Community Health Assessment by Local Health Departments: Future Questions

This Letter to the Editor is a response to the article Community Health Assessment by Local Health Departments: Presence of Epidemiologist, Governance, and Federal and State Funds are Critical published in volume 2, issue 6 of this journal. It considers how LHDs develop CHAs in complex jurisdictions, the roles of other professionals in the development of CHAs, and the conduct, quality, and use of CHAs

Diffusion of Practice-based Research in Local Public Health: What Differentiates Adopters from Non-Adopters?

Objective: To improve session-participants’ understanding of level of local health departments’ (LHDs) involvement in various practice-based research (PBR) activities. Practice-based public health research is gaining increased recognition for improving the efficiency and effectiveness of public health practice. Data: Data are drawn from NACCHO’s 2010 National Profile of LHDs Study. Questions about LHDs’ participation in PBR were administered to a stratified random sample of 625 LHDs. Findings: Over the 12 months prior to the study 38 percent of LHDs did not participate in any PBR activity and another five percent of respondents did not know if their health department had. Overall, more LHDs participated in: collecting, exchanging, or reporting data for a study (37%), disseminating research findings to key stakeholders (33%), applying research findings to practices within their own organization (26%), and analyzing and interpreting study data and findings (26%) than in other practice-based research activities. Some LHDs (22%) participated in the identification of research topics/questions relevant to public health practice and helping other organizations apply evidence to practice (16%). Few LHDs worked on developing or refining research plans and/or protocols for public health studies (12%) and/or recruiting study sites and/or study participants (12%). Twenty-nine percent of all LHDs participated in at least one research study (average=2.8 studies per LHD). Multivariate analysis was used with logistic regression to predict the tendency to perform PBR activities. Larger LHDs and those with local governance were more likely to perform most of the PBR activities, including participation in research studies. Having an MD as a top executive was positively associated with these activities. Having a local board of health and/or a full-time (as opposed to part-time) top executive was positively associated with some research activities including participation in research studies. The implications of these findings for practice-based research in public health will be discussed

Levels and Predictors of LHDs\u27 Engagement in Community Health Assessment, 2002-2013

This presentation was given at the Keeneland Conference for Public Health Systems and Services Research

Using Expert Panels to Elicit Potential Indicators and Predictors of EBPH in Local Health Departments

Research Objective: To identify appropriate indicators of local health department (LHD) use of EBPH strategies and factors that influence their use. Data Sets and Sources: Transcripts of interviews with 12 members of an expert panel representing researchers and practitioners working in PHSSR and Evidence-Based Public Health. Study Design: Participants responded to a series of questions regarding: their definition of EBPH; ways to identify and assess the use of EBPH strategies; and perceived barriers/enablers to the use of these strategies at the state and local levels. Analysis: Content analysis performed using QSR NVivo V. 9. Data matrices were created highlighting each participant\u27s comments related to EBPH strategies and factors influencing the use of EBPH strategies (including state level, local health department level and community level factors). Strategies were categorized based on definitions of EBPH used by participants. Principal Findings: Two basic definitions of EBPH emerged, with one reflecting the use of data in decision-making processes, and the other reflecting the adoption of scientifically tested interventions. Factors at the state, local health department and community levels that influenced EBPH depended, in part, on the definition of EBPH used by participants. Conclusion: LHD use of EBPH was influenced by health officer training and leadership, characteristics of the workforce, and training and technical assistance provided at the state and local levels. Familiarity with resources on tested interventions was key for one definition of EBPH. Community partnerships and competency in using data were key for others. Implications for the Field of PHSSR: PHSSR and practice related to EBPH need to include precise definitions of terms to have meaningful discussions regarding how to encourage the use of EBPH strategies

Predictors of Evidence-Based Decision Making and Population Health Practice in LHDs

Research Objective: To identify the frequency with which LHDs carry out Evidence-Based Decision Making (EBDM) and population health strategies in LHDs and state-, LHD-, and community-levels predictors of LHDs\u27 use of these strategies. Data Sets and Sources: Harmonized PHSSR dataset consisting of 2010 NACCHO Profile of Local Health Departments Survey, Module 2 respondents, 2010 ASTHO Profile of State Health Departments, US Census data, and Area Resource File data. Study Design: The study used multivariate analysis to identify predictors of EBDM and population health. We identified items in the 2010 NACCHO Profile Survey representing EBDM and population health strategies and constructed two composite dependent variables. Based on the PHSSR literature, we identified potential predictors at the state-, LHD-, and community levels. Analysis: Using descriptive analyses, we determined the frequency with which LHDs carry out EBDM strategies and population health strategies. Hierarchical linear modeling (HLM) was used to identify factors that best predict LHDs\u27 use of EBDM and population health strategies. Principal Findings: Fourteen percent of LHDs engaged in six or seven (out of seven) EBDM strategies; and 15% used six or more (out of 10) population health strategies. Hierarchical linear modeling results will identify modifiable state health department, LHD, and community context predictors of LHDs\u27 use of these strategies. Conclusion: Based on data from the NACCHO Profile Survey, LHDs vary greatly in the extent to which they focus on EBDM and population health practice. The paths that lead LHDs to focus on EBDM and population health practice are complex and diverse. Implications For The Field Of PHSSR: For PHSSR research, more precise data definitions and questions are needed in national surveys such as the NACCHO and ASTHO surveys. More research is needed to understand how LHDs use EBDM strategies (and which ones they use) as well as how they make decisions about focusing on population health practice

LHDs Increase Their Use of EBDM Practices From 2010 to 2013

Background: An evidence-based approach is needed to effectively address the gap between population health goals in the United States and current morbidity and mortality rates. Recently, the authors developed an index to allow researchers to assess the frequency of evidence-based decision making (EBDM) practice in LHDs. The first descriptive analysis was conducted with data from the NACCHO 2010 Profile Study of Local Health Departments (LHDs). The current research was designed to assess changes in the percentage of LHDs using EBDM practices from 2010 to 2013. Research Objective: To identify changes in the frequency with which LHDs carried out EBDM practices from 2010 to 2013. Data sets and sources: 2010 NACCHO Profile of LHDs Survey, 2013 NACCHO Profile of LHDs Survey. The NACCHO Profile Surveys are conducted every 2-3 years. All LHDs in the country are invited to respond. Study Design: Cross-sectional survey Analysis: The research reported here used an index of EBDM practices previously developed by the authors. Descriptive analysis was used to identify the frequency with which LHDs used each EBDM practice comprising the index and the frequency of the total number of practices they used in both 2010 and 2013. Principal Findings: Overall, the percentage of LHDs using EBDM practices increased from 2010 to 2013. Specifically, in 2010, forty-five percent of LHDs used three EBDM practices or fewer; 41.5% used four or five EBDM practices; and 13.5% used six or seven practices. In 2013, thirty-seven percent of LHDs used three EBDM practices or fewer; 39% used four or five practices; and 23.7% used six or seven practices. The overall increase in numbers of EBDM practices used by LHDs was largely driven by increases in percentages of LHDs that use the County Health Rankings (37.8% to 66.5%) and that use The Guide to Community Preventive Services (26% to 41.2%)(Table 1). Implications for PH Policy and Practice: The results reveal that there is an increase in the use of EBDM practices in LHDs from 2010 to 2013. More research is needed to understand details of how LHDs implement EBDM strategies and use them to innovate the practice of public health

Multidisciplinary top management teamwork: Effects on local health department performance.

Local health departments often use multidisciplinary top management teams (TMTs) to organize the work of the agency. The purpose of this study was to examine the use of TMTs in North Carolina local health departments and how TMTs use affected agency performance. TMT diversity and TMT performance positively affected the local health departments' (LHDs) performance. As well, the TMTs' agenda affected LHD performance. The more that TMTs discussed community health assessment and political changes in the community, the better the LHD performance on the core functions. Implications for public health practice and leadership in local health departments are discussed

Differences in Definitions of EBPH and Evidence: Implications for Communication with Practitioners

In this study, we interviewed twelve members of an expert panel to elicit their views on Evidence-based Public Health (EBPH), including how they define EBPH, what constitutes “evidence”, and what LHDs do that can be described as EBPH. Telephone interviews lasting 60 minutes were recorded and transcribed for basic content analysis. Experts differed in their definitions of EBPH and their views of what constitutes evidence. Definitions of EBPH ranged from the adoption and implementation of rigorously tested interventions to the application of evidence to decision making for population health improvement. Views on what constitutes evidence also varied, from strict “evidence from science” to broader “evidence from experience.” Because of these differences in meaning, our study suggests we use more concrete and specific messaging for what practitioners are expected to do

Promoting Community Preparedness: Lessons Learned From the Implementation of a Chemical Disaster Tabletop Exercise

Health educators are frequently called on to facilitate community preparedness planning. One planning tool is community-wide tabletop exercises. Tabletop exercises can improve the preparedness of public health system agencies to address disaster by bringing together individuals representing organizations with different roles and perspectives in specific disasters. Thus, they have the opportunity to identify each other’s roles, capabilities, and limitations and to problem-solve about how to address the gaps and overlaps in a low-threat collaborative setting. In 2005, the North Carolina Office of Public Health Preparedness and Response developed a series of exercises to test the preparedness for chemical disasters in a metropolitan region in the southeastern United States. A tabletop exercise allowed agency heads to meet in an environment promoting inter- and intraagency public—private coordination and cooperation. The evaluation results reported here suggest ways in which any tabletop exercise can be enhanced through recruitment, planning, and implementation