The National Association of County and City Health Officials (NACCHO), in collaboration with the Centers for Disease Control and Prevention, conducted the fourth National Profile of Local Health Departments study in 2005–2006. Prior Profile studies were conducted in 1989, 1992–1993, and 1996–1997. The Profile studies collect information on LHD jurisdictions and infrastructure, including governance, financing, leaders, workforce, activities, and partnerships. The Profile questionnaire is distributed to every U.S. local health department (LHD), defined for the purpose of this study as “an administrative or service unit of local or state government concerned with health, and carrying some responsibility for the health of a jurisdiction smaller than the state.” The 2005 Profile study included 2,864 LHDs.
The 2005 Profile study introduced both new methods and new topics. The 2005 Profile questionnaire was the first to be administered in a Web-based format. A personalized e-mail message was sent to each LHD that included a unique password providing access to that LHD's questionnaire. Questionnaires were preloaded with contact information from the NACCHO database for study LHDs. Paper questionnaires were mailed to those LHDs for which NACCHO did not have a functioning e-mail address.
The 2005 study was also the first Profile questionnaire to use a “core plus modules” structure. A set of core questions (similar to those included in prior Profile studies) was included in every Profile questionnaire. Additional questions were grouped into three modules, and each module was included in the questionnaire of approximately 520 LHDs. Stratified random sampling (without replacement) was used to select the LHDs that would receive the Profile modules. The sampling frame was stratified using eight strata defined by the population size of the jurisdiction served by the LHD. Because the analysis plan called for making comparisons among LHDs serving different population sizes, LHDs in the largest population categories were oversampled so that a sufficient number would be included in the sample for each module. This design allowed NACCHO to include additional topic areas and collect more detailed information about certain topics in the core questionnaire without greatly increasing the burden on respondents.
New subject areas were included in both the Profile core questionnaire and modules. The Profile core included questions on emergency preparedness and information technology for the first time. In addition, the series of questions about LHD activities and services was redesigned to obtain information about the public health activities of other organizations in the community as well as those of the LHD. Information was collected via the modules about many topics new to the Profile, including performance improvement, accreditation, workforce shortages and retirement, staff training, health inequities, and policy making.
NACCHO is very pleased with the response to the 2005 Profile questionnaire. Eighty percent of all the LHDs completed the questionnaire, and this response rate was achieved in the shortest administration period of any Profile study (4½ months). NACCHO recruited leaders in state public health associations and state health agencies to encourage their colleagues to complete the Profile questionnaire, and this strategy was effective in most states. Also, the Web-based administration was very successful, with only 98 LHDs (4% of all respondents) choosing to complete paper questionnaires. Comments from LHDs on the Web-based format were overwhelmingly positive. Local health departments particularly appreciated design features that facilitated completion of the questionnaire over multiple sittings and/or by multiple staff members.
NACCHO published a report of the results of the 2005 Profile study in July 2006—just over a year after the launch of the questionnaire. This report provides descriptive statistics for all LHDs and subgroup analyses by population size and, for the first time, by governance type and by state for certain variables. The report is available electronically at http://www.naccho.org/topics/infrastructure/2005Profile.cfm and can also be purchased in printed format. Figures 1 and 2 provide an example of the data that are available in this report.
Data from the Profile study are used by many people and organizations. NACCHO has provided state-specific data files to state associations of local health departments and state health agencies at no charge. We hope that these organizations will value and use these data and thus maintain or increase their efforts to achieve a high response rate in their state for the next Profile study. LHD staff members use Profile data to compare their LHDs or those within their states to others nationwide. Profile data are used to inform public health policy at the local, state, and federal levels, and to support projects to improve local public health practice.
Profile data are used in universities to educate future public health workforce members about LHDs, and by researchers to answer questions about public health practice. To that end, researchers can also apply to NACCHO to purchase the national data set. The Profile data use policy and fee schedule are available on the Profile Web site (see http://www.naccho.org/topics/infrastructure/2005Profile.cfm). A fee reduction or waiver is available for researchers without grant support.
NACCHO believes that to continue to address these needs and others to improve our public health system, the National Profile of LHDs should be conducted every 2 to 3 years. Although the Profile study was conducted regularly in the late 1980s and early 1990s, almost a decade passed between the third and the fourth Profile studies. Our information about this critical component of the nation's public health system needs to be kept current and relevant.