Nancy L. Winterbauer

Applying Community-Based Participatory Research Partnership Principles to Public Health Practice-Based Research Networks

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.

Designing for Dissemination: Lessons in Message Design From “1-2-3 Pap”

Despite a large number of evidence-based health communication interventions tested in private, public, and community health settings, there is a dearth of research on successful secondary dissemination of these interventions to other audiences. This article presents the case study of “1-2-3 Pap,” a health communication intervention to improve human papillomavirus (HPV) vaccination uptake and Pap testing outcomes in Eastern Kentucky, and explores strategies used to disseminate this intervention to other populations in Kentucky, North Carolina, and West Virginia. Through this dissemination project, we identified several health communication intervention design considerations that facilitated our successful dissemination to these other audiences; these intervention design considerations include (a) developing strategies for reaching other potential audiences, (b) identifying intervention message adaptations that might be needed, and (c) determining the most appropriate means or channels by which to reach these potential future audiences. Using “1-2-3 Pap” as an illustrative case study, we describe how careful planning and partnership development early in the intervention development process can improve the potential success of enhancing the reach and effectiveness of an intervention to other audiences beyond the audience for whom the intervention messages were originally designed.

Addressing psychological, mental health and other behavioural healthcare needs of the underserved populations in the United States: the role of local health departments.

Aims: (1) To assess the extent to which local health departments (LHDs) implement and evaluate strategies to target the behavioural healthcare needs for the underserved populations and (2) to identify factors that are associated with these undertakings. Methods: Data for this study were drawn from the 2013 National Profile of Local Health Departments Study conducted by National Association of County and City Health Officials. A total of 505 LHDs completed the Module 2 questionnaire of the Profile Study, in which LHDs were asked whether they implemented strategies and evaluated strategies to target the behavioural healthcare needs of the underserved populations. To assess LHDs’ level of engagement in assuring access to behavioural healthcare services, descriptive statistics were computed, whereas the factors associated with assuring access to these services were examined by using logistic regression analyses. To account for complex survey design, we used SVY routine in Stata 11. Results: Only about 24.9% of LHDs in small jurisdiction (<50,000 population) and 35.3% of LHDs in medium-size jurisdiction implemented/evaluated strategies to target the behavioural healthcare services needs of underserved populations in their jurisdiction in 2013. Logistic regression model results showed that LHDs having city/multicity jurisdiction (adjusted odds ratio (AOR) = .16, 95% confidence interval (CI): .04–.77), centralised governance (AOR = .12, 95% CI: .02–.85), and those located in South Region (AOR = .25, 95% CI: .08–.74) or the West Region (AOR = .36, 95% CI: 14–.94), were less likely to have implemented/evaluated strategies to target the behavioural healthcare needs of the underserved. Conclusions: The extent to which the LHDs implemented or evaluated strategies to target the behavioural healthcare needs of the underserved population varied by geographic regions and jurisdiction types. Different community needs or different state Medicaid programmes may have accounted for these variations. LHDs could play an important role in improving equity in access to care, including behavioural healthcare services in the communities.

A possible dose–response association between distance to farmers’ markets and roadside produce stands, frequency of shopping, fruit and vegetable consumption, and body mass index among customers in the Southern United States

BackgroundThe association between farmers’ market characteristics and consumer shopping habits remains unclear. Our objective was to examine associations among distance to farmers’ markets, amenities within farmers’ markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and body mass index (BMI). We hypothesized that the relationship between frequency of farmers’ market shopping and BMI would be mediated by fruit and vegetable consumption.MethodsIn 15 farmers’ markets in northeastern North Carolina, July–September 2015, we conducted a cross-sectional survey among 263 farmers’ market customers (199 provided complete address data) and conducted farmers’ market audits. To participate, customers had to be over 18 years of age, and English speaking. Dependent variables included farmers’ market shopping frequency, fruit and vegetable consumption, and BMI. Analysis of variance, adjusted multinomial logistic regression, Poisson regression, and linear regression models, adjusted for age, race, sex, and education, were used to examine associations between distance to farmers’ markets, amenities within farmers’ markets, frequency of farmers’ market shopping, fruit and vegetable consumption, and BMI.ResultsThose who reported shopping at farmers’ markets a few times per year or less reported consuming 4.4 (standard deviation = 1.7) daily servings of fruits and vegetables, and those who reported shopping 2 or more times per week reported consuming 5.5 (2.2) daily servings. There was no association between farmers’ market amenities, and shopping frequency or fruit and vegetable consumption. Those who shopped 2 or more times per week had a statistically significantly lower BMI than those who shopped less frequently. There was no evidence of mediation of the relationship between frequency of shopping and BMI by fruit and vegetable consumption.ConclusionsMore work should be done to understand factors within farmers’ markets that encourage fruit and vegetable purchases.

The Ten Essential Public Health Services Model as a Framework for Correctional Health Care

Correctional health care is of interest to public health practitioners due to the highly vulnerable social and health characteristics of inmates, ex-offenders, and their communities, as well as the access to health care provided to them through the criminal justice system. The public health model for correctional health care has evolved from one concerned primarily with infectious disease control within the facility to a model of comprehensive health care that additionally recognizes the importance of providing continuity of care as inmates transition into free-living communities. The Ten Essential Public Health Services is proposed as a conceptual framework for a public health approach to correctional health care and is illustrated by application to a health care program for a large jail system in Jacksonville, FL.

A Tool to Cost Environmental Health Services in North Carolina Local Health Departments

Introduction: The cost of providing a basic set of public health services necessary not been well-described. Recent work suggests public health practitioners are unlikely to have the empirically-based financing information necessary to make informed decisions regarding practice. The purpose of this paper is to describe the development of a costing tool used to collect primary data on the number of services provided, staff employed, and costs incurred for two types of mandated environmental health services: food and lodging inspections and onsite water services. Methods: The tool was iteratively reviewed, revised, and piloted with local health department (LHD) environmental health and finance managers. LHDs (n=15) received technical support to estimate costs for fiscal year 2012. Results: The tool contained the following sections: Agency/Respondent Information, Service Counts, Direct Labor Costs, Direct Non-Labor Costs, and Indirect/Overhead Costs. The time required to complete the tool ranged from 2 to 12 hours (median = 4). Implications: LHDs typically did not track costs by program area, nor did they acknowledge indirect costs or costs absorbed by the county. Nonetheless, this costing tool is one of the first to estimate costs associated with environmental health programs at the LHD level and has important implications for practitioners and researchers, particularly when these limitations are recognized.

Local Health Departments' Costs of Providing Environmental Health Services

Background: A detailed understanding of the costs that local health departments (LHDs) incur in the provision of public health services plays an important role in their efforts to provide services in an effective and efficient manner. However, surprisingly little evidence exists about the key cost components that LHDs incur in the provision of services. Purpose: The purpose of this report was to provide empirical estimates of LHDs’ cost structure. Methods: Using cost information for 2012 from 15 LHDs in North Carolina for two public health services—food and lodging and onsite water—this report first presents estimates of the total costs per service provided. In a second step, total costs are decomposed into key components, including direct and indirect costs. Both data collection and analysis were conducted in 2014. Results: For the LHDs examined in this report, median cost per service amounted to

Exploring Costing Methods for Environmental Health Services in North Carolina

145 for food and lodging and

Patient Scenario Identifies Gaps in Breast Cancer Services in a Rural Region

82 for onsite water. Service costs, however, varied widely across agencies. Decomposition showed that direct labor costs represented more than 80% of total costs. Other direct costs accounted for 10% to 15% of total costs, while indirect costs represented 5% to 6% of total costs. Implications: The finding that labor costs represent a majority of the total costs of service provision has important implications for public health practitioners. Perhaps most importantly, for the purpose of costing public health services, estimation procedures may be simplified by focusing primarily on the cost of labor required to provide any given service.

Provision of Personal Healthcare Services by Local Health Departments

All local health departments in North Carolina are mandated to provide a defined set of environmental health services, yet few have the tools to understand the costs incurred in delivering these services. The objectives of this study were to (1) derive cost estimates for 2 commonly provided environmental health services—food and lodging inspections and on-site water services—and (2) explore factors that drive variations in costs, focusing on the roles of economies of scale and scope. Using data from 15 local health departments in North Carolina, we found that costs varied substantially. A bivariate analysis found evidence of economies of scale: higher volumes of services were associated with lower costs per service. Providing a greater scope of services, however, was not consistently associated with reduced costs. In-depth cost data provide public health officials with key information when deciding how to best serve their communities.