Ashley Moore

Title: A Mixed Methods Study on Local Partnerships for Public Health Emergency Preparedness

Abstract:

Public health emergencies have direct, indirect, and often devastating effects on communities. U.S. local health departments (LHDs) are responsible for delivering health services to populations within their jurisdictions, including emergency preparedness and response. Community-based organizations (CBOs), non-governmental organizations typically operated by local residents, often serve as trusted sources of information among community members and provide them with essential resources that can be beneficial in meeting LHD goals. Partnerships among LHDs and CBOs can leverage their synergistic capabilities to support population health during and after disasters. Indeed, community engagement is recognized as a critical component in public health emergency preparedness (PHEP). However, little research has explored the determinants and outcomes of PHEP partnerships between LHDs and CBOs. This dissertation uses mixed methods research within the U.S. Department of Health and Human Services (HHS) Region 10 (Alaska, Idaho, Oregon, Washington) to assess the extent to which LHDs conduct community engagement and to identify the facilitators, barriers, strategies, and outputs of LHD-CBO partnerships through three interconnected studies. In the first study, we distributed a survey to Region 10 PHEP coordinators and measured their commitment to partnerships, their organization’s PHEP partnership activities, and the potential characteristics that might affect these variables. Participants’ commitment to PHEP partnerships and their years of experience in PHEP were associated with the extent of partnership activities. The second study involved focus groups among a subset of study 1 survey participants, as well as interviews with CBO representatives that partner with their LHDs, to explore determinants of organizational participation in PHEP partnerships. Inflexible funding mechanisms, bureaucratic constraints, and shifting priorities presented challenges to PHEP partnership engagement, while availability of and flexibility in funding, organizational commitment to partnerships, and trust-building facilitated such engagement. The third study used the same focus group and interview data to examine strategies that LHDs and CBOs use to develop and maintain their partnerships, as well as the outputs of successful collaboration. We identified partnership inputs of prioritization, collaboration, communication, and resource sharing, all of which support outputs of meeting community needs, sustaining collaboration, achieving shared goals, and maintaining situational awareness. However, gaps remain in understanding ways to measure success. Together, these studies show that LHDs and CBOs can navigate numerous barriers to maintain partnerships for PHEP, yet challenges persist in sharing resources, evaluating partnerships, and adapting to substantial shifts in political and funding priorities. This research underscores a need for better understanding of how PHEP partnership activities vary across regions, how PHEP partnership success can be measured, and how effective partnership strategies can be implemented in diverse LHD and CBO contexts.