Community engagement is enshrined in federal public health emergency preparedness (PHEP) grant guidance, national consensus statements on preparedness, and current principles of public health practice. Prior to this project, little was known about how this objective translates into local practice and whether local health departments (LHDs) can support this strategic aim. The project consisted of a two-phase investigation of LHD capacity to engage the community in PHEP involving:
(1) Secondary analysis of survey data from the National Profile of Local Health Departments;
(2) Case studies of "high-performing" and "high-aspiring" LHDs in relation to community engagement; and
Phase I statistical analyses revealed that three staff positions -- emergency preparedness coordinator, public information specialists, and health educator -- were strong predictors of whether an LHD involves the public in PHEP (controlling for other variables, including annual expenditure and size of population served). Like any other critical public health function, community engagement depends upon proper staffing. LHDs with an emergency preparedness coordinator were 13% more likely to organize PHEP coalitions, 17.9% more likely to conduct PHEP public education, and 7.8% more likely to develop a local Medical Reserve Corp unit. However, the data also showed that the presence of LHD personnel critical to community engagement in PHEP was highly variable across the country. Less than half of the LHDs surveyed had a public information specialist, and 1 of every 4 LHDs queried did not employ a health educator or preparedness coordinator.
Phase II case study interviews revealed several dominant themes. Skilled personnel, with fewer priorities competing for their time, are necessary for an LHD to engage the community in PHEP. Dedicated people are needed to develop an engagement strategy, cultivate relationships with community- and faith-based groups, conduct broad public outreach and education, and mobilize volunteers. An influential, top LHD leader who explicitly endorses community engagement in PHEP as a strategic priority is also seen as a prerequisite for the work to go forward. Helping to trigger that endorsement is clear communication by the federal government that community engagement in PHEP is a genuine priority and a grant deliverable. The backing of local political leadership, too, advances the goal of public involvement in PHEP.
The project team built upon this project to conduct a third phase in 2012 (funded by the Center for Biosecurity), consisting of a national survey of LHDs to baseline current PHEP community engagement, capacity, and needed resources.
To inform the development of this multi-phased project, the research team performed a literature review that addressed U.S. PHEP policy and practice history, public health systems infrastructure and performance, and the role of community engagement in public health campaigns. The two phases of the project used the following methods:
1. Secondary analysis of LHD National Profile survey data: To determine the effect of personnel and infrastructure on community engagement in PHEP, three outcome measures were selected from the 2005 and 2008 LHD surveys, namely whether the LHD had: (a) organized coalitions for PHEP; (b) conducted community education for PHEP; and/or (c) developed a local Medical Reserve Corps unit. Both a comparison of means and a multivariate linear probability model were used to test hypotheses that certain personnel types were positively associated with community engagement outcomes.
2. Case studies of "high-performing" and "high-aspiring" LHDs in relation to community engagement: Semi-structured interviews were conducted with the LHD leadership, the public health information officer, PHEP coordinator, and community outreach staff. Dominant themes and trends from interview transcripts and reports were recorded.
The project included in-depth interviews with health officers, emergency managers, grassroots leaders, and other key informants (from a selection of demographically and geographically diverse locales) to ascertain those variables that enable CE applications; identify the terms in which authorities and community members judge CE initiatives as "successful;" and begin documenting the consequences of CE for health emergency management. An advisory board of researchers, practitioners, and local leaders guided the study design and digital materials.