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

Abstract

BackgroundThe 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.MethodsWe 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.ResultsWe 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.ConclusionsWe 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

“…2,4 While LHDs are somewhat at the mercy of various external factors including their geography, population served, funding, and state and federal policies, our study indicates that some have successfully implemented practices that have effectively maintained or developed their agencies' role in ensuring healthy MCH outcomes 23,24 even during particularly turbulent times. We used a quantitative strategy to identify communities with better than expected MCH outcomes in this study, 11,12 but such empirical selection cannot explain why these communities were exemplary. In-depth interviews with LHD staff suggest that the agencies in our study have taken action on the policies and practices over which they have control, effectively leveraging their circumstances via partnerships to maintain essential services for their community.…”

“…11,12 We identified 50 total LHDs in jurisdictions that had better than expected MCH outcomes compared with their within-state peers (10 in Washington; 24 in Florida; 16 in New York). 11,12 We developed a semistructured interview protocol with questions divided into 3 focal areas that have been shown to make up the dimensions of public health performance as outlined by Mays et al 13 : assessment and policy development; research and evaluation; and regulatory oversight. Our study Advisory Council of 6 experts in LHD activities and MCH research and practice reviewed the interview protocol and gave feedback.…”

A county-level cross-sectional analysis of positive deviance to assess multiple population health outcomes in Indiana

“…11 25 Rust et al 26 used a different method to measure differences over time in county trends in colorectal cancer mortality to identify counties with reductions in race-related disparities. It may similarly be useful to attempt to replicate our findings with additional data points over time to investigate consistency of positive deviant counties.…”

Applying Community-Based Participatory Research Partnership Principles to Public Health Practice-Based Research Networks

“…PHSSR examines the “organization, financing, and delivery of public health services within communities, and the impact of these services on public health” (as cited in Mays, Halverson, & Scutchfield, 2003, p. 180). Examples of projects conducted by PH-PBRNs include the relationship of local health department expenditures to reductions in enteric disease (Bekemeier, Yip, Dunbar, Whitman, & Kwan-Gett, 2015); characteristics of local health departments with strong maternal and child health programs (Klaiman, Chainani, & Bekemeier, 2016; Klaiman, Pantazis, Chainani, & Bekemeier, 2016); increases in service delivery and other activities following the adoption of a core set of public health services in local health agencies (Lampe, Atherly, VanRaemdonck, Matthews, & Marshall, 2015); and factors affecting the adoption of evidence-based interventions in local health departments (Winterbauer, Bridger, Tucker, Rafferty, & Luo, 2015).…”