Factors Affecting the Progress of Community Health Assessment and Improvement Activities in Kansas. Issue 4 (July 2015) - Wetta, Ruth E.
Abstract Context: Community health assessment (CHA) and community health improvement planning (CHIP) are important functions for local health departments (LHDs) but may present challenges, particularly in rural settings. Objective: The purpose of this 2-year, mixed-methods study was to identify factors that impede or promote the timeliness and quality of CHA-CHIP completion in Kansas. Design: Focus group interviews, conducted at baseline (2012) and at 1 year (2013), included 15 and 21 groups, respectively. Scores from a 12-item attitudinal survey that explored participants' confidence to perform CHA-CHIP activities were collected in tandem with focus groups. Setting: Kansas counties that planned to conduct a CHA-CHIP process during 2012 and/or 2013 were eligible to participate. Participants: There were 128 study participants (57 in 2012, 71 in 2013), who were predominantly female (83%), aged 51 years or older (61.4%), and lived in rural areas (84.6%). Public health region representation in 2012 and 2013 was 73% and 93%, respectively. Main Outcome Measures: Changes in perceptions about CHA-CHIP inputs, process, outputs, outcomes, and self-efficacy to perform CHA-CHIP activities were explored. Results: Progress in CHA-CHIP implementation was reported in 2013. Most participants perceived the CHA-CHIP process as valuable and enhanced the LHD's visibility. Rural participants reported having completed the CHA phase, whereas urban LHDs had progressed into the planning and implementation stage. Potentiators of the CHA-CHIP process included (1) parallel assessment activities conducted by other community organizations, and (2) for rural counties, a functioning 501(c)3 community health coalition. Perceptions about the importance of partnership and leadership were unchanged. A multivariate regression analysis revealed a significant time effect and rural-urban difference in perceived self-efficacy. Conclusions: Workforce development and public health system development issues are central concerns identified by this study. Local health departments with constrained resources and limited staff, despite additional training, are unlikely to develop the capacity needed to effectively support CHA-CHIP, making long-term sustainability uncertain.