Abstract
ObjectiveThe objective of this study was to develop a measurement tool to capture local public health department (LHD) organizational characteristics that align with implementation of equity-oriented practice, which may be used to gauge progress in building public health structures and functions that address the needs of vulnerable populations and reduce health inequities.MethodsWe developed and tested a measurement tool, with practitioner input, based on an implementation science framework and informed by previous work defining public health essential services and practice recommendations for health equity. Measures assessed types of vulnerable populations served by the LHD, organizational climate, and four equity-oriented practice areas, including: assessment and planning, monitoring and analysis, leadership support, and obesity prevention. We also assessed opportunities for capacity building by identifying training needs of practitioners. Primary data were collected from Missouri local health department practitioners (n = 92, 80% response rate) via an online questionnaire, with a subset of the sample providing data for test-retest reliability.ResultsMeasures of equity-oriented implementation climate indicated areas of variability with respect to strengths and gaps across LHDs. While implementation climate was strong with respect to perceived importance (86%), a substantial proportion of LHDs cited concern over other priorities conflicting with equity-oriented implementation (32%). Likewise, a strong internal push (67%) was often accompanied by limited external political (25%) and community support (40%). Implementation climate measures generally had good to excellent reliability and were significantly associated with areas of equity-oriented practice. Frequently identified (>70%) training needs included improving skills in applying frameworks, assessment methods, and evaluating collaborations around equity.ConclusionWe developed a theory-based, practitioner-informed questionnaire to assess capacity for equity-oriented practice and identify opportunities for capacity building in local public health departments to engage in effective change toward health equity.
Highlights
The inequitable distribution of social, economic and structural determinants of health and system-wide gaps in addressing the health needs of vulnerable populations have led to stark disparities in morbidity and mortality [1,2,3,4,5,6]
While implementation climate was strong with respect to perceived importance (86%), a substantial proportion of local public health department (LHD) cited concern over other priorities conflicting with equity-oriented implementation (32%)
Implementation climate measures generally had good to excellent reliability and were significantly associated with areas of equity-oriented practice
Summary
The inequitable distribution of social, economic and structural determinants of health and system-wide gaps in addressing the health needs of vulnerable populations have led to stark disparities in morbidity and mortality [1,2,3,4,5,6]. A support structure that addresses the specific needs of local communities is needed in order to implement effective equity-oriented practices. Healthy People 2020 has numerous objectives and recommended interventions that address the social determinants of health [10]. It is, unclear to what extent local public health agencies currently have the capacities to align assessment, assurance and policy development to address equity and social determinants [11]. Tracking the unique aspects of organizational supports and workforce capacities required for equity-oriented practice is needed in order to strategically implement interventions to meet the needs of vulnerable populations in the community [12]
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