title: The role of interorganizational partnerships in health services provision among rural, suburban, and urban local health departments.
abstract: BACKGROUND
  With limited resources and increased public health challenges facing the US, the Centers for Disease Control and Prevention and others have identified partnerships between local health departments (LHDs) and nongovernmental organizations (NGOs) as critical to the public health system. LHDs utilize financial, human, and informational resources and develop partnerships with local NGOs to provide public health services.
  
  
  OBJECTIVE
  Our study had 2 primary goals: (1) compare resources and partnerships characterizing rural, suburban, and urban LHDs, and (2) determine whether partnerships play a mediating role between LHD resources and the services LHDs provide.
  
  
  METHODS
  We conducted secondary data analysis using the National Association of County and City Health Officials 2005 Profile Study. We used chi-squared and analysis of variance (ANOVA) to examine differences between rural, suburban, and urban LHDs. We used regression-based mediation methods to test whether partnerships mediated the relationship between resources and service provision.
  
  
  RESULTS
  We found significant differences between LHDs. Urban LHDs serve larger jurisdictions, have larger budgets and more staff, cultivate more partnerships with local NGOs, and provide more health services than suburban or rural LHDs. We found that partnerships were a partial mediator between resources and service provision. In playing a mediating role, partnerships reduce differences in service provision between rural, suburban, and urban LHDs.
  
  
  CONCLUSIONS
  Partnerships mediate the relationship between resources and service provision in LHDs. LHDs could place more emphasis on cultivating relationships with local NGOs in order to increase service provision. This strategy may be especially useful for rural LHDs facing limited resources and numerous health disparities.
authors.affiliation: Department of Community Health, Saint Louis University School of Public Health, St Louis, Missouri 63104, USA. kbeatty4@slu.edu
authors.forename: Kate
authors.initials: K
authors.lastname: Beatty
authors.forename: Jenine K
authors.initials: JK
authors.lastname: Harris
authors.forename: Priscilla A
authors.initials: PA
authors.lastname: Barnes
mesh_terms: D000704:Analysis of Variance; D003299:Cooperative Behavior; D016208:Databases, Factual; D006302:Health Services Research / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D009938:Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D011634:Public Health; D012044:Regression Analysis; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D013223:Statistics as Topic; D019036:Suburban Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States; D019037:Urban Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data