Term of Award

Spring 2021

Degree Name

Doctor of Public Health in Epidemiology (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Biostatistics, Epidemiology, and Environmental Health Sciences

Committee Chair

Logan Cowan

Committee Member 1

Jessica Schwind

Committee Member 2

Gulzar Shah


Public health emergencies require local health departments (LHDs) and their communities to be well prepared to mount an effective, rapid response. LHDs must continuously develop, test, and revise their emergency operations plans (EOPs) to ensure they are current and work properly. Evidence suggests EOPs are best tested through public health emergency preparedness (PHEP) exercises. A PHEP exercise often used to test EOPs is the drive-through clinic (DTC). To date, research on drivers of developing and maintaining EOPs and participating in PHEP exercises are lacking. Further, an evidence-based summary of effective practices for implementing DTCs does not exist. Three chapters (chapters 3-5) were developed to explore said knowledge gaps. Chapter 3 utilized measures from the Public Health Accreditation Board’s (PHAB) information system to cross-sectionally assess the relationship between PHEP capacity building, PHEP protocols, and LHDs’ development and maintenance of their EOPs. The fully adjusted model revealed that PHEP capacity building was positively associated with successfully developing and maintaining EOPs. Findings suggest PHEP capacity building is crucial for LHDs to continuously develop, test, and revise their EOPs. Chapter 4 employed data from the 2016 National Association of County & City Health Officials profile study to cross-sectionally evaluate the relationship between LHD PHAB accreditation status and their highest reported level of PHEP exercise participation. The adjusted results revealed LHDs in the in-progress stage (vs. unaccredited) were significantly less likely to have reported their highest exercise participation was high-level full-scale exercises and lower-level tabletop exercises. Further, in-progress LHDs were significantly less likely to have participated in any PHEP exercises, suggesting they need to increase their PHEP exercise participation. Chapter 5 identified and presented effective practices and recommendations for implementing DTCs by theme. The themes identified were (1) optimal DTC design and planning via decision support systems and decision support tools; (2) clinic layouts, locations, and design aspects; (3) staffing, training, and DTC communication; (4) throughput time; (5) community outreach methods; (6) DTC equipment; (7) infection prevention and personal protective equipment; and (8) adverse events prevention and traffic management. The effective practices and recommendations presented can be used to implement effective and efficient DTCs.

Research Data and Supplementary Material


Available for download on Tuesday, April 14, 2026