Ruth Wetta-Hall

Context: Community health assessment (CHA) and community health improvement planning (CHIP) are important functions for local health departments (LHDs) but may present challenges, particularly in rural settings. Objective: The purpose of this 2-year, mixed-methods study was to identify factors that impede or promote the timeliness and quality of CHA-CHIP completion in Kansas. Design: Focus group interviews, conducted at baseline (2012) and at 1 year (2013), included 15 and 21 groups, respectively. Scores from a 12-item attitudinal survey that explored participants' confidence to perform CHA-CHIP activities were collected in tandem with focus groups. Setting: Kansas counties that planned to conduct a CHA-CHIP process during 2012 and/or 2013 were eligible to participate. Participants: There were 128 study participants (57 in 2012, 71 in 2013), who were predominantly female (83%), aged 51 years or older (61.4%), and lived in rural areas (84.6%). Public health region representation in 2012 and 2013 was 73% and 93%, respectively. Main Outcome Measures: Changes in perceptions about CHA-CHIP inputs, process, outputs, outcomes, and self-efficacy to perform CHA-CHIP activities were explored. Results: Progress in CHA-CHIP implementation was reported in 2013. Most participants perceived the CHA-CHIP process as valuable and enhanced the LHD's visibility. Rural participants reported having completed the CHA phase, whereas urban LHDs had progressed into the planning and implementation stage. Potentiators of the CHA-CHIP process included (1) parallel assessment activities conducted by other community organizations, and (2) for rural counties, a functioning 501(c)3 community health coalition. Perceptions about the importance of partnership and leadership were unchanged. A multivariate regression analysis revealed a significant time effect and rural-urban difference in perceived self-efficacy. Conclusions: Workforce development and public health system development issues are central concerns identified by this study. Local health departments with constrained resources and limited staff, despite additional training, are unlikely to develop the capacity needed to effectively support CHA-CHIP, making long-term sustainability uncertain.

Objective: Therapeutic massage has demonstrated positive physical and emotional benefits to offset the effects of treatments associated with breast cancer. The goal of this study was to assess the impact of therapeutic massage on the quality of life of patients undergoing treatment for breast cancer. Design: Using a pre/post intervention assessment design, this prospective, convenience sample pilot study measured anxiety, pain, nausea, sleep quality, and quality of life. Treatment consisted of one 30-minute treatment per week for 3 consecutive weeks. Outcome measures: Instruments selected for this study were used in previous massage therapy studies to measure quality of life/health status and have documented validity and reliability. Results: Participants experienced a reduction in several quality of life symptom concerns after only 3 weeks of massage therapy. Respondents' cumulative pre- and post-massage mean for state anxiety, sleep quality, and quality of life/functioning showed significant improvement. Among study participants, there was variability in reported episodes of nausea, vomiting, and retching; although participants reported decreased pain and distress, changes were non-significant. Conclusions: Therapeutic massage shows potential benefits for ameliorating the effects of breast cancer treatment by reducing side affects of chemotherapy and radiation and improving perceived quality of life and overall functioning.

To assess the impact of regionalization of Kansas counties associated with emergency preparedness since 2002 via local health departments (LHDs). Three focus groups were conducted in May 2005 with 31 Kansas health department employees. Most participants were public health administrators, women, and 40 years or older. Regionalization was perceived as "absolutely necessary" by participants and resulted in improved collaboration and communication among LHDs. The process supported the development of relationships, trust, and mutual respect among LHDs and other governmental agencies. Participants agreed that LHD functioning has improved the delivery and availability of public health services, increased the efficiency and timeliness of operations, and enhanced public health's visibility in emergency preparedness efforts. Moreover, regionalization added resources to LHDs including personnel, knowledge, technology, technical expertise, and fiscal resources. Dissatisfaction with regionalization was associated with insufficient funding, frustration with changing preparedness guidelines, and differences between state and local expectations. Participants identified four issues necessary to sustain regions: funding, documented benefits, commitment from LHDs and their communities, and engagement from local elected officials. The regionalization process has been beneficial for LHDs and produced tangible and intangible benefits. Barriers to regionalization expansion should be addressed for additional collaborative ventures.

Introduction:: Prehospital and community hospital healthcare providers in the United States must be prepared to respond to burn disasters. Continuing education is the most frequently utilized method of updating knowledge, skills, and competence among healthcare professionals. Since preparedness training must meet multiple educational demands, it is vital to understand how participants'work and educational experience and the program's content and delivery methods impact knowledge acquisition, and how learning influences confidence and competence to perform new skills.Purpose:: The purpose of this exploratory, convenience sample study was to identify healthcare provider characteristics and continuing education training content areas that were predictive of self-reported improvement in competence after attending a mass-casualty burn disaster continuing education program.Methods:: Logistic regression analysis of data from a post-training evaluation from nine, one-day continuing education conferences on mass burn care was used to identify factors associated with improved self-reported competency to respond to mass burn casualties.Results:: The following factors were associated most closely with increased self-reported competency: (1) prehospital work setting (odds ratio (OR) = 3.06, confidence interval (CI) = 0.83–11.30, p = 0.09); (2) 11 or more years of practice (OR = 0.31, CI = 0.09–1.08, p = 0.07); and (3) practice in an urban setting (OR = 0.01, CI = 0.18–0.82, p >0.01). Confidence items included: (1) ability to implement appropriate airway management modalities (OR = 2.31, CI = 1.03–5.17, p >0.04); (2) manage patients with electrical injuries (OR = 4.86, CI = 1.84–12.85, p >0.001); (3) identify non-survivable injuries (OR = 2.24, CI = 0.93–5.43, p = 0.07); and (4) recognize special problems associated with burns in young children or older adults (OR = 2.14, CI = 0.87–5.23, p = 0.10). The final model explained 89.9% of the variability in self-reported competence.Conclusions:: Interventions used to train healthcare providers for burn disasters must cover a broad range of topics. However, learning needs may vary by practice setting, work experience, and previous exposure to disaster events. This evaluation research provides three-fold information for continuing education research: (1) to identify content areas that should be emphasized in future burn care training; (2) to be used as a model for CE evaluation in other domains; and (3) to provide support that many factors must be considered when designing a CE program. Results may be useful to others who are planning CE training programs.

Many terrorism preparedness trainings occur throughout the United States, yet few qualitatively examine trainees' needs and interests, reactions to training, or suggestions for training improvement. Eleven posttraining focus groups were conducted with 31 training participants at six sites. Participants were stratified by health profession discipline, and discipline-specific moderators conducted each session to better understand and probe for feedback. One additional moderator attended all sessions to increase consistency in methods across sessions. Focus group participants assessed changes in their perceptions, knowledge, and beliefs about terrorism preparedness. Participants reported perceiving terrorism as a potential threat but less likely than natural disasters. All-hazards crossover training for responding to terrorism and natural disasters was requested. The training was viewed positively, including the enrollment process, training content, and reference materials. Participants reported increased confidence in abilities to recognize a terrorist event. Participants stated they would like the training repeated annually with more first responders in attendance. Participants from rural areas had unique training needs based on limited resources and multiple roles of staff. While most participants wanted a longer, multispecialty conference with in-depth, discipline-specific breakout sessions, physicians requested shorter, separate training. Multispecialty training methods were successful and appreciated. This pilot study may serve as a template for qualitative evaluation of terrorism preparedness conferences for health professionals.

Community-based organizations often capacity build to successfully enable themselves to be adaptable and responsive to constantly changing environments. However, community-based organizations are stretched for time, staffing, and funding, and the added obligation of regularly performing management planning tools, such as strategic planning, needs assessments, program evaluations, or market demand forecasting, strain limited resources. Through case studies, this article illustrates how collaborations between universities and community-based organizations can result in the development of successful management planning tools through the use of geographic information systems and secondary resources. Such collaborations produced maximization of production and effectiveness in an environment characterized by limited resources.

Case management is a rapidly growing strategy to help vulnerable populations access the health care they need in a fragmented U.S. service delivery system. A number of lessons can be learned from the successes and challenges of a developing, hospital-based, community-focused case management group in Sedgwick County, Kansas. The Community Case Management program has a case management team based at each of four hospitals. Each team has a social worker and a nurse, whose main goal is to help the uninsured find a primary health care home. This dynamic combination has several benefits. Each team member brings a vital skill set in helping the clients change behavior and access the care and support they need. Also, the nurse-social worker team concept creates a synergy in which team members support each other and create the best solution to their clients’ needs.