Local Public Health Workers Research Articles

Qualitative Assessment of a Novel Efficacy-Focused Training Intervention for Public Health Workers in Disaster Recovery.

We trained local public health workers on disaster recovery roles and responsibilities by using a novel curriculum based on a threat and efficacy framework and a training-of-trainers approach. This study used qualitative data to assess changes in perceptions of efficacy toward Hurricane Sandy recovery and willingness to participate in future disaster recoveries. Purposive and snowball sampling were used to select trainers and trainees from participating local public health departments in jurisdictions impacted by Hurricane Sandy in October 2012. Two focus groups totaling 29 local public health workers were held in April and May of 2015. Focus group participants discussed the content and quality of the curriculum, training logistics, and their willingness to engage in future disaster recovery efforts. The training curriculum improved participants' understanding of and confidence in their disaster recovery work and related roles within their agencies (self-efficacy); increased their individual- and agency-level sense of role-importance in disaster recovery (response-efficacy); and enhanced their sense of their agencies' effective functioning in disaster recovery. Participants suggested further training customization and inclusion of other recovery agencies. Threat- and efficacy-based disaster recovery trainings show potential to increase public health workers' sense of efficacy and willingness to participate in recovery efforts. (Disaster Med Public Health Preparedness. 2016;10:615-622).

Examining Public Health Workers' Perceptions Toward Participating in Disaster Recovery After Hurricane Sandy: A Quantitative Assessment.

We aimed to quantitatively gauge local public health workers' perceptions toward disaster recovery role expectations among jurisdictions in New Jersey and Maryland affected by Hurricane Sandy. An online survey was made available in 2014 to all employees in 8 Maryland and New Jersey local health departments whose jurisdictions had been impacted by Hurricane Sandy in October 2012. The survey included perceptions of their actual disaster recovery involvement across 3 phases: days to weeks, weeks to months, and months to years. The survey also queried about their perceptions about future involvement and future available support. Sixty-four percent of the 1047 potential staff responded to the survey (n=669). Across the 3 phases, 72% to 74% of the pre-Hurricane Sandy hires knew their roles in disaster recovery, 73% to 75% indicated confidence in their assigned roles (self-efficacy), and 58% to 63% indicated that their participation made a difference (response efficacy). Of the respondents who did not think it likely that they would be asked to participate in future disaster recovery efforts (n=70), 39% indicated a willingness to participate. The marked gaps identified in local public health workers' awareness of, sense of efficacy toward, and willingness to participate in disaster recovery efforts after Hurricane Sandy represent a significant infrastructural concern of policy and programmatic relevance. (Disaster Med Public Health Preparedness. 2016;10:371-377).

Application of a Taxonomy to Characterize the Public Health Workforce.

A public health workforce taxonomy was published in 2014 to provide a standardized mechanism for describing public health worker characteristics. The Public Health Workforce Interests and Needs Survey (PH WINS) used 7 of the taxonomy's 12 axes as a basis for its survey response choices, 3 of which are the focus of this analysis. The purpose of this study was to determine the relative utility, reliability, and accuracy of the public health workforce taxonomy in categorizing local and state public health workers using a survey tool. This specifically included the goal of reducing the number of responses classified as "other" occupation, certification, or program area by recoding responses into taxonomy categories and determining potential missing categories for recommendation to the advisory committee that developed the taxonomy. Survey questions associated with the occupation, certification, and program area taxonomy axes yielded qualitative data from respondents who selected "other." The "other" responses were coded by 2 separate research teams at the University of Michigan Center of Excellence in Public Health Workforce Studies and NORC at the University of Chicago. Researchers assigned taxonomy categories to all analyzable qualitative responses and assessed the percentage of PH WINS responses that could be successfully mapped to taxonomy categories. Between respondent self-selection and research team recoding, the public health workforce taxonomy successfully categorized 95% of occupation responses, 75% of credential responses, and 83% of program area responses. Occupational categories that may be considered for inclusion in the taxonomy in the future include disease intervention specialists and occupations associated with regulation, certification, and licensing. The public health workforce taxonomy performed remarkably well in categorizing worker characteristics in its first use in a national survey. The analysis provides some recommendations for future taxonomy refinement.

Attitudinal Determinants of Local Public Health Workers' Participation in Hurricane Sandy Recovery Activities.

Local health departments play a critical role in short-, intermediate-, and long-term recovery activities after a public health emergency. However, research has not explored attitudinal determinants of health department workers' participation in the recovery phase following a disaster. Accordingly, this qualitative investigation aims to understand perceived facilitators and barriers to performing recovery-related activities following Hurricane Sandy among local health department workers. In January 2014, 2 focus groups were conducted in geographically representative clusters of local health departments affected by Hurricane Sandy (1 cluster in Maryland and 1 cluster in New Jersey). Focus groups were recorded, transcribed verbatim, and analyzed to qualitatively assess attitudes toward Hurricane Sandy recovery activities. This analysis identified 5 major thematic categories as facilitators and barriers to participation in recovery activities: training, safety, family preparedness, policies and planning, and efficacy. Systems that support engagement of health department personnel in recovery activities may endeavor to develop and communicate intra- and interjurisdictional policies that minimize barriers in these areas. Development and implementation of evidence-informed curricular interventions that explain recovery roles may also increase local health department worker motivation to participate in recovery activities.

Local health department workers, public policy, and willingness to respond during emergencies.

To determine whether an association exists between a state's authority to declare a public health emergency and local public health workers' response willingness. The 2009-2010 Johns Hopkins~Public Health Infrastructure Response Survey Tool included questions about demographics and attitudes/beliefs regarding local public health workers' response willingness during public health emergencies. Survey data were merged with data about presence/absence of a law granting states the authority to declare a public health emergency. Logistic regression analyses were performed with the presence/absence of the law and were adjusted for individuals' demographic and locale characteristics. Data were collected from eight clusters of local health department workers in nine states. Two thousand nine hundred ninety-three local health department workers. Willingness to respond to four different public health emergency scenarios. For naturally occurring and human-caused disasters, in unadjusted analyses, there was no statistically significant difference in willingness to respond between individuals living in states with a law that allowed for a governmental declaration of public health emergency and those living in states without such a law. Adjusted analyses yielded similar results. While laws giving the state the authority to declare a public health emergency are not associated with response willingness, findings may reflect the fact that states rarely declare public health emergencies, giving local public health workers few opportunities to become familiar with the implementation of these laws. In light of this, local health departments should consider altering their own internal policies to promote response willingness among their employees.

Enumeration of the governmental public health workforce, 2014.

BackgroundRegular assessment of the size and composition of the U.S. public health workforce has been a challenge for decades. Previous enumeration efforts estimated 450,000 public health workers in governmental and voluntary agencies in 2000, and 326,602 governmental public health workers in 2012, although differences in enumeration methodology and the definitions of public health worker between the two make comparisons problematic.PurposeTo estimate the size of the governmental public health workforce in 14 occupational classifications recommended for categorizing public health workers.MethodsSix data sources were used to develop enumeration estimates: five for state and local public health workers and one for the federal public health workforce. Statistical adjustments were made to address missing data, overcounting, and duplicate counting of workers across surveys. Data were collected for 2010–2013; analyses were conducted in 2014.ResultsThe multiple data sources yielded an estimate of 290,988 (range=231,464–341,053) public health workers in governmental agencies, 50%, 30%, and 20% of whom provide services in local, state, and federal public health settings, respectively. Administrative or clerical personnel (19%) represent the largest group of workers, followed by public health nurses (16%); environmental health workers (8%); public health managers (6%); and laboratory workers (5%).ConclusionsUsing multiple data sources for public health workforce enumeration potentially improves accuracy of estimates but also adds methodologic complexity. Improvement of data sources and development of a standardized study methodology is needed for continuous monitoring of public health workforce size and composition.

Understanding the local public health workforce: labels versus substance.

The workforce is a key component of the nation's public health (PH) infrastructure, but little is known about the skills of local health department (LHD) workers to guide policy and planning. To profile a sample of LHD workers using classification schemes for PH work (the substance of what is done) and PH job titles (the labeling of what is done) to determine if work content is consistent with job classifications. A secondary analysis was conducted on data collected from 2,734 employees from 19 LHDs using a taxonomy of 151 essential tasks performed, knowledge possessed, and resources available. Each employee was classified by job title using a schema developed by PH experts. The inter-rater agreement was calculated within job classes and congruence on tasks, knowledge, and resources for five exemplar classes was examined. The average response rate was 89%. Overall, workers exhibited moderate agreement on tasks and poor agreement on knowledge and resources. Job classes with higher agreement included agency directors and community workers; those with lower agreement were mid-level managers such as program directors. Findings suggest that local PH workers within a job class perform similar tasks but vary in training and access to resources. Job classes that are specific and focused have higher agreement whereas job classes that perform in many roles show less agreement. The PH worker classification may not match employees' skill sets or how LHDs allocate resources, which may be a contributor to unexplained fluctuation in public health system performance.

Sentinel Symptoms of Climate Change: Indicators for Related Health Effects

Greenhouse gas emissions are widely acknowledged to be contributing to climate change–related health effects that vary by location, and are expected to continue doing so for many years, even if substantial emission cuts occur. A workgroup of the Council of State and Territorial Epidemiologists has identified a set of indicators that it says will allow national and local officials in the United States to better predict any such changes and consequences and to take appropriate action as it becomes warranted [EHP 117:1673–1681; English et al.]. The team also identified the data needed for tracking these indicators and ascertained whether the data exist, must be improved, or must be generated. They say this is the first effort to synthesize and evaluate related information published by many sources. The team determined the best indicators of environmental changes due to climate change are quantity of greenhouse gas emissions, air quality (in particular ozone), air mass stagnation events (such as those caused by temperature inversions), temperature and humidity, pollen loads, ragweed occurrence, drought incidence, drinking water scarcity, and occurrence of wildfires and harmful algal blooms. Data for some of these indicators are strong and/or expected to improve soon, as in the case of greenhouse gases, temperature, air mass stagnation events, and drought. Data on other indicators, such as pollen, harmful algal blooms, and ozone, require substantial improvement. For indicators of human death and illness, the authors recommend tracking excess numbers of each that can be attributed to events related to climate change. Doing so will require significant improvements in existing data and methods, such as more comprehensive reporting of emergency room visits and hospitalizations related to heat waves, floods, and other extreme weather events. For infectious diseases, the targeted culprits are West Nile virus, Lyme disease, dengue fever, coccidioidomycosis, and hantavirus cardio pulmonary syndrome. The authors note that some segments of the population may be especially vulnerable to certain effects of climate change. These groups include children; the elderly; pregnant and nursing women; those with disabilities and preexisting conditions such as asthma, chronic obstructive pulmonary disease, and obesity; people living in poverty or social isolation or without access to transportation; and those living within 5 km of a coast that is highly vulnerable to sea level rise, or in a 100- or 500-year flood zone. Awareness of these vulnerable subpopulations will be important in planning appropriate prevention and intervention activities. Data for indicators of adaptability are sparse because most efforts so far have focused on mitigating climate change, not adapting to it. The authors propose that such indicators might include access to public cooling centers during heat waves, the existence of early warning systems for heat waves, mitigation plans to reduce urban heat islands, the number and quality of surveillance systems available to collect data on climate–health effects, and the availability of local public health workers and task forces trained in climate change research, surveillance, and adaptation.

Assessment of Local Public Health Workers' Willingness to Respond to Pandemic Influenza through Application of the Extended Parallel Process Model

BackgroundLocal public health agencies play a central role in response to an influenza pandemic, and understanding the willingness of their employees to report to work is therefore a critically relevant concern for pandemic influenza planning efforts. Witte's Extended Parallel Process Model (EPPM) has been found useful for understanding adaptive behavior in the face of unknown risk, and thus offers a framework for examining scenario-specific willingness to respond among local public health workers. We thus aim to use the EPPM as a lens for examining the influences of perceived threat and efficacy on local public health workers' response willingness to pandemic influenza.Methodology/Principal FindingsWe administered an online, EPPM-based survey about attitudes/beliefs toward emergency response (Johns Hopkins∼Public Health Infrastructure Response Survey Tool), to local public health employees in three states between November 2006 – December 2007. A total of 1835 responses were collected for an overall response rate of 83%. With some regional variation, overall 16% of the workers in 2006-7 were not willing to “respond to a pandemic flu emergency regardless of its severity”. Local health department employees with a perception of high threat and high efficacy – i.e., those fitting a ‘concerned and confident’ profile in the EPPM analysis – had the highest declared rates of willingness to respond to an influenza pandemic if required by their agency, which was 31.7 times higher than those fitting a ‘low threat/low efficacy’ EPPM profile.Conclusions/SignificanceIn the context of pandemic influenza planning, the EPPM provides a useful framework to inform nuanced understanding of baseline levels of – and gaps in – local public health workers' response willingness. Within local health departments, ‘concerned and confident’ employees are most likely to be willing to respond. This finding may allow public health agencies to design, implement, and evaluate training programs focused on emergency response attitudes in health departments.

Local public health workers' perceptions toward responding to an influenza pandemic

BackgroundCurrent national preparedness plans require local health departments to play an integral role in responding to an influenza pandemic, a major public health threat that the World Health Organization has described as "inevitable and possibly imminent". To understand local public health workers' perceptions toward pandemic influenza response, we surveyed 308 employees at three health departments in Maryland from March – July 2005, on factors that may influence their ability and willingness to report to duty in such an event.ResultsThe data suggest that nearly half of the local health department workers are likely not to report to duty during a pandemic. The stated likelihood of reporting to duty was significantly greater for clinical (Multivariate OR: 2.5; CI 1.3–4.7) than technical and support staff, and perception of the importance of one's role in the agency's overall response was the single most influential factor associated with willingness to report (Multivariate OR: 9.5; CI 4.6–19.9).ConclusionThe perceived risk among public health workers was shown to be associated with several factors peripheral to the actual hazard of this event. These risk perception modifiers and the knowledge gaps identified serve as barriers to pandemic influenza response and must be specifically addressed to enable effective local public health response to this significant threat.

User Patterns and Satisfaction With On-line Trainings Completed on the North Carolina Center for Public Health Preparedness Training Web Site

Short online training modules have been developed by the North Carolina Center for Public Health Preparedness (NCCPHP) and provided to registered users for free on its Training Web Site. Use of these modules can improve the knowledge, skills, and awareness of public health professionals in topics related to public health preparedness. According to the results of a survey implemented in October 2004, the NCCPHP Training Web Site is effectively reaching its target audience of local and state public health workers. The utilization of distance learning technology allows for broad distribution of training materials, with registered users in all 50 US states and 122 foreign countries. In addition, the NCCPHP Training Web Site is providing training materials in topics most requested by the public health workforce. According to the findings of this survey, online training in public health preparedness and response is an efficient way to improve the knowledge and skills of our public health workforce to increase competency.

Development and Implementation of a Public Health Workforce Training Needs Assessment Survey in North Carolina

Assessing the training needs of local public health workers is an important step toward providing appropriate training programs in emergency preparedness and core public health competencies. The North Carolina Public Health Workforce Training Needs Assessment survey was implemented through the collaboration of several organizations, including the North Carolina Center for Public Health Preparedness at the North Carolina Institute for Public Health, the outreach and service unit of the University of North Carolina School of Public Health, the Office of Public Health Preparedness and Response in the North Carolina Division of Public Health Epidemiology Section, and local health departments across the state.

The local public health agency workforce: research needs and practice realities.

There is a paucity of information about the nation's local governmental public health agency (LPHA) workforce. Without additional research, crucial questions about the individuals providing front-line public health services remain unanswered. Current national efforts to develop a public health workforce research agenda must include strategies for collecting basic data on local governmental public health workers. The work of enumerating and classifying LPHA staff is complicated, but not impossible. Projects to improve LPHA performance and discussions of the certification of public health workers are incomplete without current and accurate data on the individuals comprising our nation's public health system. The need to describe basic facets of the LPHA workforce is not trivial. As city and county budgets are cut and LPHAs are left scrambling to cover lost positions, data are needed to inform important decisions about what kinds of LPHA staff are needed to keep a community healthy.

Dissemination of responsible service of alcohol initiatives to rugby league clubs

To determine the acceptability of intervention strategies that increase the responsible service of alcohol by non-metropolitan rugby league clubs. Rugby league clubs were provided an information kit and advice by local public health workers, police and a lead agency regarding their responsible service of alcohol practices. Rugby League clubs and public health workers completed an acceptability survey at the conclusion of the study. Data were collected from 160 contactable clubs (100% consent) and 12 of 14 participating public health workers. Almost all clubs reported of contact with the lead agency, public health workers and police to be acceptable. Fifty-nine percent of clubs reported contact with public health workers to be useful. One-third of the public health workers considered that they were not the most suitable professional group to be involved in delivering the intervention. In spite of a suggested culture of harmful alcohol consumption among rugby league participants and spectators, non-metropolitan rugby league clubs appear receptive to public health strategies that increase their responsible service of alcohol. The ability of the public health sector to meet this opportunity appears limited, and may require additional strategies to increase the capacity of public health workers to develop/deliver inter-sectorial interventions in this setting.

Responsibility of Local Health Authorities in the War Emergency

THE subject assigned to me for discussion, namely, The Responsibility of Local Health Authorities in the War Emergency, carries with it the implication that all areas in the United States are served by some form of local health organization capable of accepting responsibility and exercising authority. According to this interpretation, it is assumed that full-fledged staffs of local public health workers wait only to be told what to do before springing into action. This, I am sorry to say, is far from a true picture of the situation. In spite of considerable progress in recent years, no such comprehensive network of local health services exists. In extensive areas of the United States the exercise of local health functions is vested in political jurisdictions such as townships, boroughs, villages, and, in some instances, counties, in which the population consists of from a few hundred to a few thousand inhabitants. Such local subdivisions are in most instances nothing more than geographical fictions designed to fulfil the political requirements of the horse-and-buggy era. They bear no relationship to present community life, nor do they in any sense contain -institutions or administrative units which meet the economic and social needs of the population. Like the human vermiform appendix, evolution has rendered them obsolete and functionally sterile.