Results from a 2020 field experiment encouraging voting by mail.

The ability to cast a mail ballot can safeguard the franchise. However, because there are often additional procedural protections to ensure that a ballot cast in person counts, voting by mail can also jeopardize people's ability to cast a recorded vote. An experiment carried out during the COVID-19 pandemic illustrates both forces. Philadelphia officials randomly sent 46,960 Philadelphia registrants postcards encouraging them to apply to vote by mail in the lead-up to the June 2020 primary election. While the intervention increased the likelihood a registrant cast a mail ballot by 0.4 percentage points (P = 0.017)-or 3%-many of these additional mail ballots counted only because a last-minute policy intervention allowed most mail ballots postmarked by Election Day to count.

Using a positive deviance framework to identify Local Health Departments in Communities with exceptional maternal and child health outcomes: a cross sectional study.

BACKGROUND: The United States spends more than most other countries per capita on maternal and child health (MCH), and yet lags behind other countries in MCH outcomes. Local health departments (LHDs) are responsible for administering various maternal and child health programs and interventions, especially to vulnerable populations. The goal of this study was to identify local health department jurisdictions (LHDs) that had exceptional maternal and child health outcomes compared to their in-state peers - positive deviants (PDs) - in Washington, Florida and New York in order to support the identification of strategies that can improve community health outcomes. METHODS: We used MCH expenditure data for all LHDs in FL (n = 67), and WA (n = 35), and most LHDs in NY (n = 48) for 2009-2010 from the Public Health Activities and Services Tracking (PHAST) database. We conducted our analysis in 2014-2015. Data were linked with variables depicting local context and LHD structure. We used a cross-sectional study design to identify communities with better than expected MCH outcomes and multiple regression analysis to control for factors outside of and within LHD control. RESULTS: We identified 50 positive deviant LHD jurisdictions across 3 states: WA = 10 (29 %); FL = 24 (36 %); NY = 16 (33 %). Overall, internal factor variables improved model fit for identifying PD LHD jurisdictions, but individual variables were not significant. CONCLUSIONS: We empirically identified LHD jurisdictions with better MCH outcomes compared to their peers. Research is needed to assess what factors contributed to these exceptional MCH outcomes and over which LHDs have control. The positive deviance method we used to identify high performing local health jurisdictions in the area of maternal and child health outcomes can assist in better understanding what practices work to improve health outcomes. We found that funding may not be the only predictor of exceptional outcomes, but rather, there may be activities that positive deviant LHDs are conducting that lead to improved outcomes, even during difficult financial circumstances. This method can be applied to other outcomes, communities, and/or services.

The Importance of Partnerships in Local Health Department Practice Among Communities With Exceptional Maternal and Child Health Outcomes.

OBJECTIVES: The purpose of this study was to identify unique practices underway in communities that have been empirically identified as having achieved exceptional maternal and child health (MCH) outcomes compared with their peers. METHODS: We used a qualitative, positive deviance approach to identify practices implemented by local health department (LHD) jurisdictions in Florida, Washington, and New York that achieved better MCH outcomes than expected compared with their in-state peer jurisdictions. We identified a total of 50 LHDs in jurisdictions that had better than expected MCH outcomes compared with their peers, and we conducted 39 hour-long semistructured interviews with LHD staff. We conducted inductive thematic analysis to identify key themes and subthemes across all LHD cases in the sample. RESULTS: Partnerships with providers, partnerships for data collection/assessment, and partnerships with community-based organizations were associated with exceptional MCH outcomes based on our interviews. DISCUSSION: This study offers specific examples of practices LHDs can implement to improve MCH outcomes, even with limited resources, based on the practices of high-performing local health jurisdictions.