Best of ARM: Evaluating engagement in multisector community health networks: The case of tribal organizations

Abstract

Objective To quantify variation in public health system engagement with tribal organizations across a national sample of communities and to identify predictors of engagement. Data Sources We used 2018 National Longitudinal Survey of Public Health Systems data, a nationally representative cohort of the US public health systems. Study Design Social network analysis measures were computed to indicate the extent of tribal organization participation in public health networks and to understand the sectors and social services that engage with tribal organizations in public health activities. Two‐part regression models estimated predictors of tribal engagement. Data Collection A stratified random sample of local public health agencies was surveyed, yielding 574 respondents. An additional cohort of oversampled respondents was also surveyed to include jurisdictions from the entire state upon the request of their respective state health departments (n = 154). Analyses were restricted to jurisdictions with a nearby American Indian and Alaska Native (AI/AN) serving health facility, yielding a final sample size of 258 local public health systems. Principal Findings When an AI/AN serving health facility was present in the region, tribal organizations participated in 28% of public health networks and 9% of implemented public health activities. Networks with tribal engagement were more comprehensive in terms of the breadth of sectors and social services participating in the network and the scope of public health activities implemented relative to networks without tribal engagement. The likelihood of tribal engagement increased significantly with the size of the AI/AN population, the presence of a tribal facility with Indian Health Service funding in the region, and geographic proximity to reservation land (p < 0.10). Conclusions The vast majority of public health networks do not report engagement with tribal organizations. Even when AI/AN serving health facilities are present, reported engagement of tribal organizations remains low.

Examining Characteristics of Local Public Health Systems With Exceptional Tribal Organization Participation

“…Multisector community partnerships are considered vital to improving health equity through social determinants of health and have been found in local public health efforts to improve population health outcomes when conditions are appropriate 5–8. However, our research group found that in regions with the presence of an AI/AN-serving health facility, just 28% of local public health jurisdictions surveyed in 2018 reported participation of tribal organizations in public health activities 9. To learn feasible ways to increase multisector community partnership with tribal organizations, the present study seeks to better understand characteristics of local public health systems with exceptional tribal organization participation.…”

“…A retrospective, cross-sectional study was replicated to identify exceptional tribal organization participation in local public health systems in 2018 9. The original study used a logistic regression model of community characteristics to understand outcomes in tribal organization participation in public health activities 9.…”

“…Positive deviance analysis included measures from the logistic regression model calculated in our original study that addressed population demographics, health care access, proximity to nearest tribal reservation, and presence of an AI/AN-serving health facility within local public health jurisdictions (Table 1). For this study to fully examine positive deviance, all survey observations were included in this study rather than being restricted to only public health jurisdictions with an AI/AN-serving health facility that was done in our original study 9…”

“…While learning how to partner with tribal health authorities or AI/AN communities is important, understanding which communities across the United States currently involve tribal partnerships in local public health service delivery may explain the conditions necessary for partnership to be possible. Prior research by our group identified significant predictors of engagement with tribal organizations among local health jurisdictions 9. These predictors include having an AI/AN population size over 1%, being proximate to reservation land, and having a regional presence of an IHS-funded tribal health facility 9.…”

Advancing healthcare equity through dissemination and implementation science

“…15 Examine how multisector collaborations can improve healthcare equity for marginalized populations 68. Technology (e.g., telehealth, eHealth, mHealth, health information) is increasingly incorporated in healthcare delivery of interventions.69,70 As technology is increasingly being used in healthcare systems to improve care, it is important to ensure such technologies do not exacerbate inequities.…”