Health Policy Commons^™

Local Health Departments’ Activities To Address Health Disparities And Inequities: Are We Moving In The Right Direction?, Gulzar H. Shah, John P. Sheahan

Health Policy & Management: Faculty Publications (2006-2018)

Context: Health disparities are among the critical public health challenges.

Objectives: To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs’ performing those activities since 2005, and factors associated with variation in such engagement.

Methods: We used the 2013 National Profile of LHDs Survey to perform Logistic Regression of activities LHDs performed to address health disparities.

Results: About 20 percent of LHDs did not perform any activity to address health disparities. Significant decreases occurred since 2005 in the proportion of LHDs that performed health disparity reduction/elimination activities for four …

Impact Of Laws Aimed At Healthcare-Associated Infection Reduction: A Qualitative Study, Patrica W. Stone, Monika Pogorzelska-Maziarz, Julie Reagan, Jacqueline A. Merrill, Brad Sperber, Catherine Cairns, Matthew Penn, Tara Ramanathan, Elizabeth Mothershed, Elizabeth Skillen

Health Policy & Management: Faculty Publications (2006-2018)

Background: Healthcare-associated infections (HAIs) are preventable. Globally, laws aimed at reducing HAIs have been implemented. In the USA, these laws are at the federal and state levels. It is not known whether the state interventions are more effective than the federal incentives alone.

Objective: The aims of this study were to explore the impact federal and state HAI laws have on state departments of health and hospital stakeholders in the USA and to explore similarities and differences in perceptions across states.

Methods: A qualitative study was conducted. In 2012, we conducted semistructured interviews with key stakeholders from states with and …

The State Of Accreditation Readiness In Georgia: A Case Study, Angela Peden, Gulzar H. Shah, Russell B. Toal, Dayna S. Alexander, Alesha Wright, Ashton Anderson, Nandi A. Marshall, Scott Uhlich, Jeffery A. Jones

Health Policy & Management: Faculty Publications (2006-2018)

Background: Georgia’s public health districts first began exploring the idea of national public health accreditation in 2008 when Cobb & Douglas Public Health included accreditation in their strategic plan. In May 2015, Cobb & Douglas Public Health was the first Georgia public health district to achieve national accreditation status. This article discusses the current state of accreditation readiness in Georgia and explores strengths and barriers to accreditation.

Methods: This study utilized a case study approach in order to examine PHAB accreditation efforts in Georgia within a reallife context. Data came from three sources: nine Accreditation Readiness Assessments, a PHAB Pre-Application …

Assessing The Education And Training Needs Of Nebraska's Public Health Workforce, Brandon L. Grimm, Patrik Johansson, Preethy Nayar, Bettye A. Apenteng, Samuel T. Opoku, Anh Nguyen

Health Policy & Management: Faculty Publications (2006-2018)

Introduction: In 2012, the Great Plains Public Health Training Center (Grant #UB6HP22821) conducted an online survey of state and local health departments and the American Indian (tribal clinics, tribal health departments, and urban Indian clinic) public health workforce across three professional levels. The objectives of the needs assessment were to determine the competency levels of the state’s public health workforce, assess gaps in public health competencies, identify public health training interests, needs, and preferences, and to determine the barriers and motivators to participate in public health training.

Methods: The assessment was developed using the Council on Linkages Between Academia and …

Cultural Beliefs And Understandings Of Cervical Cancer Among Mexican Immigrant Women In Southeast Georgia, John S. Luque, Yelena N. Tarasenko, Jonathan N. Maupin, Moya L. Alfonso, Lisa C. Watson, Claudia Reyes-Garcia, Daron G. Ferris

Health Policy & Management: Faculty Publications (2006-2018)

Rural Mexican immigrant women in the U.S. are infrequently screened and experience health disparities from cervical cancer. We explored cancer-related cultural beliefs in this population. We administered a cross-sectional survey to 39 Mexican immigrant women due for screening. We conducted univariate and bivariate analyses of participants’ characteristics, Pap test history, cancer-related knowledge and beliefs, and cultural consensus analysis about causes of cervical cancer and barriers to screening. For all the cultural consensus tasks, there was consensus (Eigenratios >3:1) among survey participants. Comparing the rankings of risk factor clusters, clusters related to sexual behaviors were ranked more severely than clusters related …

Assessing Changes In Safety Net Providers Since The Passage Of The Affordable Care Act, Arlesia Mathis, Julia Burke, Gulzar H. Shah

Health Policy & Management: Faculty Presentations (2008-2022)

The passage of the Affordable Care Act presented opportunities and challenges for safety net providers. Significant investments in provider capacity promised much needed expansion of services; and in 2014, the law extended coverage to millions of previously uninsured Americans. However, safety net providers are concerned that changes to financing brought about by changes in the ACA may threaten their ability to provide services to millions more who still lack insurance. This is a preliminary study of changes occurring with maternal and child health services among safety-net providers.

Use Of Facebook By Local Health Departments: Activity And Focus Areas, Rakhi Trivedi, Gulzar H. Shah

Health Policy & Management: Faculty Presentations (2008-2022)

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

Levels And Predictors Of Lhds' Engagement In Community Health Assessment, 2002-2013, Gulzar H. Shah, Kay Lovelace, Daniel F. Linder

Health Policy & Management: Faculty Presentations (2008-2022)

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

Characteristics Of Local Health Departments Associated With Their Implementation Of Electronic Health Records And Other Informatics System, Gulzar H. Shah, Jonathon P. Leider, Brian C. Castrucci, Karmen S. Williams, Huabin Luo

Health Policy & Management: Faculty Presentations (2008-2022)

Background: Information technology and information systems (IT/IS) play a critical role in the daily operation of local health departments (LHDs). Assessing LHDs’ informatics capacities is important, especially within the context of broader, system-level health reform efforts.

Research Objective: This study assesses a nationally representative sample of LHDs’ level of adoption of information systems, technology, and the factors associated with adoption/implementation. Specifically, five areas of public health informatics were examined: electronic health records (EHRs), health information exchange (HIE), immunization registry (IR), electronic disease reporting system (EDRS), and electronic lab reporting (ELR).

Data Sets and Sources: Data from NACCHO’s 2013 National Profile …

Factors Driving Local Health Department’S Collaboration With Other Organizations In The Provision Of Personal Healthcare Services, Huabin Luo, Nancy L. Winterbauer, Ashley Tucker, Gulzar H. Shah

Health Policy & Management: Faculty Presentations (2008-2022)

Background: Recent work has highlighted the necessity of integrating primary care services and public health to improve quality and reduce the cost of healthcare.

Research Objectives: To describe levels of partnership between local health departments (LHD) and other organizations in the community in the provision of personal healthcare services; and to assess LHD organizational characteristics and community factors that contribute to partnerships.

Data Sets and Sources: Data were drawn from the 2013 NACCHO Profile Study (Module 1) and the Area Health Resource File. A total of 490 LHDs responded to Module 1, where LHDs were asked to describe the level …

The Impact Of Emotional Intelligence On Conditions Of Trust Among Leaders At The Kentucky Department For Public Health, Jennifer Redmond Knight, Heather M. Bush, William A. Mase, Martha Cornwell Riddell, Meng Liu, James W. Holsinger

Health Policy & Management: Faculty Publications (2006-2018)

There has been limited leadership research on emotional intelligence and trust in governmental public health settings. The purpose of this study was to identify and seek to understand the relationship between trust and elements of emotional intelligence, including stress management, at the Kentucky Department for Public Health (KDPH). The KDPH serves as Kentucky’s state governmental health department. KDPH is led by a Commissioner and composed of seven primary divisions and 25 branches within those divisions. The study was a non-randomized cross-sectional study utilizing electronic surveys that evaluated conditions of trust among staff members and emotional intelligence among supervisors. Pearson correlation …

The Impact Of State Mandated Healthcare-Associated Infection Reporting On Infection Prevention And Control Departments In Acute Care Hospitals: Results From A National Survey, Carolyn T. A. Herzig, Monika Pogorzelska-Maziarz, Julie Reagan, Elaine Larson, Patricia W. Stone

Health Policy & Management: Faculty Presentations (2008-2022)

Background: In addition to federally mandated reporting, most US states have adopted legislation requiring hospitals to submit healthcare-associated infection (HAI) data. Evidence that state HAI laws have increased patient safety and reduced HAI rates is inconsistent, however, and resources needed to comply are considerable. We evaluated the impact of state HAI laws on infection prevention and control departments (IPCD).

Methods: Web-based survey of a national sample of hospital IPCD was conducted in Fall 2011; all non-VA hospitals enrolled in the National Healthcare Safety Network were eligible to participate. States with HAI laws effective prior to Fall 2011 were identified using …

In The Words Of The Medical Tourist: An Analysis Of Internet Narratives By Health Travelers To Turkey, Margaret E. Ozan-Rafferty, James Allen Johnson, Gulzar H. Shah, Attila Kursun

Health Policy & Management: Faculty Publications (2006-2018)

Background: Patients regularly travel to the West for advanced medical care, but now the trend is also shifting in the opposite direction. Many people from Western countries now seek care outside of their country. This phenomenon has been labeled medical tourism or health travel. Information regarding health travelers’ actual outcomes, experiences, and perceptions is lacking or insufficient. However, advanced Internet technology and apps provide information on medical tourism and are a vehicle for patients to share their experiences. Turkey has a large number of internationally accredited hospitals, is a top tourism destination, and is positioning itself to attract international patients. …

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 & Management: Faculty Presentations (2008-2022)

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

Health Policy & Community Health: Faculty Presentations (1993-2023)

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 & Management: Faculty Presentations (2008-2022)

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 …

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 & Management: Faculty Presentations (2008-2022)

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 …

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

Health Policy & Management: Faculty Presentations (2008-2022)

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 …

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 & Management: Faculty Presentations (2008-2022)

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) …

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 & Management: Faculty Presentations (2008-2022)

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 …

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 & Management: Faculty Presentations (2008-2022)

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 …

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 & Management: Faculty Presentations (2008-2022)

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 …

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 & Management: Faculty Presentations (2008-2022)

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 …

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

Health Policy & Management: Faculty Presentations (2008-2022)

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 …

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

Health Policy & Management: Faculty Presentations (2008-2022)

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 …

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 & Management: Faculty Presentations (2008-2022)

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 & Management: Faculty Presentations (2008-2022)

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 …

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

Health Policy & Management: Faculty Presentations (2008-2022)

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 …

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 & Management: Faculty Publications (2006-2018)

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 …

Global Health And Politics: Julia Alvarez’ Saving The World, Amrita Das

The Coastal Review

Julia Alvarez’ novel Saving the World (2006) is a comment on the politics of Global Health. Alvarez reconstructs the tale of Isabel Sendales y Gomez, the lone female participant in the early 19th century’s Spanish Royal Expedition to eradicate smallpox around the world, mainly in the Spanish colonies. The historical narrative is paralleled by the tale of Alma Rodríguez, a 21st Century Dominican American author who is faced with a similar situation, aiding in an idealistic project to eradicate AIDS in the Dominican Republic. Alvarez’ work throws into sharp relief what happens when the philanthropic ideals of healing the world …