Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences

First Advisor

Dr. Amy B. Curtis


The purpose of this three-paper dissertation was to conduct a mixed methods multi-state examination of specific partnership-related activities among local public health systems (LPHSs) as well as to explore perceptions of LPHS practitioners regarding partnership practices.

In the first paper, secondary data analysis of questions from the National Public Health Performance Standards Program (NPHPSP, n = 110) was used to determine the frequency that partnership activities were conducted optimally (> 75% of the time) and whether any associations existed between three different partnership capacities. Activities were matched with relational, organizational, and programmatic capacities from the Collaborative Capacity Framework. Overall, 86% of LPHSs reported nonoptimal performance in all three capacities. The capacity that was most often conducted optimally was relational (15% of LPHSs). The least frequent activity was review of partnership effectiveness (organizational capacity, 4% conducted optimally). LPHSs that performed optimally in one capacity were statistically more likely to do so in the other two capacities.

The second and third papers explored perceptions of local health department (LHD) practitioners and their partners about characteristics contributing to LPHS partnership mobilization and success. Semi-structured interviews were conducted and key findings were interpreted using metaphoric analysis. Public health practitioners described leading and administrating activities; however, some practitioners were interested in taking a support role more frequently. Practitioners reported using national assessment models and general community building principles as well as formally- and informally-structured partnerships. Practitioners, however, preferred to formalize partnerships by using contracts, memoranda of understanding, and subcommittees. Partners described working together more often in rural areas due to limited resources, but also reported greater concern of burnout. Partners' reported multiple roles in the partnerships, but did not express a desire to play more of a leadership role. Motivations to participate ranged from personal to organizational among these partners.

In general, LPHSs conducted partnership activities at non-optimal levels across all three capacities, particularly in reviewing effectiveness. LHDs' desire to take less of a leadership role was not echoed in the interviews with their partners. LHDs will need to consider specific partners' motivations and expectations of their roles in order to optimize their partnerships.

Access Setting

Dissertation-Open Access