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Factors Associated With Continuous Improvement by Local Boards of Health

Nguyen, Tran Ha DrPH; Shah, Gulzar H. PhD, MStat, MS; Schwartz, Rachel D. PhD; Jones, Jeffery A. PhD

Journal of Public Health Management and Practice: September/October 2019 - Volume 25 - Issue 5 - p 415–422
doi: 10.1097/PHH.0000000000001009
Research Reports: Research Full Report

Background: The continuous improvement function, 1 of the 6 public health governance functions, can be usefully applied in the context of local boards of health (LBoHs) operations to target self-improvements.

Purpose: The purpose of this study was to determine the engagement level of LBoHs in continuous improvement efforts and to identify factors associated with this function.

Methods: Negative binomial regression was performed to analyze data from the 2015 Local Board of Health National Profile. The LBoH taxonomy was used as the guiding model. The taxonomy includes 6 governance functions as structural domains and LBoHs' characteristics and strengths as the central or seventh domain.

Results: For the 17 items that comprise the continuous improvement domain, the mean of the dichotomous responses was 4.97 (SD = 3.41). The negative binomial regression analysis showed that the overall summary scale for the other 5 governance domains and the LBoHs' other strengths domain had a significant positive association with the governance domain continuous improvement domain (incidence rate ratio [IRR] = 1.05, P < .001). The 5 individual scales for the governance domains also had significant positive associations with the continuous improvement domain, which included the governance functions of policy development (IRR = 1.13, P < .001), resource stewardship (IRR = 1.18, P < .001), legal authorization (IRR = 1.09, P < .001, partnership engagement (IRR = 1.12, P < .001), and oversight (IRR = 1.29, P < .001). The scale for other characteristics and strengths also showed positive association with continuous improvement (IRR = 1.14, P < .001).

Conclusion: The findings of this study revealed that there was room for improvement in LBoHs' engagement in the continuous improvement governance function. The results also identified other governance functions and LBoHs' characteristics as factors associated with their continuous improvement.

Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia.

Correspondence: Gulzar H. Shah, PhD, MStat, MS, Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460 (

The authors declare no conflicts of interest.

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