title: Institutional facilitators and barriers to local public health preparedness planning for vulnerable and at-risk populations.
abstract: OBJECTIVE
  Numerous institutional facilitators and barriers to preparedness planning exist at the local level for vulnerable and at-risk populations. Findings of this evaluation study contribute to ongoing practice-based efforts to improve response services and address public health preparedness planning and training as they relate to vulnerable and at-risk populations.
  
  
  METHODS
  From January 2012 through June 2013, we conducted a multilevel, mixed-methods evaluation study of the North Carolina Preparedness and Emergency Response Research Center's Vulnerable & At-Risk Populations Resource Guide, an online tool to aid local health departments' (LHDs') preparedness planning efforts. We examined planning practices across multiple local, regional, and state jurisdictions utilizing user data, follow-up surveys, and secondary data. To identify potential incongruities in planning, we compared respondents' reported populations of interest with corresponding census data to determine whether or not there were differences in planning priorities.
  
  
  RESULTS
  We used data collected from evaluation surveys to identify key institutional facilitators and barriers associated with planning for at-risk populations, including challenges to conducting assessments and lack of resources. Results identified both barriers within institutional culture and disconnects between planning priorities and evidence-based identification of vulnerable and at-risk populations, including variation in the planning process, partnerships, and perceptions.
  
  
  CONCLUSIONS
  Our results highlight the important role of LHDs in preparedness planning and the potential implications associated with organizational and bureaucratic impediments to planning implementation. A more in-depth understanding of the relationships among public institutions and the levels of preparedness that contribute to the conditions and processes that generate vulnerability is needed.
authors.affiliation: University of North Carolina at Chapel Hill, Gillings School of Global Public Health, North Carolina Institute for Public Health, Chapel Hill, NC.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Bevc
authors.affiliation: University of North Carolina at Chapel Hill, Gillings School of Global Public Health, North Carolina Institute for Public Health, Chapel Hill, NC.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Simon
authors.affiliation: University of North Carolina at Chapel Hill, Gillings School of Global Public Health, North Carolina Institute for Public Health, Chapel Hill, NC.
authors.forename: Tanya A
authors.initials: TA
authors.lastname: Montoya
authors.affiliation: University of North Carolina at Chapel Hill, Gillings School of Global Public Health, North Carolina Institute for Public Health, Chapel Hill, NC.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Horney
mesh_terms: D002959:Civil Defense / Q000458:organization & administration; D003625:Data Collection; D004189:Disaster Planning / Q000458:organization & administration*; D055317:Evidence-Based Practice; D006292:Health Priorities; D006801:Humans; D007324:Institutional Management Teams / Q000458:organization & administration; D020407:Internet; D009111:Local Government; D009657:North Carolina; D015279:Organizational Culture; D011159:Population Surveillance; D015980:Public Health Practice; D012944:Social Support; D035862:Vulnerable Populations