Accredited Public Health Department Characteristics Associated With Workforce Gaps Identified in Workforce Development Plans

Abstract

Objective: When pursuing accreditation by the Public Health Accreditation Board, local health departments (LHDs) must submit a workforce development plan (WDP). The purpose of this study was to examine LHD characteristics associated with workforce gaps identified and strategies implemented by LHDs. Design: We conducted a qualitative content analysis of all WDPs submitted to the Public Health Accreditation Board between March 2016 and November 2021. Setting: We examined WDPs from all accredited LHDs (n = 183) at the time of data collection in January 2022. A majority of LHDs had more than 50 staff members (n = 106, 57.9%), had a decentralized governance structure (n = 164, 89.6%), had county-level jurisdictions (n = 99, 54.1%), and served rural populations (n = 146, 79.8%). Main Outcome Measures: For each overarching theme, we constructed 2 binary variables indicating whether the LHD identified a workforce gap or strategy among any subthemes within each overarching theme. Logistic regressions were used to examine relationships between LHD characteristics and identification of a workforce gap or strategy for each theme. Results: Few LHD characteristics were significantly associated with gaps identified or strategies implemented by LHDs. LHDs applying for reaccreditation had higher odds (adjusted odds ratio [AOR], 2.44; confidence interval [CI], 1.04-5.83) of identifying a leadership gap and of identifying a recruitment gap (AOR, 2.94; CI, 1.11-7.52) compared to LHDs applying for accreditation for the first time. LHDs serving urban populations had higher odds (AOR, 2.83; CI, 1.32-6.25) of identifying a recruitment strategy compared to LHDs that only served suburban/rural populations. Conclusions: Overall, many workforce gaps reported by LHDs were universally observed irrespective of LHD characteristics. While most LHDs identified strategies to address gaps, our findings also reveal workforce areas where LHDs reported gaps without an accompanying strategy, indicating areas where LHDs could use more technical assistance and support.