title: Voices across Kansas: community health assessment and improvement efforts among local health departments.
abstract: BACKGROUND
  Community health assessment (CHA) and community health improvement planning (CHIP) is central to public health accreditation and essential functions and therefore important to local health departments (LHDs). However, rural states face significant challenges to pursue public health accreditation.
  
  
  OBJECTIVE
  The purpose of this statewide study was to identify factors that impede or promote the timeliness of CHA and CHIP completion.
  
  
  METHODS
  Fifteen focus groups, representing 11 of 15 public health regions, were conducted via telephone, using a structured interview script between April and September 2012.
  
  
  METHODS
  The sampling frame for the project was represented by counties in Kansas that planned to conduct a CHA-CHIP activity during 2012.
  
  
  METHODS
  Participants (N = 76) were LHD administrators, hospital representatives, and key community stakeholders from frontier, rural, and urban settings who were involved in CHA-CHIP activities. They were predominantly female (86.0%) and 51 years or older (66.7%).
  
  
  METHODS
  The study assessed perceptions and opinions about the inputs, process, outputs, and outcomes of CHA-CHIP activities within the community.
  
  
  RESULTS
  Overall, CHA-CHIP implementation in Kansas was in its early stages. Rural counties reported a lack of capacity and confidence to perform many CHA-CHIP activities. Early CHA-CHIP adopters were located in more populous, metropolitan areas and had progressed further into the CHA-CHIP process. Regardless of rural/urban status, a history of collaborative activity among community stakeholder groups appeared to promote progress in CHA-CHIP completion. Participants reported that additional funding, time, trained staff, technical assistance, and community leadership were needed to conduct CHA-CHIP activities. Barriers included maintaining required LHD services while conducting assessment and planning activities and differences in public health and federal cycles for performing CHA.
  
  
  CONCLUSIONS
  Study findings have implications for strengthening rural workforce development and technical assistance for CHA-CHIP activities.
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita (Dr Wetta and Ms Brown); Kansas Health Institute, Topeka (Dr Pezzino and Ms LaClair); SOCO Consulting, Wichita, Kansas (Ms Orr).
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Wetta
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Pezzino
authors.forename: Barbara
authors.initials: B
authors.lastname: LaClair
authors.forename: Shirley
authors.initials: S
authors.lastname: Orr
authors.forename: Molly B
authors.initials: MB
authors.lastname: Brown
mesh_terms: D000068:Accreditation; D057191:Capacity Building / Q000458:organization & administration; D018672:Community Health Planning / Q000458:organization & administration* / Q000592:standards; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D007615:Kansas; D007857:Leadership; D009111:Local Government; D008297:Male; D008875:Middle Aged; D011635:Public Health Administration / Q000592:standards*; D012111:Residence Characteristics