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Kett PM, Shahrir S, Bekemeier B. Public Health Nurses' Proficiencies and Training Needs in an Emergency Response: A Cross-Sectional Observational Study. J Public Health Manag Pract 2024; 30:354-366. [PMID: 38489524 DOI: 10.1097/phh.0000000000001888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To address gaps in understanding the public health nursing workforce regarding competencies recognized as critical during an emergency response. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional observational study using data with information on local health department staff- and organizational-level characteristics collected from across the United States in 2021. We used logistic regression to estimate the association between 2 binary nurse-specific predictors-(1) whether the staff person was a nurse and (2) whether the staff worked in a local health department that was "nurse-led" (directed by a nurse)-and reported proficiencies important to the COVID-19 response. Models controlled for relevant local health department and community characteristics. RESULTS In the sample, 19% were nurses and 37% were at nurse-led health departments. Nurse versus nonnurse staff had higher odds of reporting proficiencies in skills related to Justice, Equity, Diversity, and Inclusion and in the skill "identifying/applying evidence-based approaches to address public health issues." However, nurses, compared with their nonnurse peers, had higher odds of reporting training needs in domains related to community engagement, policy engagement, and cross-sectoral collaboration. Conversely, staff at nurse-led health departments, compared with non-nurse-led staff, had higher odds of reporting proficiencies in many of these same areas, including "collaborating across the public health system" and "influencing policies external to the organization that affect community health." There were no areas in which nurse-led staff had lower odds of reporting proficiencies or higher odds of identifying training needs. CONCLUSIONS Findings from this study highlight areas of strength for public health nurses, particularly strengths related to diversity, equity, and inclusion, as well as areas where more training is needed. Such findings can help guide future public health nurse workforce development as well as underscore the value of public health nursing leadership and staff at local health departments for supporting community health.
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Affiliation(s)
- Paula M Kett
- Author Affiliations: Center for Health Workforce Studies, Department of Family Medicine, School of Medicine (Drs Kett and Shahrir); and Department of Child, Family, and Population Health, School of Nursing (Dr Bekemeier), University of Washington, Seattle, Washington
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Adhia A, Pugh D, Lucas R, Rogers M, Kelley J, Bekemeier B. Improving School Environments for Preventing Sexual Violence Among LGBTQ+ Youth. J Sch Health 2024; 94:243-250. [PMID: 37859302 DOI: 10.1111/josh.13406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/18/2023] [Accepted: 09/23/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Sexual violence (SV) is a serious public health concern, and lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ+) youth report higher rates than their heterosexual and cisgender peers. This qualitative study aimed to understand LGBTQ+ students' perspectives on how middle and high school environments can better prevent and address SV. METHODS In partnership with a school-based LGBTQ+ support group in Washington State, we recruited 31 LGTBQ+ students ages 13-18 for virtual interviews (n = 24) and for providing text-based answers to interview questions (n = 7). We used inductive thematic analysis to analyze data and identify themes. RESULTS To prevent and respond to SV, students highlighted schools having: (1) access to gender-neutral spaces; (2) LGBTQ+ competency training for staff; (3) enforcement of school policies (eg, SV, anti-bullying) and accountability; (4) LGBTQ+-competent mental health support; and (5) comprehensive sexual health education that addresses LGBTQ+ relationships and SV. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Students expressed the need for changes in school physical and social environments to address SV among LGBTQ+ youth. CONCLUSIONS Incorporating youth perspectives, particularly LGBTQ+ youth at high risk of SV, can help schools implement strategies that are supported by youth and thus potentially more sustainable and effective.
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Affiliation(s)
- Avanti Adhia
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA
| | - Dylan Pugh
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
| | - Ruby Lucas
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
- Northwest Center for Public Health Practice, University of Washington, Seattle, WA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Megan Rogers
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
- Northwest Center for Public Health Practice, University of Washington, Seattle, WA
| | - Jessi Kelley
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
- Northwest Center for Public Health Practice, University of Washington, Seattle, WA
| | - Betty Bekemeier
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
- Northwest Center for Public Health Practice, University of Washington, Seattle, WA
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Adhia A, Casanova N, Rogers M, Bekemeier B. Using Cognitive Interviews to Adapt Interpersonal Violence Measures for Use With Middle School Youth. J Interpers Violence 2024; 39:897-909. [PMID: 37655633 PMCID: PMC10775639 DOI: 10.1177/08862605231197748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Experiences of interpersonal violence are common among youth. Starting prevention programming early (e.g., middle school) may be beneficial for primary prevention. Evaluating whether such programs are effective often requires collecting self-report data from youth, but many existing measures have been developed for high school and college-aged youth. This study aimed to assess adolescents' comprehension of self-report survey items on interpersonal violence with middle school youth. We conducted virtual cognitive interviews with 15 youth in grades 6 to 8. A content analysis was used to identify patterns and to classify the nature and type of comprehension issues youth experienced. Nearly all students found most questions clear and understandable. We identified the following comprehension issues: (1) uncertainty with how the intent of a perpetrator factored into a victim's experience (e.g., distinguishing the difference between joking and bullying, or intentional versus unintentional behavior); (2) lack of familiarity with certain expressions of sexualized violence (e.g., "sexual looks") or sex-related terminology (e.g., intercourse); and (3) narrow interpretations of question prompts (e.g., interpreting "forced" as physically forced, not psychologically coerced). Students suggested including language describing dating relationships, types of social media platforms where cyber abuse takes place, and additional examples alongside items to enhance relevance and clarity. Survey questions to measure interpersonal violence may need to be adapted for use among middle school youth. Our findings highlight potential considerations for improving the measurement of interpersonal violence in this age group.
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Cullen R, Heitkemper E, Backonja U, Bekemeier B, Kong HK. Designing an infographic webtool for public health. J Am Med Inform Assoc 2024; 31:342-353. [PMID: 37354553 PMCID: PMC10797264 DOI: 10.1093/jamia/ocad105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/24/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE To create and evaluate a public health informatics tool, Florence, for communicating information to the public. MATERIALS AND METHODS This user-centered design study included 3 phases: (1) an interview and survey study with public health practitioners to assess needs for creating infographics; (2) the application of assessment findings and public health-motivated design guidelines to the design and development of a public health-specific infographic design tool; and (3) a feasibility and usability study to evaluate the feasibility and usability of the tool. RESULTS In phase 1, participants noted the importance of tailoring infographics to an audience and wanted flexible tools along with design guidance to help make fewer design decisions. In phase 2, we developed a prototype tool with: (1) layout and functionality familiar to PH users, (2) quick and intuitive ways to add and modify data in visualizations, and (3) health-focused visual elements. In phase 3, participants found Florence to be usable, providing an intuitive and straightforward experience, and that the focus on public health was useful. DISCUSSION Based on needs assessments and existing literature, we created Florence along with public health practitioners to address their domain specific needs, ultimately leading to a tool that participants in our study deemed useful. Future research can build on our work to develop user-centered tools to meet their needs. CONCLUSION Infographics are important for public health communication. Creating user-centered solutions to address the unique needs of public health can support communication efforts.
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Affiliation(s)
- Riley Cullen
- Department of Computer Science, Seattle University, Seattle, Washington, USA
| | | | - Uba Backonja
- Department of Biomedical Informatics Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
- School of Nursing and Healthcare Leadership, University of Washington Tacoma, Tacoma, Washington, USA
| | - Betty Bekemeier
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
| | - Ha-Kyung Kong
- Department of Computer Science, Seattle University, Seattle, Washington, USA
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Kulik PKG, Alperin M, Todd Barrett KS, Bekemeier B, Documet PI, Francis KA, Gloria CT, Healy E, Hileman R, Kenefick HW, Lederer AM, Leider JP, McCormick LC, Prechter L, Reynolds KA, Rogers MH, Rose B, Scallan Walter EJ, Walkner LM, Zemmel DJ, Power LE. The Need for Responsive Workforce Development During the Pandemic and Beyond: A Case Study of the Regional Public Health Training Centers. J Public Health Manag Pract 2024; 30:46-55. [PMID: 37966951 DOI: 10.1097/phh.0000000000001835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
CONTEXT The COVID-19 pandemic underscored the importance of a strong public health infrastructure for protecting and supporting the health of communities. This includes ensuring an adaptive workforce capable of leading through rapidly changing circumstances, communicating effectively, and applying systems thinking to leverage cross-sector partnerships that help promote health equity. The 10 Regional Public Health Training Centers (PHTCs) advance the capacity of the current and future public health workforce through skill development and technical assistance in these and other strategic areas. PROGRAM This study examines activities through which the Regional PHTCs and their partners supported the public health workforce during the pandemic. Representatives of the 10 Regional PHTCs completed a survey in the spring of 2022. The survey included (1) pulling trends in training usage from 2018-2021 annual performance reports and (2) questions assessing the type, content, and reach of training needs assessments, training and technical assistance, student placements, and PHTC Network collaborative activities that occurred from January 1, 2020, to December 31, 2021. Respondents also reflected on trends in use, challenges, lessons learned, stories of impact, and future PHTC practice. EVALUATION During the pandemic, the Regional PHTCs engaged in numerous efforts to assess needs, provide training and technical assistance to the practice community, facilitate projects that built student competency to support public health agency efforts, and collaborate as the PHTC Network on national-level initiatives. Across these activities, the Regional PHTCs adjusted their approaches and learned from each other in order to meet regional needs. DISCUSSION The Regional PHTCs provided student and professional development in foundational public health knowledge and skills within their regions and nationally while being flexible and responsive to the changing needs of the field during the pandemic. Our study highlights opportunities for collaboration and adaptive approaches to public health workforce development in a postpandemic environment.
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Affiliation(s)
- Phoebe K G Kulik
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Mss Kulik and Zemmel and Dr Power); Region IV Public Health Training Center at the Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Alperin); New England Public Health Training Center at the Boston University School of Public Health, Boston, Massachusetts (Ms Todd Barrett and Dr Kenefick); Northwest Center for Public Health Practice at the University of Washington (UW) School of Public Health, Seattle, Washington (Dr Bekemeier and Mss Rogers and Rose); UW School of Nursing, Seattle, Washington (Dr Bekemeier); Mid-Atlantic Regional Public Health Training Center, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania (Dr Documet and Ms Francis); Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania (Dr Documet); Region 2 Public Health Training Center and Department of Sociomedical Sciences at the Columbia University Mailman School of Public Health, New York City, New York (Dr Gloria); Region IX Western Region Public Health Training Center at the University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona (Mr Healy and Dr Reynolds); Midwestern Public Health Training Center and the Institute for Public Health Practice, University of Iowa College of Public Health, Iowa City, Iowa (Mr Hileman and Ms Walkner); Department of Applied Health Science at Indiana University's School of Public Health, Bloomington, Indiana (Dr Lederer); formerly the Region 6 South Central Public Health Training Center at Tulane University's School of Public Health and Tropical Medicine, New Orleans, Louisiana (Dr Lederer); Region V Public Health Training Center and Center for Public Health Systems in the Division of Health Policy and Management at the University of Minnesota School of Public Health, Minneapolis, Minnesota (Dr Leider); Region IV Public Health Training Center, Office of Public Health Practice, and Department of Health Policy and Organization at the University of Alabama at Birmingham School of Public Health, Birmingham, Alabama (Dr McCormick); National Coordinating Center for Public Health Training at the National Network of Public Health Institutes, New Orleans, Louisiana (Ms Prechter); and Rocky Mountain Public Health Training Center, the Colorado Integrated Food Safety Center of Excellence, and the Department of Epidemiology at the University of Colorado Anschutz Medical Campus Colorado School of Public Health, Aurora, Colorado (Dr Scallan Walter)
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Walker SC, Baquero B, Bekemeier B, Parnes M, Arora K. Strategies for enacting health policy codesign: a scoping review and direction for research. Implement Sci 2023; 18:44. [PMID: 37735397 PMCID: PMC10512571 DOI: 10.1186/s13012-023-01295-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Strategies for supporting evidence-informed health policy are a recognized but understudied area of policy dissemination and implementation science. Codesign describes a set of strategies potentially well suited to address the complexity presented by policy formation and implementation. We examine the health policy literature describing the use of codesign in initiatives intended to combine diverse sources of knowledge and evidence in policymaking. METHODS The search included PubMed, MEDLINE, PsychInfo, CINAHL, Web of Science, and Google Scholar in November 2022 and included papers published between 1996 and 2022. Terms included codesign, health, policy, and system terminology. Title and abstracts were reviewed in duplicate and included if efforts informed policy or system-level decision-making. Extracted data followed scoping review guidelines for location, evaluation method, health focus, codesign definition, description, level of health system user input, sectors involved, and reported benefits and challenges. RESULTS From 550 titles, 23 citations describing 32 policy codesign studies were included from multiple continents (Australia/New Zealand, 32%; UK/Europe, 32%; South America, 14%; Africa, 9%; USA/Canada 23%). Document type was primarily case study (77%). The area of health focus was widely distributed. Policy type was more commonly little p policy (47%), followed by big p policy (25%), and service innovations that included policy-enabled funding (25%). Models and frameworks originated from formal design (e.g., human-centered or participatory design (44%), political science (38%), or health service research (16%). Reported outcomes included community mobilization (50%), policy feasibility (41%), improved multisector alignment (31%), and introduction of novel ideas and critical thinking (47%). Studies engaging policy users in full decision-making roles self-reported higher levels of community mobilization and community needs than other types of engagement. DISCUSSION Policy codesign is theoretically promising and is gaining interest among diverse health sectors for addressing the complexity of policy formation and implementation. The maturity of the science is just emerging. We observed trends in the association of codesign strategies and outcomes that suggests a research agenda in this area could provide practical insights for tailoring policy codesign to respond to local contextual factors including values, needs, and resources.
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Affiliation(s)
- Sarah Cusworth Walker
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 356560, Seattle, USA.
| | - Barbara Baquero
- School of Public Health, University of Washington, 3980 15th Ave, Box 351621, Seattle, NE, USA
| | - Betty Bekemeier
- School of Nursing, University of Washington, Box 357263, Seattle, USA
| | - McKenna Parnes
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 356560, Seattle, USA
| | - Kashika Arora
- Seattle Children's Hospital, 6901 Sand Point Way NE, Seattle, WA, 98115, USA
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Bekemeier B, Heitkemper E, Backonja U, Whitman G, Schultz M, Jiang Y, Baquero B, Turner AM. Rural Public Health Data Challenges During the COVID-19 Pandemic: The Case for Building Better Systems Ahead of a Public Health Crisis. J Public Health Manag Pract 2023; 29:496-502. [PMID: 36867496 DOI: 10.1097/phh.0000000000001726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
CONTEXT Rural public health personnel serve communities that have been particularly susceptible to COVID-19 and yet faced the pandemic with far less well-resourced capacity than their urban counterparts. A critical aspect of addressing local health inequities is access to high-quality population data and the capacity to effectively use data to support decision making. However, much of the data required to investigate inequities are not readily available to rural local health departments and the tools and training to analyze data are often lacking. PROGRAM The purpose of our effort was to explore rural data challenges related to COVID-19 and provide recommendations for improving rural data access and capacity ahead of future crises. IMPLEMENTATION We gathered qualitative data in 2 phases, more than 8 months apart, from rural public health practice personnel. Initial data were gathered in October-November 2020 regarding rural public health data needs during the COVID-19 pandemic and then to later identify whether the same findings held true in July 2021 or whether access to and capacity to use data to address the pandemic and related inequities improved as the pandemic progressed. EVALUATION In our 4-state exploration focused on access and use of data among rural public health systems to promote health equity in the Northwest United States, we found tremendous and ongoing unmet data needs, challenges with communicating data, and a lack of capacity to meet this public health crisis. DISCUSSION Recommendations for addressing these challenges include increasing dedicated resources specifically to rural public health systems, improving data access and infrastructure, and providing dedicated data-related workforce development.
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Affiliation(s)
- Betty Bekemeier
- Schools of Nursing (Drs Bekemeier and Backonja and Mr Whitman), Public Health (Drs Bekemeier, Baquero, and Turner), and Medicine (Drs Backonja and Turner), University of Washington, Seattle, Washington; School of Nursing, University of Texas, Austin (Dr Heitkemper); University of Wisconsin-Madison, Madison, Wisconsin (Ms Schultz); School of Nursing and Healthcare Leadership, University of Washington Tacoma, Tacoma, Washington (Dr Backonja); and Carnegie Mellon University, Pittsburgh, Pennsylvania (Ms Jiang)
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Kett PM, Bekemeier B, Patterson DG, Schaffer K. Competencies, Training Needs, and Turnover Among Rural Compared With Urban Local Public Health Practitioners: 2021 Public Health Workforce Interests and Needs Survey. Am J Public Health 2023; 113:689-699. [PMID: 37196230 DOI: 10.2105/ajph.2023.307273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Objectives. To compare rural versus urban local public health workforce competencies and training needs, COVID-19 impact, and turnover risk. Methods. Using the 2021 Public Health Workforce Interest and Needs Survey, we examined the association between local public health agency rural versus urban location in the United States (n = 29 751) and individual local public health staff reports of skill proficiencies, training needs, turnover risk, experiences of bullying due to work as a public health professional, and posttraumatic stress disorder symptoms attributable to COVID-19. Results. Rural staff had higher odds than urban staff of reporting proficiencies in community engagement, cross-sectoral partnerships, and systems and strategic thinking as well as training needs in data-based decision-making and in diversity, equity, and inclusion. Rural staff were also more likely than urban staff to report leaving because of stress, experiences of bullying, and avoiding situations that made them think about COVID-19. Conclusions. Our findings demonstrate that rural staff have unique competencies and training needs but also experience significant stress. Public Health Implications. Our findings provide the opportunity to accurately target rural workforce development trainings and illustrate the need to address reported stress and experiences of bullying. (Am J Public Health. 2023;113(6):689-699. https://doi.org/10.2105/AJPH.2023.307273).
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Affiliation(s)
- Paula M Kett
- Paula M. Kett and Davis G. Patterson are with the Center for Health Workforce Studies, Department of Family Medicine, and Betty Bekemeier is with the School of Nursing, University of Washington, Seattle. Kay Schaffer is with the de Beaumont Foundation, Bethesda, MD
| | - Betty Bekemeier
- Paula M. Kett and Davis G. Patterson are with the Center for Health Workforce Studies, Department of Family Medicine, and Betty Bekemeier is with the School of Nursing, University of Washington, Seattle. Kay Schaffer is with the de Beaumont Foundation, Bethesda, MD
| | - Davis G Patterson
- Paula M. Kett and Davis G. Patterson are with the Center for Health Workforce Studies, Department of Family Medicine, and Betty Bekemeier is with the School of Nursing, University of Washington, Seattle. Kay Schaffer is with the de Beaumont Foundation, Bethesda, MD
| | - Kay Schaffer
- Paula M. Kett and Davis G. Patterson are with the Center for Health Workforce Studies, Department of Family Medicine, and Betty Bekemeier is with the School of Nursing, University of Washington, Seattle. Kay Schaffer is with the de Beaumont Foundation, Bethesda, MD
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Dada OO, Bekemeier B, Flaxman A, de Castro A. Association Between Local Boards of Health Authority Over Budgets and PHAB Accreditation Standard Score. AJPM Focus 2023; 2:100070. [PMID: 37790650 PMCID: PMC10546599 DOI: 10.1016/j.focus.2023.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction This study examined the relationship between local board of health authority and local health departments' budget-related activities and performance scores in the Public Health Accreditation Board standards while considering the governance structure under which the local health agencies operate. Methods Data from 250 local health departments were obtained from the Public Health Accreditation Board and were combined with data from the 2016 National Association of County and City Officials Profile Survey. Multilevel regression analysis was used to examine the relationship between local board of health authority on local health departments' budget-related activities, using the governance structure as the group-level variable. Results Analyses identified positive associations between local board of health authority on local health departments' budget-related activities and local health departments' aggregate average performance scores in Public Health Accreditation Board accreditation. No apparent association was found between the type of governance structure under which a local health department operates and performance scores in Public Health Accreditation Board accreditation standards, perhaps attributable to variation in the characteristics and roles of their governing bodies. Conclusions The analyses suggest that local boards of health with authority related to local health departments' budgets appear to have an influential role in budget-related activities and may improve local health departments' performance scores in Public Health Accreditation Board accreditation standards. However, vast variations in more specific local boards of health roles and characteristics exist across local health departments and for which there are no national data. More research is thus needed to control for or examine the influences of specific local boards of health characteristics before the benefits of expanded local boards of health authority over local health departments' budgetary decision making on local health departments' performance can be fully understood.
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Affiliation(s)
- Oluwatosin O. Dada
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, Washington
| | - Betty Bekemeier
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, Washington
| | - Abraham Flaxman
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington
| | - A.B. de Castro
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, Washington
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Petrovskis A, Bekemeier B, van Draanen J, Heitkemper E. Grouping Public Health Skills to Facilitate Workforce Development: A Factor Analysis of PH WINS. J Public Health Manag Pract 2023; 29:E79-E89. [PMID: 36731059 DOI: 10.1097/phh.0000000000001613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study examined whether distinct factors exist among public health skills, measured through the Public Health Workforce Interests and Needs Survey (PH WINS). Understanding how workforce training needs group is important for developing targeted and appropriate public health workforce training sessions. DESIGN Exploratory factor analysis was used to examine public health skills among tier 1 staff (nonmanagers) and a combined group of tier 2 and 3 staff (managers and executives). SETTING Data for this study come from the 2017 PH WINS, which assessed public health workforce perceptions of training needs, workplace environment, job satisfaction, perceptions about national trends, and demographics. The analysis included 22 items. PARTICIPANTS All public health staff in participating agencies were eligible to complete the survey. The national data set included participants from 47 state health agencies, 26 large local health departments (LHDs), and 71 mid-sized LHDs across all 10 Health and Human Services regions in the United States (including LHDs from all states). The analytic sample was n = 9630 in tier 1, n = 4829 in tier 2, and n = 714 in tier 3 staff. MAIN OUTCOME MEASURE Three factors were identified within the skills portion of PH WINS, using exploratory factor analysis. To interpret retained factors, the following parameters were used: factor loadings greater than 0.4, factor cross-loadings less than 0.4 or higher than loadings on other factors, and communalities greater than 0.5. RESULTS Factors included (1) data and systems thinking, (2) planning and management, and (3) community collaboration, with slight variation in item loadings between tier 1 and tier 2 and 3 staff analyses. CONCLUSION This study was the first known factor analysis of the training needs and workforce skills portion of PH WINS in the published literature. This study advances our conceptualization of public health workforce skills and has the potential to shape future critical workforce training development.
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Affiliation(s)
- Anna Petrovskis
- School of Nursing, University of Washington, Seattle, Washington (Dr Petrovskis and Drs Bekemeier and van Draanen); and School of Nursing, University of Texas at Austin, Austin, Texas (Dr Heitkemper)
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Bekemeier B, Heitkemper E, Zaichkin DL, Whitman G, Singh SR, Leider JP. A Uniform Chart of Accounts: Strengthening Public Health Practice and Research Through Standardized Financial Data. J Public Health Manag Pract 2023; 29:E69-E78. [PMID: 36477581 DOI: 10.1097/phh.0000000000001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT The COVID-19 pandemic made the long-standing need for a national uniform financial reporting standard for governmental public health agencies clear, as little information was available to quantify state and local public health agencies' financial needs during the pandemic response. Such a uniform system would also inform resource allocation to underresourced communities and for specific services, while filling other gaps in practice, research, and policy making. This article describes lessons learned and recommendations for ensuring broad adoption of a national Uniform Chart of Accounts (UCOA) for public health departments. PROGRAM Leveraging previous efforts, the UCOA for public health systems was developed through collaboration with public health leaders. The UCOA allows state and local public health agencies to report spending on activities and funding sources, along with practice-defined program areas and capabilities. IMPLEMENTATION To date, 78 jurisdictions have utilized the UCOA to crosswalk financial information at the program level, enabling comparisons with peers. EVALUATION Jurisdictions participating in the UCOA report perceptions of substantial up-front time investment to crosswalk their charts of accounts to the UCOA standard but derive a sense of valuable potential for benchmarking against peers, ability to engage in resource allocation, use of data for accountability, and general net positive value of engagement with the UCOA. IMPLICATIONS FOR POLICY AND PRACTICE The UCOA is considered a need among practice partners. Implementing the UCOA at scale will require government involvement, a reporting requirement and/or incentives, technical assistance, financial support for agencies to participate, and a means of visualizing the data.
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Affiliation(s)
- Betty Bekemeier
- University of Washington School of Nursing, Seattle, Washington (Dr Bekemeier and Mr Whitman); School of Nursing, The University of Texas at Austin, Austin, Texas (Dr Heitkemper); Pacific Lutheran University School of Nursing, Tacoma, Washington (Dr Zaichkin); School of Public Health, University of Michigan, Ann Arbor, Michigan (Dr Singh); and School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider)
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12
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Orr JM, Leider JP, Kuehnert P, Bekemeier B. COVID-19 Revealed Shortcomings Of The US Public Health System And The Need To Strengthen Funding And Accountability. Health Aff (Millwood) 2023; 42:374-382. [PMID: 36877906 DOI: 10.1377/hlthaff.2022.01234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
The US governmental public health system, which includes federal, state, and local agencies, is seen by many observers as having a money problem, stemming from a lack of resources. During the COVID-19 pandemic, this lack of resources has had unfortunate consequences for the communities that public health practice leaders are expected to protect. Yet the money problem is complex and involves understanding the nature of chronic public health underinvestment, identifying what money is spent in public health and what the country gets for it, and determining how much money is needed to do the work of public health in the future. This Commentary elucidates each of these issues and provides recommendations for making public health services more financially sustainable and accountable. Well-functioning public health systems require adequate funding, but a modernized public health financial data system is also key to the systems' success. There is a great need for standardization and accountability in public health finance, along with incentives and the generation of research evidence demonstrating the value of and most effective delivery for a baseline of public health services that every community should expect.
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Affiliation(s)
- Jason M Orr
- Jason M. Orr, University of Minnesota, Minneapolis, Minnesota
| | | | - Paul Kuehnert
- Paul Kuehnert, Public Health Accreditation Board, Alexandria, Virginia
| | - Betty Bekemeier
- Betty Bekemeier , University of Washington, Seattle, Washington
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13
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Petrovskis A, Bekemeier B, Heitkemper E, van Draanen J. The DASH model: Data for addressing social determinants of health in local health departments. Nurs Inq 2023; 30:e12518. [PMID: 35982547 DOI: 10.1111/nin.12518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 01/25/2023]
Abstract
Recent frameworks, models, and reports highlight the critical need to address social determinants of health for achieving health equity in the United States and around the globe. In the United States, data play an important role in better understanding community-level and population-level disparities particularly for local health departments. However, data-driven decision-making-the use of data for public health activities such as program implementation, policy development, and resource allocation-is often presented theoretically or through case studies in the literature. We sought to develop a preliminary model that identifies the factors that contribute to data-driven decision-making in US local health departments and describe relationships between them. Guided by implementation science literature, we examined organizational-level capacity and individual-level factors contributing to using data for decision-making related to social determinants of health and the reduction of county-level disparities. This model has the potential to improve implementation of public health interventions and programs aimed at upstream structural factors, by elucidating the factors critical to incorporating data in decision-making.
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Affiliation(s)
- Anna Petrovskis
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Betty Bekemeier
- School of Nursing, University of Washington, Seattle, Washington, USA
| | | | - Jenna van Draanen
- School of Nursing, University of Washington, Seattle, Washington, USA
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Kulik PKG, Leider JP, Rogers M, Karnik H, Power LE, Schaffer K, Bekemeier B. PH WINS for All: The Critical Role of Partnerships for Engaging All Local Health Departments in the Public Health Workforce Interests and Needs Survey. J Public Health Manag Pract 2023; 29:S48-S53. [PMID: 36223512 PMCID: PMC10573110 DOI: 10.1097/phh.0000000000001635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The 2021 "PH WINS for All" pilot sought to address a rural research gap by including small local health departments in the Public Health Workforce Interests and Needs Survey (PH WINS) for the first time. To do so, the de Beaumont Foundation partnered with the Public Health Training Centers in Health and Human Services Regions V and X. This article describes the collaborative efforts that made the PH WINS for All pilot successful, presents respondent demographics by agency size, and discusses the importance of gathering such data to address the unique needs of the workforce in small local health departments.
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Affiliation(s)
- Phoebe K. G. Kulik
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Jonathon P. Leider
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Megan Rogers
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Harshada Karnik
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Laura E. Power
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Kay Schaffer
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
| | - Betty Bekemeier
- Region V Public Health Training Center and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan (Ms Kulik and Dr Power); Region V Public Health Training Center and Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota (Drs Leider and Karnik); de Beaumont Foundation, Bethesda, Maryland (Ms Schaffer); and Northwest Center for Public Health Practice, University of Washington School of Public Health, Seattle, Washington (Ms Rogers and Dr Bekemeier)
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15
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Kett PM, Bekemeier B, Herting JR, Altman MR. Advancing health equity: Organizational characteristics emphasized by health department nurse lead executives. Public Health Nurs 2022; 39:1308-1317. [PMID: 35714667 DOI: 10.1111/phn.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare nurse and non-nurse lead executives' relationship with organizational characteristics supporting performance and health equity in local health departments (LHD). DESIGN This was a cross-sectional quantitative study. SAMPLE The final national sample consisted of 1447 LHDs using the 2019 Profile of Local Health Departments survey. MEASUREMENTS We used multivariable logistic and negative binomial regression analyses to explore the relationship between nurse versus non-nurse LHD lead executives and involvement in ten organizational characteristics including community health assessment (CHA) and community health improvement plan (CHIP) completion and policy activities related to the social determinants of health (SDOH). RESULTS Multivariable logistic regression models showed that, for nurse lead executives, the odds of having completed a CHA is 1.49 times, and the odds of having completed a CHIP is 1.56 times, that of non-nurse lead executives. Negative binomial regression models predicted nurse lead executives, compared to non-nurses, to perform 1.18 times more SDOH-related policy activities. CONCLUSION Results suggest that nurse lead executives are more likely than non-nurses to emphasize assessment in their work and engage in upstream-focused policy activities. As such, they are important partners in work to facilitate health equity.
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Affiliation(s)
- Paula M Kett
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Betty Bekemeier
- Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Jerald R Herting
- Department of Sociology, College of Arts and Sciences, University of Washington, Seattle, Washington, USA
| | - Molly R Altman
- Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
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Dada OO, Bekemeier B, Flaxman A, de Castro B. Local Health Departments' Characteristics and Their Performance Scores in PHAB Accreditation Standards. J Public Health Manag Pract 2022; 28:375-383. [PMID: 35045009 DOI: 10.1097/phh.0000000000001458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Local health departments (LHDs) function to promote and protect population health by executing programs and activities through the 10 essential public health (PH) services in their operationalization of the core functions of PH systems-assessment, policy development, and assurance. PH accreditation supports LHDs by assessing their ability to promote community well-being through a set of standards and measures based on the 10 essential PH services. Prior studies show variation in LHD characteristics relative to their likelihood of participating in accreditation, but no studies have examined the variation in LHD accreditation scores to understand how LHD characteristics relate to performance improvement. OBJECTIVE This work examines variation in LHD accreditation scores relative to their organizational and jurisdiction characteristics. DESIGN Cross-sectional data were obtained from 250 LHDs from 38 states that underwent Public Health Accreditation Board (PHAB) accreditation review. ANALYSIS We used exploratory cluster analysis to identify and group LHDs with similar performance scores in PHAB accreditation standards. Descriptive analyses were undertaken to characterize each LHD cluster group's organizational structure, jurisdiction characteristics, and core PH function activity levels. We then employed multivariate regression analysis to confirm the cluster analysis results. RESULTS The analysis showed 3 clusters of PHAB accreditation performance scores (cluster 1 = 0.95; cluster 2 = 0.87; and cluster 3 = 0.71). Subtle differences in organizational and jurisdiction characteristics across clusters, notably in population size of the jurisdictions served, were observed. LHDs in cluster 3 tended to have jurisdictions with less than 250000 population size and serve more than 1 county. CONCLUSIONS Performance scores in PHAB accreditation can be a useful standardized metric for assessing LHD ability to promote community well-being. LHDs serving less than 20000 population size, which exhibit relatively lower performance than other LHDs, may require more targeted supports to close the gap in their performance score.
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Affiliation(s)
- Oluwatosin Omolara Dada
- University of Washington School of Nursing, Seattle, Washington (Drs Dada, Bekemeier, and de Castro); and University of Washington Department of Global Health, Seattle, Washington (Dr Flaxman)
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Lim S, Pintye J, Seong H, Bekemeier B. Estimating the Association Between Public Health Spending and Sexually Transmitted Disease Rates in the United States: A Systematic Review. Sex Transm Dis 2022; 49:462-468. [PMID: 35312659 DOI: 10.1097/olq.0000000000001627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Public health spending is important for managing increases in sexually transmitted diseases (STDs) in the United States. Although previous studies suggest that a beneficial link exists between public health spending and changes in STD rates, there have been no systematic reviews synthesizing existing evidence regarding the association for STDs at the population level. The objective of this study was to synthesize evidence from studies that assessed the associations between general and STD-specific public health spending and STD rates. We conducted a systematic review using Ovid-Medline, EMBASE, CINAHL, Cochrane Library, Web of Science, and EconLit for relevant studies that examined the association between public health spending and gonorrhea, syphilis, chlamydia, and chancroid rates following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 5 articles (2 regarding general public health spending and 3 regarding STD-specific public health spending) met our inclusion criteria. There was a significant decrease in gonorrhea, syphilis, chlamydia, and chancroid rates associated with increased public health spending. We also found that STD-specific public health spending has a greater effect on STD rates compared with general public health spending. Our review provides evidence that increases in general and STD-specific public health spending are associated with a reduction of STD rates. Such research regarding estimates of the impact of STD prevention spending can help policy makers identify priority funding areas and inform health resource allocation decisions.
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Affiliation(s)
- Sungwon Lim
- From the Departments of Child, Family, and Population Health
| | - Jillian Pintye
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA
| | - Hohyun Seong
- School of Nursing, University of Maryland, Baltimore, MD
| | - Betty Bekemeier
- From the Departments of Child, Family, and Population Health
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18
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Dada OO, Bekemeier B, Flaxman A, de Castro AB. Associations Between Local Health Department Expenditures on Foundational Capabilities and PHAB Accreditation Standards Scores. Front Public Health 2022; 10:861587. [PMID: 35692346 PMCID: PMC9174657 DOI: 10.3389/fpubh.2022.861587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/27/2022] [Indexed: 02/03/2023] Open
Abstract
Context Foundational Capabilities (FC) are the public health (PH) infrastructure areas that are essential for local health departments (LHDs) to support a "minimum package" of programs and services that promote population health. Despite being a critical component of LHD programs, FC are chronically underfunded, and studies specific to the relationship between LHD FC expenditures and their performance-the LHDs' ability to provide essential PH programs and services to their community-have not been previously reported. Public Health Accreditation Board (PHAB) accreditation is a nationally recognized accreditation program for PH agencies. PHAB accreditation assesses LHDs' performance against sets of standards that are based on the 10 essential PH services. Alignment between FC and the PHAB standards presents a means for assessing LHD FC expenditures relative to their performance in PHAB accreditation standards. Objectives We examined the association between LHD total FC expenditures, as well as FC funding allocation patterns, and performance score on selected PHAB accreditation standards. Methods We used Bayesian regression methods to estimate the coefficients for the aggregate performance score, and performance scores on individual PHAB standards. Results Analyses showed that a dollar increase in total FC expenditures is associated with a 0.2% increase in the aggregate performance score in selected PHAB standards as well as the performance score on most of the standards examined. LHDs that allocated FC budgets more evenly across FC programs were found to be more likely to have higher scores. Conclusions Investment in FC could improve LHD performance scores in PHAB accreditation standards and support LHDs' capability for improving community health outcomes. Allocating available FC resources across the various FC programs could support better LHD performance, as indicated by accreditation scores. This study contributes to advancing the understanding of public health finances in relation to performance and could help guide effective LHD resource allocation.
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Affiliation(s)
- Oluwatosin O. Dada
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States,*Correspondence: Oluwatosin O. Dada
| | - Betty Bekemeier
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
| | - Abraham Flaxman
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States,Department of Global Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - A. B. de Castro
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
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19
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Kett PM, Bekemeier B, Altman MR, Herting JR. "Not everybody approaches it that way": Nurse-trained health department directors' leadership strategies and skills in public health. Nurs Inq 2022; 29:e12487. [PMID: 35266247 DOI: 10.1111/nin.12487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
Evidence points to nurses as possessing particular skills which are important for public health leadership; in particular, investigators have found that a nurse public health director is strongly associated with positive health department performance. To better understand this association and to guide the effective deployment of nurse leaders, researchers sought to explore the specific leadership strategies used by nurse public health directors, using a critical thematic analysis approach to examine these leadership strategies in the context of certain ideologies, power differentials, and social hierarchies. Data were collected via semistructured interviews conducted from July to September 2020 with 13 nurse public health directors from across the United States. Major themes illustrate a distinct picture of the nursing approach to public health leadership: (a) approaching their work with an other-focused lens, (b) applying theoretical knowledge, (c) navigating the political side of their role, and (d) leveraging their nursing identity. Findings articulate the nurse public health director's distinctive combination of skills which reflect the interprofessional nature of public health nursing practice. Such skills demonstrate a specialized approach that may set nurse leaders apart from other types of leaders in carrying out significant public health work.
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Affiliation(s)
- Paula M Kett
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Betty Bekemeier
- Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Molly R Altman
- Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Jerald R Herting
- Department of Sociology, University of Washington, Seattle, Washington, USA
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20
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Walker SC, White J, Rodriguez V, Turk E, Gubner N, Ngo S, Bekemeier B. Cocreating evidence-informed health equity policy with community. Health Serv Res 2022; 57 Suppl 1:137-148. [PMID: 35239188 PMCID: PMC9108222 DOI: 10.1111/1475-6773.13940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To explore the feasibility of a rapid, community‐engaged strategy to prioritize health equity policy options as informed by research evidence, community‐voiced needs, and public health priorities. Data Sources Data came from residents in a midsized, demographically, and geographically diverse county over a period of 8 months in 2020 and an evidence review of the health equity policy literature during the same time period. Study Design A descriptive case study is used to explore the feasibility and potential value of a community codesigned approach to establish community priorities for health equity policy. Data Collection/Extraction Methods Evidence synthesis of health equity policy was conducted parallel to 15 community listening sessions across the county to elicit information on health needs. We used scoping review methods to obtain literature from academic databases and scholarly public health and policy organizations. This information was cross walked with themes from the listening sessions to identify 10 priority policy areas, which were taken back to the community for 15 participatory discussion and ranking sessions. Principal Findings The process appeared to authentically engage the input of 200 community members representative of minoritized groups while identifying 99 evidence‐informed policy levers to promote health equity. Discussion and ranking activities were successful in facilitating community discussion and policy decision making. Remote platforms may have limited the engagement of some residents while promoting the participation of others. Conducting information integration within the research team prior to community policy ranking sessions limited the community ownership over how policies were interpreted and communicated. Conclusions A combination of information integration and community ranking activities can be used to achieve community‐engaged policy prioritization of options in a fairly rapid period of time. While this process provides an example of authentic community ownership of policy prioritization, the compressed timeline limited the community's engagement in the information integration phase.
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Affiliation(s)
- Sarah Cusworth Walker
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Johnna White
- Tacoma-Pierce County Health Department, Tacoma, Washington, USA
| | | | - Emily Turk
- Department of Psychiatry and Behavioral Sciences, University of Washington Seattle Campus, Seattle, Washington, USA
| | - Noah Gubner
- Department of Psychiatry and Behavioral Sciences, University of Washington Seattle Campus, Seattle, Washington, USA
| | - Sally Ngo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Betty Bekemeier
- School of Public Health, University of Washington, Seattle, Washington, USA
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21
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Kett PM, Bekemeier B, Herting JR, Altman MR. Addressing Health Disparities: The Health Department Nurse Lead Executive's Relationship to Improved Community Health. J Public Health Manag Pract 2022; 28:E566-E576. [PMID: 34475368 DOI: 10.1097/phh.0000000000001425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
CONTEXT The nurse-trained local health department (LHD) lead executive has been shown to be positively associated with LHD performance; however, no other research has explored whether this association translates to improved community health. OBJECTIVE To investigate the relationship between the type of LHD leadership-whether or not the lead executive is a nurse-and changes in health outcomes. DESIGN This study used a multivariate panel time series design. Each model was estimated as a pooled time series and using time and unit fixed effects, with a 1-year lag used for all covariates and the main predictor. SETTING A national, county-level data set was compiled containing variables pertaining to the LHD, community demographics, and health outcomes for the years 2010-2018. PARTICIPANTS The unit of analysis was the LHD. The data set was restricted to those counties with measurable mortality rates during at least 8 of the 9 time periods of the study, resulting in a total of 626 LHDs. MAIN OUTCOME MEASURES The outcomes of interest were changes in 15- to 44-year-old all-cause mortality, infant mortality, and entry into prenatal care. RESULTS In models with combined time and unit fixed effects, a significant relationship exists between a nurse-led LHD and reduced mortality in the 15- to 44-year-old Black population (-5.2%, P < .05) and a reduction in the Black-White mortality ratio (-6%, P < .05). In addition, there is a relationship between the nurse-led LHD and a reduction in the percentage of the population with late or no entry to prenatal care. CONCLUSIONS The evidence presented here helps connect the known positive association between nurse lead executives and LHD performance to improvements in community health. It suggests that nurse leaders are associated with health improvements in line with addressing health inequities.
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Affiliation(s)
- Paula M Kett
- Department of Child, Family, and Population Health, School of Nursing (Drs Kett, Bekemeier, and Altman), and Department of Sociology, College of Arts and Sciences (Dr. Herting), University of Washington, Seattle, Washington
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22
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Petrovskis A, Baquero B, Bekemeier B. Involvement of Local Health Departments in Obesity Prevention: A Scoping Review. J Public Health Manag Pract 2022; 28:E345-E353. [PMID: 33729187 PMCID: PMC8781226 DOI: 10.1097/phh.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Local health department (LHD) obesity prevention (OP) efforts, particularly by rural LHDs, are seemingly uncommon, in part, due to limited infrastructure, workforce capacity, accessible data, and available population-level interventions aimed at social determinants of health (SDOH). METHODS We conducted a scoping review to determine LHD roles in OP efforts and interventions. Inclusion criteria were articles including evidence-based OP and LHD leaders or staff. Articles were coded by type of LHD involvement, data use, intervention characteristics, use of an SDOH lens, and urban or rural setting. RESULTS We found 154 articles on LHD OP-52 articles met inclusion criteria. Typically, LHDs engaged in only surveillance, initial intervention development, or evaluation and were not LHD led. Data and SDOH lens use were infrequent, and interventions typically took place in urban settings. CONCLUSION LHDs could likely play a greater role in OP and population-level interventions and use data in intervention decision making. However, literature is limited. Future research should focus on LHD capacity building, including academic-public health partnerships. Studies should include rural populations, data, and SDOH frameworks addressing "upstream" factors.
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Affiliation(s)
- Anna Petrovskis
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
| | - Barbara Baquero
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
| | - Betty Bekemeier
- School of Nursing (Ms Petrovskis and Dr Bekemeier), and Department of Health Services, School of Public Health (Dr Baquero), University of Washington, Seattle, Washington
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23
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Viall AH, Bekemeier B, Yeager V, Carton T. Dance of Dollars: State Funding Effects on Local Health Department Expenditures. J Public Health Manag Pract 2022; 28:E577-E585. [PMID: 34475369 PMCID: PMC8810718 DOI: 10.1097/phh.0000000000001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We examined changes in total local health department (LHD) expenditures in the state of Washington following introduction of a new state funding program to support core public health services and infrastructure. METHODS We used a pre/posttest design regression model to evaluate changes in LHD expenditures 1, 2, and 6 years into the new state program. To address potential endogeneity in the model, we repeated all 3 analyses using 2-stage least squares regression. RESULTS In the base case, overall spending among LHDs significantly increased with receipt of the new state funds in the first years of the program (2008 and 2009). However, those increases were not sustained over the longer term (2013). In subpopulation analyses, total LHD spending increased more among larger LHDs. CONCLUSIONS Between 2006 and 2013, new state investments in core public health functions increased Washington State LHD expenditures in the short term, but those increases did not persist over time. For public health financial modernization efforts to translate into public health infrastructure modernization successes, the way new investments are structured may be as important as the amount of funding added.
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Affiliation(s)
- Abigail H. Viall
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Betty Bekemeier
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Valerie Yeager
- Department of Health Management and Policy, Richard M. Fairbanks School of Public Health, Indiana University, Bloomington, IN, USA
| | - Thomas Carton
- Louisiana Public Health Institute, New Orleans, LA, USA
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Grembowski D, Lim S, Pantazis A, Bekemeier B. Analytic Approaches to Assess the Impact of Local Spending on Sexually Transmitted Diseases. Health Serv Res 2021; 57:644-653. [PMID: 34806188 DOI: 10.1111/1475-6773.13915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/31/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the estimated associations between annual STD (sexually transmitted diseases) expenditures per capita and STD rates among Florida and Washington local health departments (LHDs) from 2001-2017, using two approaches--a longitudinal regression model with lagged STD spending, and a regression model with the Arellano-Bond panel estimator. DATA SOURCES Secondary data for LHDs were obtained from Florida and Washington state government offices and combined with county sociodemographic and health system data from the federal government. STUDY DESIGN We examined LHDs in Florida and Washington using a longitudinal panel study design to estimate ecological relationships between annual STD expenditures per capita and annual STD incidence rates from 2001 to 2017 with LHDs as the unit of analysis. We compared two regression models: generalized estimating equations (GEE) and the Arellano-Bond panel estimator (an instrumental variable approach). DATA COLLECTION The secondary data were combined to build a longitudinal panel database for LHDs in Florida and Washington from 2001 to 2017. PRINCIPAL FINDINGS In the GEE model with both states, greater STD spending in a prior year was associated unexpectedly with greater STD incidence rates in succeeding years. The Arellano-Bond models for both states had the expected inverse associations but were not significant. In the Arellano-Bond models for Florida, a $1 increase in STD spending in previous years was followed by decreases in STD incidence rates ranging between 29 and 59 points in succeeding years (0.09 ≥ p ≥ 0.04). CONCLUSIONS In longitudinal panel data for LHDs in two states, the Arellano-Bond estimator, or other instrumental variable approach, is preferred over conventional regression models to obtain unbiased estimates of the relationship between annual STD spending rates and annual STD rates. Future studies will require accurate, standardized, and detailed longitudinal data and rigorous analytic approaches, such as those illustrated in our study. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- David Grembowski
- Department of Health Systems and Population Health, University of Washington, Hans Rosling Center, 3980 15th Avenue NE, Box 351622, Seattle, WA, United States
| | - Sungwon Lim
- Department of Child, Family and Population Health Nursing, School of Nursing, University of Washington, Box 357263, 1959 NE Pacific Street, Seattle, WA, United States
| | | | - Betty Bekemeier
- Department of Health Systems and Population Health, University of Washington, Hans Rosling Center, 3980 15th Avenue NE, Box 351622, Seattle, WA, United States.,Department of Child, Family and Population Health Nursing, School of Nursing, University of Washington, Box 357263, 1959 NE Pacific Street, Seattle, WA, United States
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Park S, Bekemeier B, Flaxman A, Schultz M. Impact of data visualization on decision-making and its implications for public health practice: a systematic literature review. Inform Health Soc Care 2021; 47:175-193. [PMID: 34582297 DOI: 10.1080/17538157.2021.1982949] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Data visualization tools have the potential to support decision-making for public health professionals. This review summarizes the science and evidence regarding data visualization and its impact on decision-making behavior as informed by cognitive processes such as understanding, attitude, or perception.An electronic literature search was conducted using six databases, including reference list reviews. Search terms were pre-defined based on research questions.Sixteen studies were included in the final analysis. Data visualization interventions in this review were found to impact attitude, perception, and decision-making compared to controls. These relationships between the interventions and outcomes appear to be explained by mediating factors such as perceived trustworthiness and quality, domain-specific knowledge, basic beliefs shared by social groups, and political beliefs.Visualization appears to bring advantages by increasing the amount of information delivered and decreasing the cognitive and intellectual burden to interpret information for decision-making. However, understanding data visualization interventions specific to public health leaders' decision-making is lacking, and there is little guidance for understanding a participant's characteristics and tasks. The evidence from this review suggests positive effects of data visualization can be identified, depending on the control of confounding factors on attitude, perception, and decision-making.
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Affiliation(s)
- Seungeun Park
- Department of Social and Preventive Medicine, School of Medicine, Sungkyunkwan University, Suwon, Korea
| | - Betty Bekemeier
- Department of Child, Family, & Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
| | - Abraham Flaxman
- Institute for Health Metrics and Evaluation, Department of Global Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - Melinda Schultz
- Department of Child, Family, & Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
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Sainkhuu S, Cunha-Cruz J, Rogers M, Knerr S, Bekemeier B. Evaluation of Training Gaps Among Public Health Practitioners in Washington State. J Public Health Manag Pract 2021; 27:473-483. [PMID: 32810065 DOI: 10.1097/phh.0000000000001184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Identifying training gaps in public health competencies and skills is a first step in developing priorities for advancing the workforce. OBJECTIVE Our purpose was to identify training gaps in competencies and skills among local, state, and nonjurisdictional public health employees in Washington State. Our secondary aim was to determine whether training gaps differed by employees' work-related and demographic characteristics. DESIGN We used data from our training needs assessment of the public health workforce, conducted as an online cross-sectional survey in Spring/Summer of 2016. RESPONDENTS AND SETTING Employees from governmental local, state, and nonjurisdictional public health departments in Washington State. MAIN OUTCOME MEASURES Training gaps were calculated for 8 public health competencies and 8 skills, using a composite score of respondents' ratings of their "training confidence" and "training need." For each domain and skill area, we calculated the percentage of associated items, where respondents rated their training needs as high and their confidence as low to create scores ranging from 0% to 100%. RESULTS The largest training gaps in public health competencies were in the Financial Planning and Policy Development domains. For skills, Quality Improvement and Developing Effective Communication Campaigns had the largest training gaps. In adjusted models, female employees or employees working in local health departments in select Washington State regions had higher training gaps in Financial Planning, Policy Development, and Quality Improvement, relative to male or state health department employees. Employees who worked in specialized programs, such as Communicable Disease Control, and Maternal, Child, and Family Health, had higher training gaps in Financial Planning and Developing Effective Communication Campaigns than those who worked in Administrative and Support Services. CONCLUSIONS We identified important training gaps in several competency domains and skills. Findings are informing decisions about tailoring training opportunities for public health practitioners in Washington and other states.
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Affiliation(s)
- Solongo Sainkhuu
- Departments of Oral Health Sciences, School of Dentistry (Dr Cunha-Cruz) and Health Services, School of Public Health (Drs Cunha-Cruz, Knerr, and Bekemeier and Ms Rogers), University of Washington, Seattle, Washington; and Northwest Center for Public Health Practice, University of Washington, Seattle, Washington (Ms Rogers and Dr Bekemeier)
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Brown MC, Kava C, Bekemeier B, Ornelas IJ, Harris JR, Chan KCG, Robertson M, Hannon PA. Local Health Departments' Capacity for Workplace Health Promotion Programs to Prevent Chronic Disease: Comparison of Rural, Micropolitan, and Urban Contexts. J Public Health Manag Pract 2021; 27:E183-E188. [PMID: 32487926 PMCID: PMC8670205 DOI: 10.1097/phh.0000000000001182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine local health department (LHD) contexts, capacity for, and interest in partnering with employers on workplace health promotion programs (WHPPs) for chronic disease prevention. DESIGN Qualitative interviews with LHD directors. SETTING LHDs from 21 counties in 10 states. PARTICIPANTS Twenty-one LHD directors. MAIN OUTCOME MEASURESS Experiences and perceptions of existing partnerships, decision making, funding, data needs, and organizational capacity for WHPP partnerships with employers. RESULTS We identified 3 themes: (1) LHDs see the value of partnering with employers but lack the capacity to do so effectively; (2) while LHDs base priorities on community need, funding ultimately drives decision making; and (3) rural, micropolitan, and urban LHDs differ in their readiness and capacity to work with employers. CONCLUSIONS Understanding LHDs' partnership capacity and context is essential to the successful implementation of WHPP partnerships with employers. Expanding these partnerships may require additional financial investments, particularly among rural LHDs.
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Affiliation(s)
- Meagan C Brown
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
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Ryan-Ibarra S, Nishimura H, Gallington K, Grinnell S, Bekemeier B. Time to Modernize: Local Public Health Transitions to Population-Level Interventions. J Public Health Manag Pract 2021; 27:464-472. [PMID: 31834010 DOI: 10.1097/phh.0000000000001100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify facilitating factors that guide local health departments (LHDs) in their transition from direct clinical service provision to population-level interventions addressing the social determinants of health. DESIGN Key informant interviews with LHD leaders and their staff were conducted using a semistructured interview guide. Thematic qualitative analysis was used to identify common characteristics and strategies among the LHD leaders and staff. PARTICIPANTS LHDs represented both rural and urban communities with population sizes from 9746 to 919 628 and agencies in Illinois, Montana, North Carolina, Oregon, Tennessee, Washington, and West Virginia. OUTCOME MEASURE The impetus and facilitators for transitioning health department services from clinical to population health. RESULTS Leaders from 7 LHDs emphasized that an impetus for their transition from direct clinical services to population-level interventions was that it was "time to modernize." Among LHDs interviewed, most included the 10 Essential Public Health Services or Public Health 3.0 in their strategic plan. Adding this focus to their strategic plan facilitated buy-in from local government and the ability to maintain the LHDs' focus on population-level interventions. We found that strong relationships and open communication with community members and partner organizations (eg, federally qualified health centers) were critical facilitators of transition. Themes from interviews were used to identify an initial set of 8 key elements of an effective transition: partnership/leadership, vision/goals, communication, community engagement, interventions, data/evaluation, workforce issues, and sustainability. CONCLUSIONS Prevention systems suffer from a lack of adequate health promotion and access to quality care for their community's residents. There is a need for LHDs to access technical support to strategically address complexity and ensure core population-focused prevention. The results shared provide replicable solutions, practices, and methods that enable successful transitions of LHDs toward maximizing their role in population health.
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Affiliation(s)
- Suzanne Ryan-Ibarra
- Survey Research Group (Dr Ryan-Ibarra and Mss Nishimura and Gallington) and Population Health Innovation Lab (Ms Grinnell), Public Health Institute, Oakland, California; and Northwest Center for Public Health Practice, Seattle, Washington (Dr Bekemeier)
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Bekemeier B, Kuehnert P, Zahner SJ, Johnson KH, Kaneshiro J, Swider SM. A critical gap: Advanced practice nurses focused on the public's health. Nurs Outlook 2021; 69:865-874. [PMID: 33958201 PMCID: PMC8092811 DOI: 10.1016/j.outlook.2021.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/10/2021] [Accepted: 03/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic has highlighted the need for nurse leaders who "embrace the interconnection" between medicine and public health. The inequitable impact of COVID-19 on people of color demonstrates the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues. Yet, despite a clear need for improved population health, educational programs designed to produce Advanced Public Health Nurses, with skills to address complex system changes, have become increasingly scarce. PURPOSE We put forward the perspective that the nation needs more advanced practice nurses prepared for leadership roles focused on the health of whole populations, marginalized communities, and the systems and policies that promote their health. DISCUSSION We argue that opportunities should be expanded for nurses to attain education for these roles through increased investments in the Doctor of Nursing Practice model to prepare nurses for advanced public health specialty practice.
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Affiliation(s)
- Betty Bekemeier
- Professor, Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA.
| | - Paul Kuehnert
- President & CEO, Public Health Accreditation Board, Alexandria, VA.
| | - Susan J Zahner
- Professor, School of Nursing, University of Wisconsin-Madison, Madison, WI.
| | - Kathleen H Johnson
- Professor, Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA.
| | - Jasmine Kaneshiro
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, School of Nursing, Seattle, WA.
| | - Susan M Swider
- Professor, College of Nursing, Rush University, Chicago, IL.
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Park S, Bekemeier B, Flaxman AD. Understanding data use and preference of data visualization for public health professionals: A qualitative study. Public Health Nurs 2021; 38:531-541. [PMID: 33569821 DOI: 10.1111/phn.12863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to assess public health professionals' use of data, information, and evidence and to understand perceptions and preferences regarding data visualization to inform future design of data visualization tools. DESIGN We conducted qualitative interviews with public health professionals who use data for decision making as part of community health assessment and program planning from state and local health departments across six states. RESULTS We identified four themes: 1) collection of data, information, and evidence; 2) management and analysis of data and information to inform decisions; 3) use of data to support public health practice; and 4) preferences for data visualization and how visualization is being used. Public health professionals use data, information, and evidence from various resources for communicating with co-workers, stakeholders, and the public, and decision making regarding their programs and services. CONCLUSION Data visualization tools can help public health professionals improve their understanding and communication, their education of stakeholders, and their decision making using data, information, and evidence. Public health professionals believe in the value of using data, information, and evidence. Opportunities exist in ways to support public health professionals' data use by adopting data visualization tools and by mitigating systematic challenges in public health information systems.
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Affiliation(s)
- Seungeun Park
- Department of Social and Preventive Medicine, School of Medicine, Sungkyunkwan University, Suwon, Korea
| | - Betty Bekemeier
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, USA
| | - Abraham D Flaxman
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, University of Washington School of Medicine, Seattle, WA, USA
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McFadden SM, Sonney J, Bekemeier B. A model for systems-level influences on toddler immunization completion. Public Health Nurs 2020; 38:406-411. [PMID: 33314306 DOI: 10.1111/phn.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/21/2020] [Accepted: 11/30/2020] [Indexed: 12/01/2022]
Abstract
Toddler immunization completion rates vary across populations in the United States, and this variation may be contributing to the national rise in vaccine preventable diseases. Yet existing theoretical scholarship for improving toddler immunization uptake is largely focused on the individual level, neglecting the multiple system-level environments that should be considered. Population characteristics are distinct from the sum of individual characteristics. Thus, a reformulation of the ecological systems theory is proposed to provide theoretical direction and guide future population health research regarding system-level influences on vaccine coverage.
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Affiliation(s)
- SarahAnn M McFadden
- Yale Institute for Global Health, New Haven, CT, USA.,Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer Sonney
- University of Washington School of Nursing, Seattle, WA, USA
| | - Betty Bekemeier
- University of Washington School of Nursing, Seattle, WA, USA
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Brewer A, Colbert AM, Sekula K, Bekemeier B. A need for trauma informed care in sexually transmitted disease clinics. Public Health Nurs 2020; 37:696-704. [PMID: 32776628 DOI: 10.1111/phn.12784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/16/2020] [Accepted: 07/19/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This review examines trauma from violence as a risk factor for sexually transmitted diseases (STDs) among women attending STD clinics. The review also aims to suggest trauma informed care (TIC) integrated into STD clinics might more effectively address traumatic effects of violence linked to sexual risk behaviors among this population. DESIGN AND SAMPLE A systematic literature review was conducted to identify empirical studies examining the relationship between multiple forms of violence and sexual risk behaviors among women attending STD clinics. RESULTS All studies found high rates of violence including childhood sexual abuse, intimate partner violence, and/or community violence associated with high rates of sexual risk behaviors among women attending these settings. Researchers recommend screening for multiple forms of violence, interdisciplinary STD clinic services, and more trauma informed sexual risk reduction interventions to address multiple forms of violence found prevalent among this population. CONCLUSION Women attending STD clinics very often experience multiple forms of violence during their lifetime. TIC to address traumatic effects of violence might reduce sexual risk behaviors and sexually transmitted disease rates for improved health outcomes among this population.
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Bekemeier B, Delaney K, Wenzl S, Roberts M, Hersh D. The Diamond Project: A Quality Improvement Model for Adopting Shared Service Delivery in the Washington Vaccines for Children Program. Front Public Health 2020; 8:272. [PMID: 32760687 PMCID: PMC7372928 DOI: 10.3389/fpubh.2020.00272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 05/26/2020] [Indexed: 11/13/2022] Open
Abstract
Context: Increasing federal requirements with no change in the Centers for Disease Control and Prevention budget creates an unsustainable delivery model between states and their local counterparts for programs like Vaccines for Children (VFC). Project: The Washington State Department of Health collaborated with the Washington Association of Local Public Health Officials to identify how best to improve the quality of the VFC program. Approach: Utilizing Quality improvement and Lean Six Sigma methods, the project team was able to adopt a new shared-service delivery model to improve the quality of the VFC program in Washington State. Discussion: Through utilization of quality improvement methods and Lean methodology Washington State Department of Health identified recommendations to adopt a shared-service delivery and implemented those changes.
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Affiliation(s)
- Betty Bekemeier
- School of Public Health, University of Washington, Seattle, WA, United States
| | - Kylerose Delaney
- School of Public Health, University of Washington, Seattle, WA, United States
| | - Stacy Wenzl
- Washington State Department of Children, Youth, and Families, Olympia, WA, United States
| | - Michele Roberts
- Washington State Department of Health, Olympia, WA, United States
| | - Dorene Hersh
- Public Health - Seattle & King County, Seattle, WA, United States
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Gyllstrom E, Gearin K, Nease D, Bekemeier B, Pratt R. Measuring Local Public Health and Primary Care Collaboration: A Practice-Based Research Approach. J Public Health Manag Pract 2020; 25:382-389. [PMID: 31136512 DOI: 10.1097/phh.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the degree of public health and primary care collaboration at the local level and develop a model framework of collaboration, the Community Collaboration Health Model (CCHM). DESIGN Mixed-methods, cross-sectional surveys, and semistructured, key informant interviews. SETTING All local health jurisdictions in Colorado, Minnesota, Washington, and Wisconsin. PARTICIPANTS Leaders from each jurisdiction were identified to describe local collaboration. Eighty percent of local health directors completed our survey (n = 193), representing 80% of jurisdictions. The parallel primary care survey had a 31% response rate (n = 128), representing 50% of jurisdictions. Twenty pairs of local health directors and primary care leaders participated in key informant interviews. MAIN OUTCOME MEASURE(S) Thirty-seven percent of jurisdictions were classified as having strong foundational and energizing characteristics in the model. Ten percent displayed high energizing/low foundational characteristics, 11% had high foundational/low energizing characteristics, and 42% of jurisdictions were low on both. RESULTS Respondents reported wide variation in relationship factors. They generally agreed that foundational characteristics were present in current working relationships but were less likely to agree that relationships had factors promoting sustainability or innovation. CONCLUSIONS Both sectors valued working together in principle, yet few did. Identifying shared priorities and achieving tangible benefits may be critical to realizing sustained relationships resulting in population health improvement. Our study reveals broad variation in experiences among local jurisdictions in our sample. Tools, such as the CCHM, and technical assistance may be helpful to support advancing collaboration. Dedicated funding, reimbursement redesign, improved data systems, and data sharing capability are key components of promoting collaboration. Yet, even in the absence of new reimbursement models or funding mechanisms, there are steps leaders can take to build and sustain their relationships. The self-assessment tool and the CCHM can identify opportunities for improving collaboration and link practitioners to strategies.
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Affiliation(s)
- Elizabeth Gyllstrom
- Center for Public Health Practice, Minnesota Department of Health, St Paul, Minnesota (Drs Gyllstrom and Gearin); Department of Family Medicine, University of Colorado, Aurora, Colorado (Dr Nease); Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington (Dr Bekemeier); and Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota (Dr Pratt)
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Blakeney EAR, Bekemeier B, Zierler BK. Relationships Between the Great Recession and Widening Maternal and Child Health Disparities: Findings From Washington and Florida. Race Soc Probl 2020; 12:87-102. [PMID: 32802213 PMCID: PMC7423194 DOI: 10.1007/s12552-019-09272-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of this study was to explore relationships between the Great Recession in the United States and maternal and child health (MCH) disparities in prenatal care, birth weight, gestational age, and infant mortality. Using annual, 2005-2011 individual-level Washington (WA) and Florida (FL) birth certificate data, we analyzed MCH outcome rates and disparities among subpopulation component groups (e.g., subpopulation 'maternal ethnicity' divided into component groups such as non-Hispanic White, non-Hispanic Black). We focused on whether disparities widened during two recession periods: Period 1 (December 2007-June 2009-official dates of Great Recession) and Period 2 (January 2010-December 2011) and compared these to a Baseline Period 0 (January 2005-March 2007). Subpopulations (n=14) and component groups (n=47) were identified a priori. Results indicate that disparities widened on at least one MCH outcome for 22 component groups in WA during Period 1 and 37 component groups during Period 2, compared to baseline. In FL, disparities widened for 25 component groups during Period 1 and 31 during Period 2. Disparities increased in both periods on the same outcomes for 11 WA component groups and 7 component groups in FL. Disparity increases tended to cluster among those with young age, low education, and among members of minority race/ethnicity groups-particularly Black mothers. Findings support hypothesized relationships between expected increases in need during the Great Recession, and worsening MCH outcomes and disparities. Compared to baseline, there were more disparity increases in Period 2 than 1. Additional research regarding specific factors influencing changes in disparities are needed.
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Blakeney EL, Herting JR, Zierler BK, Bekemeier B. The effect of women, infant, and children (WIC) services on birth weight before and during the 2007-2009 great recession in Washington state and Florida: a pooled cross-sectional time series analysis. BMC Pregnancy Childbirth 2020; 20:252. [PMID: 32345244 PMCID: PMC7189643 DOI: 10.1186/s12884-020-02937-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 04/13/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to have positive effects in promoting healthy birth outcomes in the United States. We explored whether such effects held prior to and during the most recent Great Recession to improve birth outcomes and reduce differences among key socio-demographic groups. METHODS We used a pooled cross-sectional time series design to study pregnant women and their infants with birth certificate data. We included Medicaid and uninsured births from Washington State and Florida (n = 226,835) before (01/2005-03/2007) and during (12/2007-06/2009) the Great Recession. Interactions between WIC enrollment and key socio-demographic groupings were analyzed for binary and continuous birth weight outcomes. RESULTS Our study found beneficial WIC interaction effects on birth weight. For race, prenatal care, and maternal age we found significantly better birth weight outcomes in the presence of WIC compared to those without WIC. For example, being Black with WIC was associated with an increase in infant birth weight of 53.5 g (baseline) (95% CI = 32.4, 74.5) and 58.0 g (recession) (95% CI = 27.8, 88.3). For most groups this beneficial relationship was stable over time. CONCLUSIONS This paper supports previous research linking maternal utilization of WIC services during pregnancy to improved birth weight (both reducing LBW and increasing infant birth weight in grams) among some high-disadvantage groups. WIC appears to have been beneficial at decreasing disparity gaps in infant birth weight among the very young, Black, and late/no prenatal care enrollees in this high-need population, both before and during the Great Recession. Gaps are still present among other social and demographic characteristic groups (e.g., for unmarried mothers) for whom we did not find WIC to be associated with any detectable value in promoting better birth weight outcomes. Future research needs to examine how WIC (and/or other maternal and child health programs) could be made to work better and reach farther to address persistent disparities in birth weight outcomes. Additionally, in preparation for future economic downturns it will be important to determine how to preserve and, if possible, expand WIC services during times of increased need. TRIAL REGISTRATION Not applicable, this article reports only on secondary retrospective data (no health interventions with human participants were carried out).
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Affiliation(s)
- Erin L. Blakeney
- Department of Behavioral Nursing and Health Informatics, School of Nursing, University of Washington, Box # 357266, Seattle, WA 98195 USA
| | - Jerald R. Herting
- Department of Sociology, University of Washington, Box 353340, Seattle, WA 98195 USA
| | - Brenda Kaye Zierler
- Department of Behavioral Nursing and Health Informatics, School of Nursing, University of Washington, Box # 357266, Seattle, WA 98195 USA
| | - Betty Bekemeier
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Box # 357263, Seattle, WA 98195 USA
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Carey TS, Bekemeier B, Campos-Outcalt D, Koch-Weser S, Millon-Underwood S, Teutsch S. National Institutes of Health Pathways to Prevention Workshop: Achieving Health Equity in Preventive Services. Ann Intern Med 2020; 172:272-278. [PMID: 31931530 DOI: 10.7326/m19-3171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Expert groups, including the U.S. Preventive Services Task Force (USPSTF), recommend a range of clinical preventive services for persons at average risk for disease. Use of these services often is substantially lower among racial and ethnic minority groups, rural residents, and persons of lower socioeconomic status. On 19 and 20 June 2019, the National Institutes of Health (NIH) convened the Pathways to Prevention Workshop: Achieving Health Equity in Preventive Services to assess the available evidence on disparities in the use of 10 USPSTF-recommended clinical preventive services for cancer, heart disease, and diabetes. The workshop was cosponsored by the NIH Office of Disease Prevention; National Institute on Minority Health and Health Disparities; National Cancer Institute; National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases. A multidisciplinary working group developed the agenda, and an Evidence-based Practice Center prepared the evidence report. During the workshop, invited experts considered the evidence, with discussion among attendees. After weighing evidence from the review, presentations, and public comments, an independent panel prepared a draft report that was posted for public comment. This final report summarizes the panel's findings, identifying current gaps in knowledge. The panel made 26 recommendations for new research and methods development to improve implementation of proven services to reduce disparities in preventable conditions.
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Affiliation(s)
- Timothy S Carey
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (T.S.C.)
| | - Betty Bekemeier
- University of Washington School of Nursing, Seattle, Washington (B.B.)
| | | | - Susan Koch-Weser
- Tufts University School of Medicine, Boston, Massachusetts (S.K.)
| | | | - Steven Teutsch
- University of Southern California, Los Angeles, California (S.T.)
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Bekemeier B, Park S, Whitman G. Challenges and lessons learned in promoting adoption of standardized local public health service delivery data through the application of the Public Health Activities and Services Tracking model. J Am Med Inform Assoc 2019; 26:1660-1663. [PMID: 31550365 PMCID: PMC7647159 DOI: 10.1093/jamia/ocz160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/24/2019] [Accepted: 08/17/2019] [Indexed: 11/12/2022] Open
Abstract
Population-level prevention activities are often publicly invisible and excluded in planning and policymaking. This creates an incomplete picture of prevention service-related inputs, particularly at the local level. We describe the process and lessons learned by the Public Health Activities and Services Tracking team in promoting adoption of standardized service delivery measures developed to assess public health inputs and guide system transformations. The 3 factors depicted in our Public Health Activities and Services Tracking model-data need and use, data access, and standardized measures-must be realized to promote collection of standard public health system data. Bureaucratic, resource, system, and policy challenges hampered our efforts toward adoption of the standardized measures we promoted. Substantial investments of time, resources, and coordination appear necessary for systems to adopt changes needed for collecting comparable service delivery data. Lessons from our process of promoting adoption of standardized measures provide recommendations to support future efforts to measure public health system contributions to the public's health.
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Affiliation(s)
- Betty Bekemeier
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, Washington, USA
| | - Seungeun Park
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, Washington, USA
| | - Greg Whitman
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, Washington, USA
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Blakeney EL, Herting JR, Bekemeier B, Zierler BK. Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010. BMC Pregnancy Childbirth 2019; 19:390. [PMID: 31664939 PMCID: PMC6819461 DOI: 10.1186/s12884-019-2486-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007-June 2009). METHODS Data from 678,235 Washington (WA) and Florida (FL) birth certificates were linked to community and state characteristic data to carry out cross-sectional pooled time series analyses with institutional review board approval for human subjects' research. Predictors of on-time as compared to late or non-entry to prenatal care utilization (late/no prenatal care utilization) were identified and compared among pregnant women. Also explored was a simulated triadic relationship among time (within recession-related periods), social characteristics, and prenatal care utilization by clustering individual predictors into three scenarios representing low, average, and high degrees of social disadvantage. RESULTS Individual and community indicators of need (e.g., maternal Medicaid enrollment, unemployment rate) increased during the Recession. Associations between late/no prenatal care utilization and individual-level characteristics (including disparate associations among race/ethnicity groups) did not shift greatly with young maternal age and having less than a high school education remaining the largest contributors to late/no prenatal care utilization. In contrast, individual maternal enrollment in a supplemental nutrition program for women, infants, and children (WIC) exhibited a protective association against late/no prenatal care utilization. The magnitude of association between community-level partisan voting patterns and expenditures on some maternal child health programs increased in non-beneficial directions. Simulated scenarios show a high combined impact on prenatal care utilization among women who have multiple disadvantages. CONCLUSIONS Our findings provide a compelling picture of the important roles that individual characteristics-particularly low education and young age-play in late/no prenatal care utilization among pregnant women. Targeted outreach to individuals with high disadvantage characteristics, particularly those with multiple disadvantages, may help to increase first trimester entry to utilization of prenatal care. Finally, WIC may have played a valuable role in reducing late/no prenatal care utilization, and its effectiveness during the Great Recession as a policy-based approach to reducing late/no prenatal care utilization should be further explored.
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Affiliation(s)
- Erin L. Blakeney
- Department of Biobehavioral Nursing and Health Informatics, Center for Health Sciences Interprofessional Education, Research, and Practice (CHSIE), Seattle, USA
| | - Jerald R. Herting
- Department of Sociology, University of Washington, Box 353340, Seattle, WA 98195 USA
| | - Betty Bekemeier
- School of Nursing, University of Washington, UW Health Sciences Building, Box 357266, Seattle, WA 98195 USA
| | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health Informatics, Center for Health Sciences Interprofessional Education, Research, and Practice (CHSIE), Seattle, USA
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Bekemeier B, Park S, Backonja U, Ornelas I, Turner AM. Data, capacity-building, and training needs to address rural health inequities in the Northwest United States: a qualitative study. J Am Med Inform Assoc 2019; 26:825-834. [PMID: 30990561 PMCID: PMC7647197 DOI: 10.1093/jamia/ocz037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/04/2019] [Accepted: 03/09/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Rural public health system leaders struggle to access and use data for understanding local health inequities and to effectively allocate scarce resources to populations in need. This study sought to determine these rural public health system leaders' data access, capacity, and training needs. MATERIALS AND METHODS We conducted qualitative interviews across Alaska, Idaho, Oregon, and Washington with individuals expected to use population data for analysis or decision-making in rural communities. We used content analysis to identify themes. RESULTS We identified 2 broad themes: (1) challenges in accessing or using data to monitor and address health disparities and (2) needs for training in data use to address health inequities. Participants faced challenges accessing or using data to address rural disparities due to (a) limited availability or access to data, (b) data quality issues, (c) limited staff with expertise and resources for analyzing data, and (d) the diversity within rural jurisdictions. Participants also expressed opportunities for filling capacity gaps through training-particularly for displaying and communicating data. DISCUSSION Rural public health system leaders expressed data challenges, many of which can be aided by informatics solutions. These include interoperable, accessible, and usable tools that help capture, access, analyze, and display data to support health equity efforts in rural communities. CONCLUSION Informatics has the potential to address some of the daunting data-related challenges faced by rural public health system leaders working to enhance health equity. Future research should focus on developing informatics solutions to support data access and use in rural communities.
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Affiliation(s)
- Betty Bekemeier
- Department of Psychosocial & Community Health, University of Washington School of Nursing, Seattle, Washington, USA
- Northwest Center for Public Health Practice, University of Washington,Seattle, Washington, USA
| | - Seungeun Park
- Department of Psychosocial & Community Health, University of Washington School of Nursing, Seattle, Washington, USA
| | - Uba Backonja
- Nursing & Healthcare Leadership, University of Washington, Tacoma, Washington, USA
| | - India Ornelas
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | - Anne M Turner
- Northwest Center for Public Health Practice, University of Washington,Seattle, Washington, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
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Abstract
This study investigated the prevalence and severity of menopausal symptoms and associated factors among women living with HIV in Cambodia. Menopause Rating Scale (MRS) assessed the menopausal symptoms, and SPSS Version 20.0 analyzed the data. The three most dominant symptoms, which were also rated the top three "severe" symptoms, were psychological: physical and mental exhaustion (91.5%), irritability (84.1%), and depressive mood (83.6%). The highest incidence was among the perimenopausal women. Severity of symptoms was associated with personal income, abortion, and intake of calcium supplements. Health-care professionals need to provide appropriate individualized interventions to maintain the social, emotional, and overall well-being of menopausal women living with HIV.
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Affiliation(s)
- Roshna Thapa
- School of Nursing, Chonbuk National University , Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Youngran Yang
- School of Nursing, Research Institute of Nursing Science, Chonbuk National University , Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Betty Bekemeier
- School of Nursing, University of Washington , Seattle, Washington, USA
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Mamaril CBC, Mays GP, Branham DK, Bekemeier B, Marlowe J, Timsina L. Estimating the Cost of Providing Foundational Public Health Services. Health Serv Res 2018; 53 Suppl 1:2803-2820. [PMID: 29282722 PMCID: PMC6056592 DOI: 10.1111/1475-6773.12816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To estimate the cost of resources required to implement a set of Foundational Public Health Services (FPHS) as recommended by the Institute of Medicine. STUDY DESIGN A stochastic simulation model was used to generate probability distributions of input and output costs across 11 FPHS domains. We used an implementation attainment scale to estimate costs of fully implementing FPHS. DATA COLLECTION/EXTRACTION METHODS We use data collected from a diverse cohort of 19 public health agencies located in three states that implemented the FPHS cost estimation methodology in their agencies during 2014-2015. PRINCIPAL FINDINGS The average agency incurred costs of $48 per capita implementing FPHS at their current attainment levels with a coefficient of variation (CV) of 16 percent. Achieving full FPHS implementation would require $82 per capita (CV=19 percent), indicating an estimated resource gap of $34 per capita. CONCLUSIONS Substantial variation in costs exists across communities in resources currently devoted to implementing FPHS, with even larger variation in resources needed for full attainment. Reducing geographic inequities in FPHS may require novel financing mechanisms and delivery models that allow health agencies to have robust roles within the health system and realize a minimum package of public health services for the nation.
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Affiliation(s)
- Cezar Brian C. Mamaril
- Department of Health Management and PolicyUniversity of Kentucky College of Public HealthLexingtonKY
| | - Glen P. Mays
- Department of Health Management and PolicyUniversity of Kentucky College of Public HealthLexingtonKY
| | - Douglas Keith Branham
- Department of Health Management and PolicyUniversity of Kentucky College of Public HealthLexingtonKY
| | | | - Justin Marlowe
- Daniel J. Evans School of Public Policy and GovernanceUniversity of WashingtonSeattleWA
| | - Lava Timsina
- Center for Outcomes Research in SurgeryIndiana University School of MedicineIndianapolisIN
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Bekemeier B, Park S. Development of the PHAST model: generating standard public health services data and evidence for decision-making. J Am Med Inform Assoc 2018; 25:428-434. [PMID: 29106585 PMCID: PMC7647004 DOI: 10.1093/jamia/ocx126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/08/2017] [Accepted: 10/08/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Standardized data regarding the distribution, quality, reach, and variation in public health services provided at the community level and in wide use across states and communities do not exist. This leaves a major gap in our nation's understanding of the value of prevention activities and, in particular, the contributions of our government public health agencies charged with assuring community health promotion and protection. Public health and community leaders, therefore, are eager for accessible and comparable data regarding preventive services that can inform policy decisions about where to invest resources. Methods We used literature review and a practice-based approach, employing an iterative process to identify factors that facilitate data provision among public health practitioners. Results This paper describes the model, systematically developed by our research team and with input from practice partners, that guides our process toward maximizing the uptake and integration of these standardized measures into state and local data collection systems. Discussion The model we developed, using a dissemination and implementation science framework, is intended to foster greater interest in and accountability for data collection around local health department services and to facilitate spatial exploration and statistical analysis of local health department service distribution, change, and performance. Conclusion Our model is the first of its kind to thoroughly develop a means to guide research and practice in realizing the National Academy of Medicine's recommendation for developing systems to measure and track state and local public health system contributions to population health.
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Affiliation(s)
- Betty Bekemeier
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA
| | - Seungeun Park
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA
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Espina CR, Bekemeier B, Storey-Kuyl M. Population-Focused Practice Competency Needs Among Public Health Nursing Leaders in Washington State. J Contin Educ Nurs 2017; 47:212-9. [PMID: 27124075 DOI: 10.3928/00220124-20160419-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 01/20/2016] [Indexed: 11/20/2022]
Abstract
HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Population-Focused Practice Competency Needs Among Public Health Nursing Leaders in Washington State," found on pages 212-219, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until April 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Describe supports and barriers to adopting population-focused care in public health nursing practice. Describe the benefit of using practice models to assess staff readiness for adopting evidence-based guidelines or practice competencies. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. Public health nurses (PHNs) need effective strategies to reduce health disparities, requiring a workforce that can practice with a population-focus across the continuum of care and with an ecological approach to health. A statewide leadership group of county-level PHN leaders in Washington assessed their training needs in population-focused knowledge and skills. Interview findings from 17 members were coded based on the Quad Council PHN Competencies. Recommendations were organized around the Push-Pull Infrastructure (PPI) practice model established to help bridge the practice-research gap. The PHN leaders in Washington State want to strengthen their own leadership skills and provide support to staff in transitioning to population-focused care. This article describes the assessment findings of PHN leaders' training needs using the PPI practice model and explores how the PPI might serve to develop evidence-based training for PHNs and local health department staff. J Contin Educ Nurs. 2016;47(5):212-219.
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Wenzel J, Bekemeier B. Mentees on mentoring: A commentary on mentor relationships and paying it forward. Nurs Outlook 2017; 65:325-326. [PMID: 28342544 DOI: 10.1016/j.outlook.2017.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/08/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Jennifer Wenzel
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Betty Bekemeier
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA.
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Winterbauer NL, Bekemeier B, VanRaemdonck L, Hoover AG. Applying Community-Based Participatory Research Partnership Principles to Public Health Practice-Based Research Networks. Sage Open 2016; 6:10.1177/2158244016679211. [PMID: 31131152 PMCID: PMC6533003 DOI: 10.1177/2158244016679211] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
With real-world relevance and translatability as important goals, applied methodological approaches have arisen along the participatory continuum that value context and empower stakeholders to partner actively with academics throughout the research process. Community-based participatory research (CBPR) provides the gold standard for equitable, partnered research in traditional communities. Practice-based research networks (PBRNs) also have developed, coalescing communities of practice and of academics to identify, study, and answer practice-relevant questions. To optimize PBRN potential for expanding scientific knowledge, while bridging divides across knowledge production, dissemination, and implementation, we elucidate how PBRN partnerships can be strengthened by applying CBPR principles to build and maintain research collaboratives that empower practice partners. Examining the applicability of CBPR partnership principles to public health (PH) PBRNs, we conclude that PH-PBRNs can serve as authentic, sustainable CBPR partnerships, ensuring the co-production of new knowledge, while also improving and expanding the implementation and impact of research findings in real-world settings.
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Affiliation(s)
| | | | - Lisa VanRaemdonck
- Public Health Alliance of Colorado & Colorado Association of Local Public Health Officials, Denver, USA
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Klaiman T, Pantazis A, Chainani A, Bekemeier B. Using a positive deviance framework to identify Local Health Departments in Communities with exceptional maternal and child health outcomes: a cross sectional study. BMC Public Health 2016; 16:602. [PMID: 27435170 PMCID: PMC4952145 DOI: 10.1186/s12889-016-3259-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 07/01/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The United States spends more than most other countries per capita on maternal and child health (MCH), and yet lags behind other countries in MCH outcomes. Local health departments (LHDs) are responsible for administering various maternal and child health programs and interventions, especially to vulnerable populations. The goal of this study was to identify local health department jurisdictions (LHDs) that had exceptional maternal and child health outcomes compared to their in-state peers - positive deviants (PDs) - in Washington, Florida and New York in order to support the identification of strategies that can improve community health outcomes. METHODS We used MCH expenditure data for all LHDs in FL (n = 67), and WA (n = 35), and most LHDs in NY (n = 48) for 2009-2010 from the Public Health Activities and Services Tracking (PHAST) database. We conducted our analysis in 2014-2015. Data were linked with variables depicting local context and LHD structure. We used a cross-sectional study design to identify communities with better than expected MCH outcomes and multiple regression analysis to control for factors outside of and within LHD control. RESULTS We identified 50 positive deviant LHD jurisdictions across 3 states: WA = 10 (29 %); FL = 24 (36 %); NY = 16 (33 %). Overall, internal factor variables improved model fit for identifying PD LHD jurisdictions, but individual variables were not significant. CONCLUSIONS We empirically identified LHD jurisdictions with better MCH outcomes compared to their peers. Research is needed to assess what factors contributed to these exceptional MCH outcomes and over which LHDs have control. The positive deviance method we used to identify high performing local health jurisdictions in the area of maternal and child health outcomes can assist in better understanding what practices work to improve health outcomes. We found that funding may not be the only predictor of exceptional outcomes, but rather, there may be activities that positive deviant LHDs are conducting that lead to improved outcomes, even during difficult financial circumstances. This method can be applied to other outcomes, communities, and/or services.
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Affiliation(s)
- Tamar Klaiman
- />AccessMatters, 1700 Market St., Suite 15th Fl., Philadelphia, PA 19103 USA
| | - Athena Pantazis
- />University of Washington School of Nursing, Psychosocial & Community Health, Box 357263, Seattle, WA USA
| | - Anjali Chainani
- />University of the Sciences, 4101 Woodland Ave., Box 22, Philadelphia, PA 19104 USA
| | - Betty Bekemeier
- />University of Washington School of Nursing, Psychosocial & Community Health, Box 357263, Seattle, WA USA
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Bekemeier B, Zahner SJ, Kulbok P, Merrill J, Kub J. Assuring a strong foundation for our nation's public health systems. Nurs Outlook 2016; 64:557-565. [PMID: 27480677 DOI: 10.1016/j.outlook.2016.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/03/2016] [Accepted: 05/20/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND A strong public health infrastructure is necessary to assure that every community is capable of carrying out core public health functions (assessment of population health, assurance of accessible and equitable health resources, and development of policies to address population health) to create healthy conditions. Yet, due to budget cuts and inconsistent approaches to base funding, communities are losing critical prevention and health promotion services and staff that deliver them. PURPOSE This article describes key components of and current threats to our public health infrastructure and suggests actions necessary to strengthen public health systems and improve population health. DISCUSSION National nursing and public health organizations have a duty to advocate for policies supporting strong prevention systems, which are crucial for well-functioning health care systems and are fundamental goals of the nursing profession. CONCLUSION We propose strengthening alliances between nursing organizations and public health systems to assure that promises of a reformed health system are achieved.
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Affiliation(s)
- Betty Bekemeier
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA.
| | - Susan J Zahner
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | - Pamela Kulbok
- University of Virginia, School of Nursing, Charlottesville, VA
| | - Jacqueline Merrill
- Biomedical Informatics at Columbia University Medical Center, New York, NY
| | - Joan Kub
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
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Yang Y, Bekemeier B, Choi J. A cultural and contextual analysis of health concepts and needs of women in a rural district of Nepal. Glob Health Promot 2016; 25:15-22. [DOI: 10.1177/1757975916639869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Globally, individuals and groups have different notions of health promotion influenced by their social and cultural contexts. Effective primary health care and healthy public policy depend on a clear understanding of people’s perceptions of health and their health needs. Women in the Far Western Region (FWR) of Nepal live in one of the most remote and rural areas in that country, and their general health status is one of the worst in that country. In this study we explored the socio-cultural health concepts and needs of women in a district of Nepal’s FWR. Methods: Qualitative research methods and a culture-centred approach guided the study, with 30 women from the district of Dadeldhura in the FWR participating in in-depth interviews. Data were analysed through qualitative content analysis. Results: The women’s concepts of health included ‘absence of disease’, ‘no tension’, ‘peace in the family’ and ‘being able to work’. The participants felt good health required good food, wealth, education and employment for their children, and a healthy community (free of drug or alcohol addiction). ‘Money is everything’ also emerged as a main theme, linking the concept of wealth to good health. To improve health, respondents recommended that the government provide financial support for education and employment and a focus on listening to and caring for the country’s rural poor. Conclusions: Overall, participants’ perceived health as not just about themselves but their families and communities. Socially as well as culturally determined gender roles influenced the health concepts and needs of the women. This study’s findings can be used to guide public health leaders in priority-setting and in determining strategies for women’s health promotion in rural districts of Nepal and other similar cultures.
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Affiliation(s)
- Youngran Yang
- Chonbuk National University – Chonbuk National University – School of Nursing, Research Institute of Nursing Science, Jeonju, Republic of Korea
| | | | - Jongsan Choi
- Chonbuk National University – College of Agricultural Life Science, Jeonju, Republic of Korea
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Bekemeier B, Yip MPY, Dunbar MD, Whitman G, Kwan-Gett T. Local health department food safety and sanitation expenditures and reductions in enteric disease, 2000-2010. Am J Public Health 2015; 105 Suppl 2:S345-52. [PMID: 25689186 PMCID: PMC4355703 DOI: 10.2105/ajph.2015.302555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In collaboration with Public Health Practice-Based Research Networks, we investigated relationships between local health department (LHD) food safety and sanitation expenditures and reported enteric disease rates. METHODS We combined annual infection rates for the common notifiable enteric diseases with uniquely detailed, LHD-level food safety and sanitation annual expenditure data obtained from Washington and New York state health departments. We used a multivariate panel time-series design to examine ecologic relationships between 2000-2010 local food safety and sanitation expenditures and enteric diseases. Our study population consisted of 72 LHDs (mostly serving county-level jurisdictions) in Washington and New York. RESULTS While controlling for other factors, we found significant associations between higher LHD food and sanitation spending and a lower incidence of salmonellosis in Washington and a lower incidence of cryptosporidiosis in New York. CONCLUSIONS Local public health expenditures on food and sanitation services are important because of their association with certain health indicators. Our study supports the need for program-specific LHD service-related data to measure the cost, performance, and outcomes of prevention efforts to inform practice and policymaking.
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Affiliation(s)
- Betty Bekemeier
- Betty Bekemeier, Michelle Pui-Yan Yip, and Greg Whitman are with the Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle. Tao Kwan-Gett is with the Department of Health Services, University of Washington School of Public Health, Seattle. Matthew D. Dunbar is with the Center for Studies in Demography and Ecology, University of Washington, Seattle
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