Public Health Commons^™

Lhds' Implementation And Evaluation Of Strategies To Target Psychological, Mental Health, And Other Behavioral Healthcare Needs Of The Underserved Population, Gulzar H. Shah, Huabin Luo, Carolyn J. Leep, Nancy L. Winterbauer

Health Policy and Management Faculty Presentations

Background: Underserved subgroups face barriers when accessing behavioral healthcare. Local health departments (LHDs) are charged with “linking people to needed personal health services and assure the provision of healthcare when otherwise unavailable”.

Research Objectives: 1) To assess the extent to which LHDs implement and evaluate strategies to target the behavioral healthcare needs for the underserved populations; 2) To identify factors that are associated with these undertakings.

Datasets and Sources: Data were drawn from the 2013 National Profile of Local Health Departments Study conducted by National Association of County and City Health Officials The Module 2 questionnaire of the Profile contained …

Lhds Increase Their Use Of Ebdm Practices From 2010 To 2013, Kay A. Lovelace, Gulzar H. Shah, Carolyn J. Leep, Robert Aronson

Department of Health Policy and Community Health Faculty Presentations

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 …

Local Public Health In Financial Crises: Common Decision Drivers For Changes In Services Due To Economic Downturn, Gulzar H. Shah

Health Policy and Management Faculty Presentations

We measured the impact of the 2008-2010 economic recession on local health departments (LHDs) across the United States. Between 2008 and 2010, we conducted 3 Web-based, cross-sectional surveys of a nationally representative sample of LHDs to assess cuts to budgets, workforce, and programs. By early 2010, more than half of the LHDs (53%) were experiencing cuts to their core funding. In excess of 23 000 LHDs jobs were lost in 2008-2009. All programmatic areas were affected by cuts, and more than half of protecting the health of the public, such as monitoring health status to identify and solve community health …

The Resilient Local Health Department: Surviving The 2008 Economic Crisis, Paul C. Erwin, Gulzar H. Shah, Glen P. Mays

Health Policy and Management Faculty Presentations

Research Objective: The purpose of this study was to identify potential modifiable factors that can protect local health departments from job losses and budget cuts during periods of economic stress.

Study Design: This was a retrospective cohort study which used data from census surveys of local health departments (LHDs) which were conducted in 2005 and 2010 by the National Association of County and City Health Officials. The 2005 survey data served as the source of independent variables, which were grouped around domains of organization, revenue, and services. The outcome of interest - resiliency of the LHD - represented financial resiliency …

Community Health Assessment Activity By Lhds: The Influence Of Local Health Agency And Community Characteristics, Gulzar H. Shah, Barbara Laymon, Carolyn Leep, Julia Elligers

Health Policy and Management Faculty Presentations

Research Objective: This study investigates organizational and community characteristics associated with the likelihood of local health departments to conduct community health assessments (CHAs).

Study Design: For this observational study, we used data from the 2010 National Profile of Local Health Departments Study (Profile). Using the FIPS codes for the county and place, additional data were merged with Profile data to capture community characteristics. To compute estimates of community characteristics for LHDs involving multiple cities/counties, we computed population weighted averages. In order to estimate unbiased population parameters, we used appropriate statistical weights in all analyses, to account for disproportionate non-responses …

Using Expert Panels To Elicit Potential Indicators And Predictors Of Ebph In Local Health Departments, Robert Aronson, Kay Lovelace, Mark Smith, Gulzar H. Shah

Health Policy and Management Faculty Presentations

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 …

Predictors Of Evidence-Based Decision Making And Population Health Practice In Lhds, Kay Lovelace, Robert Aronson, Kelly Rulison, Gulzar H. Shah, Mark Smith

Health Policy and Management Faculty Presentations

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' 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 …

Clarifying And Expanding Concepts Of Cross-Jurisdictional Sharing: Early Lessons Learned From Conducting Qi With Georgia’S Health Districts, William C. Livingood, Nandi A. Marshall, Angela Peden, Ketty Gonzales, Gulzar H. Shah, Dayna S. Alexander, Alesha Wright, Russell B. Toal, Lynn S. Woodhouse, Deanna Keene

Health Policy and Management Faculty Presentations

Research Objective: Assess the legal and organization cultural foundations for Cross-Jurisdictional Sharing (CJS) in support of local public health accreditation and QI in Georgia.

Data Sets and Sources: Archival data (primarily state statutes), secondary data from previous qualitative comparative research on Deep South public health organization, secondary data from previous surveys, and oral interviews and written communication.

Study Design: Primarily Qualitative design combining ethnographic and participatory research methods.

Analysis: Qualitative Content analysis based on predetermined and emergent themes.

Principal Findings: Georgia’s Health Districts have emerged as major CJS entities that support delivery of essential services and local public health (LPH) …

Local Health Departments’ Plan To Seek Voluntary National Accreditation And Its Association With Phab Accreditation Prerequisites, Gulzar H. Shah, Kate Beatty, Carolyn Leep

Health Policy and Management Faculty Presentations

Research Objective: To examine the nature of relationship between LHDs’ intentions to seek Public Health Accreditation Board (PHAB) accreditation in the future and having completed within five years the three PHAB pre-requisites: community health assessment (CHA), community health improvement plan (CHIP), and the agency-wide strategic plan.

Data Sets And Sources: We used data from the NACCHO’s 2010 National Profile of Local Health Departments (2010 Profile Study) survey, administered to 2,656 LHDs, with a module sent to a nationally representative stratified random sample of 625 LHDs which contained questions on LHDs’ plans to seek voluntary national accreditation (the dependent …

There Is No “I” In Team: Players, Leaders, And Team Performance In Public Health Emergency Response, William Riley, Paige Anderson Bowen, Micky Scullard, Cheryl Petersen-Kroeber, Gulzar H. Shah

Health Policy and Management Faculty Presentations

Research Objective: Research objectives are to: 1) assess effect of controller-led in situ simulation on emergency response capacity of state health department; 2) study effects of training on team function, dynamics, and communications among staff responsible for emergency operations at state health department; and 3) train public health teams for high reliability.

Data Sets and Sources: Thirty trials (one-hour functional exercises) conducted in the state department operations center over a 16-month period (May 2010 to September 2011). Data gathered using in situ simulation methodology (recording, live viewing, playback analysis). Behavioral markers data collected using event set observational tool …

Diffusion Of Practice-Based Research In Local Public Health: What Differentiates Adopters From Non-Adopters?, Gulzar H. Shah, Kay Lovelace, Reba Novich

Health Policy and Management Faculty Presentations

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 …

Extent And Nature Of Resource Sharing Among Local Health Departments, Joshua Vest, Gulzar H. Shah

Health Policy and Management Faculty Presentations

Objective: Collaborative arrangements between local health departments (LHDs) by which they share services, responsibilities, or staff, is a growing occurrence in the US. This phenomenon is referred to as regionalization, resource sharing, or intra-state resource sharing. Participants of this session will learn about the current state of resource sharing among LHDs in terms of the public health activities, nature of the relationships, and geography. We will also discuss which characteristics of LHDs are associated with resource-sharing.

Data Source: Data for this analysis come from the National Association of City & County Health Official's 2010 Profile of Local Health Departments. The …

Health Districts As Quality Improvement Collaboratives And Multi-Jurisdictional Entities, William C. Livingood, Nandi A. Marshall, Angela Peden, Ketty Gonzales, Gulzar H. Shah, Dayna S. Alexander, Kellie O. Penix, Russell B. Toal, Lynn D. Woodhouse

Health Policy and Management Faculty Presentations

Research Objective: The Georgia Public Health PBRN assessed the utility of the Multi-county Health District as a structured Quality Improvement Collaborative (QIC), and as multi jurisdictional entities for purposes of meeting standards for accreditation by the Public Health Accreditation Board.

Data Sets and Sources: Data were collected from online surveys followed up with phone interviews or paper surveys to maximize participation. A newly developed clinical care QIC instrument (Schouten et al, 2010) was modified to collect data with a revised focus on QICs for public health. We retained QI culture constructs in the instrument while shifting the focus …

The Resilient Local Health Department: Attributes Of Survival During The Economic Crisis, Paul C. Erwin, Gulzar H. Shah

Health Policy and Management Faculty Presentations

The purpose of this research is to explore the attributes of local health departments (LHDs) which have survived the recent economic crises without loss of staff. A retrospective cohort study is being conducted, using the 2005 and 2010 Profile of Local Health Departments datasets from the National Association of County and City Health Officials. LHDs which responded to both surveys and which provided data on full-time equivalents (FTEs) and expenditures are included for analysis. LHDs are categorized as resilient or non-resilient based on whether the LHD gained or did not lose FTEs between 2005 and 2010 (“resilient LHD”) vs. those …

Key Findings From A Council On Linkages Survey Of Public Health Workers, Vincent Francisco, Jeffery A. Jones, Robin Pendley

Jeffery A Jones

The US governmental public health workforce is dwindling while the need for additional workers is increasing. In an historic effort to address this issue, in March 2010 the Council on Linkages Between Academia and Public Health Practice (Council on Linkages) surveyed over 70,000 public health workers across the US to determine how, when, and why they entered the governmental public health workforce and reasons they have remained in the workforce. Key survey findings were released in the spring of 2011 and have informed the development by the Council on Linkages of evidence-assisted recruitment and retention strategies for the US public …

The Role Of Social Support In Multiple Morbidity Self-Management Among Rural Residents, Shoshana Bardach, Yelena N. Tarasenko, Nancy E. Schoenberg

Yelena N. Tarasenko

Social support generally is considered a valuable asset that may compensate for health service deficiencies among rural populations. Employing a mixed methods approach, we explored how vulnerable rural residents described social support in the context of self-management for multiple chronic conditions. Participants generally felt support was available, though emotional/ informational support was perceived as less available than other types of support. Participants did not rely heavily on informal support to help them manage their multiple morbidities, preferring to call on their doctor and their own resources. We discuss implications of these findings for meeting this vulnerable population’s self-management needs.

Local Health Departments’ Governance: A Visual Display Using Lhd Shape Files, Gulzar H. Shah Dr., Carolyn J. Leep, Reba Novich

Health Policy and Management Faculty Presentations

Analyses conducted for public health systems and services research (PHSSR) frequently include a variable that represents the relationship between state and local health departments (i.e., a governance category) in their analyses, either as an explanatory variable or a control variable. A number of organizations and researchers has categorized states according to governance, but the categorizations have been inconsistent across studies. This lack of agreement regarding governance category has been problematic for PHSSR.

The Association of State and Territorial Health Officials (ASTHO) in conjunction with NORC at the University of Chicago and with input from the National Association of County and …

The Emergency Department As A Potential Intervention Recruitment Venue Among Vulnerable Rural Residents, Yelena N. Tarasenko, Nancy E. Schoenberg, Keisa L. Bennett

Yelena N. Tarasenko

Meeting the health care needs of rural residents is complicated by their substantial medical burdens that frequently outstrip patient and community resources. Nowhere is this more evident than in central Appalachia. Preventive procedures are often sacrificed as patients and providers attend to more pressing medical issues. We report the results of a pilot study designed to explore the need for and appropriateness of a potential intervention placed in an emergency department (ED), with the eventual goal of using the ED to link traditionally underserved patients to preventive services. We used a convenience sample of 49 ED patients to explore their …

Drive Alive: Teen Seat Belt Survey Program, Katie M. Burkett, Steve Davidson, Carol Cotton, James Barlament, Laurel Loftin, James H. Stephens, Martin Dunbar, Ryan Butterfield

Health Policy and Management Faculty Publications

Objective: To increase teen seat belt use among drivers at a rural high school by implementing the Drive Alive Pilot Program (DAPP), a theory-driven intervention built on highway safety best practices.

Methods: The first component of the program was 20 observational teen seat belt surveys conducted by volunteer students in a high school parking lot over a 38-month period before and after the month-long intervention. The survey results were published in the newspaper. The second component was the use of incentives, such as gift cards, to promote teen seat belt use. The third component involved disincentives, such as increased police …

Public Health Workforce Trust Measures: Comparative Analysis Of T1-T2 Measures Across Two Lhd’S And Organizational Responses To Economic Hard Times, William A. Mase

William A. Mase

This public health workforce research initiative expands practice-based employee trust measurement in a time-one time-two (T1 – T2) quantitative design methodology. The initiative is an expansion of previously conducted research within the Cincinnati and Northern Kentucky Health Departments. Tailored workforce-based quality improvement (QI) initiatives were developed and implemented within the two local health departments (LHD’s). Workforce-based QI was a product of strategic initiatives defined by leadership of both health departments and informed by a critical review of the data collected in 2008. Analysis of additional independent variables and interaction terms were evaluated and are presented for supervisor/employee race concordance. In …

Physician Colorectal Cancer Screening Recommendations: An Explanation Based On Informed Decision-Making, Yelena N. Tarasenko, Sarah B. Wackerbarth, Jennifer M. Joyce, Steven A. Haist

Yelena N. Tarasenko

Objective: The purpose of this research was to examine the content of physicians’ colorectal cancer screening recommendations. More specifically, using the framework of informed decision making synthesized by Braddock and colleagues, we conducted a qualitative study of the content of recommendations to describe how physicians are currently presenting this information to patients.

Methods: We conducted semi-structured interviews with 65 primary care physicians. We analyzed responses to a question designed to elicit how the physicians typically communicate their recommendation.

Results: Almost all of the physicians (98.5%) addressed the “nature of decision” element. A majority of physicians discussed “uncertainties …