A National Network of Public Health and Faith-Based Organizations to Increase Influenza Prevention Among Hard-to-Reach Populations.

We studied a national collaboration to prevent the spread of 2009 H1N1 and seasonal influenza, and highlighted how a partnership among the Interfaith Health Program (IHP) at Emory University, the Department of Health and Human Services Partnership Center, the Centers for Disease Control and Prevention, and the Association of State and Territorial Health Officials (ASTHO) leveraged the distinctive capabilities of local public health, health care, and faith-based organizations in 10 communities around the country. From 2009 to 2016, IHP, ASTHO, and the Partnership Center worked as intermediaries with these partnerships, aligning and amplifying their capacity to extend influenza prevention services for hard-to-reach vulnerable populations. We suggested that intermediary organizations enabled information sharing, co-learning, and dissemination of best practices through horizontal and vertical channels. We recommended practices for these partnerships to engage local networks that share commitments to eliminate health disparities, to use a frame of strengths and assets, and to provide a supportive multilocal, multilevel learning community.

Local Health Departments' Partners and Challenges in Electronic Exchange of Health Information.

BACKGROUND: Unprecedented amounts of data are produced by the health care and other sectors, presenting opportunities for local health departments (LHDs) to access these data. LHDs will need to participate in health information exchange (HIE) with a number of partners in order to benefit from these data resources. LHDs' participation in HIEs with specific partners has not been studied. OBJECTIVES: To describe the level of and challenges in LHD participation in HIE with other partners, and variation by LHD population size and governance type. DATA AND METHODS: This research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, with a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling design. A total of 324 completed responses were received with a 50% response rate. Survey data were cleaned, and bivariate comparisons were conducted using χ and Somer's D. RESULTS: Substantial variation existed in LHDs' participation in HIE by type of exchange partner. Although 71% participated in HIE with the state departments of health, only 12% with jail/correctional health, 14% with health or county-based purchasing plans, and 15% with home health agencies. Compared with large LHDs (jurisdiction populations of ≥500 000), smaller LHDs were more likely to participate in HIE with state departments of health, but less likely with other exchange partners. The challenges to HIE participation were technological, and organizational/interorganizational in nature and variation existed by LHDs' population size and governance structure with respect to state authority. CONCLUSIONS: Local public health agencies more commonly participate in HIE with some partners, but may need to improve HIE with many others. National strategies targeting an increase in HIE of LHDs may use our findings to focus those initiatives.

Using Information Systems to Improve a Mid-Sized Local Health Department's Effectiveness in a Time of Rapid Change.

BACKGROUND: Informatics capacity building is resource and personnel intensive. Many local health departments (LHDs) face tradeoffs between using their resources to carry out existing mandates and using resources to build their capacity, for example, through informatics, to deliver essential services in a more effective and efficient manner. OBJECTIVE: The purpose of this case study is to describe how a mid-sized LHD built and used information systems to support its strategic objectives, clinical services, and surveillance. METHODS: The mid-sized LHD described here was chosen for its "best practices" in informatics capacity building and use by NACCHO's study advisory committee. To conduct the case study, authors reviewed departmental documents and conducted semistructured interviews with key informants in the agency. Interviews were recorded, transcribed, thematically coded, and analyzed. RESULTS AND CONCLUSIONS: Findings from the case study suggest that including capacity building in informatics as a strategic priority is one of the most effective ways to ensure that informatics are assessed, updated, and included in resource decisions. Leadership at all levels is critical to the successful implementation of informatics as is proactive partnership with community partners who have overlapping goals. The efficiency and effectiveness of LHDs rely on informatics capacity, especially when resources are challenged.

An Iterative, Low-Cost Strategy to Building Information Systems Allows a Small Jurisdiction Local Health Department to Increase Efficiencies and Expand Services.

OBJECTIVE AND METHODS: The objective of this case study was to describe the process and outcomes of a small local health department's (LHD's) strategy to build and use information systems. The case study is based on a review of documents and semi-structured interviews with key informants in the Pomperaug District Health Department. Interviews were recorded, transcribed, coded, and analyzed. RESULTS AND CONCLUSIONS: The case study here suggests that small LHDs can use a low-resource, incremental strategy to build information systems for improving departmental effectiveness and efficiency. Specifically, we suggest that the elements for this department's success were simple information systems, clear vision, consistent leadership, and the involvement, training, and support of staff.

Laying the groundwork for evidence-based public health: why some local health departments use more evidence-based decision-making practices than others.

We examined variation in the use of evidence-based decision-making (EBDM) practices across local health departments (LHDs) in the United States and the extent to which this variation was predicted by resources, personnel, and governance. We analyzed data from the National Association of County and City Health Officials Profile of Local Health Departments, the Association of State and Territorial Health Officials State Health Departments Profile, and the US Census using 2-level multilevel regression models. We found more workforce predictors than resource predictors. Thus, although resources are related to LHDs' use of EBDM practices, the way resources are used (e.g., the types and qualifications of personnel hired) may be more important.

Resilience of Vietnamese refugees: resources to cope with natural disasters in their resettled country.

OBJECTIVE: Study findings suggest that refugees are more vulnerable than the general population to mental disorders from disasters. This pilot study explored the nature of Vietnamese refugees' resilience to a potential natural disaster as a first step toward improving their disaster mental health. METHODS: Interviews were conducted with 20 ethnic Vietnamese and Montagnard adult refugees using a semistructured interview guide. Factors in resilience at both individual and family levels were examined. RESULTS: Our results indicated that these refugees had positive personalities and strong family cohesion. However, although a majority of the participants had experienced natural disasters, they lacked knowledge and specific strategies to cope with these events. The individual participants and their families lacked sufficient information, financial resources, emergency supplies, or social support for a natural disaster. CONCLUSIONS: Enhancing refugees' current strengths in responding to disasters, delivering them tailored emergency training, strengthening relationships between refugee service providers and refugee communities, and advocating for refugees' socioeconomic capacity building should be considered.

Diffusion of practice-based research in local public health: what differentiates adopters from nonadopters?

OBJECTIVE: To examine the level of involvement by local health departments (LHDs) in practice-based research (PBR) activities, and determine factors associated with variation in such involvement. DESIGN: A total of 625 LHDs in a nationally representative stratified random sample of LHDs were administered questions about their participation in PBR activities along with the core instrument in the 2010 National Profile of Local Health Departments Study. Using the Profile data set, zero-inflated negative binomial regression is used to examine the relationships among the variables in the model. MAIN OUTCOME MEASURE: The dependent variable was a count variable about the number of PBR activities performed by LHDs. RESULTS: About 62% of LHDs participated in at least one research activity. Participating in research activities was significantly associated with the following characteristics of LHDs: serving a population of 500 000 to 999 999, local governance, having a full-time top executive, having heard of the county health rankings, and having performed a Community Health Assessment in the last 5 years. Of LHDs performing at least one research activity, only LHD jurisdiction size predicted the number of research activities in which LHDs participated. Among these LHDs, the range in participation was from about 12% of research plans developed by LHDs to 37% collected data. CONCLUSIONS AND IMPLICATIONS: Large public health agencies may be overrepresented, raising the risk that research results may not adequately address the needs, uncertainties, and innovations arising in smaller settings. Correcting this imbalance may require mechanisms for greater involvement of low-resource LHDs in PBR and expanded federal support for such activities through PBR networks.

Framing photovoice using a social-ecological logic model as a guide.

Photovoice is a community-based participatory action research method designed to uncover the root causes of community problems and to collectively address them. Individual change and empowerment are desired outcomes of the photovoice process, but more importantly, the process seeks to engage groups and whole communities to foster positive systems change. This article presents a logic model informed by the social-ecological model of health to guide photovoice planners and participants in planning activities that produce individual-and community-level change. The model presented here should help planners and participants plan, implement, and evaluate other photovoice efforts and provide them a visual guide to ensure that all parties are on the same conceptual page and increase the intentionality of their efforts.

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.

Public health educators' participation in teams: implications for preparation and practice.

Collaboration among public health organizations is essential to ensuring the health of the public. Much of the day-to-day work of public health educators is done in groups or teams or in consultation with others. This study examined the extent of health educators' work in teams as a proxy for collaboration. Health educators participated in an average of four teams per individual; three of these were interorganizational teams. Moreover, 40% of the respondents participated in five or more teams. Health educators supervised by other health educators were more likely to work in interorganizational teams than were those supervised by other professionals. Certified Health Education Specialists were more likely to participate in intraorganizational teams. Curricula in academic programs should reflect the extensive teamwork in which health educators are involved. Employers need to provide health educators with grounding in organizational priorities and support to carry out their collaborative work.

All-hazards preparedness in an era of bioterrorism funding.

OBJECTIVES: All-hazards preparedness was evaluated in North Carolina's 85 local health departments (LHDs). METHODS: In regional meetings, data were collected from LHD teams from North Carolina's LHDs using an instrument constructed from Centers for Disease Control and Prevention's preparedness indicators and from the Local Public Health Preparedness and Response Capacity Inventory. RESULTS AND CONCLUSIONS: Levels of preparedness differ widely by disaster types. LHDs reported higher levels of preparedness for natural disasters, outbreaks, and bioterrorist events than for chemical, radiation, or mass trauma disasters. LHDs face challenges to achieving all-hazards preparedness since preparation for one type of disaster does not lead to preparedness for all types of disasters. LHDs in this survey were more prepared for disasters for which they were funded (bioterrorism) and for events they faced regularly (natural disasters, outbreaks) than they were for other types of disasters.

A profile of public health educators in North Carolina's local health departments.

The purpose of this study was to provide a profile of the public health education workforce in North Carolina. A survey was administered to all practicing health educators at local health departments (LHDs) in North Carolina. The study specifically attempted to answer four questions: (1) Who functions as health educators in LHDs in North Carolina? (2) What is the educational background and professional training of North Carolina LHD health educators? (3) What are the characteristics of health educators' positions in North Carolina? and (4) How do these characteristics of health educators (demographics and education) as well as their titles, job responsibilities, and supervisory relationships differ according to the size of the LHD? The study showed that most public health educators in North Carolina are white females; most do not have Certified Health Education Specialist certification; that younger health educators are more likely to have health education degrees; and that almost two thirds of public health educators have administrative responsibilities.

Assessment of public health educator practice: health educator responsibilities.

This study presents a method for better understanding how practicing health educators in local health departments spend their time. The purpose of this study was to document the daily practice of health educators in the 10 areas of responsibility as defined by a competency-based framework for graduate-level health educators. The results of the current study present the average percentage of time health educators spent carrying out each area of responsibility and the percentage of health educators that did not carry out activities related to a specific area of responsibility. For example, the greatest percentage of time was spent implementing programs (21.2%), and approximately 60% of the health educators in the sample did not conduct research nor did they participate in activities to advance the profession. These findings have implications for the professional preparation of health educators and for their continuing education. The current study contains several suggestions for future research in this area.