Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Health Serv Res. 2022 Oct;57(5):1077-1086. doi: 10.1111/1475-6773.14012. Epub 2022 Jun 6.
To quantify variation in public health system engagement with tribal organizations across a national sample of communities and to identify predictors of engagement.
We used 2018 National Longitudinal Survey of Public Health Systems data, a nationally representative cohort of the US public health systems.
Social network analysis measures were computed to indicate the extent of tribal organization participation in public health networks and to understand the sectors and social services that engage with tribal organizations in public health activities. Two-part regression models estimated predictors of tribal engagement.
A stratified random sample of local public health agencies was surveyed, yielding 574 respondents. An additional cohort of oversampled respondents was also surveyed to include jurisdictions from the entire state upon the request of their respective state health departments (n = 154). Analyses were restricted to jurisdictions with a nearby American Indian and Alaska Native (AI/AN) serving health facility, yielding a final sample size of 258 local public health systems.
When an AI/AN serving health facility was present in the region, tribal organizations participated in 28% of public health networks and 9% of implemented public health activities. Networks with tribal engagement were more comprehensive in terms of the breadth of sectors and social services participating in the network and the scope of public health activities implemented relative to networks without tribal engagement. The likelihood of tribal engagement increased significantly with the size of the AI/AN population, the presence of a tribal facility with Indian Health Service funding in the region, and geographic proximity to reservation land (p < 0.10).
The vast majority of public health networks do not report engagement with tribal organizations. Even when AI/AN serving health facilities are present, reported engagement of tribal organizations remains low.
量化全国范围内公共卫生系统与部落组织互动的变化，并确定互动的预测因素。
我们使用了 2018 年全国公共卫生系统纵向调查的数据，这是美国公共卫生系统的全国代表性队列。
采用社会网络分析方法来衡量部落组织参与公共卫生网络的程度，并了解在公共卫生活动中与部落组织合作的部门和社会服务。两部分回归模型估计了部落参与的预测因素。
对地方公共卫生机构进行了分层随机抽样调查，共调查了 574 名受访者。根据各自州卫生部门的要求，还对抽样过多的受访者进行了额外的调查，以包括整个州的司法管辖区（n=154）。分析仅限于附近有服务于美洲印第安人和阿拉斯加原住民的卫生机构的司法管辖区，最终样本量为 258 个地方公共卫生系统。
当该地区有服务于美洲印第安人和阿拉斯加原住民的卫生机构时，部落组织参与了 28%的公共卫生网络和 9%的已实施的公共卫生活动。与没有部落参与的网络相比，有部落参与的网络在参与网络的部门和社会服务的广度以及实施的公共卫生活动的范围方面更加全面。与美洲印第安人人口规模、该地区有获得印度卫生服务基金资助的部落机构以及与保留地的地理接近程度（p<0.10）显著相关，部落参与的可能性显著增加。
绝大多数公共卫生网络没有报告与部落组织的互动。即使当有服务于美洲印第安人和阿拉斯加原住民的卫生机构存在时，报告的部落组织参与度仍然很低。
