DOI: 10.3886/icpsr36153.v1
title: Forces of Change Survey, United States, 2014, Restricted-Use Level 1 Data
title: Version 1

description: The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey is an evolution of NACCHO's Job Losses and Program Cuts Surveys (also known as the Economic Surveillance Surveys) which measured the impact of the economic recession on local health departments' (LHD) budgets, staff, and programs. The Forces of Change Survey continues to measure changes in LHD budgets, staff, and programs and assess more broadly the impact of forces affecting change in LHDs, such as health reform and accreditation. More specifically, the survey collected information about LHD staffing levels, workforce reductions, and changes in budget sizes; provided services or functions; changes in the level of service delivery; billing for clinical services; efforts to help people enroll in health insurance from exchanges under the Affordable Care Act; awareness of and involvement in the State Innovation Models Initiative; participation in the Public Health Accreditation Board's national accreditation program for LHDs; and whether LHDs are part of a combined health and human services agency.
The collection is comprised of the public-use version (Restricted-Use Level 1) of the Forces of Change 2014 dataset, and includes 133 variables for 648 cases, with demographic variables related to LHD budgets, governance type, and number of employees.
description: The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey was developed as an evolution to NACCHO's Job Losses and Program Cuts surveys, which measured the impact of the economic recession on local health departments' (LHD) budgets, staff, and programs. The Forces of Change Survey measured changes in LHD budgets, staff, and programs and assessed more broadly the impact of forces affecting change in LHDs (such as health reform). Beginning in 2014, NACCHO began conducting the Forces of Change survey yearly in years that the National Profile Study of Local Health Departments was not fielded.
description: The National Association of County and City Health Officials (NACCHO) administered the questionnaire using Qualtrics, an online survey administration tool. On January 15, 2014, the designated primary contact of every local health department (LHD) in the sample received an invitation via e-mail from NACCHO's president to participate in the survey. The survey link was sent via Qualtrics on January 23, 2014. After the initial invitation, the potential participants received up to five reminder e-mails. In addition, NACCHO made reminder calls to people who had yet to complete the survey, targeting states with low response rates. Some state associations of county and city health officials (SACCHOs) assisted by encouraging their members to take part in the survey.
NACCHO generated national statistics using estimation weights to account for sampling and non-response. All data were self-reported; NACCHO did not independently verify the data provided by LHDs. A detailed description of survey methodology is available on NACCHO's Forces of Change webpage.
description: Variables are related to questionnaire topics, including budget cuts and job losses, changes in service delivery, and local health departments' collaboration with healthcare.
description: ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of 
				disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major 
				statistical software formats as well as standard codebooks to accompany the data. In addition to 
				these procedures, ICPSR performed the following processing steps for this data collection:
			   		Checked for undocumented or out-of-range codes..
description: Presence of Common Scales: 
					Several Likert-type scales were used.
description: Response Rates: 
					68 percent
description: Datasets: 
					
						DS1: Public-Use Dataset
description: web-based survey
description: Local health departments (LHD) in 48 states and the District of Columbia. Hawaii and Rhode Island were excluded from the survey because they had no LHDs.
				   		Smallest Geographic Unit: State
description: The National Association of County and City Health Officials (NACCHO) used a stratified random sampling design for the 2014 Forces of Change Survey. A representative sample was used instead of a complete census design to minimize survey burden on local health departments (LHD) while enabling the calculation of both national- and state-level estimates.
LHDs were stratified by two variables: state and size of the population served. For stratification by size of population served, three categories were used: small (less than 50,000 people served), medium (50,000-499,999 people served), and large (500,000 or more people served). Because LHDs with large population sizes represent a relatively small portion of all LHDs, these LHDs were oversampled to ensure a sufficient number of responses for the analysis. Two states (Hawaii and Rhode Island) were excluded from the study because they had no LHDs. In addition, some states did not have any LHDs in a particular size category, resulting in a total of 122 strata. The sampling plan was designed to select a minimum of 33 percent of the LHDs in a given stratum and at least two LHDs per stratum whenever possible.


Once the sampling plan was finalized, NACCHO drew a random sample of the specified size from within each stratum. In some centralized states, two or more LHDs had the same person listed as the contact person. To minimize response burden, no more than two LHDs with the same contact person were kept in the sample. However, two contacts in Alabama received three surveys each because additional contacts in their state were not available. When LHDs with a common contact person were dropped from sample, or when contact information was not available, a replacement was drawn. Overall, a sample of 952 LHDs was selected of which 648 responded to the survey.