Context: Local health departments (LHDs) are implementing a national mandate to engage community partners, including individuals, businesses, and community- and faith-based organizations in the larger public health emergency preparedness (PHEP) enterprise.
Objective: Investigate how LHDs of varying size and resource levels successfully engage the community in PHEP to help uncover "best practices" that aspiring agencies can replicate, particularly in low-resource environments.
Design: In-depth, semistructured qualitative interviews with practitioners from 9 highly performing LHDs.
Setting: Participating agencies comprised equal amounts of small (serving <50 000 residents), medium (serving 50 000-500 000 residents), and large (serving >500 000 residents) LHDs and were diverse in terms of geographic region, rural-urban environment, and governance structure.
Participants: A cross section of LHD staff (n = 34) including agency leaders, preparedness coordinators, public information officers, and health educators/promoters.
Main outcome measure: Local health department performance at community engagement as determined by top scores in 2 national LHD surveys (2012, 2015) regarding community engagement in PHEP.
Results: Based on key informant accounts, high-performing LHDs show a holistic, organization-wide commitment to, rather than discrete focus on, community engagement. Best practices clustered around 5 domains: administration (eg, top executive who models collaborative behavior), organizational culture (eg, solicitous rather than prescriptive posture regarding community needs), social capital (eg, mining preexisting community connections held by other LHD programs), workforce skills (eg, cultural competence), and methods/tactics (eg, visibility in community events unrelated to PHEP).
Conclusions: For LHDs that wish to enhance their performance at community engagement in PHEP, change will entail adoption of evidence-based interventions (the technical "what") as well as evidence-based administrative approaches (the managerial "how"). Smaller, rural LHDs should be encouraged that, in the case of PHEP community engagement, they have unique social assets that may help offset advantages that larger, more materially resourced metropolitan health departments may have.