Using Photovoice to Improve Engagement in Community Health Assessments Addressing Behavioral Health.

Behavioral health disorders are well-known to have close links with the social determinants of health, yet little is known about how impacted communities perceive these links. Qualitative participatory methods can not only provide insight into how communities conceptualize these relationships but also empower those with lived experience to contextualize their perspectives and formulate calls to action. This study used Photovoice as a participatory method to supplement the Clark County Health Department Community Health Assessment and determine priority facilitators and barriers contributing to the behavioral health of Clark County, KY, residents. A secondary aim was to gain a greater understanding of how the Photovoice methodology impacts community engagement efforts in Community Health Assessments. Twenty-three Clark County residents participated in four Photovoice groups involving five weekly sessions, which included photograph "show and tell," critical group dialogue, participatory analysis, and planning for dissemination. Secondary analysis of Photovoice focus group discussions revealed behavioral health facilitators and barriers were most influenced by (1) public sector unresponsiveness, (2) strong partnerships formed between community and grassroots organizations, and (3) the siloed division of responsibility between agencies and across sectors. The authors also found the Photovoice method successfully enhanced engagement and empowered those with lived experience to frame their perspectives of the behavioral health landscape. This project has implications for enhancing community engagement and empowerment in behavioral health-focused public health assessments and shaping policy to promote multi-sector collaboration.

Pursuing Public Health Accreditation: A Focus on HOW.

INTRODUCTION: Balancing competing imperatives of conserving scarce resources while improving organizational performance and community health, many local health departments (LHDs) have decided to pursue national, voluntary public health accreditation as a guide to improvement, but how to do so in the most efficient way possible remains a question for many. METHODS: This study employed a participatory action research approach in which LHD directors and accreditation coordinators from 7 accredited and 3 late-stage accreditation ready Kentucky LHD jurisdictions participated. Participants organized a set of accreditation deliverables into a chronological sequencing of each site's accreditation readiness process, which was then coded by researchers to identify similarities and differences. RESULTS: All participating jurisdictions had all-hazards emergency operations plans and public health emergency operations plans while none had workforce development plans, quality improvement plans, or performance management plans before launching accreditation readiness activities. Also identified were the number of accreditation deliverables attempted, simultaneously, by each site and the importance of specific deliverables having a singular focus. Sequences of work on specific deliverables by the majority of participants included completing work on the quality improvement plan immediately, followed by the performance management plan, the Community Health Assessment before the Community Health Improvement Plan, and a strategic plan, followed by a workforce development plan. Factors influencing accreditation readiness processes, elements for sustaining processes, and lessons learned throughout the pursuit of accreditation were also provided by participants. CONCLUSIONS: Recognizing the impact of staff availability, staff skill sets, training, and available financial resources on the pursuit of accreditation, participants determined that aggregating lessons learned into a flowchart highlighting the interconnectedness of accreditation deliverables could produce a road map for LHDs. Accreditation deliverables could be attempted in a logical, efficient order particularly valuable to small LHDs with limited resources and yet adaptable for those jurisdictions able to devote more resources to the process.

Cross Jurisdictional Boundaries to Build a Health Coalition: A Kentucky Case Study.

Cross-jurisdictional sharing is accomplished through collaboration across jurisdictional boundaries to deliver essential public health services and solve problems that cannot be easily addressed by single organizations or jurisdictions. Partners across 10 counties and three public health jurisdictions of the Barren River Area Development District (BRADD) convened as Barren River Initiative to Get Healthy Together (BRIGHT), a community health improvement coalition. Focus groups and interviews with BRIGHT members indicate that the use of effective strategies to focus collaborative health improvement efforts fosters a cohesive coalition even when the group is populated by individuals from across public health jurisdictional boundaries. Focusing strategies identified included: the importance of organizing workgroups so members can draw upon expertise, adoption of a community engagement model for health assessment and improvement; and use of a facilitator, who offers guidance and administrative support to groups and focuses members on accomplishing goals.

Facilitating Community Health Improvement Capacity Through Nongovernmental Public Health Partners.

The purpose of this study was to evaluate the effectiveness of the Facilitating the Community Health Improvement Process training in increasing the capacity of nongovernmental public health partners to serve as facilitators and supporters of community health improvement coalitions. Ten members of WellCare Advocacy and Community-Based Program teams (CommUnity Advocates) serving communities across the country were identified to participate in the pilot training group. They completed pre- and posttraining surveys to evaluate knowledge of community health improvement process models and facilitation techniques, as well as qualitative interviews to assess use of training material 6 months after the training. Results of the project revealed successful use of content from the training, which enhanced the impact of nongovernmental public health partners as facilitators of community health improvement planning and implementation.

Organizational Variation in Implementation of an Evidence-Based Human Papillomavirus Intervention.

INTRODUCTION: "1-2-3 Pap" is a video-based intervention designed to improve human papillomavirus (HPV) vaccine adherence rates among young women in rural Eastern Kentucky. The efficacy trial for the original intervention linked video exposure with increased likelihood of vaccine series completion among the target audience. Given their historic focus on prevention, local health departments were selected as pilot sites to study implementation of 1-2-3 Pap in a public health setting and identify site-specific variations in its implementation. METHODS: A mixed-method, pre- and post-comparison pilot study conducted between October 2013 and April 2014 addressed three primary research questions: (1) how specific implementation planning activities using existing organizational resources and processes affect the selection and optimization of dissemination channels for evidence-based public health interventions; (2) what organizational resources, processes, or other attributes facilitate or impede implementation of evidence-based public health interventions; and (3) how variation in dissemination channels corresponds with intervention outcomes. RESULTS: Although analysis conducted in October 2014 found that the pilot study did not generate significant changes in HPV vaccine rates, data yielded from the Organizational Readiness to Change Assessment survey instrument and process evaluation interviews revealed variation in pre-study planning and in the use and coordination of staff, the adaptation of materials provided for implementation, and sites' ability to access HPV vaccine rate data throughout the study. CONCLUSIONS: The mixed-method pilot study advances dissemination and implementation science through identification of variation in planning activities and use of organizational resources and processes for implementation of prevention interventions in public health settings.