1
|
Tsai E, Allen P, Saliba LF, Brownson RC. The power of partnerships: state public health department multisector collaborations in major chronic disease programme areas in the United States. Health Res Policy Syst 2022; 20:80. [PMID: 35804420 PMCID: PMC9264297 DOI: 10.1186/s12961-021-00765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multisector collaboration between state public health departments (SHDs) and diverse community partners is increasingly recognized as important for promoting positive public health outcomes, addressing social determinants of health, and reducing health inequalities. This study investigates collaborations between SHDs in the United States and different types of organizations addressing chronic disease in and outside of the health sector. METHODS SHD employees were randomly selected from the National Association of Chronic Disease Directors membership list for participation in an online survey. Participants were asked about their primary chronic disease work unit (cancer, obesity, tobacco, diabetes, cardiovascular disease, and others), as well as their work unit collaborations (exchange of information/cooperation in activities) with organizations in health and non-health sectors. As a measure of the different organizations SHDs collaborated with in health and non-health sectors, a collaboration heterogeneity score for each programme area was calculated. One-way analysis of variance (ANOVA) with Tukey's post hoc tests were used to assess differences in collaborator heterogeneity between programme areas. RESULTS A total of 574 participants were surveyed. Results indicated that the cancer programme area, along with diabetes and cardiovascular disease, had significantly less collaboration heterogeneity with organizations outside of the health sector compared to the obesity and tobacco programme areas. CONCLUSIONS While collaborations with health sector organizations are commonly reported, public health departments can increase collaboration with sectors outside of health to more fully address chronic disease prevention.
Collapse
Affiliation(s)
- Edward Tsai
- Division of Public Health Sciences, Department of Surgery, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA.
| | - Peg Allen
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
| | - Louise Farah Saliba
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
| | - Ross C Brownson
- Division of Public Health Sciences, Department of Surgery, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
| |
Collapse
|
2
|
Hearld LR, Kelly RJ, Tafili A. Generation and Use of Evidence by Local Health Departments: The Role of Leader Attributes. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:384-392. [PMID: 34939603 DOI: 10.1097/phh.0000000000001472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine whether certain types of leaders were associated with the degree to which local health departments (LHDs) generate and use evidence to inform their service offering. DESIGN Pooled, cross-sectional analysis using 4 waves (2010, 2013, 2016, and 2019) of the National Profiles of Local Health Departments sponsored by the National Association of County and City Health Officials (NACCHO). Univariate analysis was used to assess the extent to which LHDs were generating and using evidence to improve the health of their local communities and whether this changed over time. Multinomial logistic regression models were used to examine the relationships between LHD leader attributes and the extent to which LHDs were generating and using evidence. PARTICIPANTS Between 1496 and 2087 (varied by survey round) LHDs from throughout the United States. MAIN OUTCOME MEASURES Two outcome variables pertaining to the generation of evidence: (1) how recently an LHD completed a community health assessment and (2) how recently an LHD completed a community health improvement plan. A third outcome variable reflected how extensively an LHD used the Community Guide, a compendium of evidence-based findings. RESULTS In 2010, 25.1% and 41.4% of all LHDs had not completed a community health assessment or a community health improvement plan, respectively; by 2019, those figures declined significantly to 14.6% and 24.7%. Similarly, in 2010, 61.7% of all LHDs were not using the Community Guide; by 2019, that percentage declined significantly to 42.5%. Multivariable analysis revealed that leader experience was a more robust correlate of evidence generation and use by LHDs than leader education. CONCLUSIONS While LHDs' generation and use of evidence have grown over the past decade, there is room for improvement. Local health department leader attributes-education and experience-highlight targeted opportunities to fill gaps in the use of evidence-based public health practices.
Collapse
Affiliation(s)
- Larry R Hearld
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama (Dr Hearld and Ms Tafili); and Department of Health Administration and Policy, School of Health Sciences, University of New Haven, West Haven, Connecticut (Dr Kelly)
| | | | | |
Collapse
|
3
|
Jacob RR, Parks RG, Allen P, Mazzucca S, Yan Y, Kang S, Dekker D, Brownson RC. How to "Start Small and Just Keep Moving Forward": Mixed Methods Results From a Stepped-Wedge Trial to Support Evidence-Based Processes in Local Health Departments. Front Public Health 2022; 10:853791. [PMID: 35570955 PMCID: PMC9096224 DOI: 10.3389/fpubh.2022.853791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Local health departments (LHDs) in the United States are charged with preventing disease and promoting health in their respective communities. Understanding and addressing what supports LHD's need to foster a climate and culture supportive of evidence-based decision making (EBDM) processes can enhance delivery of effective practices and services. Methods We employed a stepped-wedge trial design to test staggered delivery of implementation supports in 12 LHDs (Missouri, USA) to expand capacity for EBDM processes. The intervention was an in-person training in EBDM and continued support by the research team over 24 months (March 2018-February 2020). We used a mixed-methods approach to evaluate: (1) individuals' EBDM skills, (2) organizational supports for EBDM, and (3) administered evidence-based interventions. LHD staff completed a quantitative survey at 4 time points measuring their EBDM skills, organizational supports, and evidence-based interventions. We selected 4 LHDs with high contact and engagement during the intervention period to interview staff (n = 17) about facilitators and barriers to EBDM. We used mixed-effects linear regression to examine quantitative survey outcomes. Interviews were transcribed verbatim and coded through a dual independent process. Results Overall, 519 LHD staff were eligible and invited to complete quantitative surveys during control periods and 593 during intervention (365 unique individuals). A total of 434 completed during control and 492 during intervention (83.6 and 83.0% response, respectively). In both trial modes, half the participants had at least a master's degree (49.7-51.7%) and most were female (82.1-83.8%). No significant intervention effects were found in EBDM skills or in implementing evidence-based interventions. Two organizational supports scores decreased in intervention vs. control periods: awareness (-0.14, 95% CI -0.26 to -0.01, p < 0.05) and climate cultivation (-0.14, 95% CI -0.27 to -0.02, p < 0.05) but improved over time among all participants. Interviewees noted staff turnover, limited time, resources and momentum as challenges to continue EBDM work. Setting expectations, programmatic reviews, and pre-existing practices were seen as facilitators. Conclusions Challenges (e.g., turnover, resources) may disrupt LHDs' abilities to fully embed organizational processes which support EBDM. This study and related literature provides understanding on how best to support LHDs in building capacity to use and sustain evidence-based practices.
Collapse
Affiliation(s)
- Rebekah R. Jacob
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Renee G. Parks
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Peg Allen
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Yan Yan
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Sarah Kang
- Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, CA, United States
| | - Debra Dekker
- National Association of County and City Health Officials, Washington, DC, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| |
Collapse
|
4
|
Petrovskis A, Baquero B, Bekemeier B. Involvement of Local Health Departments in Obesity Prevention: A Scoping Review. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E345-E353. [PMID: 33729187 PMCID: PMC8781226 DOI: 10.1097/phh.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Local health department (LHD) obesity prevention (OP) efforts, particularly by rural LHDs, are seemingly uncommon, in part, due to limited infrastructure, workforce capacity, accessible data, and available population-level interventions aimed at social determinants of health (SDOH). METHODS We conducted a scoping review to determine LHD roles in OP efforts and interventions. Inclusion criteria were articles including evidence-based OP and LHD leaders or staff. Articles were coded by type of LHD involvement, data use, intervention characteristics, use of an SDOH lens, and urban or rural setting. RESULTS We found 154 articles on LHD OP-52 articles met inclusion criteria. Typically, LHDs engaged in only surveillance, initial intervention development, or evaluation and were not LHD led. Data and SDOH lens use were infrequent, and interventions typically took place in urban settings. CONCLUSION LHDs could likely play a greater role in OP and population-level interventions and use data in intervention decision making. However, literature is limited. Future research should focus on LHD capacity building, including academic-public health partnerships. Studies should include rural populations, data, and SDOH frameworks addressing "upstream" factors.
Collapse
Affiliation(s)
- Anna Petrovskis
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
| | - Barbara Baquero
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
| | - Betty Bekemeier
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
| |
Collapse
|
5
|
Evaluating efficiency of counties in providing diabetes preventive care using data envelopment analysis. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2021; 21:324-338. [PMID: 34824558 DOI: 10.1007/s10742-020-00237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
For patients with diabetes, annual preventive care is essential to reduce the risk of complications. Local healthcare resources affect the utilization of diabetes preventive care. Our objectives were to evaluate the relative efficiency of counties in providing diabetes preventive care and explore potential to improve efficiencies. The study setting is public and private healthcare providers in US counties with available data. County-level demographics were extracted from the Area Health Resources File using data from 2010 to 2013, and individual-level information of diabetes preventive service use was obtained from the 2010 Behavioral Risk Factor Surveillance System. 1112 US counties were analyzed. Cluster analysis was used to place counties into three similar groups in terms of economic wellbeing and population characteristics. Group 1 consisted of metropolitan counties with prosperous or comfortable economic levels. Group 2 mostly consisted of non-metropolitan areas between distress and mid-tier levels, while Group 3 were mostly prosperous or comfortable counties in metropolitan areas. We used data enveopement analysis to assess efficiencies within each group. The majority of counties had modest efficiency in providing diabetes preventive care; 36 counties (57.1%), 345 counties (61.1%), and 263 counties (54.3%) were inefficient (efficiency scores < 1) in Group 1, Group 2, and Group 3, respectively. For inefficient counties, foot and eye exams were often identified as sources of inefficiency. Available health professionals in some counties were not fully utilized to provide diabetes preventive care. Identifying benchmarking targets from counties with similar resources can help counties and policy makers develop actionable strategies to improve performance.
Collapse
|
6
|
Rodriguez Weno E, Mazzucca S, Parks RG, Padek M, Allen P, Brownson RC. Use and Awareness of The Community Guide in State and Local Health Department Chronic Disease Programs. Prev Chronic Dis 2020; 17:E133. [PMID: 33092684 PMCID: PMC7587308 DOI: 10.5888/pcd17.200196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The Community Guide (Guide) is a user-friendly, systematic review system that provides information on evidence-based interventions (EBIs) in public health practice. Little is known about what predicts Guide awareness and use in state health departments (SHDs) and local health departments (LHDs). METHODS We pooled data from 3 surveys (administered in 2016, 2017, and 2018) to employees in chronic disease programs at SHDs and LHDs. Participants (n = 1,039) represented all 50 states. The surveys asked about department practices and individual, organizational, and external factors related to decisions about EBIs. We used χ2 tests of independence for analyses. RESULTS Eighty-one percent (n = 498) of SHD and 54% (n = 198) of LHD respondents reported their agency uses the Guide. Additionally, 13% of SHD participants reported not being aware of the Guide. Significant relationships were found between reporting using the Guide and academic collaboration, population size, rated importance of forming partnerships, and accreditation. CONCLUSION Awareness and use of the Guide in LHD and SHD chronic disease programs is widespread. Awareness of the Guide can be vital to implementation practice, because it enhances implementation of EBI practices. However, awareness of the Guide alone is likely not enough for health departments to implement EBIs. Changes at the organizational level, including sharing information about the Guide and providing training on how to best use it, may increase its awareness and use.
Collapse
Affiliation(s)
- Emily Rodriguez Weno
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr, Campus Box 1196, St. Louis, MO 63130.
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Renee G Parks
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Margaret Padek
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Peg Allen
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
- Department of Surgery, Division of Public Health Sciences, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
7
|
Erwin PC, Parks RG, Mazzucca S, Allen P, Baker EA, Hu H, Davis-Joyce J, Brownson RC. Evidence-Based Public Health Provided Through Local Health Departments: Importance of Academic-Practice Partnerships. Am J Public Health 2019; 109:739-747. [PMID: 30896995 PMCID: PMC6459662 DOI: 10.2105/ajph.2019.304958] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the extent to which US local health departments (LHDs) are engaged in evidence-based public health and whether this is influenced by the presence of an academic health department (AHD) partnership. METHODS We surveyed a cross-sectional stratified random sample of 579 LHDs in 2017. We ascertained the extent of support for evidence-based decision-making and the use of evidence-based interventions in several chronic disease programs and whether the LHD participated in a formal, informal, or no AHD partnership. RESULTS We received 376 valid responses (response rate 64.9%). There were 192 (51.6%) LHDs with a formal, 80 (21.6%) with an informal, and 99 (26.7%) with no AHD partnership. Participants with formal AHD partnerships reported higher perceived organizational supports for evidence-based decision-making and interventions compared with either informal or no AHD partnerships. The odds of providing 1 or more chronic disease evidence-based intervention were significantly higher in LHDs with formal AHD partnerships compared with LHDs with no AHD partnerships (adjusted odds ratio = 2.3; 95% confidence interval = 1.3, 4.0). CONCLUSIONS Formal academic-practice partnerships can be important means for advancing evidence-based decision-making and for implementing evidence-based programs and policies.
Collapse
Affiliation(s)
- Paul Campbell Erwin
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Renee G Parks
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Stephanie Mazzucca
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Peg Allen
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Elizabeth A Baker
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Hengrui Hu
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Johnnetta Davis-Joyce
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| | - Ross C Brownson
- Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham, Birmingham. During article preparation, Renee G. Parks, Stephanie Mazzucca, Peg Allen, Hengrui Hu, and Ross C. Brownson were with the Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, MO. Elizabeth A. Baker is with the Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO. Johnnetta Davis-Joyce is with the National Association of County and City Health Officials, Washington, DC
| |
Collapse
|