Term of Award

Fall 2024

Degree Name

Doctor of Public Health (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

College of Public Health

Committee Chair

Gulzar Shah

Committee Member 1

William Mase

Committee Member 2

Bettye Apenteng

Committee Member 3

Kristie Waterfield

Abstract

Despite pandemic warning signs and guidance since the early 2000s, COVID-19 brought to light gaps in the emergency preparedness of local health departments (LHDs). This study sought to address questions regarding harassment and examine if changes in staffing associated with turnover and burnout are related to the use of informatics systems. Data on harassment was collected through interviews, while quantitative data was collected on informatics use through jurisdictions from the National Association of County and City Health Officials (NACCHO) 2022 Profile Study. Thematic analyses point to significant challenges of burnout, turnover, and decreases in interoperability, leading to harassment that reduces informatics use. Regression analyses found that LHD characteristics were statistically associated with the odds of adopting various informatics systems. For all systems, organizational factors such as the size of the LHD as measured by the number of full-time employees (FTE) were more often statistically associated with system implementation and the classification of local governance relative to the population served. For eCR, each additional FTE increased the odds of adopting eCR (AOR=1.014, p=0.027); for local governance, the odds were lower (AOR=0.365, p=0.017). EHR adoption was more likely if there were additional FTEs (AOR=1.054, p=0.000), especially if the LHD was under shared governance (AOR=6.701, p=0.000). For ELR, the odds of implementing ELR also increased if there were additional FTEs (AOR=1.091, p=0.015), and the LHD was shared governance (AOR=7.348, p=0.000). The odds of adopting HIE increased if there were additional FTEs (AOR=1.054, p=0.000) and the LHD was shared governance (AOR=1.827, p=0.040). IR adoption odds increased if LHDs had additional FTEs (AOR=1.077, p=0.000) and the LHD was under shared governance (AOR=2.534, p=0.000). Recommendations for the next steps include supporting favorable working conditions and developing a targeted training program to build staff resilience to enhance public health response.

Research Data and Supplementary Material

No

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