摘要：Objectives. To assess how health department contextual factors influence perceptions of the 15 Public Health Preparedness Capabilities, developed by the Centers for Disease Control and Prevention (CDC) to provide guidance on organizing preparedness activities. Methods. We conducted an online survey and focus group between September 2015 and May 2016 with directors of preparedness programs in state, metropolitan, and territorial jurisdictions funded by CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement. The survey collected demographic information and data on contextual factors including leadership, partnerships, organizational structure, resources and structural capacity, and data and evaluation. Results. Seventy-seven percent (48 of 62) of PHEP directors completed the survey and 8 participated in the focus group. Respondents were experienced directors (mean = 10.6 years), and 58% led 7 or more emergency responses. Leadership, partnerships, and access to fiscal and human resources were associated with perception and use of the capabilities. Conclusions. Despite some deficiencies, PHEP awardees believe the capabilities provide useful guidance and a flexible framework for organizing their work. Contextual factors affect perceptions of the capabilities and possibly the effectiveness of their use. Public Health Implications. The capabilities can be used to address challenges in preparedness, including identifying evidence-based practices, developing performance measures, and improving responses. Since 2002, federal funding for public health preparedness has been provided by the Centers for Disease Control and Prevention (CDC) to state, tribal, local, and territorial public health departments through the Public Health Emergency Preparedness (PHEP) cooperative agreement. The PHEP cooperative agreement is the main source of funding used to develop and maintain the ability to respond to public health threats, including infectious diseases; natural disasters; and biological, chemical, nuclear, and radiological events. 1 These funds, totaling more than $9 billion, have also been used to address specific threats, such as the 2009 H1N1 novel influenza A virus, Ebola virus disease, and Zika. 2–4 PHEP funds have supported a broad range of programs to complement and extend preparedness activities. A 2014 assessment conducted by CDC’s Division of State and Local Readiness found that since September 11, 2001, PHEP funds accounted for approximately 81% of the funding expended by jurisdictions to develop public health emergency operations centers. In terms of sustaining operations, CDC data indicate that PHEP funds accounted for 51% of awardees’ overall 2014 budgets for maintaining electronic disease surveillance systems, 63% of overall 2014 budgets for the Laboratory Response Network’s response to biological threats, and 88% of the network’s response to chemical threats. 5 In March 2011, CDC promulgated 15 Public Health Preparedness Capabilities to serve as national public health preparedness standards. Public Health Preparedness Capabilities: National Standards for State and Local Planning provides state and local public health departments with guidance on planning and organizing their preparedness activities. 6 The 15 capabilities were developed on the basis of the peer-reviewed literature and the subject matter expertise of professionals working in public health preparedness at the federal, state, and local levels. The capabilities help ensure that federal preparedness funds are directed to priority areas within individual jurisdictions. Previously published research provides few examples of awardees’ use of the capabilities. In general, research indicates that health departments use the capabilities as a framework to structure preparedness and planning activities. The capabilities are part of a broader constellation of inputs that feed into planning activities. 7,8 For example, some awardees use the capabilities to identify and fill gaps in their preparedness plans. 9 Others map current activities to the capabilities, allowing them to identify gaps and prioritize resources. 10,11 Awardees also use the capabilities to organize response—for example, using the emergency operations coordination capability to facilitate partnerships, coordination, communication, and management of resources. 12 Current literature describes contextual factors with the potential to affect health departments’ perception of the capabilities: Leadership: the ability of leaders at multiple levels of the organization to promote or champion the capabilities. 13–15 Partnerships: the ability of health departments to forge partnerships within the community, among different sectors, and across jurisdictions. 13,14,16 Organizational structure: the organizational attributes of the health department, including size and whether it is embedded in a centralized or decentralized system. 17–19 Resources and structural capacity: capacity of the organization, including funding streams and their stability; capacity of the workforce; and facilities and other infrastructure (e.g., legal and administrative capacities). 14,16,19–21 Data and evaluation: the ability to collect and use data to create an impact. 13,16,17,21 In this report, we explore how health departments perceive the 15 Public Health Preparedness Capabilities, as well as how contextual factors affect these perceptions.
