Supporting Rural Community Emergency Planning, Response, and Recovery.

When rural communities are faced with an emergency or disaster, their capacity to support the response is often exceeded. The NORC Walsh Center for Rural Health Analysis and the Rural Health Information Hub (RHIhub) developed the Rural Emergency Preparedness and Response Toolkit (the Toolkit) to support rural communities with disaster planning, response, and recovery. The Toolkit provides information drawn from literature, subject matter experts, and case studies and shares key considerations for emergency preparedness. This article highlights the development of and key insights from the Toolkit, including preparedness frameworks, population considerations, plan and assessment examples, and funding support. Investing in emergency preparedness is vital for rural communities and this Toolkit offers strategies and best practices for each phase of a disaster.

Benefits and Impacts of Public Health Accreditation for Small Local Health Departments.

OBJECTIVE: This study sought to identify accreditation benefits and impacts among local health departments (LHDs) stratifying by size of population served to determine differences between small, medium, and large LHDs. BACKGROUND: The Public Health Accreditation Board operates the national accreditation program for public health departments, through which 306 LHDs have been accredited as of August 2022. Benefits of accreditation for LHDs are well documented, despite potential challenges and barriers to seeking accreditation. Research on the benefits of accreditation for small LHDs, specifically, is more limited. METHODS: All health departments that completed the accreditation process between December 2013 and May 2022 were surveyed following receipt of the accreditation decision. The analytic sample included 266 LHDs (response rate of 93.7%). Data for LHDs were analyzed for specific variables related to experiences, challenges, and benefits, and stratified by size to compare small LHDs with medium and large LHDs. Bivariate analyses were conducted to identify statistical significance. RESULTS: Generally, small LHDs reported similar outcomes of accreditation to medium and large LHDs. These included improvements in staff competencies, capacity to provide high-quality services, and relationships with partners. Small LHDs were significantly more likely than medium and large LHDs to report that accreditation increased their use of evidence-based practices. LHDs of all sizes reported an increase in quality improvement activities due to accreditation. Challenges for small LHDs included limited staff time or staff turnover and limited funding. CONCLUSIONS: The public health accreditation program has offered numerous benefits to LHDs of all sizes, including small LHDs. These accreditation benefits may be particularly important for small LHDs because of their critical role in the public health system and the ongoing need to support performance improvement, strengthen infrastructure, and increase resilience.

The Public Health National Center for Innovations: An Initial Qualitative Evaluation.

CONTEXT: The Public Health National Center for Innovations (PHNCI) was launched in 2015 as a division of the Public Health Accreditation Board (PHAB) to serve as a hub for fostering public health innovation and transformation. OBJECTIVES: We explored perspectives of key informants to assess PHNCI's work in its first 5 years, including implementation of activities, outputs, accomplishments, and opportunities. DESIGN: This qualitative study involved a Web site review; secondary document review; 15 interviews with 17 key informants purposively sampled from 2 groups-PHNCI and PHAB staff and leadership (PHNCI respondents), and external partners and collaborators (external respondents); and thematic analysis of qualitative data. SETTING: United States. RESULTS: PHNCI implemented its planned activities over the past 5 years-including grant programs and learning communities; large-scale public health initiatives; conferences, events, and convenings; webinar trainings; and resources, tools, and materials-resulting in more than 150 outputs. According to key informants, PHNCI's major accomplishments were as follows: contributed to an increased understanding and awareness of innovation in the public health field; provided grants and learning communities to support innovation; developed and disseminated materials to help practitioners innovate; established partnerships and promoted cross-sector collaboration; supported systems transformation; incorporated innovation into public health accreditation; and focused efforts to advance health equity. CONCLUSIONS: Going forward, PHNCI should continue to prioritize its core activities that support public health innovation and transformation; expand its work by addressing innovation in new public health topic areas; strengthen and expand its cross-sector work, partnerships, and activities to advance health equity and antiracism; and increase its visibility and reach, particularly within other sectors. Continued commitment and leadership are important for strengthening the capacity of the public health system to innovate, respond to ongoing and emerging public health threats and challenges, and advance health equity.

Exploring the Linkage Between Accreditation Outcomes and Public Health Emergency Preparedness and Response.

Public health emergency preparedness is a critical health department function. The national public health accreditation program may enhance public health preparedness by building the capabilities and overall capacity of health departments and also by improving capabilities specific to preparedness. This study presents findings from a survey sent to health departments 1 year after achieving accreditation, with a focus on accreditation outcomes related to public health preparedness. Between April 2014 and February 2020, 214 health departments responded to the survey. Most respondents indicated that accreditation had positively influenced their health department's performance within each of the selected topic areas that may influence public health preparedness: workforce development; quality improvement efforts; use of evidence and data to drive decisions; and partnerships, accountability, and credibility among external stakeholders. Enhancing overall health department capacity through accreditation may support the ability of health departments to prepare for, respond to, and recover from public health emergencies.

Impact of Accreditation on Health Department Financial Resources.

CONTEXT: There is limited data available on the financial benefits of public health accreditation. OBJECTIVE: This study assessed the financial impacts reported by public health departments as a result of participating in the Public Health Accreditation Board (PHAB) national accreditation program. DESIGN: Data from an ongoing survey of outcomes among health departments accredited for 1 year were linked to PHAB administrative data on health department characteristics to examine self-reported financial impacts of accreditation as of June 2020. SETTING: Accredited public health departments in the United States. PARTICIPANTS: Leadership from 214 unique state, local, Tribal, and Army installation health departments that had been accredited for 1 year by PHAB. MAIN OUTCOME MEASURES: Improved utilization of resources, increased competitiveness for funding opportunities, and new funding resulting from accreditation. RESULTS: One year following accreditation, 57% of all responding health departments reported improved utilization of resources whereas less than half reported improved competitiveness for funding (39%) and new funding (23%) as a result of accreditation. Health departments reporting new funding as a result of accreditation, compared with those that did not report new funding, were also more likely to report other outcomes from accreditation, including improved staff competencies, increased health department capacity to address health priorities and provide high-quality programs and services, increased use of evidence-based practices, new opportunities for external partnerships and collaboration, improved understanding of the health department's role among governing entities and policy makers, and improved credibility. Accredited local health departments (LHDs) with annual budgets less than $10 million reported new funding more often than LHDs with larger annual budgets. CONCLUSIONS: Accredited health departments that reported new funding were also more likely to report other outcomes of accreditation, including improved staff competencies, new partnerships, and improved credibility. More research is needed to further understand the relationship between accreditation and financial impacts.

Factors Affecting Implementation of Evidence-Based Practices in Public Health Preparedness and Response.

CONTEXT: There is limited research on what factors are most salient to implementation of evidence-based practices (EBPs) among public health agencies in public health emergency preparedness and response (PHPR) and under what conditions EBP implementation will occur. OBJECTIVE: This study assessed the conditions, barriers, and enablers affecting EBP implementation among the PHPR practice community and identified opportunities to support EBP implementation. DESIGN: A Web-based survey gathered information from public health agencies. Data obtained from 228 participating agencies were analyzed. SETTING: State, local, and territorial public health agencies across the United States. PARTICIPANTS: Preparedness program officials from 228 public health agencies in the United States, including Public Health Emergency Preparedness (PHEP) cooperative agreement awardees (PHEP awardees) and a random sample of local health departments (LHDs). RESULTS: Respondents indicated that EBP is necessary and improves PHPR functions and tasks and that staff are interested in improving skills for EBP implementation. Top system-level barriers to EBP implementation were insufficient funding, lack of EBP, and lack of clarity regarding which practices are evidence based. PHEP awardees were significantly more likely to report a lack of EBP in the field, whereas LHDs were significantly more likely to report a lack of incentives. The top organizational-level barrier was insufficient staff. Most respondents indicated their agency culture supports EBP; however, LHDs were significantly more likely to report a lack of support from supervisors and leadership. Few respondents reported individual barriers to EBP implementation. CONCLUSIONS: Findings indicate an opportunity to improve dissemination strategies, communication efforts, and incentives to support EBP implementation in PHPR. Potential strategies include improving awareness of and accessibility to EBPs through targeted dissemination efforts; building organizational capacity to support EBP implementation, particularly staff capacity, knowledge, and skills; and identifying funding and incentives to promote EBP uptake and sustainment.

Quality Improvement and Performance Management Benefits of Public Health Accreditation: National Evaluation Findings.

OBJECTIVE: To identify the quality improvement (QI) and performance management benefits reported by public health departments as a result of participating in the national, voluntary program for public health accreditation implemented by the Public Health Accreditation Board (PHAB). DESIGN: We gathered quantitative data via Web-based surveys of all applicant and accredited public health departments when they completed 3 different milestones in the PHAB accreditation process. PARTICIPANTS: Leadership from 324 unique state, local, and tribal public health departments in the United States. RESULTS: Public health departments that have achieved PHAB accreditation reported the following QI and performance management benefits: improved awareness and focus on QI efforts; increased QI training among staff; perceived increases in QI knowledge among staff; implemented new QI strategies; implemented strategies to evaluate effectiveness and quality; used information from QI processes to inform decision making; and perceived achievement of a QI culture. The reported implementation of QI strategies and use of information from QI processes to inform decision making was greater among recently accredited health departments than among health departments that had registered their intent to apply but not yet undergone the PHAB accreditation process. Respondents from health departments that had been accredited for 1 year reported higher levels of staff QI training and perceived increases in QI knowledge than those that were recently accredited. CONCLUSIONS: PHAB accreditation has stimulated QI and performance management activities within public health departments. Health departments that pursue PHAB accreditation are likely to report immediate increases in QI and performance management activities as a result of undergoing the PHAB accreditation process, and these benefits are likely to be reported at a higher level, even 1 year after the accreditation decision.

Benefits and Perceptions of Public Health Accreditation Among Health Departments Not Yet Applying.

OBJECTIVE: To identify the benefits and perceptions among health departments not yet participating in the public health accreditation program implemented by the Public Health Accreditation Board (PHAB). DESIGN: Quantitative and qualitative data were gathered via Web-based surveys of health departments that had not yet applied for PHAB accreditation (nonapplicants) and health departments that had been accredited for 1 year. PARTICIPANTS: Respondents from 150 nonapplicant health departments and 57 health departments that had been accredited for 1 year. RESULTS: The majority of nonapplicant health departments are reportedly conducting a community health assessment (CHA), community health improvement plan (CHIP), and health department strategic plan-3 documents that are required to be in place before applying for PHAB accreditation. To develop these documents, most nonapplicants are reportedly referencing PHAB requirements. The most commonly reported perceived benefits of accreditation among health departments that planned to or were undecided about applying for accreditation were as follows: increased awareness of strengths and weaknesses, stimulated quality improvement (QI) and performance improvement activities, and increased awareness of/focus on QI. Nonapplicants that planned to apply reported a higher level of these perceived benefits. Compared with health departments that had been accredited for 1 year, nonapplicants were more likely to report that their staff had no or limited QI knowledge or familiarity. CONCLUSIONS: The PHAB accreditation program has influenced the broader public health field-not solely health departments that have undergone accreditation. Regardless of their intent to apply for accreditation, nonapplicant health departments are reportedly referencing PHAB guidelines for developing the CHA, CHIP, and health department strategic plan. Health departments may experience benefits associated with accreditation prior to their formal involvement in the PHAB accreditation process. The most common challenge for health departments applying for accreditation is identifying the time and resources to dedicate to the process.

Evaluating the Impact of National Public Health Department Accreditation - United States, 2016.

In 2011, the nonprofit Public Health Accreditation Board (PHAB) launched the national, voluntary public health accreditation program for state, tribal, local, and territorial public health departments. As of May 2016, 134 health departments have achieved 5-year accreditation through PHAB and 176 more have begun the formal process of pursuing accreditation. In addition, Florida, a centralized state in which the employees of all 67 local health departments are employees of the state, achieved accreditation for the entire integrated local public health department system in the state. PHAB-accredited health departments range in size from a small Indiana health department that serves approximately 17,000 persons to the much larger California Department of Public Health, which serves approximately 38 million persons. Collectively, approximately half the U.S. population, or nearly 167 million persons, is covered by an accredited health department. Forty-two states and the District of Columbia now have at least one nationally accredited health department. In a survey conducted through a contract with a social science research organization during 2013-2016, >90% of health departments that had been accredited for 1 year reported that accreditation has stimulated quality improvement and performance improvement opportunities, increased accountability and transparency, and improved management processes.

Barriers and facilitators of older adults' use of ride share services.

Introduction: Safe, affordable, and convenient transportation may help older adults (age 65 and older) stay independent, access healthcare services, and maintain their quality of life. While older adults in the United States primarily rely on private automobiles, those who reduce or cease driving may require alternative forms of transportation. Ride share services show promise as an alternative mode of transportation for older adults, particularly for those who no longer drive. Methods: We employed a qualitative research design to explore barriers and facilitators of older adults' use of ride share services and compare findings to younger adults (age 18 to 64). We conducted 96 telephone interviews (68 older adults and 28 younger adults), and 10 in-person focus groups (56 older adults and 17 younger adults), including individuals who used a ride share service and those who never used a ride share service. We conducted qualitative data analysis to identify key themes and developed a conceptual framework to organize and describe findings. Results: The qualitative analysis revealed the most important facilitator of older adults' use of ride share services was the desire to remain independent, particularly among those with health conditions and special needs that prevented them from using other transportation. Other facilitators included driver assistance (door-to-door service), a polite and courteous driver, a clean vehicle, and prompt and dependable service. Barriers among older adults included safety concerns, affordability, technology, and a lack of ride share services in the community. Among younger adults, technology was a facilitator of use. Conclusion: Ride share services are a promising transportation option. Findings highlight a need to tailor these services to older adults' needs. Ride share services that are safe, reliable, and offer driver assistance and telephone scheduling have the potential to support older adults' health, mobility, and independence.

Older Adult Willingness to Use Fully Autonomous Vehicle (FAV) Ride Sharing.

In the United States, older adults (age 65 and older) rely on private automobiles for transportation. For those who stop driving, access to alternative modes of transportation is important for health, wellbeing, mobility, and independence. This paper explores older adult willingness to use fully autonomous vehicle (FAV) ride sharing and the features or services of FAV ride sharing that would make them willing to take a ride. These data were gathered as part of a larger qualitative research study designed to explore the factors affecting older adult use of ride share services. For the larger study, we conducted 68 telephone interviews with older adults, and 10 in-person focus groups with 56 older adults, including individuals who both used and never used ride share services. We used a convenience sample recruited by study partners, including ride share and transportation services and a recruitment firm. The predominant thematic findings of the qualitative analysis included a desire for a proven safety record in terms of performance and technology, followed by dependability and accuracy of FAV ride sharing. Older adults' concerns about FAV ride sharing included safety concerns and preferences for social interaction with drivers. Ride share services that use FAVs in the future may need to tailor transportation offerings for older adults to increase their willingness to use FAVS to support their mobility and social needs.

Characteristics of ride share services for older adults in the United States.

INTRODUCTION: Safe and accessible transportation options are important for older adults' health, safety, mobility, and independence. Ride share services may promote older adult health and well-being. This is the first study that describes ride share services available to older adults (65+ years) in the United States, including factors that may affect use of services. METHODS: We analyzed secondary data from two research and administrative databases provided by ITNAmerica, a national non-profit transportation service for older adults: ITNRides, which tracks information on older adults who used ITN in 29 locations across the United States from 1996 to 2019, and Rides in Sight, the largest national data source on ride share services for older adults. We conducted a literature review, and telephone interviews with nine key informants representing ride share services, referral services, and other organizations. We offer a conceptual framework describing factors that may affect older adults' use of ride share services. RESULTS: This study identified 917 non-profit ride share services and eleven for-profit ride share services available for older adults in the United States as of August 2018. Services varied by corporate structure, location, use of technology, and business model. The majority of non-profit services served primarily older adults, while the for-profit services served primarily younger adults. Riders from one multi-site non-profit service had a median age of 82. Use of ride share services is affected by individual needs and preferences; social conditions; and business and policy factors. CONCLUSION: Ride share services may offer a promising alternative to driving for older adults and may help to address negative health consequences associated with driving cessation. Practical applications: These findings may help policy makers, practitioners, and other stakeholders understand older adults' needs related to use of ride share services in order to offer solutions that prioritize public health and safety.

Identifying and Prioritizing Information Needs and Research Priorities of Public Health Emergency Preparedness and Response Practitioners.

OBJECTIVE: This study describes findings from an assessment conducted to identify perceived knowledge gaps, information needs, and research priorities among state, territorial, and local public health preparedness directors and coordinators related to public health emergency preparedness and response (PHPR). The goal of the study was to gather information that would be useful for ensuring that future funding for research and evaluation targets areas most critical for advancing public health practice. METHODS: We implemented a mixed-methods approach to identify and prioritize PHPR research questions. A web survey was sent to all state, city, and territorial health agencies funded through the Public Health Emergency Preparedness (PHEP) Cooperative Agreement program and a sample of local health departments (LHDs). Three focus groups of state and local practitioners and subject matter experts from the Centers for Disease Control and Prevention (CDC) were subsequently conducted, followed by 3 meetings of an expert panel of PHPR practitioners and CDC experts to prioritize and refine the research questions. RESULTS: We identified a final list of 44 research questions that were deemed by study participants as priority topics where future research can inform PHPR programs and practice. We identified differences in perceived research priorities between PHEP awardees and LHD survey respondents; the number of research questions rated as important was greater among LHDs than among PHEP awardees (75%, n=33, compared to 24%, n=15). CONCLUSIONS: The research questions identified provide insight into public health practitioners' perceived knowledge gaps and the types of information that would be most useful for informing and advancing PHPR practice. The study also points to a higher level of information need among LHDs than among PHEP awardees. These findings are important for CDC and the PHPR research community to ensure that future research studies are responsive to practitioners' needs and provide the information required to enhance their capacity to meet the needs of the communities and jurisdictions they serve. (Disaster Med Public Health Preparedness. 2017;11:552-561).