Exploring Local Health Departments' Understanding of and Engagement in Cross-Sector Collaboration and Community Engagement for Systems Change.

Context: Iowa's local public health services (LPHS) contract funding required local health departments (LHDs) to shift toward population health work. In previous research, LHDs indicated interest in learning about cross-sector collaboration (CSC) and community engagement (CE) approaches to systems change to pursue health equity. CSC and CE approaches were on the menu of approved activities for this LPHS funding thereby creating a unique opportunity to explore practitioners' understanding of and engagement in CSC and CE for systems change.

Objectives: To collect evidence about what is needed for LHDs to translate CSC and CE principles to practice and to develop skill and capacity-building initiatives for collaborative systems change.

Design: The multi-phase, qualitative methods study employed an action research design drawing LHDs from Iowa's local public health system.

Setting and participants: Practitioners from LHDs, the Iowa Department of Health and Human Services, the Midwestern Public Health Training Center, and the Iowa Public Health Association formed an action research team to review and validate thematic findings and develop recommendations. Seven LHDs (19 individuals) were selected as participants from Iowa's 99 LHDs.

Results: LHD practitioners described authentic, non-transactional, sustained relationships in the community and with cross-sector partners as foundational to collaborative systems change. Their experience demonstrated that system context (eg, community dynamics and priorities) heavily influences collaborative systems change. Key principles present in systems change frameworks are represented in practitioners' understanding of collaborative systems change. While participants described establishing processes and structures for collaboration as important, no universal best practices emerged; rather practices evolved as collaboratives engaged in shared learning.

Conclusions: LHD practitioners characterize CSC and CE for systems change (ie, what it is, the processes for and successes of) thereby moving beyond high-level constructs to language that might better connect with public health practitioners (ie, words matter).