Priscilla Barnes | Indiana University (original) (raw)

Papers by Priscilla Barnes

Research paper thumbnail of Measures of Highly Functioning Health Coalitions: Corollaries for an Effective Public Health System

American Journal of Public Health, 2014

In Tennessee, health coalitions provide guidance in conducting community assessments, health impr... more In Tennessee, health coalitions provide guidance in conducting community assessments, health improvement plans and policies and delivering of health and human services, which are considered core functions of public health. In fact, it has been postulated that these coalitions may serve as the organizational embodiment of the local public health system (LPHS). This study identifies functional characteristics of 63 Tennessee County Health Councils (CHCs), advisory councils to local and regional governmental public health agencies on broad issues of health, that contribute to its ability to operate as the primary advising entity of the LPHS. Exploratory factor analysis was conducted on 20 questions serving as proxy measures of functional characteristics. Eight functional characteristics related to structure, operations and leadership were identified. These characteristics are essential in further developing and tracking capacity and performance of health coalitions serving as an advisory and possibly decision making entity of the LPHS. This study also lays the groundwork to explore how to link coalition function with performance in order to determine characteristics that are most strongly associated with optimal performance and population health.

Research paper thumbnail of Advantages of Coordinated School Health Portfolios: Documenting and Showcasing Achievements

Journal of School Health, 2013

Research paper thumbnail of The Role of Interorganizational Partnerships in Health Services Provision Among Rural, Suburban, and Urban Local Health Departments

The Journal of Rural Health, 2010

With limited resources and increased public health challenges facing the US, the Centers for Dise... more With limited resources and increased public health challenges facing the US, the Centers for Disease Control and Prevention and others have identified partnerships between local health departments (LHDs) and nongovernmental organizations (NGOs) as critical to the public health system. LHDs utilize financial, human, and informational resources and develop partnerships with local NGOs to provide public health services. Purpose: Our study had 2 primary goals: (1) compare resources and partnerships characterizing rural, suburban, and urban LHDs, and (2) determine whether partnerships play a mediating role between LHD resources and the services LHDs provide. Methods: We conducted secondary data analysis using the National Association of County and City Health Officials 2005 Profile Study. We used chisquared and analysis of variance (ANOVA) to examine differences between rural, suburban, and urban LHDs. We used regression-based mediation methods to test whether partnerships mediated the relationship between resources and service provision. Findings: We found significant differences between LHDs. Urban LHDs serve larger jurisdictions, have larger budgets and more staff, cultivate more partnerships with local NGOs, and provide more health services than suburban or rural LHDs. We found that partnerships were a partial mediator between resources and service provision. In playing a mediating role, partnerships reduce differences in service provision between rural, suburban, and urban LHDs. Conclusions: Partnerships mediate the relationship between resources and service provision in LHDs. LHDs could place more emphasis on cultivating relationships with local NGOs in order to increase service provision. This strategy may be especially useful for rural LHDs facing limited resources and numerous health disparities.

Research paper thumbnail of A National Examination of Partnerships Among Local Health Departments and Faith Communities in the United States

Journal of Public Health Management and Practice, 2009

Local health departments (LHDs) can play a major role in partnering with faith-based organization... more Local health departments (LHDs) can play a major role in partnering with faith-based organizations to enhance the overall health status of the public. This study examines the frequency that LHDs and faith-based partnerships occur, types of activities performed as reported by LHDs, and population and functional characteristics associated with these partnerships. Secondary data analysis of the 2005 National Profile of LHDs study (Profile), developed by the National Association of County & City Health Officials, was conducted on a stratified random sample of 517 LHDs receiving the core questionnaire and a module with questions about partnership and collaboration. Results indicated that 361 LHDs (83.1%) reported partnership activities occurring with faith-based organizations. At least one partnership activity was performed, with the overall most commonly reported activity as exchanging information (66.6%) across small, medium, and large LHDs. Size of jurisdiction, was positively associated with any partnership activity, higher median number of partnership activities, and higher percentage of high-level partnerships (ie providing financial resources or taking the leadership role). Further studies should consider types of programs and services produced by LHDs and faith-based partnerships, additional factors that impact partnership activities, and differences in partnership activities existing by racial and ethnic characteristics of LHD jurisdictions.

Research paper thumbnail of History Will Be Kind

Journal of Public Health Management and Practice, 2007

r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r... more r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r

Research paper thumbnail of A Multistate Examination of Partnership Activity Among Local Public Health Systems Using the National Public Health Performance Standards

Journal of Public Health Management and Practice, 2012

Ramal Moonesinghe, PhD r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r ... more Ramal Moonesinghe, PhD r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r T his study examines whether partnership-related measures in the second version of the National Public Health Performance Standards (NPHPS) are useful in evaluating level of activity as well as identifying latent constructs that exist among local public health systems (LPHSs). In a sample of 110 LPHSs, descriptive analysis was conducted to determine frequency and percentage of 18 partnership-related NPHPS measures. Principal components factor analysis was conducted to identify unobserved characteristics that promote effective partnerships among LPHSs. Results revealed that 13 of the 18 measures were most frequently reported at the minimal-moderate level (conducted 1%-49% of the time). Coordination of personal health and social services to optimize access (74.6%) was the most frequently reported measure at minimal-moderate levels. Optimal levels (conducted >75% of the time) were reported most frequently in 2 activities: participation in emergency preparedness coalitions and local health departments ensuring service provision by working with state health departments (67% and 61% of respondents, respectively) and the least optimally reported activity was review partnership effectiveness (4% of respondents). Factor analysis revealed categories of partnership-related measures in 4 domains: resources and activities contributing to relationship building, evaluating community leadership activities, research, and state and local linkages to support public health activities. System-oriented public health assessments may have questions that serve as proxy measures to examine levels of interorganizational partnerships. Several measures from the NPHPS were useful in establishing a national baseline of minimal and optimal activity levels as well as identifying factors to enhance the delivery of the 10 essential public health services among organizations and individuals in public health systems.

Research paper thumbnail of Institutional and Structural Barriers to HIV Testing: Elements for a Theoretical Framework

AIDS Patient Care and STDs, 2014

Stigma is a barrier to HIV health seeking, but little is known about institutional and structural... more Stigma is a barrier to HIV health seeking, but little is known about institutional and structural expressions of stigma in HIV testing. This study examines evidence of institutional and structural stigma in the HIV testing process. A qualitative, grounded theory study was conducted using secondary data from a 2011 HIV test site evaluation data in a Midwestern, moderate HIV incidence state. Expressions of structural and institutional stigma were found with over half of the testing sites and at three stages of the HIV testing visit. Examples of structural stigma included social geography, organization, and staff behavior at first encounter and reception, and staff behavior when experiencing the actual HIV test. Institutional stigma was socially expressed through staff behavior at entry/reception and when experiencing the HIV test. The emerging elements demonstrate the potential compounding of stigma experiences with deleterious effect. Study findings may inform future development of a theoretical framework. In practice, findings can guide organizations seeking to reduce HIV testing barriers, as they provide a window into how test seekers experience HIV test sites at first encounter, entry/reception, and at testing stages; and can identify how stigma might be intensified by structural and institutional expressions.

Research paper thumbnail of Measures of Highly Functioning Health Coalitions: Corollaries for an Effective Public Health System

American Journal of Public Health, 2014

In Tennessee, health coalitions provide guidance in conducting community assessments, health impr... more In Tennessee, health coalitions provide guidance in conducting community assessments, health improvement plans and policies and delivering of health and human services, which are considered core functions of public health. In fact, it has been postulated that these coalitions may serve as the organizational embodiment of the local public health system (LPHS). This study identifies functional characteristics of 63 Tennessee County Health Councils (CHCs), advisory councils to local and regional governmental public health agencies on broad issues of health, that contribute to its ability to operate as the primary advising entity of the LPHS. Exploratory factor analysis was conducted on 20 questions serving as proxy measures of functional characteristics. Eight functional characteristics related to structure, operations and leadership were identified. These characteristics are essential in further developing and tracking capacity and performance of health coalitions serving as an advisory and possibly decision making entity of the LPHS. This study also lays the groundwork to explore how to link coalition function with performance in order to determine characteristics that are most strongly associated with optimal performance and population health.

Research paper thumbnail of Advantages of Coordinated School Health Portfolios: Documenting and Showcasing Achievements

Journal of School Health, 2013

Research paper thumbnail of The Role of Interorganizational Partnerships in Health Services Provision Among Rural, Suburban, and Urban Local Health Departments

The Journal of Rural Health, 2010

With limited resources and increased public health challenges facing the US, the Centers for Dise... more With limited resources and increased public health challenges facing the US, the Centers for Disease Control and Prevention and others have identified partnerships between local health departments (LHDs) and nongovernmental organizations (NGOs) as critical to the public health system. LHDs utilize financial, human, and informational resources and develop partnerships with local NGOs to provide public health services. Purpose: Our study had 2 primary goals: (1) compare resources and partnerships characterizing rural, suburban, and urban LHDs, and (2) determine whether partnerships play a mediating role between LHD resources and the services LHDs provide. Methods: We conducted secondary data analysis using the National Association of County and City Health Officials 2005 Profile Study. We used chisquared and analysis of variance (ANOVA) to examine differences between rural, suburban, and urban LHDs. We used regression-based mediation methods to test whether partnerships mediated the relationship between resources and service provision. Findings: We found significant differences between LHDs. Urban LHDs serve larger jurisdictions, have larger budgets and more staff, cultivate more partnerships with local NGOs, and provide more health services than suburban or rural LHDs. We found that partnerships were a partial mediator between resources and service provision. In playing a mediating role, partnerships reduce differences in service provision between rural, suburban, and urban LHDs. Conclusions: Partnerships mediate the relationship between resources and service provision in LHDs. LHDs could place more emphasis on cultivating relationships with local NGOs in order to increase service provision. This strategy may be especially useful for rural LHDs facing limited resources and numerous health disparities.

Research paper thumbnail of A National Examination of Partnerships Among Local Health Departments and Faith Communities in the United States

Journal of Public Health Management and Practice, 2009

Local health departments (LHDs) can play a major role in partnering with faith-based organization... more Local health departments (LHDs) can play a major role in partnering with faith-based organizations to enhance the overall health status of the public. This study examines the frequency that LHDs and faith-based partnerships occur, types of activities performed as reported by LHDs, and population and functional characteristics associated with these partnerships. Secondary data analysis of the 2005 National Profile of LHDs study (Profile), developed by the National Association of County & City Health Officials, was conducted on a stratified random sample of 517 LHDs receiving the core questionnaire and a module with questions about partnership and collaboration. Results indicated that 361 LHDs (83.1%) reported partnership activities occurring with faith-based organizations. At least one partnership activity was performed, with the overall most commonly reported activity as exchanging information (66.6%) across small, medium, and large LHDs. Size of jurisdiction, was positively associated with any partnership activity, higher median number of partnership activities, and higher percentage of high-level partnerships (ie providing financial resources or taking the leadership role). Further studies should consider types of programs and services produced by LHDs and faith-based partnerships, additional factors that impact partnership activities, and differences in partnership activities existing by racial and ethnic characteristics of LHD jurisdictions.

Research paper thumbnail of History Will Be Kind

Journal of Public Health Management and Practice, 2007

r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r... more r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r

Research paper thumbnail of A Multistate Examination of Partnership Activity Among Local Public Health Systems Using the National Public Health Performance Standards

Journal of Public Health Management and Practice, 2012

Ramal Moonesinghe, PhD r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r ... more Ramal Moonesinghe, PhD r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r T his study examines whether partnership-related measures in the second version of the National Public Health Performance Standards (NPHPS) are useful in evaluating level of activity as well as identifying latent constructs that exist among local public health systems (LPHSs). In a sample of 110 LPHSs, descriptive analysis was conducted to determine frequency and percentage of 18 partnership-related NPHPS measures. Principal components factor analysis was conducted to identify unobserved characteristics that promote effective partnerships among LPHSs. Results revealed that 13 of the 18 measures were most frequently reported at the minimal-moderate level (conducted 1%-49% of the time). Coordination of personal health and social services to optimize access (74.6%) was the most frequently reported measure at minimal-moderate levels. Optimal levels (conducted >75% of the time) were reported most frequently in 2 activities: participation in emergency preparedness coalitions and local health departments ensuring service provision by working with state health departments (67% and 61% of respondents, respectively) and the least optimally reported activity was review partnership effectiveness (4% of respondents). Factor analysis revealed categories of partnership-related measures in 4 domains: resources and activities contributing to relationship building, evaluating community leadership activities, research, and state and local linkages to support public health activities. System-oriented public health assessments may have questions that serve as proxy measures to examine levels of interorganizational partnerships. Several measures from the NPHPS were useful in establishing a national baseline of minimal and optimal activity levels as well as identifying factors to enhance the delivery of the 10 essential public health services among organizations and individuals in public health systems.

Research paper thumbnail of Institutional and Structural Barriers to HIV Testing: Elements for a Theoretical Framework

AIDS Patient Care and STDs, 2014

Stigma is a barrier to HIV health seeking, but little is known about institutional and structural... more Stigma is a barrier to HIV health seeking, but little is known about institutional and structural expressions of stigma in HIV testing. This study examines evidence of institutional and structural stigma in the HIV testing process. A qualitative, grounded theory study was conducted using secondary data from a 2011 HIV test site evaluation data in a Midwestern, moderate HIV incidence state. Expressions of structural and institutional stigma were found with over half of the testing sites and at three stages of the HIV testing visit. Examples of structural stigma included social geography, organization, and staff behavior at first encounter and reception, and staff behavior when experiencing the actual HIV test. Institutional stigma was socially expressed through staff behavior at entry/reception and when experiencing the HIV test. The emerging elements demonstrate the potential compounding of stigma experiences with deleterious effect. Study findings may inform future development of a theoretical framework. In practice, findings can guide organizations seeking to reduce HIV testing barriers, as they provide a window into how test seekers experience HIV test sites at first encounter, entry/reception, and at testing stages; and can identify how stigma might be intensified by structural and institutional expressions.

Research paper thumbnail of Community partners' perceptions in working with local health departments: an exploratory study

International Journal of Qualitative Research in Services, 2013

Research paper thumbnail of Community partners' perceptions in working with local health departments: an exploratory study

International Journal of Qualitative Research in Services, 2013

Research paper thumbnail of Assessing Gaps in the Maternal and Child Health Safety Net

Population Health Management, 2013

The Patient Protection and Affordable Care Act of 2010 proposed sweeping changes to health insura... more The Patient Protection and Affordable Care Act of 2010 proposed sweeping changes to health insurance and health care delivery systems. As a result, local health departments, community health centers, and other safety net providers are expected to play a role in providing access to care for millions of individuals. This study examines the availability of population-based services by local health departments and community health centers in the Midwest/Great Lakes region. For this study, the authors used secondary data on location of community health centers collected by the Health Resources and Services Administration and local health department services delivery from the 2008 National Profile of Local Health Departments. To simultaneously examine the geospatial patterns of service delivery and location of community health centers, the geographic information system shape files of local health department jurisdictions were used to examine prenatal care services. Additionally, the effect of service availability was examined by analyzing the rate of low birth weight births within the service areas of these facilities. Results show large variation in the distribution of community health centers. Additionally, the analysis of local health department services shows that prenatal care services are not available in every jurisdiction. Furthermore, the rates of low birth weight births in these areas are significantly higher than in areas where prenatal care is available. Future studies are needed to examine the relationship between safety net providers as well as their role in improving population health. (Population Health Management 2013;16:270-275)

Research paper thumbnail of Methods for Managing and Analyzing Electronic Medical Records: A Formative Examination of a Hospital-Congregation-Based Intervention

Population Health Management, 2014

Electronic medical records (EMRs) can be a valuable tool in evaluating interventions involving fa... more Electronic medical records (EMRs) can be a valuable tool in evaluating interventions involving faith-based institutions. Working with EMRs is complex. Methodological designs that can be used by public health and health administrators to assess the effectiveness of interventions are lacking. The study team conducted a formative evaluation of the Congregational Health Network (CHN) using propensity matching and Cox proportional hazard models to examine health outcomes and readmission rates. Along with CHN's relevance in addressing the needs of the most vulnerable population, factors are discussed that must be taken into consideration when designing such methodologies as well as limitations that merit attention from public health researchers and hospital administrators interested in conducting a formative evaluation using existing data to track the effectiveness of an intervention.

Research paper thumbnail of Assessing Gaps in the Maternal and Child Health Safety Net

Population Health Management, 2013

The Patient Protection and Affordable Care Act of 2010 proposed sweeping changes to health insura... more The Patient Protection and Affordable Care Act of 2010 proposed sweeping changes to health insurance and health care delivery systems. As a result, local health departments, community health centers, and other safety net providers are expected to play a role in providing access to care for millions of individuals. This study examines the availability of population-based services by local health departments and community health centers in the Midwest/Great Lakes region. For this study, the authors used secondary data on location of community health centers collected by the Health Resources and Services Administration and local health department services delivery from the 2008 National Profile of Local Health Departments. To simultaneously examine the geospatial patterns of service delivery and location of community health centers, the geographic information system shape files of local health department jurisdictions were used to examine prenatal care services. Additionally, the effect of service availability was examined by analyzing the rate of low birth weight births within the service areas of these facilities. Results show large variation in the distribution of community health centers. Additionally, the analysis of local health department services shows that prenatal care services are not available in every jurisdiction. Furthermore, the rates of low birth weight births in these areas are significantly higher than in areas where prenatal care is available. Future studies are needed to examine the relationship between safety net providers as well as their role in improving population health. (Population Health Management 2013;16:270-275)

Research paper thumbnail of Methods for Managing and Analyzing Electronic Medical Records: A Formative Examination of a Hospital-Congregation-Based Intervention

Population Health Management, 2014

Electronic medical records (EMRs) can be a valuable tool in evaluating interventions involving fa... more Electronic medical records (EMRs) can be a valuable tool in evaluating interventions involving faith-based institutions. Working with EMRs is complex. Methodological designs that can be used by public health and health administrators to assess the effectiveness of interventions are lacking. The study team conducted a formative evaluation of the Congregational Health Network (CHN) using propensity matching and Cox proportional hazard models to examine health outcomes and readmission rates. Along with CHN's relevance in addressing the needs of the most vulnerable population, factors are discussed that must be taken into consideration when designing such methodologies as well as limitations that merit attention from public health researchers and hospital administrators interested in conducting a formative evaluation using existing data to track the effectiveness of an intervention.

Research paper thumbnail of Measures of Highly Functioning Health Coalitions: Corollaries for an Effective Public Health System

American Journal of Public Health, 2014

In Tennessee, health coalitions provide guidance in conducting community assessments, health impr... more In Tennessee, health coalitions provide guidance in conducting community assessments, health improvement plans and policies and delivering of health and human services, which are considered core functions of public health. In fact, it has been postulated that these coalitions may serve as the organizational embodiment of the local public health system (LPHS). This study identifies functional characteristics of 63 Tennessee County Health Councils (CHCs), advisory councils to local and regional governmental public health agencies on broad issues of health, that contribute to its ability to operate as the primary advising entity of the LPHS. Exploratory factor analysis was conducted on 20 questions serving as proxy measures of functional characteristics. Eight functional characteristics related to structure, operations and leadership were identified. These characteristics are essential in further developing and tracking capacity and performance of health coalitions serving as an advisory and possibly decision making entity of the LPHS. This study also lays the groundwork to explore how to link coalition function with performance in order to determine characteristics that are most strongly associated with optimal performance and population health.

Research paper thumbnail of Advantages of Coordinated School Health Portfolios: Documenting and Showcasing Achievements

Journal of School Health, 2013

Research paper thumbnail of The Role of Interorganizational Partnerships in Health Services Provision Among Rural, Suburban, and Urban Local Health Departments

The Journal of Rural Health, 2010

With limited resources and increased public health challenges facing the US, the Centers for Dise... more With limited resources and increased public health challenges facing the US, the Centers for Disease Control and Prevention and others have identified partnerships between local health departments (LHDs) and nongovernmental organizations (NGOs) as critical to the public health system. LHDs utilize financial, human, and informational resources and develop partnerships with local NGOs to provide public health services. Purpose: Our study had 2 primary goals: (1) compare resources and partnerships characterizing rural, suburban, and urban LHDs, and (2) determine whether partnerships play a mediating role between LHD resources and the services LHDs provide. Methods: We conducted secondary data analysis using the National Association of County and City Health Officials 2005 Profile Study. We used chisquared and analysis of variance (ANOVA) to examine differences between rural, suburban, and urban LHDs. We used regression-based mediation methods to test whether partnerships mediated the relationship between resources and service provision. Findings: We found significant differences between LHDs. Urban LHDs serve larger jurisdictions, have larger budgets and more staff, cultivate more partnerships with local NGOs, and provide more health services than suburban or rural LHDs. We found that partnerships were a partial mediator between resources and service provision. In playing a mediating role, partnerships reduce differences in service provision between rural, suburban, and urban LHDs. Conclusions: Partnerships mediate the relationship between resources and service provision in LHDs. LHDs could place more emphasis on cultivating relationships with local NGOs in order to increase service provision. This strategy may be especially useful for rural LHDs facing limited resources and numerous health disparities.

Research paper thumbnail of A National Examination of Partnerships Among Local Health Departments and Faith Communities in the United States

Journal of Public Health Management and Practice, 2009

Local health departments (LHDs) can play a major role in partnering with faith-based organization... more Local health departments (LHDs) can play a major role in partnering with faith-based organizations to enhance the overall health status of the public. This study examines the frequency that LHDs and faith-based partnerships occur, types of activities performed as reported by LHDs, and population and functional characteristics associated with these partnerships. Secondary data analysis of the 2005 National Profile of LHDs study (Profile), developed by the National Association of County & City Health Officials, was conducted on a stratified random sample of 517 LHDs receiving the core questionnaire and a module with questions about partnership and collaboration. Results indicated that 361 LHDs (83.1%) reported partnership activities occurring with faith-based organizations. At least one partnership activity was performed, with the overall most commonly reported activity as exchanging information (66.6%) across small, medium, and large LHDs. Size of jurisdiction, was positively associated with any partnership activity, higher median number of partnership activities, and higher percentage of high-level partnerships (ie providing financial resources or taking the leadership role). Further studies should consider types of programs and services produced by LHDs and faith-based partnerships, additional factors that impact partnership activities, and differences in partnership activities existing by racial and ethnic characteristics of LHD jurisdictions.

Research paper thumbnail of History Will Be Kind

Journal of Public Health Management and Practice, 2007

r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r... more r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r

Research paper thumbnail of A Multistate Examination of Partnership Activity Among Local Public Health Systems Using the National Public Health Performance Standards

Journal of Public Health Management and Practice, 2012

Ramal Moonesinghe, PhD r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r ... more Ramal Moonesinghe, PhD r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r T his study examines whether partnership-related measures in the second version of the National Public Health Performance Standards (NPHPS) are useful in evaluating level of activity as well as identifying latent constructs that exist among local public health systems (LPHSs). In a sample of 110 LPHSs, descriptive analysis was conducted to determine frequency and percentage of 18 partnership-related NPHPS measures. Principal components factor analysis was conducted to identify unobserved characteristics that promote effective partnerships among LPHSs. Results revealed that 13 of the 18 measures were most frequently reported at the minimal-moderate level (conducted 1%-49% of the time). Coordination of personal health and social services to optimize access (74.6%) was the most frequently reported measure at minimal-moderate levels. Optimal levels (conducted >75% of the time) were reported most frequently in 2 activities: participation in emergency preparedness coalitions and local health departments ensuring service provision by working with state health departments (67% and 61% of respondents, respectively) and the least optimally reported activity was review partnership effectiveness (4% of respondents). Factor analysis revealed categories of partnership-related measures in 4 domains: resources and activities contributing to relationship building, evaluating community leadership activities, research, and state and local linkages to support public health activities. System-oriented public health assessments may have questions that serve as proxy measures to examine levels of interorganizational partnerships. Several measures from the NPHPS were useful in establishing a national baseline of minimal and optimal activity levels as well as identifying factors to enhance the delivery of the 10 essential public health services among organizations and individuals in public health systems.

Research paper thumbnail of Institutional and Structural Barriers to HIV Testing: Elements for a Theoretical Framework

AIDS Patient Care and STDs, 2014

Stigma is a barrier to HIV health seeking, but little is known about institutional and structural... more Stigma is a barrier to HIV health seeking, but little is known about institutional and structural expressions of stigma in HIV testing. This study examines evidence of institutional and structural stigma in the HIV testing process. A qualitative, grounded theory study was conducted using secondary data from a 2011 HIV test site evaluation data in a Midwestern, moderate HIV incidence state. Expressions of structural and institutional stigma were found with over half of the testing sites and at three stages of the HIV testing visit. Examples of structural stigma included social geography, organization, and staff behavior at first encounter and reception, and staff behavior when experiencing the actual HIV test. Institutional stigma was socially expressed through staff behavior at entry/reception and when experiencing the HIV test. The emerging elements demonstrate the potential compounding of stigma experiences with deleterious effect. Study findings may inform future development of a theoretical framework. In practice, findings can guide organizations seeking to reduce HIV testing barriers, as they provide a window into how test seekers experience HIV test sites at first encounter, entry/reception, and at testing stages; and can identify how stigma might be intensified by structural and institutional expressions.

Research paper thumbnail of Measures of Highly Functioning Health Coalitions: Corollaries for an Effective Public Health System

American Journal of Public Health, 2014

In Tennessee, health coalitions provide guidance in conducting community assessments, health impr... more In Tennessee, health coalitions provide guidance in conducting community assessments, health improvement plans and policies and delivering of health and human services, which are considered core functions of public health. In fact, it has been postulated that these coalitions may serve as the organizational embodiment of the local public health system (LPHS). This study identifies functional characteristics of 63 Tennessee County Health Councils (CHCs), advisory councils to local and regional governmental public health agencies on broad issues of health, that contribute to its ability to operate as the primary advising entity of the LPHS. Exploratory factor analysis was conducted on 20 questions serving as proxy measures of functional characteristics. Eight functional characteristics related to structure, operations and leadership were identified. These characteristics are essential in further developing and tracking capacity and performance of health coalitions serving as an advisory and possibly decision making entity of the LPHS. This study also lays the groundwork to explore how to link coalition function with performance in order to determine characteristics that are most strongly associated with optimal performance and population health.

Research paper thumbnail of Advantages of Coordinated School Health Portfolios: Documenting and Showcasing Achievements

Journal of School Health, 2013

Research paper thumbnail of The Role of Interorganizational Partnerships in Health Services Provision Among Rural, Suburban, and Urban Local Health Departments

The Journal of Rural Health, 2010

With limited resources and increased public health challenges facing the US, the Centers for Dise... more With limited resources and increased public health challenges facing the US, the Centers for Disease Control and Prevention and others have identified partnerships between local health departments (LHDs) and nongovernmental organizations (NGOs) as critical to the public health system. LHDs utilize financial, human, and informational resources and develop partnerships with local NGOs to provide public health services. Purpose: Our study had 2 primary goals: (1) compare resources and partnerships characterizing rural, suburban, and urban LHDs, and (2) determine whether partnerships play a mediating role between LHD resources and the services LHDs provide. Methods: We conducted secondary data analysis using the National Association of County and City Health Officials 2005 Profile Study. We used chisquared and analysis of variance (ANOVA) to examine differences between rural, suburban, and urban LHDs. We used regression-based mediation methods to test whether partnerships mediated the relationship between resources and service provision. Findings: We found significant differences between LHDs. Urban LHDs serve larger jurisdictions, have larger budgets and more staff, cultivate more partnerships with local NGOs, and provide more health services than suburban or rural LHDs. We found that partnerships were a partial mediator between resources and service provision. In playing a mediating role, partnerships reduce differences in service provision between rural, suburban, and urban LHDs. Conclusions: Partnerships mediate the relationship between resources and service provision in LHDs. LHDs could place more emphasis on cultivating relationships with local NGOs in order to increase service provision. This strategy may be especially useful for rural LHDs facing limited resources and numerous health disparities.

Research paper thumbnail of A National Examination of Partnerships Among Local Health Departments and Faith Communities in the United States

Journal of Public Health Management and Practice, 2009

Local health departments (LHDs) can play a major role in partnering with faith-based organization... more Local health departments (LHDs) can play a major role in partnering with faith-based organizations to enhance the overall health status of the public. This study examines the frequency that LHDs and faith-based partnerships occur, types of activities performed as reported by LHDs, and population and functional characteristics associated with these partnerships. Secondary data analysis of the 2005 National Profile of LHDs study (Profile), developed by the National Association of County & City Health Officials, was conducted on a stratified random sample of 517 LHDs receiving the core questionnaire and a module with questions about partnership and collaboration. Results indicated that 361 LHDs (83.1%) reported partnership activities occurring with faith-based organizations. At least one partnership activity was performed, with the overall most commonly reported activity as exchanging information (66.6%) across small, medium, and large LHDs. Size of jurisdiction, was positively associated with any partnership activity, higher median number of partnership activities, and higher percentage of high-level partnerships (ie providing financial resources or taking the leadership role). Further studies should consider types of programs and services produced by LHDs and faith-based partnerships, additional factors that impact partnership activities, and differences in partnership activities existing by racial and ethnic characteristics of LHD jurisdictions.

Research paper thumbnail of History Will Be Kind

Journal of Public Health Management and Practice, 2007

r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r... more r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r

Research paper thumbnail of A Multistate Examination of Partnership Activity Among Local Public Health Systems Using the National Public Health Performance Standards

Journal of Public Health Management and Practice, 2012

Ramal Moonesinghe, PhD r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r ... more Ramal Moonesinghe, PhD r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r T his study examines whether partnership-related measures in the second version of the National Public Health Performance Standards (NPHPS) are useful in evaluating level of activity as well as identifying latent constructs that exist among local public health systems (LPHSs). In a sample of 110 LPHSs, descriptive analysis was conducted to determine frequency and percentage of 18 partnership-related NPHPS measures. Principal components factor analysis was conducted to identify unobserved characteristics that promote effective partnerships among LPHSs. Results revealed that 13 of the 18 measures were most frequently reported at the minimal-moderate level (conducted 1%-49% of the time). Coordination of personal health and social services to optimize access (74.6%) was the most frequently reported measure at minimal-moderate levels. Optimal levels (conducted >75% of the time) were reported most frequently in 2 activities: participation in emergency preparedness coalitions and local health departments ensuring service provision by working with state health departments (67% and 61% of respondents, respectively) and the least optimally reported activity was review partnership effectiveness (4% of respondents). Factor analysis revealed categories of partnership-related measures in 4 domains: resources and activities contributing to relationship building, evaluating community leadership activities, research, and state and local linkages to support public health activities. System-oriented public health assessments may have questions that serve as proxy measures to examine levels of interorganizational partnerships. Several measures from the NPHPS were useful in establishing a national baseline of minimal and optimal activity levels as well as identifying factors to enhance the delivery of the 10 essential public health services among organizations and individuals in public health systems.

Research paper thumbnail of Institutional and Structural Barriers to HIV Testing: Elements for a Theoretical Framework

AIDS Patient Care and STDs, 2014

Stigma is a barrier to HIV health seeking, but little is known about institutional and structural... more Stigma is a barrier to HIV health seeking, but little is known about institutional and structural expressions of stigma in HIV testing. This study examines evidence of institutional and structural stigma in the HIV testing process. A qualitative, grounded theory study was conducted using secondary data from a 2011 HIV test site evaluation data in a Midwestern, moderate HIV incidence state. Expressions of structural and institutional stigma were found with over half of the testing sites and at three stages of the HIV testing visit. Examples of structural stigma included social geography, organization, and staff behavior at first encounter and reception, and staff behavior when experiencing the actual HIV test. Institutional stigma was socially expressed through staff behavior at entry/reception and when experiencing the HIV test. The emerging elements demonstrate the potential compounding of stigma experiences with deleterious effect. Study findings may inform future development of a theoretical framework. In practice, findings can guide organizations seeking to reduce HIV testing barriers, as they provide a window into how test seekers experience HIV test sites at first encounter, entry/reception, and at testing stages; and can identify how stigma might be intensified by structural and institutional expressions.

Research paper thumbnail of Community partners' perceptions in working with local health departments: an exploratory study

International Journal of Qualitative Research in Services, 2013

Research paper thumbnail of Community partners' perceptions in working with local health departments: an exploratory study

International Journal of Qualitative Research in Services, 2013

Research paper thumbnail of Assessing Gaps in the Maternal and Child Health Safety Net

Population Health Management, 2013

The Patient Protection and Affordable Care Act of 2010 proposed sweeping changes to health insura... more The Patient Protection and Affordable Care Act of 2010 proposed sweeping changes to health insurance and health care delivery systems. As a result, local health departments, community health centers, and other safety net providers are expected to play a role in providing access to care for millions of individuals. This study examines the availability of population-based services by local health departments and community health centers in the Midwest/Great Lakes region. For this study, the authors used secondary data on location of community health centers collected by the Health Resources and Services Administration and local health department services delivery from the 2008 National Profile of Local Health Departments. To simultaneously examine the geospatial patterns of service delivery and location of community health centers, the geographic information system shape files of local health department jurisdictions were used to examine prenatal care services. Additionally, the effect of service availability was examined by analyzing the rate of low birth weight births within the service areas of these facilities. Results show large variation in the distribution of community health centers. Additionally, the analysis of local health department services shows that prenatal care services are not available in every jurisdiction. Furthermore, the rates of low birth weight births in these areas are significantly higher than in areas where prenatal care is available. Future studies are needed to examine the relationship between safety net providers as well as their role in improving population health. (Population Health Management 2013;16:270-275)

Research paper thumbnail of Methods for Managing and Analyzing Electronic Medical Records: A Formative Examination of a Hospital-Congregation-Based Intervention

Population Health Management, 2014

Electronic medical records (EMRs) can be a valuable tool in evaluating interventions involving fa... more Electronic medical records (EMRs) can be a valuable tool in evaluating interventions involving faith-based institutions. Working with EMRs is complex. Methodological designs that can be used by public health and health administrators to assess the effectiveness of interventions are lacking. The study team conducted a formative evaluation of the Congregational Health Network (CHN) using propensity matching and Cox proportional hazard models to examine health outcomes and readmission rates. Along with CHN's relevance in addressing the needs of the most vulnerable population, factors are discussed that must be taken into consideration when designing such methodologies as well as limitations that merit attention from public health researchers and hospital administrators interested in conducting a formative evaluation using existing data to track the effectiveness of an intervention.

Research paper thumbnail of Assessing Gaps in the Maternal and Child Health Safety Net

Population Health Management, 2013

The Patient Protection and Affordable Care Act of 2010 proposed sweeping changes to health insura... more The Patient Protection and Affordable Care Act of 2010 proposed sweeping changes to health insurance and health care delivery systems. As a result, local health departments, community health centers, and other safety net providers are expected to play a role in providing access to care for millions of individuals. This study examines the availability of population-based services by local health departments and community health centers in the Midwest/Great Lakes region. For this study, the authors used secondary data on location of community health centers collected by the Health Resources and Services Administration and local health department services delivery from the 2008 National Profile of Local Health Departments. To simultaneously examine the geospatial patterns of service delivery and location of community health centers, the geographic information system shape files of local health department jurisdictions were used to examine prenatal care services. Additionally, the effect of service availability was examined by analyzing the rate of low birth weight births within the service areas of these facilities. Results show large variation in the distribution of community health centers. Additionally, the analysis of local health department services shows that prenatal care services are not available in every jurisdiction. Furthermore, the rates of low birth weight births in these areas are significantly higher than in areas where prenatal care is available. Future studies are needed to examine the relationship between safety net providers as well as their role in improving population health. (Population Health Management 2013;16:270-275)

Research paper thumbnail of Methods for Managing and Analyzing Electronic Medical Records: A Formative Examination of a Hospital-Congregation-Based Intervention

Population Health Management, 2014

Electronic medical records (EMRs) can be a valuable tool in evaluating interventions involving fa... more Electronic medical records (EMRs) can be a valuable tool in evaluating interventions involving faith-based institutions. Working with EMRs is complex. Methodological designs that can be used by public health and health administrators to assess the effectiveness of interventions are lacking. The study team conducted a formative evaluation of the Congregational Health Network (CHN) using propensity matching and Cox proportional hazard models to examine health outcomes and readmission rates. Along with CHN's relevance in addressing the needs of the most vulnerable population, factors are discussed that must be taken into consideration when designing such methodologies as well as limitations that merit attention from public health researchers and hospital administrators interested in conducting a formative evaluation using existing data to track the effectiveness of an intervention.