Division of Health Research, Mathematica, Princeton, NJ, United States of America.
Department of Social and Behavioral Sciences, Harvard University, Cambridge, MA, United States of America.
PLoS One. 2024 Apr 18;19(4):e0301450. doi: 10.1371/journal.pone.0301450. eCollection 2024.
A critical driver of population health, well-being, and equity is making health a shared value, or the belief that health is a priority for oneself and one's community. For people in positions of influence, attitudes regarding their organization's perspective may result in decisions that advance health equity or reinforce inequities. Yet despite the potential role of leaders in influencing health and well-being, little is known about their attitudes regarding their organization's perspective on what shapes health, or how their attitudes translate into actions that improve population health. The objectives of this study are twofold: (1) to understand leaders' attitudes with regard to their organization's perspective on population health and (2) to identify the attitudes associated with leaders' perspectives regarding their organization's intention to engage in behaviors that advance population health. We designed a survey instrument grounded in the Theory of Planned Behavior and fielded the survey to 18,367 state and community leaders across all 50 U.S. states, 325 U.S. cities, and nine sectors from fall 2020 until spring 2022. We received surveys from 5,450 leaders, yielding a 32 percent response rate. Survey respondents viewed social determinants of health and health equity as important factors influencing population health. Additionally, two attitudes were most associated with leaders' intentions to promote population health-"self-efficacy" (a leader's confidence in taking action to promote health for all) and "behaviors valued by important others" (how much certain groups want the organization to take action that promotes health for all). Efforts to improve population health through leaders should focus on supporting leaders' self-efficacy and on increasing leaders' perceptions regarding behaviors valued by important others. Governmental entities and funders can use these data to support leaders' efforts in improving population health, well-being, and equity.
人口健康、福祉和公平的一个关键驱动因素是将健康视为共同价值观，即个人和社区都将健康视为优先事项。对于有影响力的人来说，他们对组织观点的态度可能会导致做出促进健康公平或加剧不公平的决策。然而，尽管领导者在影响健康和福祉方面可能发挥作用，但人们对他们对组织对塑造健康的看法的态度以及这些态度如何转化为改善人口健康的行动知之甚少。本研究的目的有两个：（1）了解领导者对组织对人口健康的看法的态度；（2）确定与领导者对组织参与促进人口健康的行为的意图相关的态度。我们设计了一个基于计划行为理论的调查工具，并从 2020 年秋季到 2022 年春季，向全美 50 个州、325 个美国城市和 9 个部门的 18367 名州和社区领导人发放了调查。我们收到了 5450 名领导人的调查回复，回复率为 32%。调查受访者认为健康的社会决定因素和公平是影响人口健康的重要因素。此外，两个态度与领导者促进人口健康的意图最相关——“自我效能”（领导者采取行动促进所有人健康的信心）和“重要他人重视的行为”（组织采取行动促进所有人健康的意愿）。通过领导者改善人口健康的努力应侧重于支持领导者的自我效能，并提高领导者对重要他人重视的行为的认识。政府实体和资助者可以利用这些数据来支持领导者改善人口健康、福祉和公平的努力。
