SESSION 3A: System Structure & Performance-Managing the CHA/CHIP Process
Room: Thoroughbred 1
Wednesday, April 9, 2014, 10:45 am-12pm
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KC14 Session 3A on System Structure & Performance: Managing the CHA/CHIP Process by NCC for PHSSR
MODERATOR
Patricia Sweeney, J.D., M.P.H., RN
PRESENTERS
Kimberley Shoaf, Dr.P.H.
Collaboration Between Public Health and Schools: A Case of Missed Opportunities
Co-Investigators: Michael Prelip, Ph.D., M.P.H, CHES, CPH
Background: School systems are an important component of the public health system as they represent more than 20% of the US population. Collaboration between public health and schools is vital to protecting and promoting the health of children and the community.
Research Objective: The Objective of this presentation is to explore the collaborative efforts between public health and schools to protect and promote the health of children and communities.
Data Sets and Sources: The data for this study come from a national survey of local health departments (LHDs) conducted by the UCLA Preparedness and Emergency Response Research Center to assess collaborative efforts between public health and schools for emergency preparedness and response.
Study Design: This study utilized a national sample of LHDs, stratified on size of jurisdiction served. A probability-proportional-to-size design was used to select 750 LHDs for the study. An online questionnaire measured collaboration between LHDs and schools for general health issues as well as emergency preparedness and response. Letters were mailed to the LHD director with instructions asking the individual responsible for emergency preparedness to complete the online survey.
Analysis: Analysis was performed using IBM SPSS v. 22 (IBM, 2013). Observations were weighted inversely to their probability of selection to adjust for sample design. Descriptive statistics were generated to identify the frequency LHDs reported a variety of collaborative efforts with schools to protect and promote health.
Principal Findings: A total of 159 LHDs completed the survey. Collaboration between public health and schools ranged from a high of 93% engaging around immunizations to a low 31% for family planning efforts. With the exception of immunizations, oral health and infectious disease surveillance, the majority of the collaboration was defined as only education or providing health education materials.
Conclusions: This represents missed opportunities for protecting and promoting the health of children. While education is laudable, it is not sufficient to improve the health status of this vulnerable population.
Implications for Public Health Practice and Policy: There needs to be an increased focus on interventions that extend beyond traditional health education to improve the health of children, families, and communities.
Gianfranco Pezzino, M.D., M.P.H.
Factors Affecting the Progress of Community Health Assessment and Improvement Activities in Kansas - results from focus groups
Co-Investigators: Ruth Wetta, Ph.D., M.P.H, RN (Presenting), Frank Dong, Ph.D., Barbara LaClair, M.S.
Background: Community Health Assessment (CHA) and Improvement Planning (CHIP) are important functions for local health departments (LHDs), but may be challenging in rural settings.
Research Objective: The purpose of this two-year, mixed methods study was to identify factors that impede or promote the timeliness and quality of CHA-CHIP completion in Kansas.
Datasets and Sources: Data were collected through focus groups and a brief survey. The project’s sampling frame was represented by Kansas counties that planned to conduct a CHA-CHIP during 2012 and/or 2013.
Study Design: Fifteen focus groups were conducted at baseline (2012), followed by 21 after one year (2013). Change in perceptions about CHA-CHIP inputs, process, outputs, outcomes and self-efficacy to perform CHA-CHIP activities were explored. There were 128 study participants (57 in 2012, 71 in 2013), who were predominantly female, older and lived in rural areas. In addition to traditional focus group procedures, a 12-item attitudinal survey that explored participants’ confidence to perform CHA-CHIP activities was collected.
Analysis: Analysis of survey data was conducted using univariate and multivariate techniques. Information from focus groups was analyzed through standard qualitative method techniques.
Principal Findings: Substantial progress in CHA-CHIP activities was reported between 2012 and 2013. Most participants perceived the CHA-CHIP process as valuable and enhancing the local health department’s visibility in the community. Rural participants more often reported completing the CHA while urban LHDs had progressed into the CHIP and implementation stages. Factors influencing the CHA-CHIP process included (1) parallel assessment activities conducted by other community organizations, and (2) for rural counties, a functioning, 501(c)3 community health coalition. Self-confidence items showed improvement between 2012 and 2013. A multivariate regression analysis revealed a significant time effect and rural-urban difference in perceived self-efficacy.
Conclusions: Uneven gains in the implementation of CHA-CHIP procedures and confidence to perform CHA-CHIP activities were observed.
Implications for Public Health Practice and Policy: Results can help define mechanisms to individualize CHA-CHIP training content to settings were the needs are greater, such as rural counties. Solutions appropriate for those settings can help reduce gaps in capacity and ability to complete timely, high-quality CHA-CHIP processes.
Gianfranco Pezzino, M.D., M.P.H.
Differences in timeliness, quality, and impact of CHA-CHIP processes among local health departments in Kansas
Co-Investigators: Barbara LaClair, M.S., Ruth Wetta, Ph.D., M.P.H, RN (Presenting), Frank Dong, Ph.D.
Background: Community Health Assessment (CHA) and Improvement Planning (CHIP) are important aspects of public health core functions, but local health department (LHD) experience with and capacity for conducting CHA-CHIP activities is highly variable.
Research Objective: To identify progress of LHD in completing timely and high-quality CHA-CHIP processes in Kansas.
Data Sets and Sources: Quantitative data describing LHD characteristics, available resources to support CHA/CHIP efforts, and experiences with and results of CHA-CHIP activities were collected through two online surveys conducted in September 2012 and July 2013. Study Design: Prospective pre-post cohort study.
Analysis: Survey responses were summarized using descriptive statistics. Composite scoring methods were developed to measure community collaboration, self-reported quality of the completed CHA, and perceived impact of CHA-CHIP activities. Chi-square and t-test statistics were used to test for differences between subgroups of respondents.
Principal Findings: Substantial, but uneven progress with CHA-CHIP activities was observed during the study period. Many LHDs, particularly smaller agencies serving rural locations, reported facing challenges including lack of internal capacity, competing demands on staff time, and limited availability of local data, but continued to work through the CHA/CHIP process. Rural LHD were more likely to rely on external consultants to complete their CHA-CHIP. Although many LHDs had not yet completed their CHIP activities at the conclusion of this study, nearly all identified some positive impact related to early CHA-CHIP efforts. Increased community awareness of health issues, and strengthened community partnerships were most frequently identified as benefits of CHA-CHIP work.
Conclusions: During the study period, substantial progress with CHA-CHIP activities in Kansas was observed, but progress and challenges were uneven. Nearly all respondents (even those who had not completed their CHA-CHIP) identified some positive impact from early efforts.
Implications for Public Health Practice and Policy: CHA-CHIP processes require significant investments for successful completion. To be viewed as valuable, it is important that practitioners perceive the process as resulting in positive benefits. Early results in Kansas suggest that while difficulties and challenges were encountered, most LHDs are viewing the CHA-CHIP process as beneficial. Disparity in challenges and resources between urban and rural jurisdictions needs to be addressed.