Disability Inclusion in Local Health Department Community Health Assessments and Community Health Improvement Plans in HHS Region 4

Authors' Affiliations

Kate Beatty Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN Dawn Rowe Department of Educational Foundations and Special Education, Clemmer College, East Tennessee State University, Johnson City, TN Thomas Quade, Special Olympics International, Washington, D.C.

Location

D.P. Culp Center Room 304

Start Date

4-5-2024 1:30 PM

End Date

4-5-2024 2:30 PM

Name of Project's Faculty Sponsor

Casie Balio

Faculty Sponsor's Department

Center for Rural Health Research

Competition Type

Competitive

Type

Oral Presentation

Presentation Category

Health

Abstract or Artist's Statement

Disability can impact anyone regardless of age, gender, sexual orientation, race, ethnicity, or other identities. People with disabilities experience poorer health outcomes and health behaviors compared to people without disabilities, but are often not included in health decisions at the individual or community level. Local health departments (LHDs) are responsible for understanding the health status of their jurisdiction by conducting a community health assessment (CHA) and community health improvement plan (CHIP) which are designed to inform activities for the coming years. The purpose of this study is to describe and quantify disability inclusion in CHAs and CHIPs compared to characteristics of the jurisdiction served in U.S. HHS Region 4. This cross-sectional study used PHAB Accreditation, 2022 American Community Survey, and 2023 Agency Health Resources Files datasets to examine the relationship between CHA and CHIP disability inclusion and characteristics of the LHDs and the jurisdiction served. First, CHA and CHIP data extraction for disability inclusion was conducted. Publicly available LHD CHAs and CHIPs were analyzed for disability inclusion measures such as including disability demographics; including people with disabilities in surveys, focus groups, and committees; and including CHIP goals, objectives, or activities that specifically address people with disabilities. The sample included 82 LHDs that are PHAB accredited and had completed a CHA between 2019 and 2024. Among these 82 LHDs they serve an average population of 337,000 persons (range=7,704 to 2.5 million), the average percent of population that is rural is 39% (range=0 to 100% rural), and the average percent of population living with a disability is 15.5% (range= 8.8% to 23.3%). More than half of LHDs (n=55) did not include a disability partner agency in their CHA. Of these 82 LHDs, 71 LHDs completed a CHIP based on their most recent CHA. Of these, 14 LHDs included a CHIP goal, objective, or activity specific to disability. LHDs have greater odds for having any mention of disability in the CHA for every 1,000 additional population (OR=1.03; 95% CI 1.002-1.06) and for each percentage increase in rurality (OR=1.07; 95% CI 1.01-1.12). LHDs have greater odds for including disability in a CHIP goal, objective, or activity for an increase in population living with a disability (OR=1.44; 95% CI 1.07-1.94). This study found that on average, a larger population and a larger rural population led to any mention of disability in the CHA whereas a higher percentage of population living with a disability led to more CHIP goals, objectives, and activities that included people with disabilities. While this study is the first to describe and quantify disability inclusion in LHD CHAs and CHIPs, there are limitations. Limitations include a small sample size and the sample is limited to predominantly LHDs in one state within one region. Additional research is recommended to understand disability inclusion in LHD CHAs and CHIPs and how to promote further disability inclusion.

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Apr 5th, 1:30 PM Apr 5th, 2:30 PM

Disability Inclusion in Local Health Department Community Health Assessments and Community Health Improvement Plans in HHS Region 4

D.P. Culp Center Room 304

Disability can impact anyone regardless of age, gender, sexual orientation, race, ethnicity, or other identities. People with disabilities experience poorer health outcomes and health behaviors compared to people without disabilities, but are often not included in health decisions at the individual or community level. Local health departments (LHDs) are responsible for understanding the health status of their jurisdiction by conducting a community health assessment (CHA) and community health improvement plan (CHIP) which are designed to inform activities for the coming years. The purpose of this study is to describe and quantify disability inclusion in CHAs and CHIPs compared to characteristics of the jurisdiction served in U.S. HHS Region 4. This cross-sectional study used PHAB Accreditation, 2022 American Community Survey, and 2023 Agency Health Resources Files datasets to examine the relationship between CHA and CHIP disability inclusion and characteristics of the LHDs and the jurisdiction served. First, CHA and CHIP data extraction for disability inclusion was conducted. Publicly available LHD CHAs and CHIPs were analyzed for disability inclusion measures such as including disability demographics; including people with disabilities in surveys, focus groups, and committees; and including CHIP goals, objectives, or activities that specifically address people with disabilities. The sample included 82 LHDs that are PHAB accredited and had completed a CHA between 2019 and 2024. Among these 82 LHDs they serve an average population of 337,000 persons (range=7,704 to 2.5 million), the average percent of population that is rural is 39% (range=0 to 100% rural), and the average percent of population living with a disability is 15.5% (range= 8.8% to 23.3%). More than half of LHDs (n=55) did not include a disability partner agency in their CHA. Of these 82 LHDs, 71 LHDs completed a CHIP based on their most recent CHA. Of these, 14 LHDs included a CHIP goal, objective, or activity specific to disability. LHDs have greater odds for having any mention of disability in the CHA for every 1,000 additional population (OR=1.03; 95% CI 1.002-1.06) and for each percentage increase in rurality (OR=1.07; 95% CI 1.01-1.12). LHDs have greater odds for including disability in a CHIP goal, objective, or activity for an increase in population living with a disability (OR=1.44; 95% CI 1.07-1.94). This study found that on average, a larger population and a larger rural population led to any mention of disability in the CHA whereas a higher percentage of population living with a disability led to more CHIP goals, objectives, and activities that included people with disabilities. While this study is the first to describe and quantify disability inclusion in LHD CHAs and CHIPs, there are limitations. Limitations include a small sample size and the sample is limited to predominantly LHDs in one state within one region. Additional research is recommended to understand disability inclusion in LHD CHAs and CHIPs and how to promote further disability inclusion.