Papers by Betty Bekemeier
PubMed, Mar 1, 2017
Bookmarks Related papers MentionsView impact
Nursing Inquiry, 2023
Bookmarks Related papers MentionsView impact
Maternal and Child Health Journal, Jun 17, 2015
Two local health departments (LHDs) in Washington State, Spokane Regional Health District and Cla... more Two local health departments (LHDs) in Washington State, Spokane Regional Health District and Clark County Public Health, are transitioning their Maternal and Child Health (MCH) services from an individual-focused (mother-child dyads/family) home visiting model to a population-focused, place-based model. This paper describes the innovative process and strategies these LHDs used in applying existing MCH funding in new ways. The pilot communities selected in both jurisdictions for the initial transition were communities experiencing disproportionately high rates of maternal smoking, child abuse and neglect, births to single women, and low-income women on Medicaid. Available evidence suggested that the reach and effectiveness of existing, individual-level MCH approaches were not adequately improving these indicators in these communities. Using a population-based approach that addressed policy factors as well as social, organizational, and behavioral change; both counties developed neighborhood level initiatives directed at the root causes of health inequities. The approach included developing meaningful community partnerships, capacity building, and creation of a shared vision for community change. Both LHDs and their partners engaged county-wide groups in neighborhood selection, jointly established priority intervention areas, and actively engaged communities focused on reducing specific health inequities. With existing funding resources, the two county LHDs dramatically changed their practice to better address underlying conditions that threaten MCH. Early successes from these pilots have contributed to important local and state system-level changes in MCH programming as well as effective community-level efforts to reduce health inequities.
Bookmarks Related papers MentionsView impact
Journal of the American Medical Informatics Association, Apr 17, 2019
ObjectiveRural public health system leaders struggle to access and use data for understanding loc... more ObjectiveRural public health system leaders struggle to access and use data for understanding local health inequities and to effectively allocate scarce resources to populations in need. This study sought to determine these rural public health system leaders’ data access, capacity, and training needs.Materials and MethodsWe conducted qualitative interviews across Alaska, Idaho, Oregon, and Washington with individuals expected to use population data for analysis or decision-making in rural communities. We used content analysis to identify themes.ResultsWe identified 2 broad themes: (1) challenges in accessing or using data to monitor and address health disparities and (2) needs for training in data use to address health inequities. Participants faced challenges accessing or using data to address rural disparities due to (a) limited availability or access to data, (b) data quality issues, (c) limited staff with expertise and resources for analyzing data, and (d) the diversity within rural jurisdictions. Participants also expressed opportunities for filling capacity gaps through training—particularly for displaying and communicating data.DiscussionRural public health system leaders expressed data challenges, many of which can be aided by informatics solutions. These include interoperable, accessible, and usable tools that help capture, access, analyze, and display data to support health equity efforts in rural communities.ConclusionInformatics has the potential to address some of the daunting data-related challenges faced by rural public health system leaders working to enhance health equity. Future research should focus on developing informatics solutions to support data access and use in rural communities.
Bookmarks Related papers MentionsView impact
Journal of Public Health Management and Practice, Mar 1, 2012
The activities that local health departments (LHDs) conduct and their workforce characteristics c... more The activities that local health departments (LHDs) conduct and their workforce characteristics change over time. We know little, however, about how changes among the services LHDs conduct are associated with the nature of LHD leadership and how these factors impact health. This study investigated changes in LHD services and leadership and how these changes are associated with mortality disparities. We conducted regression analyses of secondary data using an exploratory panel time series design. We used secondary data to investigate changes in LHD services and leadership and how these changes were associated with each other and with 1993 to 2005 changes in black-white mortality disparities. Local health department services were examined relative to change in breadth of services within each of 10 program domains between 1993 and 2005. LHD leadership was examined for discipline of the lead executive in 1993 and 2005. Our sample included 558 county or multicounty "common local areas," representing county-level data for LHDs and their jurisdictions. Significant beneficial relationships exist between having a clinician as lead executive in an LHD and reductions in black-white mortality disparities. Local health departments with a clinician (usually a nurse or physician) as their lead executive in 1993 and/or 2005 experienced a significant decrease in black-white mortality disparities for young adults (age 15-44 years) in their jurisdictions from 1993 to 2005 when compared with LHDs with nonclinician leaders. The discipline of an LHD's lead executive as a clinician appears to have a significant relationship with the impact of LHD practice on reducing black-white mortality disparities. This study suggests that the discipline of an LHD's leadership may be an important factor to consider in relation to local public health capacity to impact health disparities. Further research related to the mechanisms at play in these relationships is warranted.
Bookmarks Related papers MentionsView impact
Journal of Public Health Management and Practice
Context: Rural public health personnel serve communities that have been particularly susceptible ... more Context: Rural public health personnel serve communities that have been particularly susceptible to COVID-19 and yet faced the pandemic with far less well-resourced capacity than their urban counterparts. A critical aspect of addressing local health inequities is access to high-quality population data and the capacity to effectively use data to support decision making. However, much of the data required to investigate inequities are not readily available to rural local health departments and the tools and training to analyze data are often lacking. Program: The purpose of our effort was to explore rural data challenges related to COVID-19 and provide recommendations for improving rural data access and capacity ahead of future crises. Implementation: We gathered qualitative data in 2 phases, more than 8 months apart, from rural public health practice personnel. Initial data were gathered in October-November 2020 regarding rural public health data needs during the COVID-19 pandemic an...
Bookmarks Related papers MentionsView impact
BMC Pregnancy and Childbirth
Background The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has ... more Background The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to have positive effects in promoting healthy birth outcomes in the United States. We explored whether such effects held prior to and during the most recent Great Recession to improve birth outcomes and reduce differences among key socio-demographic groups. Methods We used a pooled cross-sectional time series design to study pregnant women and their infants with birth certificate data. We included Medicaid and uninsured births from Washington State and Florida (n = 226,835) before (01/2005–03/2007) and during (12/2007–06/2009) the Great Recession. Interactions between WIC enrollment and key socio-demographic groupings were analyzed for binary and continuous birth weight outcomes. Results Our study found beneficial WIC interaction effects on birth weight. For race, prenatal care, and maternal age we found significantly better birth weight outcomes in the presence of WIC compare...
Bookmarks Related papers MentionsView impact
Health Services Research
ObjectiveTo explore the feasibility of a rapid, community‐engaged strategy to prioritize health e... more ObjectiveTo explore the feasibility of a rapid, community‐engaged strategy to prioritize health equity policy options as informed by research evidence, community‐voiced needs, and public health priorities.Data SourcesData came from residents in a midsized, demographically, and geographically diverse county over a period of 8 months in 2020 and an evidence review of the health equity policy literature during the same time period.Study DesignA descriptive case study is used to explore the feasibility and potential value of a community codesigned approach to establish community priorities for health equity policy.Data Collection/Extraction MethodsEvidence synthesis of health equity policy was conducted parallel to 15 community listening sessions across the county to elicit information on health needs. We used scoping review methods to obtain literature from academic databases and scholarly public health and policy organizations. This information was cross walked with themes from the li...
Bookmarks Related papers MentionsView impact
Evidence & Policy, 2022
Background:Not attending to local political climate negatively impacts the implementation and sus... more Background:Not attending to local political climate negatively impacts the implementation and sustainability of evidence-informed models of health service. Policy codesign aims to align policy, systems, and community from the ‘ground up’, with structured information gathering, synthesis and creative design methods that incorporate relevant scientific evidence. Aims and objectives:This paper provides an example of policy codesign to develop a jail-based re-entry programme for adults with opioid use disorder in a rural county in the US. Methods:The design process adapted Theory U, a systems planning framework to include a rapid evidence review. The process included five sessions from July-September 2020. Mixed methods were used to collect data from the design team (n=5), community at large (n=10), and potential consumers (n=14). Qualitative and descriptive analyses assessed satisfaction with the design process, and the acceptability and perceived feasibility of programme implementatio...
Bookmarks Related papers MentionsView impact
Health Services Research, 2022
ObjectiveTo compare the estimated associations between annual sexually transmitted diseases (STD)... more ObjectiveTo compare the estimated associations between annual sexually transmitted diseases (STD) expenditures per capita and STD incidence rates among Florida and Washington local health departments (LHDs) from 2001 to 2017, using two approaches—a longitudinal regression model with lagged STD spending and a regression model with the Arellano–Bond panel estimator.Data sourcesSecondary data for LHDs were obtained from Florida and Washington state government offices and combined with county sociodemographic and health system data from the federal government.Study designWe examined LHDs in Florida and Washington using a longitudinal panel study design to estimate ecological relationships between annual STD expenditures per capita and annual STD incidence rates from 2001 to 2017, with LHDs as the unit of analysis. We compared two regression models: generalized estimating equations (GEE) and the Arellano–Bond panel estimator (an instrumental variable approach).Data collectionThe secondar...
Bookmarks Related papers MentionsView impact
Bookmarks Related papers MentionsView impact
Journal of Public Health Management and Practice, 2021
Supplemental Digital Content is Available in the Text. Context: The nurse-trained local health de... more Supplemental Digital Content is Available in the Text. Context: The nurse-trained local health department (LHD) lead executive has been shown to be positively associated with LHD performance; however, no other research has explored whether this association translates to improved community health. Objective: To investigate the relationship between the type of LHD leadership—whether or not the lead executive is a nurse—and changes in health outcomes. Design: This study used a multivariate panel time series design. Each model was estimated as a pooled time series and using time and unit fixed effects, with a 1-year lag used for all covariates and the main predictor. Setting: A national, county-level data set was compiled containing variables pertaining to the LHD, community demographics, and health outcomes for the years 2010-2018. Participants: The unit of analysis was the LHD. The data set was restricted to those counties with measurable mortality rates during at least 8 of the 9 time periods of the study, resulting in a total of 626 LHDs. Main Outcome Measures: The outcomes of interest were changes in 15- to 44-year-old all-cause mortality, infant mortality, and entry into prenatal care. Results: In models with combined time and unit fixed effects, a significant relationship exists between a nurse-led LHD and reduced mortality in the 15- to 44-year-old Black population (−5.2%, P < .05) and a reduction in the Black-White mortality ratio (−6%, P < .05). In addition, there is a relationship between the nurse-led LHD and a reduction in the percentage of the population with late or no entry to prenatal care. Conclusions: The evidence presented here helps connect the known positive association between nurse lead executives and LHD performance to improvements in community health. It suggests that nurse leaders are associated with health improvements in line with addressing health inequities.
Bookmarks Related papers MentionsView impact
Race and Social Problems, 2020
Bookmarks Related papers MentionsView impact
Maternal and Child Health Journal, 2015
Two local health departments (LHDs) in Washington State, Spokane Regional Health District and Cla... more Two local health departments (LHDs) in Washington State, Spokane Regional Health District and Clark County Public Health, are transitioning their Maternal and Child Health (MCH) services from an individual-focused (mother-child dyads/family) home visiting model to a population-focused, place-based model. This paper describes the innovative process and strategies these LHDs used in applying existing MCH funding in new ways. The pilot communities selected in both jurisdictions for the initial transition were communities experiencing disproportionately high rates of maternal smoking, child abuse and neglect, births to single women, and low-income women on Medicaid. Available evidence suggested that the reach and effectiveness of existing, individual-level MCH approaches were not adequately improving these indicators in these communities. Using a population-based approach that addressed policy factors as well as social, organizational, and behavioral change; both counties developed neighborhood level initiatives directed at the root causes of health inequities. The approach included developing meaningful community partnerships, capacity building, and creation of a shared vision for community change. Both LHDs and their partners engaged county-wide groups in neighborhood selection, jointly established priority intervention areas, and actively engaged communities focused on reducing specific health inequities. With existing funding resources, the two county LHDs dramatically changed their practice to better address underlying conditions that threaten MCH. Early successes from these pilots have contributed to important local and state system-level changes in MCH programming as well as effective community-level efforts to reduce health inequities.
Bookmarks Related papers MentionsView impact
Nursing Inquiry, Mar 9, 2022
Evidence points to nurses as possessing particular skills which are important for public health l... more Evidence points to nurses as possessing particular skills which are important for public health leadership; in particular, investigators have found that a nurse public health director is strongly associated with positive health department performance. To better understand this association and to guide the effective deployment of nurse leaders, researchers sought to explore the specific leadership strategies used by nurse public health directors, using a critical thematic analysis approach to examine these leadership strategies in the context of certain ideologies, power differentials, and social hierarchies. Data were collected via semistructured interviews conducted from July to September 2020 with 13 nurse public health directors from across the United States. Major themes illustrate a distinct picture of the nursing approach to public health leadership: (a) approaching their work with an other‐focused lens, (b) applying theoretical knowledge, (c) navigating the political side of their role, and (d) leveraging their nursing identity. Findings articulate the nurse public health director's distinctive combination of skills which reflect the interprofessional nature of public health nursing practice. Such skills demonstrate a specialized approach that may set nurse leaders apart from other types of leaders in carrying out significant public health work.
Bookmarks Related papers MentionsView impact
Public Health Nursing
Bookmarks Related papers MentionsView impact
Frontiers in Public Health, 2016
Bookmarks Related papers MentionsView impact
BMC Pregnancy and Childbirth, 2019
Background Early, regular prenatal care utilization is an important strategy for improving matern... more Background Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007–June 2009). Methods Data from 678,235 Washington (WA) and Florida (FL) birth certificates were linked to community and state characteristic data to carry out cross-sectional pooled time series analyses with institutional review board approval for human subjects’ research. Predictors of on-time as compared to late or non-entry to prenatal care utilization (late/no prenatal care utilization) were identified and compared among pregnant women. Also explored was a simulated triadic relationship among time (within recession-related periods), social characteristics, and prenatal care utilization by clustering individual pred...
Bookmarks Related papers MentionsView impact
Journal of the American Medical Informatics Association, 2017
Objective Standardized data regarding the distribution, quality, reach, and variation in public h... more Objective Standardized data regarding the distribution, quality, reach, and variation in public health services provided at the community level and in wide use across states and communities do not exist. This leaves a major gap in our nation’s understanding of the value of prevention activities and, in particular, the contributions of our government public health agencies charged with assuring community health promotion and protection. Public health and community leaders, therefore, are eager for accessible and comparable data regarding preventive services that can inform policy decisions about where to invest resources. Methods We used literature review and a practice-based approach, employing an iterative process to identify factors that facilitate data provision among public health practitioners. Results This paper describes the model, systematically developed by our research team and with input from practice partners, that guides our process toward maximizing the uptake and inte...
Bookmarks Related papers MentionsView impact
Health services research, Jan 28, 2017
To estimate the cost of resources required to implement a set of Foundational Public Health Servi... more To estimate the cost of resources required to implement a set of Foundational Public Health Services (FPHS) as recommended by the Institute of Medicine. A stochastic simulation model was used to generate probability distributions of input and output costs across 11 FPHS domains. We used an implementation attainment scale to estimate costs of fully implementing FPHS. We use data collected from a diverse cohort of 19 public health agencies located in three states that implemented the FPHS cost estimation methodology in their agencies during 2014-2015. The average agency incurred costs of $48 per capita implementing FPHS at their current attainment levels with a coefficient of variation (CV) of 16 percent. Achieving full FPHS implementation would require $82 per capita (CV=19 percent), indicating an estimated resource gap of $34 per capita. Substantial variation in costs exists across communities in resources currently devoted to implementing FPHS, with even larger variation in resourc...
Bookmarks Related papers MentionsView impact
Uploads
Papers by Betty Bekemeier