Abstract
Objective: This study's primary objective was to determine where the viewpoints of public health officials and county commissioners differed on interjurisdictional collaboration in public health service delivery.
Design: After cataloging literature findings on interjurisdictional collaboration, an original questionnaire for 2 population groups within a cross-sectional design was developed.
Setting: The questionnaire was administered in a rural or frontier state (Montana) that operates a generally decentralized public health system.
Participants: Respondents (n = 83) were 29 lead local public health officials representing 34 counties, and 54 county commissioners representing 33 counties.
Outcome Measures: Sixteen reasons to collaborate, 13 barriers to collaboration, and 18 policy considerations that would lead respondents to support or oppose a collaborative system were assessed, along with perceptions of current and ideal levels of interjurisdictional collaboration using the 4-level National Association of County and City Health Officials scale.
Results: Viewpoints of public health officials and county commissioners were found to differ significantly on 7 of 47 items. The potential benefit of improved surge capacity to manage large-scale events or emergencies was found by public health officials to be a more important reason to collaborate across jurisdictional lines. Long-standing commitment to home rule, current political climate, perceived threats to local elected officials, loss of local input into public health services and priorities, and lack of collaborative government and staffing models were all identified by public health officials as greater barriers to interjurisdictional collaboration. County commissioners were more likely to neither support nor oppose using existing disaster and emergency services district boundaries to define public health regional boundaries.
Conclusions: Public health officials and county commissioners seem to have similar viewpoints on reasons to collaborate and policy considerations, but different viewpoints on barriers to collaboration. Reconciling those key differences is critical to effecting system change.