Abstract
Objectives: To identify facilitating factors that guide local health departments (LHDs) in their transition from direct clinical service provision to population-level interventions addressing the social determinants of health.
Design: Key informant interviews with LHD leaders and their staff were conducted using a semistructured interview guide. Thematic qualitative analysis was used to identify common characteristics and strategies among the LHD leaders and staff.
Participants: LHDs represented both rural and urban communities with population sizes from 9746 to 919 628 and agencies in Illinois, Montana, North Carolina, Oregon, Tennessee, Washington, and West Virginia.
Outcome Measure: The impetus and facilitators for transitioning health department services from clinical to population health.
Results: Leaders from 7 LHDs emphasized that an impetus for their transition from direct clinical services to population-level interventions was that it was "time to modernize." Among LHDs interviewed, most included the 10 Essential Public Health Services or Public Health 3.0 in their strategic plan. Adding this focus to their strategic plan facilitated buy-in from local government and the ability to maintain the LHDs' focus on population-level interventions. We found that strong relationships and open communication with community members and partner organizations (eg, federally qualified health centers) were critical facilitators of transition. Themes from interviews were used to identify an initial set of 8 key elements of an effective transition: partnership/leadership, vision/goals, communication, community engagement, interventions, data/evaluation, workforce issues, and sustainability.
Conclusions: Prevention systems suffer from a lack of adequate health promotion and access to quality care for their community's residents. There is a need for LHDs to access technical support to strategically address complexity and ensure core population-focused prevention. The results shared provide replicable solutions, practices, and methods that enable successful transitions of LHDs toward maximizing their role in population health.