Supporting Capacity-Building in Public Health: Measuring Values using Best-Worst Scaling
Greater capacity in public health is needed to maintain and improve population health. Building capacity may be enhanced by having a better understanding of populations’ underlying value systems, particularly those who are intended to benefit from capacity-building efforts. Underlying value systems can be revealed using a relatively novel methodological approach in public health, termed best-worst scaling (BWS). BWS statistically relates choice information to underlying values by assuming that these values motivate choice, which can be directly observed. This dissertation investigates the components of public health capacity, and the underlying values relating to some of these components. This dissertation utilized data from a qualitative review of reports made after the 2003 Severe Acute Respiratory Syndrome outbreak, and three BWS experiments. These data were used to: 1) identify some of the components of public health capacity; and determine the relative importance of 2) community well-being indicators; 3) environmental health information management system features; and, 4) environmental health professional competencies. Seventeen components of public health capacity were identified, and then organized into five tiers: human resources, foundation, program, integrative, and enhanced public health. Underlying values relating to three of the capacity components, namely enhanced public health (community well-being), data and information (information management system), and human resources (discipline-specific competencies) were further investigated. With respect to community well-being, local citizens considered healthy populations to be most important relative to other aspects of community well-being, followed by living standards, time use, education, community vitality, leisure and culture, environment, and democratic engagement. Key features of an environmental health information management system that were evaluated using BWS were software that can be used in all practice areas, and that can be used off-line to collect new data and view past data. Communication was considered most important relative to other types of competencies, followed by public health sciences, assessment and analysis, policy and program planning, implementation and evaluation, partnerships, collaboration and advocacy, legal and regulatory, leadership, and diversity and inclusiveness. These findings may help to guide capacity-building efforts by elucidating underlying value systems that can be used to better tailor these efforts, and ultimately enhance population health.