Multilevel Factors Impacting Workforce Competence and Capacity to Deliver Public Health Services.

Abstract

The public health workforce is a critical component of public health infrastructure theorized to impact organizational capacity of health departments. Despite its importance in operationalizing public health programs and interventions, little is known about workforce size, composition, training and educational background. The purpose of this dissertation is to identify characteristics of health departments and its workers that are associated with worker competence and organizational capacity to deliver public health services. The dissertation starts with a systematic review of literature focused on four public health workforce research themes: size and composition; effectiveness and impact on population health; forecasting demand; and workforce development policies, which leads to a study of state health department epidemiologists to identify individual-level correlates of worker competence, and closes with an analysis of workforce development policies and workforce characteristics in public health, environmental and agricultural laboratories (PHEALs) to examine multilevel associations with measures of organizational capacity.

Results of the systematic review yielded few evidence-based findings, as a paucity of quantitative studies exist in the peer-reviewed literature. Systematic review findings were valuable in identifying key workforce variables used in the subsequent dissertation analyses including workforce size, competence, training, education, and job experience. Data for the remainder of this dissertation were drawn from the 2009 Epidemiology Capacity Assessment (ECA) provided by the Council of State and Territorial Epidemiologists, the 2010 Association of State and Territorial Health Officials Profile of State Public Health, and the 2011 National Laboratory Capacity Assessment conducted by the Association of Public Health Laboratories and University of Michigan Center of Excellence in Public Health Workforce Studies. Analysis of ECA data showed that workforce characteristics influencing competence varied depending on the epidemiologist’s job tier. Job experience was an important factor for all types of epidemiologists; education training and background were also significant predictors of competence in several models. PHEAL capacity was significantly predicted by laboratory workforce size and proportion of college-educated workers, although findings were mixed in terms of whether the association was positive or negative. PHEALs that provided several types of professional development and continuing education opportunities for staff were also associated with higher laboratory capacity.