title: An instrument for assessing public health system performance: validity in rural settings.
abstract: OBJECTIVE
  This study evaluated the validity and utility of the Local Public Health System Assessment Instrument (Local Instrument) of the National Public Health Performance Standards Program in rural settings.
  
  
  METHODS
  The study compared the Local Instrument scores of 6 rural local public health systems to external assessments of those public health systems. The 6 public health systems represented 3 states in which 1 of the 2 local jurisdictions had scored well below and the other well above the state median in a pilot test of the Local Instrument. The study design featured a case study approach consisting of an iterative and integrated combination of semistructured individual and focus group interviews along with the collection of archival materials provided by the 6 public health systems.
  
  
  RESULTS
  Despite differences in Local Instrument scores, the representative public health systems in each state provided roughly the same levels of public health services. Sites varied tremendously in the percentage of survey items rated highly or less relevant.
  
  
  CONCLUSIONS
  The National Public Health Performance Standards Program Local Instrument can provide a useful structure and process for assessing public health system performance at the local level. Key informants provided several recommendations to improve the Local Instrument, including clarification of difficult terminology and acronyms, and development of multiple instruments structured around subsets of survey items.
authors.affiliation: RTI International, Research Triangle Park, NC 27709, USA. driscoll@rti.org
authors.forename: David
authors.initials: D
authors.lastname: Driscoll
authors.forename: Lucia
authors.initials: L
authors.lastname: Rojas-Smith
authors.forename: Sergey
authors.initials: S
authors.lastname: Sotnikov
authors.forename: Kim
authors.initials: K
authors.lastname: Gadsden-Knowles
authors.forename: Natalie Brevard
authors.initials: NB
authors.lastname: Perry
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Lenaway
authors.forename: Paul K
authors.initials: PK
authors.lastname: Halverson
mesh_terms: D019538:Health Care Surveys / Q000379:methods; D006801:Humans; D015397:Program Evaluation / Q000379:methods*; D011635:Public Health Administration; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D015203:Reproducibility of Results; D012424:Rural Population