solution for both middle- and high-school students marked by initiation of an increasing number of substances used at greater frequency. These classes included Substance Nonusers, Primarily Alcohol Users, Initiators-Low Frequency Users, and Initiators-Moderate-to-High Lifetime Frequency Users. About 6%-10% of youth reported using prescription drugs at least once, and in the moderate-to-high frequency class, middle-school youth were more likely to use prescription drugs and inhalants compared to high-school youth in the same class. The 4 classes were associated with race/ethnicity, and in high school with receiving free/reduced price lunch. CONCLUSION In general, younger adolescents have lower overall use rates, but within certain classes identified by this analysis, the observed pattern suggests that younger cohorts are turning to prescription drugs and inhalants. These findings support the implementation of universal substance use prevention programs, targeted programs for youth experiencing risk factors associated with substance use, and improved rural substance abuse treatment options.
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Affiliation(s)
- Roderick A Rose
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Paul R Smokowski
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Social Welfare, University of Kansas, Lawrence, Kansas
| | - Matthew O Howard
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katie L Stalker
- School of Social Work, Arizona State University, Tucson, Arizona
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Welch Bacon CE, Erickson CD, Kay MC, Weber ML, Valovich McLeod TC. School nurses' perceptions and experiences with an interprofessional concussion management team in the secondary school setting. J Interprof Care 2017; 31:725-733. [PMID: 28876140 DOI: 10.1080/13561820.2017.1345873] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Following a concussion, both cognitive and physical rest are imperative aspects of injury management. The inclusion of academic adjustments and the formation of an interprofessional concussion management team (ICMT) provide a mechanism to manage academic issues following a concussion. As one of the sole healthcare providers presents during school hours, the school nurse may offer unique insight regarding the infrastructure of an ICMT in the secondary school setting. The purpose of this study was to explore school nurses' perceptions of and experiences with an ICMT for adolescents following a concussion in the secondary school setting. The consensual qualitative research approach was used to guide this study. Semi-structured individual telephone interviews were conducted with 15 school nurses employed in the secondary school setting across the United States. During data analysis, themes and categories were established based on a consensus process by the research team. Study findings indicated that school nurses identified several stakeholders regarding the concussion management team that are essential to include in the concussion management process. In addition to the school nurse, participants perceived an ICMT should include a physician, athletic trainer, school counsellor, teachers, and other stakeholders such as the patient and their parents. Additionally, participants discussed their perceptions of their own role as a member of an ICMT in the secondary school setting. The inclusion of an ICMT to aid the recovery following a concussion is vital to ensure proper care for the adolescent patient. Furthermore, the school nurse and athletic trainer must effectively collaborate, when possible, to ensure that concussed adolescents are allowed sufficient cognitive rest via the incorporation of academic adjustments during the recovery process.
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Affiliation(s)
- Cailee E Welch Bacon
- a Athletic Training Programs , A.T. Still University , Mesa , Arizona , USA.,b School of Osteopathic Medicine in Arizona , A.T. Still University , Mesa , Arizona , USA
| | - Casey D Erickson
- a Athletic Training Programs , A.T. Still University , Mesa , Arizona , USA
| | - Melissa C Kay
- c Department of Exercise Science , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Michelle L Weber
- d Department of Kinesiology, University of Georgia , Athens , Georgia , USA
| | - Tamara C Valovich McLeod
- a Athletic Training Programs , A.T. Still University , Mesa , Arizona , USA.,b School of Osteopathic Medicine in Arizona , A.T. Still University , Mesa , Arizona , USA
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Harris JK, Jonson-Reid M, Carothers BJ, Fowler P. The Structure of Policy Networks for Injury and Violence Prevention in 15 US Cities. Public Health Rep 2017; 132:381-388. [PMID: 28426291 DOI: 10.1177/0033354917705367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Changes in policy can reduce violence and injury; however, little is known about how partnerships among organizations influence policy development, adoption, and implementation. To understand partnerships among organizations working on injury and violence prevention (IVP) policy, we examined IVP policy networks in 15 large US cities. METHODS In summer 2014, we recruited 15 local health departments (LHDs) to participate in the study. They identified an average of 28.9 local partners (SD = 10.2) working on IVP policy. In late 2014, we sent survey questionnaires to 434 organizations, including the 15 LHDs and their local partners, about their partnerships and the importance of each organization to local IVP policy efforts; 319 participated. We used network methods to examine the composition and structure of the policy networks. RESULTS Each IVP policy network included the LHD and an average of 21.3 (SD = 6.9) local partners. On average, nonprofit organizations constituted 50.7% of networks, followed by government agencies (26.3%), schools and universities (11.8%), coalitions (11.2%), voluntary organizations (9.6%), hospitals (8.5%), foundations (2.2%), and for-profit organizations (0.7%). Government agencies were perceived as important by the highest proportion of partners. Perceived importance was significantly associated with forming partnerships in most networks; odds ratios ranged from 1.07 (95% CI, 1.02-1.13) to 2.35 (95% CI, 1.68-3.28). Organization type was significantly associated with partnership formation in most networks after controlling for an organization's importance to the network. CONCLUSIONS Several strategies could strengthen local IVP policy networks, including (1) developing connections with partners from sectors that are not well integrated into the networks and (2) encouraging indirect or less formal connections with important but missing partners and partner types.
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Affiliation(s)
- Jenine K Harris
- 1 Brown School, Washington University in St Louis, St Louis, MO, USA
| | | | - Bobbi J Carothers
- 1 Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Patrick Fowler
- 1 Brown School, Washington University in St Louis, St Louis, MO, USA
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Patterns and predictors of local health department accreditation in Missouri. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 21:116-25. [PMID: 24722052 DOI: 10.1097/phh.0000000000000089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Healthy People 2020 goal for the public health system is "to ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services." To address this goal, Missouri established the first statewide, voluntary accreditation program of local health departments (LHDs) and began accrediting the LHDs in 2003. The purpose of this study was to identify organizational, structural, and workforce factors related to accreditation status of LHDs in Missouri. METHODS Using data from the National Association of County & City Health Officials (2010) and the Missouri Department of Health & Senior Services (2012), binary logistic regression analysis was performed to predict accreditation status of LHDs. Likelihood ratio tests were used to examine whether the addition of each predictor added significantly to the model compared with a model including total revenues alone. Adjusted odds ratios (aORs), 95% confidence intervals, the significance level of the likelihood ratio test, and the overall Nagelkerke pseudo-R for each model are reported. RESULTS Having a community health improvement plan (aOR = 6.2), a strategic plan (aOR = 7.9), evaluating programs (aOR = 3.6), being in a region with a high proportion of accredited LHDs (aOR = 5.5), and participating in multijurisdictional collaborations (aOR = 6.4) all increased the likelihood of accreditation. Barriers of time (aOR = 0.1) and cost (aOR = 0.3) were negatively associated with accreditation. CONCLUSIONS Accredited LHDs were more likely to have completed the prerequisites for accreditation and collaborate with other LHDs. These activities help LHDs meet the accreditation standards. In addition, with shrinking budgets, LHDs will need additional financial and technical support to achieve accreditation. Assisting LHDs to find ways to increase the staff is important. Through collaborations with other LHDs, regional or multicounty positions can be created. Also collaborations with universities, specifically colleges or schools of public health, can provide opportunities for internships at LHDs giving practical experience while providing important assistance to LHDs.
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The diffusion of evidence-based decision making among local health department practitioners in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 21:134-40. [PMID: 25136937 DOI: 10.1097/phh.0000000000000129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Evidence-based decision making (EBDM) is the process, in local health departments (LHDs) and other settings, of translating the best available scientific evidence into practice. Local health departments are more likely to be successful if they use evidence-based strategies. However, EBDM and use of evidence-based strategies by LHDs are not widespread. Drawing on diffusion of innovations theory, we sought to understand how LHD directors and program managers perceive the relative advantage, compatibility, simplicity, and testability of EBDM. DESIGN, SETTING, AND PARTICIPANTS Directors and managers of programs in chronic disease, environmental health, and infectious disease from LHDs nationwide completed a survey including demographic information and questions about diffusion attributes (advantage, compatibility, simplicity, and testability) related to EBDM. Bivariate inferential tests were used to compare responses between directors and managers and to examine associations between participant characteristics and diffusion attributes. RESULTS Relative advantage and compatibility scores were high for directors and managers, whereas simplicity and testability scores were lower. Although health department directors and managers of programs in chronic disease generally had higher scores than other groups, there were few significant or large differences between directors and managers across the diffusion attributes. Larger jurisdiction population size was associated with higher relative advantage and compatibility scores for both directors and managers. CONCLUSIONS Overall, directors and managers were in strong agreement on the relative advantage of an LHD using EBDM, with directors in stronger agreement than managers. Perceived relative advantage has been demonstrated to be the most important factor in the rate of innovation adoption, suggesting an opportunity for directors to speed EBDM adoption. However, lower average scores across all groups for simplicity and testability may be hindering EBDM adoption. Recommended strategies for increasing perceived EBDM simplicity and testability are provided.
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Hale NL, Klaiman T, Beatty KE, Meit MB. Local Health Departments as Clinical Safety Net in Rural Communities. Am J Prev Med 2016; 51:706-713. [PMID: 27344107 DOI: 10.1016/j.amepre.2016.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/28/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The appropriate role of local health departments (LHDs) as a clinical service provider remains a salient issue. This study examines differences in clinical service provision among rural/urban LHDs for early periodic screening, diagnosis, and treatment (EPSDT) and prenatal care services. METHODS Data collected from the 2013 National Association of County and City Health Officials Profile of Local Health Departments Survey was used to conduct a cross-sectional analysis of rural/urban differences in clinical service provision by LHDs. Profile data were linked with the 2013 Area Health Resource File to derive other county-level measures. Data analysis was conducted in 2015. RESULTS Approximately 35% of LHDs in the analysis provided EPSDT services directly and 26% provided prenatal care. LHDs reporting no others providing these services in the community were four times more likely to report providing EPSDT services directly and six times more likely to provide prenatal care services directly. Rural LHDs were more likely to provide EPSDT (OR=1.46, 95% CI=1.07, 2.00) and prenatal care (OR=2.43, 95% CI=1.70, 3.47) services than urban LHDs. The presence of a Federally Qualified Health Center in the county was associated with reduced clinical service provision by LHDs for EPSDT and prenatal care. CONCLUSIONS Findings suggest that many LHDs in rural communities remain a clinical service provider and a critical component of the healthcare safety net. The unique position of rural LHDs should be considered in national policy discussions around the organization and delivery of public health services, particularly as they relate to clinical services.
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Affiliation(s)
- Nathan L Hale
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee.
| | - Tamar Klaiman
- Health Policy and Public Health, University of the Sciences, Philadelphia, Pennsylvania
| | - Kate E Beatty
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee
| | - Michael B Meit
- Public Health Research Department, NORC at the University of Chicago, Chicago, Illinois
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20
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Barriers and Incentives to Rural Health Department Accreditation. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22:138-48. [DOI: 10.1097/phh.0000000000000264] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Shah GH, Badana ANS, Robb C, Livingood WC. Cross-Jurisdictional Resource Sharing in Changing Public Health Landscape: Contributory Factors and Theoretical Explanations. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22:110-9. [PMID: 26808685 DOI: 10.1097/phh.0000000000000368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Local health departments (LHDs) are striving to meet public health needs within their jurisdictions, amidst fiscal restraints and complex dynamic environment. Resource sharing across jurisdictions is a critical opportunity for LHDs to continue to enhance effectiveness and increase efficiency. PURPOSE This research examines the extent of cross-jurisdictional resource sharing among LHDs, the programmatic areas and organizational functions for which LHDs share resources, and LHD characteristics associated with resource sharing. METHODS Data from the National Association of County & City Health Officials' 2013 National Profile of LHDs were used. Descriptive statistics and multinomial logistic regression were performed for the 5 implementation-oriented outcome variables of interest, with 3 levels of implementation. RESULTS More than 54% of LHDs shared resources such as funding, staff, or equipment with 1 or more other LHDs on a continuous, recurring basis. Results from the multinomial regression analysis indicate that economies of scale (population size and metropolitan status) had significant positive influences (at P ≤ .05) on resource sharing. Engagement in accreditation, community health assessment, community health improvement planning, quality improvement, and use of the Community Guide were associated with lower levels of engagement in resource sharing. Doctoral degree of the top executive and having 1 or more local boards of health carried a positive influence on resource sharing. CONCLUSIONS Cross-jurisdictional resource sharing is a viable and commonly used process to overcome the challenges of new and emerging public health problems within the constraints of restricted budgets. LHDs, particularly smaller LHDs with limited resources, should consider increased resource sharing to address emerging challenges.
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Affiliation(s)
- Gulzar H Shah
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro (Drs Shah and Robb and Mr Badana); and Center for Health Equity and Quality Research, UF College of Medicine-Jacksonville, Florida (Dr Livingood)
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Harris JK, Beatty K, Leider JP, Knudson A, Anderson BL, Meit M. The Double Disparity Facing Rural Local Health Departments. Annu Rev Public Health 2016; 37:167-84. [PMID: 26735428 DOI: 10.1146/annurev-publhealth-031914-122755] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.
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Affiliation(s)
- Jenine K Harris
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130;
| | - Kate Beatty
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee 37614;
| | - J P Leider
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205;
| | - Alana Knudson
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Britta L Anderson
- NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Michael Meit
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
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Goins KV, Ye J, Leep CJ, Robin N, Lemon SC. Local Health Department Engagement in Community Physical Activity Policy. Am J Prev Med 2016; 50:57-68. [PMID: 26410187 DOI: 10.1016/j.amepre.2015.06.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/10/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study assessed correlates of self-reported local health department (LHD) participation in community policy/advocacy activities that support physical activity. METHODS In 2014, cross-sectional data from the nationally representative 2013 National Profile of Local Health Departments study administered by the National Association of County and City Health Officials were analyzed. Outcomes were participation in policy/advocacy activities related to urban design/land use, active transportation, and access to recreational facilities. Independent variables included structural characteristics, performance improvement efforts, and collaboration. Multivariate logistic regression models were computed. RESULTS Representatives of 490 LHDs participated (79% response rate). Respondents reported similar participation in urban design/land use (25%); active transportation (16%); and recreational facility access (23%) policy/advocacy. LHDs with populations of ≥500,000 were more likely to report urban design/land use (p=0.004) as well as active transportation policy/advocacy participation (p=0.007) compared with those with populations of ≤50,000. LHDs with a community health improvement plan were more likely to participate in urban design/land use policy/advocacy (p=0.001). LHDs who regularly use the Community Guide were more likely to report policy/advocacy activity on active transportation (p=0.007) and expanding access to recreation facilities (p=0.009). LHDs engaged in a land use partnership were more likely to report urban design/land use (p<0.001) and active transportation (p=0.001) policy/advocacy participation. CONCLUSIONS Participation in community physical activity policy/advocacy among LHDs was low in this study and varied by LHD characteristics. Intervention opportunities include assisting smaller LHDs and promoting performance improvement efforts and evidence-based practice resources.
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Affiliation(s)
- Karin V Goins
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jiali Ye
- National Association of County and City Health Officials, Washington, District of Columbia
| | - Carolyn J Leep
- National Association of County and City Health Officials, Washington, District of Columbia
| | - Nathalie Robin
- National Association of County and City Health Officials, Washington, District of Columbia
| | - Stephenie C Lemon
- Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
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Patterns in PARTNERing across Public Health Collaboratives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12412-25. [PMID: 26445053 PMCID: PMC4626976 DOI: 10.3390/ijerph121012412] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/18/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022]
Abstract
Inter-organizational networks represent one of the most promising practice-based approaches in public health as a way to attain resources, share knowledge, and, in turn, improve population health outcomes. However, the interdependencies and effectiveness related to the structure, management, and costs of these networks represents a critical item to be addressed. The objective of this research is to identify and determine the extent to which potential partnering patterns influence the structure of collaborative networks. This study examines data collected by PARTNER, specifically public health networks (n = 162), to better understand the structured relationships and interactions among public health organizations and their partners, in relation to collaborative activities. Combined with descriptive analysis, we focus on the composition of public health collaboratives in a series of Exponential Random Graph (ERG) models to examine the partnerships between different organization types to identify the attribute-based effects promoting the formation of network ties within and across collaboratives. We found high variation within and between these collaboratives including composition, diversity, and interactions. The findings of this research suggest common and frequent types of partnerships, as well as opportunities to develop new collaborations. The result of this analysis offer additional evidence to inform and strengthen public health practice partnerships.
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Smith SA, Mays GP, Felix HC, Tilford JM, Curran GM, Preston MA. Impact of Economic Constraints on Public Health Delivery Systems Structures. Am J Public Health 2015; 105:e48-53. [PMID: 26180988 PMCID: PMC4539844 DOI: 10.2105/ajph.2015.302769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We estimated the effect of economic constraints on public health delivery systems (PHDS) density and centrality during 3 time periods, 1998, 2006, and 2012. METHODS We obtained data from the 1998, 2006, and 2012 National Longitudinal Study of Public Health Agencies; the 1993, 1997, 2005, and 2010 National Association for County and City Health Officials Profile Study; and the 1997, 2008, and 2011 Area Resource Files. We used multivariate regression models for panel data to estimate the impact of economic constraints on PHDS density and centrality. RESULTS Findings indicate that economic constraints did not have a significant impact on PHDS density and centrality over time but population is a significant predictor of PHDS density, and the presence of a board of health (BOH) is a significant predictor of PHDS density and centrality. Specifically, a 1% increase in population results in a significant 1.71% increase in PHDS density. The presence of a BOH is associated with a 10.2% increase in PHDS centrality, after controlling for other factors. CONCLUSIONS These findings suggest that other noneconomic factors influence PHDS density centrality.
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Affiliation(s)
- Sharla A Smith
- Sharla A. Smith, Holly C. Felix, and J. Mick Tilford are with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Science, Little Rock. Glen P. Mays is with the Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington. Geoffrey M. Curran is with the Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Michael A. Preston is with Cancer Control and Population Science, University of Arkansas for Medical Sciences, Little Rock
| | - Glen P Mays
- Sharla A. Smith, Holly C. Felix, and J. Mick Tilford are with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Science, Little Rock. Glen P. Mays is with the Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington. Geoffrey M. Curran is with the Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Michael A. Preston is with Cancer Control and Population Science, University of Arkansas for Medical Sciences, Little Rock
| | - Holly C Felix
- Sharla A. Smith, Holly C. Felix, and J. Mick Tilford are with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Science, Little Rock. Glen P. Mays is with the Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington. Geoffrey M. Curran is with the Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Michael A. Preston is with Cancer Control and Population Science, University of Arkansas for Medical Sciences, Little Rock
| | - J Mick Tilford
- Sharla A. Smith, Holly C. Felix, and J. Mick Tilford are with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Science, Little Rock. Glen P. Mays is with the Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington. Geoffrey M. Curran is with the Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Michael A. Preston is with Cancer Control and Population Science, University of Arkansas for Medical Sciences, Little Rock
| | - Geoffrey M Curran
- Sharla A. Smith, Holly C. Felix, and J. Mick Tilford are with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Science, Little Rock. Glen P. Mays is with the Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington. Geoffrey M. Curran is with the Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Michael A. Preston is with Cancer Control and Population Science, University of Arkansas for Medical Sciences, Little Rock
| | - Michael A Preston
- Sharla A. Smith, Holly C. Felix, and J. Mick Tilford are with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Science, Little Rock. Glen P. Mays is with the Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington. Geoffrey M. Curran is with the Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Michael A. Preston is with Cancer Control and Population Science, University of Arkansas for Medical Sciences, Little Rock
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Brownson RC, Allen P, Jacob RR, Harris JK, Duggan K, Hipp PR, Erwin PC. Understanding mis-implementation in public health practice. Am J Prev Med 2015; 48:543-51. [PMID: 25891053 PMCID: PMC4405656 DOI: 10.1016/j.amepre.2014.11.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION A better understanding of mis-implementation in public health (ending effective programs and policies or continuing ineffective ones) may provide important information for decision makers. The purpose of this study is to describe the frequency and patterns in mis-implementation of programs in state and local health departments in the U.S. METHODS A cross-sectional study of 944 public health practitioners was conducted. The sample included state (n=277) and local health department employees (n=398) and key partners from other agencies (n=269). Data were collected from October 2013 through June 2014 (analyzed in May through October 2014). Online survey questions focused on ending programs that should continue, continuing programs that should end, and reasons for endings. RESULTS Among state health department employees, 36.5% reported that programs often or always end that should have continued, compared with 42.0% of respondents in local health departments and 38.3% of respondents working in other agencies. In contrast to ending programs that should have continued, 24.7% of state respondents reported programs often or always continuing when they should have ended, compared to 29.4% for local health departments and 25% of respondents working in other agencies. Certain reasons for program endings differed at the state versus local level (e.g., policy support, support from agency leadership), suggesting that actions to address mis-implementation are likely to vary. CONCLUSIONS The current data suggest a need to focus on mis-implementation in public health practice in order to make the best use of scarce resources.
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Affiliation(s)
- Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis; Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis.
| | - Peg Allen
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis
| | - Rebekah R Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis
| | - Jenine K Harris
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis
| | - Kathleen Duggan
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis
| | - Pamela R Hipp
- Medical Affairs, Centene Corporation, St. Louis, Missouri
| | - Paul C Erwin
- Department of Public Health, University of Tennessee, Knoxville, Tennessee
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Factors affecting regional variations in hospitalization expenditures of elderly residents in Japan. J Public Health (Oxf) 2014. [DOI: 10.1007/s10389-014-0621-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Chilenski SM, Ang PM, Greenberg MT, Feinberg ME, Spoth R. The impact of a prevention delivery system on perceived social capital: the PROSPER project. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2014; 15:125-137. [PMID: 23404665 PMCID: PMC3718867 DOI: 10.1007/s11121-012-0347-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The current study examined the impact of the PROSPER delivery system for evidence-based prevention programs on multiple indicators of social capital in a rural and semi-rural community sample. Utilizing a randomized blocked design, 317 individuals in 28 communities across two states were interviewed at three time points over the course of 2.5 years. Bridging, linking, and the public life skills forms of social capital were assessed via community members' and leaders' reports on the perceptions of school functioning and the Cooperative Extension System, collaboration among organizations, communication and collaboration around youth problems, and other measures. Longitudinal mixed model results indicate significant improvements in some aspects of bridging and linking social capital in PROSPER intervention communities. Given the strength of the longitudinal and randomized research design, results advance prevention science by suggesting that community collaborative prevention initiatives can significantly impact community social capital in a rural and semi-rural sample. Future research should further investigate changes in social capital in different contexts and how changes in social capital relate to other intervention effects.
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Affiliation(s)
- Sarah M Chilenski
- Prevention Research Center, The Pennsylvania State University, University Park, PA, USA.
- , 135 E Nittany Ave, Suite 402, State College, PA, 16801, USA.
| | | | - Mark T Greenberg
- Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Mark E Feinberg
- Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Richard Spoth
- Partnerships in Prevention Science Institute, Iowa State University, Ames, IA, USA
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Environmental factors and quality improvement in county and local health departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2014; 19:240-9. [PMID: 23348521 DOI: 10.1097/phh.0b013e31825f74b2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE On the basis of resource dependency theory and the uncertainty principle, this study examines the relationship between the local public health market environment and the use of quality improvement (QI) strategies in local health departments. DESIGN This cross-sectional study uses secondary data from the 2008 National Association of County & City Health Officials profile study, the Health Resources and Services Administration's Area Resource File, and the County Health Rankings 2010 data set. SETTING AND PARTICIPANTS US local health departments. MAIN OUTCOME MEASURES Seven binary dependent variables that represented the use of QI processes or QI training within local health departments were used. Eight independent variables were identified and operationalized to measure the constructs of munificence, dynamism, and complexity for the local public health market environment. Bivariate and multivariate regression analyses were used. RESULTS Two of the 3 munificence variables were positively associated with QI, as predicted. These included percentage of zip codes with healthy food outlets (β = +.016, P < .05) and the number of primary care physicians per capita (β = +1.327, P < .05). Two of the 3 measures of complexity were, as predicted, negatively associated with indicators of QI. These included smoking prevalence (β = -.118, P < .05) and obesity rates (β = -.081, P < .10). With respect to dynamism, 1 variable (change in population size over a 5-year period) was unexpectedly, positively related to QI (β = +.118, P < .10 and β = +0.235, P < .05). CONCLUSIONS Overall findings provide moderate support for the use of resource dependency theory and the uncertainty perspective to understand the influence of the external environment on QI within the local public health setting. Future research should examine other ways of operationalizing these environmental constructs to examine the relationship between the environment and other elements of public health practice.
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Payne LL, Zimmermann JAM, Mowen AJ, Orsega-Smith E, Godbey GC. Community size as a factor in health partnerships in community parks and recreation, 2007. Prev Chronic Dis 2013; 10:E124. [PMID: 23886043 PMCID: PMC3725847 DOI: 10.5888/pcd10.120238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Although partnerships between park and recreation agencies and health agencies are prevalent, little research has examined partnership characteristics and effectiveness among communities of different sizes. The objective of this study was to determine whether park and recreation leaders’ perceptions of partnership characteristics, effectiveness, and outcomes vary by community size. Methods A web-based survey was completed in 2007 by 1,217 National Recreation and Park Association members. Community size was divided into 4 categories: very small, small, medium, and large. Questions measured agencies’ recognition of the need for partnerships, their level of experience, and the effectiveness and outcomes of partnerships. Results Larger communities were significantly more likely to recognize the need for and have more experience with partnerships than smaller communities. Very small and large communities partnered significantly more often with senior services, nonprofit health promotion agencies, and public health agencies than did small and medium ones. Large and small communities were significantly more likely than very small and medium communities to agree that their decision making in partnerships is inclusive and that they have clearly defined goals and objectives. Large communities were significantly more likely than very small communities to report that their partnership helped leverage resources, make policy changes, meet their mission statement, and link to funding opportunities. Conclusion Community size shapes partnership practices, effectiveness, and outcomes. Very small communities are disadvantaged in developing and managing health partnerships. Increasing education, training, and funding opportunities for small and rural park and recreation agencies may enable them to more effectively partner with organizations to address community health concerns.
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Affiliation(s)
- Laura L Payne
- University of Illinois Urbana-Champaign, Department of Recreation, Sport and Tourism, Champaign, IL 61820, USA.
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McLeod TCV, Bliven KCH, Lam KC, Bay RC, Valier ARS, Parsons JT. The national sports safety in secondary schools benchmark (N4SB) study: defining athletic training practice characteristics. J Athl Train 2013; 48:483-92. [PMID: 23768120 PMCID: PMC3718351 DOI: 10.4085/1062-6050-48.4.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Increased rates of sport participation and sport-related injury have led to greater emphasis on and attention to medical care of student-athletes in the secondary school setting. Access to athletic training services is seen as a critical factor for delivering adequate injury prevention and medical care to student-athletes. However, few data are available regarding practice characteristics of athletic trainers (ATs) in this setting. OBJECTIVE To characterize the practices of secondary school athletic trainers (ATs). DESIGN Descriptive study. SETTING Web-based survey. PATIENTS OR OTHER PARTICIPANTS A total of 17 558 ATs with current National Athletic Trainers' Association membership were identified for survey distribution. Of these, 4232 ATs indicated that they practiced in the secondary school setting, and 4045 completed some part of the survey. MAIN OUTCOME MEASURE(S) A Web-based survey was used to obtain demographic information about ATs and their secondary schools and characteristics of athletic training practice. Descriptive data regarding the athletic trainer's personal characteristics, secondary school characteristics, and practice patterns are reported as percentages and frequencies. RESULTS Most respondents were in the early stages of their careers and relatively new to the secondary school practice setting. Nearly two-thirds (62.4%; n = 2522) of respondents had 10 or fewer years of experience as secondary school ATs, 52% (n = 2132) had been certified for 10 or fewer years, and 53.4% (n = 2164) had 10 or fewer years of experience in any practice setting. The majority of respondents (85%) worked in public schools with enrollment of 1000 to 1999 (35.5%) and with football (95.5%). More than half of respondents were employed directly by their school. Most respondents (50.6%) reported an athletic training budget of less than $4000. The majority of ATs performed evaluations (87.5%) on-site all of the time, with a smaller percentage providing treatments (73.3%) or rehabilitation (47.4%) services all of the time. CONCLUSIONS This is the first study to describe secondary school athletic training that reflects national practice trends. To improve the quality of athletic training care and to support and improve current working conditions, the profession must examine how its members practice on a day-to-day basis.
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Affiliation(s)
- Tamara C Valovich McLeod
- Athletic Training Program, Department of Interdisciplinary Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206, USA.
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Policy Activity and Policy Adoption in Rural, Suburban, and Urban Local Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:E1-8. [DOI: 10.1097/phh.0b013e318252ee8c] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Harris JK. Communication ties across the national network of local health departments. Am J Prev Med 2013; 44:247-53. [PMID: 23415121 DOI: 10.1016/j.amepre.2012.10.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/31/2012] [Accepted: 10/22/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Using evidence-based strategies within U.S. local health departments (LHDs) to provide community services can increase the likelihood of success and efficient use of resources. Dissemination of such strategies, a necessary precursor to implementation, occurs through networks of relationships and can be facilitated by weak network ties, whereas implementation is associated with strong network ties. PURPOSE To identify LHD characteristics associated with weak and strong ties in the national network of LHDs. METHODS Data on the structure and functions of participating LHDs (n=2107) were taken from the 2010 National Association of County and City Health Officials Profile of Local Health Departments (Profile Study). The 2010 Profile Study was the first to include a question on communication links across the national network of LHDs. Descriptive network analysis and exponential random graph modeling were used to identify LHD characteristics associated with weak and strong communication ties. Analysis was conducted in 2012. RESULTS The LHD network was relatively sparse overall, indicating that dissemination across the entire network would be difficult. Few strong nationwide ties were found, indicating a lack of structural influences encouraging implementation. Several LHD characteristics were associated with a higher likelihood of weak and strong ties. In bivariate analyses, larger health departments were more likely to have strong ties. Weak ties were more likely among LHDs sharing jurisdiction and organizational characteristics. The only network predictor of strong ties was being in the same state. CONCLUSIONS Public health efforts aimed at broad dissemination and implementation of evidence-based programming may benefit from strengthening partnerships in each state. The largest jurisdictions within each state may be identified as partners in order to facilitate implementation, whereas identification of partners with differing levels of staffing, funding, and leadership is key to ensuring widespread dissemination across LHDs.
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Affiliation(s)
- Jenine K Harris
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA.
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Brownson RC, Allen P, Duggan K, Stamatakis KA, Erwin PC. Fostering more-effective public health by identifying administrative evidence-based practices: a review of the literature. Am J Prev Med 2012; 43:309-19. [PMID: 22898125 PMCID: PMC3990249 DOI: 10.1016/j.amepre.2012.06.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CONTEXT The aim of evidence-based decision-making in public health involves the integration of science-based interventions with community preferences to improve population health. Although considerable literature is available on the development and adoption of evidence-based guidelines and barriers to their implementation, the evidence base specific to public health administration is less developed. This article reviews the literature from public health and related disciplines to identify administrative evidence-based practices (A-EBPs; i.e., agency-level structures and activities that are positively associated with performance measures). EVIDENCE ACQUISITION A "review of reviews" was carried out to assess the evidence for the effectiveness of A-EBPs covering the time frame January 2000 through March 2012. The following steps were used: (1) select databases; (2) determine search parameters and conduct the search; (3) screen titles and abstracts; (4) obtain selected documents; (5) perform initial synthesis; (6) abstract data; and (7) synthesize evidence. EVIDENCE SYNTHESIS In both the reviews and original empiric studies, the most common outcome reported was performance of the local health department or local public health system. On the basis of a synthesis of data from 20 reviews, a total of 11 high-priority A-EBPs were identified (i.e., practices that local public health systems potentially can modify within a few years). The A-EBPs covered five major domains of workforce development, leadership, organizational climate and culture, relationships and partnerships, and financial processes. CONCLUSIONS As the body of practice-based research continues to grow and the ability to measure administrative evidence-based practices improves, this initial list can be further developed and improved.
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Affiliation(s)
- Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri 63110, USA.
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