The purpose of this three-paper dissertation was to conduct an examination of specific partnership types among local public health systems (PHS) as well as to explore the associations between public health system partnerships and local public health expenditures, maternal and child health (MCH) service delivery, and infant mortality. In the first paper, secondary data analysis of questions from the National Longitudinal Study of Public Health Agencies (NLSPHA, n = 947) were used to determine the type of partnership, changes in partnership type over time, and whether partnerships were associated with revenue constraints. Public health system partnerships (PHSPs) density and centrality were the primary variables of interest. Density is the number of partners in the PHSPs and centrality defines the position of an organization in a partnership. PHSPs density and centrality varied over time. PHSPs density ranged from 11 to 17 percent while PHSPs centrality remained constant over time at 14 percent from 1998 to 2012. In addition, economic constraints had no statistically significant impact on PHSPs density and centrality. The second and third papers examined the impact of PHSPs on maternal and child services delivery and infant mortality. In the second paper, a cross-sectional online survey was conducted and key findings were coded to examine variation in the characteristics of PHSPs from 2006 to 2012. PHSPs were grouped into four categories of change: diffuse and contracting, expanding and diffuse, centralizing and expanding, and centralizing and contracting. PHSPs categorized as diffuse and contracting reported delivering the least number of maternal and child health services. They also reported achieving the least number of MCH outcomes. In the third paper, secondary data analysis of questions from the NLSPHA (n = 947) was used to determine whether PHSPs were association with infant mortality. PHSPs density and centrality were significantly associated with an increase in infant mortality. A 1 percent increase in organizational density was associated with a .05 percent increase in infant mortality (p< .05) after controlling for all other factors in the model. In addition, a 1 percent increase in organizational centrality was associated with a .03 percent increase in infant mortality after controlling for other factors in the model. Due to the findings, PHS may want to consider evaluating specific partner's motivations and expectations of their role in addressing infant mortality in the communities they serve.
|Advisor:||Tilford, J. Mick, Mays, Glen|
|Commitee:||Bird, Tommy, Curran, Geoffrey, Felix, Holly|
|School:||University of Arkansas for Medical Sciences|
|Department:||Health Systems Research|
|School Location:||United States -- Arkansas|
|Source:||DAI-B 75/05(E), Dissertation Abstracts International|
|Keywords:||Infant mortality, Maternal and child health, PHSPs density, Partners|
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