Operationalizing health equity: a mixed-methods approach to measuring organizational capacity in public health practice
- 1Prevention Research Center, Bursky School of Public Health, Washington University in St. Louis , , ,
- 2Bursky School of Public Health, Washington University in St. Louis , , ,
Abstract
Introduction: Health equity is a core function of public health practice, yet most public health agencies lack tools to assess their internal capacity to advance it. Existing measurement efforts have focused primarily on community-level health disparities rather than the organizational infrastructure, leadership, and practices needed to address them. This study aimed to develop a reliable survey for measuring organizational equity capacity within public health agencies.
Methods: We used a two-phase, mixed-methods approach. First, we identified priority organizational domains through concept mapping with 73 state and local practitioners. Findings informed the development of a 47-item survey administered to a national sample of practitioners ( n = 234). We conducted psychometric analyses and confirmatory factor analysis (CFA) to refine the instrument and evaluate model fit.
Results: Concept mapping identified eight domains: Funding, Agency Practices, Communication, Data Practices, Organizational Partnerships, Community Representation, Leadership, and Staff Development. Through CFA, we identified a 32-item, eight-factor survey with strong model fit (CFI = 0.908; RMSEA = 0.066). All subscale domains showed good to excellent internal consistency (Cronbach's alpha = 0.79–0.91).
Conclusion: Organizational health equity capacity is multidimensional rather than a single undifferentiated construct. This pragmatic and reliable 32-item instrument provides a rigorous tool for agencies to assess internal equity infrastructure. Agencies can use this tool to benchmark organizational capacity and track systemic progress toward institutionalizing health equity.
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BibTeX
@article{mazzuccaragan2026operationalizing,
title = {{Operationalizing health equity: a mixed-methods approach to measuring organizational capacity in public health practice}},
author = {Stephanie Mazzucca-Ragan and Rebekah R. Jacob and Douglas A. Luke and Sara Malone and Cheryl A. Valko and Ross C. Brownson},
journal = {Frontiers in public health},
year = {2026},
month = sep,
doi = {10.3389/fpubh.2026.1913380},
url = {https://europepmc.org/article/PMC/PMC13661554},
note = {CC BY},
}
RIS
TY - JOUR
TI - Operationalizing health equity: a mixed-methods approach to measuring organizational capacity in public health practice
AU - Stephanie Mazzucca-Ragan
AU - Rebekah R. Jacob
AU - Douglas A. Luke
AU - Sara Malone
AU - Cheryl A. Valko
AU - Ross C. Brownson
PY - 2026
DA - 2026/09/30
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1913380
UR - https://europepmc.org/article/PMC/PMC13661554
AB - Introduction: Health equity is a core function of public health practice, yet most public health agencies lack tools to assess their internal capacity to advance it. Existing measurement efforts have focused primarily on community-level health disparities rather than the organizational infrastructure, leadership, and practices needed to address them. This study aimed to develop a reliable survey for measuring organizational equity capacity within public health agencies. Methods: We used a two-phase, mixed-methods approach. First, we identified priority organizational domains through concept mapping with 73 state and local practitioners. Findings informed the development of a 47-item survey administered to a national sample of practitioners ( n = 234). We conducted psychometric analyses and confirmatory factor analysis (CFA) to refine the instrument and evaluate model fit. Results: Concept mapping identified eight domains: Funding, Agency Practices, Communication, Data Practices, Organizational Partnerships, Community Representation, Leadership, and Staff Development. Through CFA, we identified a 32-item, eight-factor survey with strong model fit (CFI = 0.908; RMSEA = 0.066). All subscale domains showed good to excellent internal consistency (Cronbach's alpha = 0.79–0.91). Conclusion: Organizational health equity capacity is multidimensional rather than a single undifferentiated construct. This pragmatic and reliable 32-item instrument provides a rigorous tool for agencies to assess internal equity infrastructure. Agencies can use this tool to benchmark organizational capacity and track systemic progress toward institutionalizing health equity.
SN - 2296-2565
ER -