Research Objective: This study investigates organizational and community characteristics associated with the likelihood of local health departments to conduct community health assessments (CHAs).
Study Design: For this observational study, we used data from the 2010 National Profile of Local Health Departments Study (Profile). Using the FIPS codes for the county and place, additional data were merged with Profile data to capture community characteristics. To compute estimates of community characteristics for LHDs involving multiple cities/counties, we computed population weighted averages. In order to estimate unbiased population parameters, we used appropriate statistical weights in all analyses, to account for disproportionate non-responses by LHDs serving different population sizes. Bivariate analysis and multinomial logistic regression analysis were performed with a dependent variable measuring LHD’s performance of community health assessment with the following attributes: LHDs were asked to respond to the question, “Has a community health assessment been completed for your LHD’s jurisdiction? (Select all that apply)”, with five response categories which were re-grouped as follows: (1) “Yes, within five years”, (2) “No but plan to in the next year”, and (3) “Not within the last five years and no plan in the next year”.
Population Studied: The study population included all 2565 LHDs in the U.S. that met the definition of a local health department at the time of the study: “an administrative or service unit of local or state government concerned with health and carrying some responsibility for the health of a jurisdiction smaller than the state.”
Principal Findings: Significantly higher proportion of LHDs staffed with one or more epidemiologists reported a CHA within five years. Local health departments with local or shared governance were more likely than state-governed LHDs to have completed community health assessment in the past five years. LHDs serving smaller jurisdictions had a lower proportion of CHAs, as did LHDs without epidemiologists. After controlling for jurisdiction type, LHD jurisdictional population size, , sources of revenue and community characteristics, the multivariate analysis showed that LHDs without an epidemiologist were less likely to report a CHA compared to LHDs with an epidemiologist (OR = 0.621, p = 0.024). LHDs with higher proportions of revenues from state and federal sources were significantly more likely to report a CHA within the last five years. All three community socio-demographic variables included in the model were also associated with the completion of CHA.
Conclusion: LHDs varied in their performance of CHA by modifiable characteristics including having an epidemiologist on the LHD staff, the higher proportion of funds from state and federal revenue sources, and the type of LHD governance. Variation in LHDs completion of CHA was also found by community characteristics, included lower home ownership rates, higher proportion of adult population, and higher unemployment rate in the LHD jurisdiction.
Implications for Policy, Delivery or Practice: With pressure on LHDs to complete CHA as a prerequisite for voluntary accreditation, the factors predicting CHA suggest ways to strengthen the local public health infrastructure.
Funding Source(s): N/A
Oral presentation at Academy Health Annual Research Meeting in session titled: “ Public Health Systems in Flux: Social, Economic, and Political Influences"
Shah, Gulzar H. Dr., Barbara Laymon, Carolyn Leep, Julia Elligers.
"Community Health Assessment Activity by LHDs: The Influence of Local Health Agency and Community Characteristics."
Health Policy and Management Faculty Presentations.