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. 2022 Aug 16:10:906602.
doi: 10.3389/fpubh.2022.906602. eCollection 2022.

Cross-sector decision landscape in response to COVID-19: A qualitative network mapping analysis of North Carolina decision-makers

Caitlin B Biddell  1   2 , Karl T Johnson  1 , Mehul D Patel  3 , Raymond L Smith  4 , Hillary K Hecht  1 , Julie L Swann  5 , Maria E Mayorga  5 , Kristen Hassmiller Lich  1
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Cross-sector decision landscape in response to COVID-19: A qualitative network mapping analysis of North Carolina decision-makers

Caitlin B Biddell et al. Front Public Health. .

Abstract

Introduction: The COVID-19 pandemic response has demonstrated the interconnectedness of individuals, organizations, and other entities jointly contributing to the production of community health. This response has involved stakeholders from numerous sectors who have been faced with new decisions, objectives, and constraints. We examined the cross-sector organizational decision landscape that formed in response to the COVID-19 pandemic in North Carolina.

Methods: We conducted virtual semi-structured interviews with 44 organizational decision-makers representing nine sectors in North Carolina between October 2020 and January 2021 to understand the decision-making landscape within the first year of the COVID-19 pandemic. In line with a complexity/systems thinking lens, we defined the decision landscape as including decision-maker roles, key decisions, and interrelationships involved in producing community health. We used network mapping and conventional content analysis to analyze transcribed interviews, identifying relationships between stakeholders and synthesizing key themes.

Results: Decision-maker roles were characterized by underlying tensions between balancing organizational mission with employee/community health and navigating organizational vs. individual responsibility for reducing transmission. Decision-makers' roles informed their perspectives and goals, which influenced decision outcomes. Key decisions fell into several broad categories, including how to translate public health guidance into practice; when to institute, and subsequently loosen, public health restrictions; and how to address downstream social and economic impacts of public health restrictions. Lastly, given limited and changing information, as well as limited resources and expertise, the COVID-19 response required cross-sector collaboration, which was commonly coordinated by local health departments who had the most connections of all organization types in the resulting network map.

Conclusions: By documenting the local, cross-sector decision landscape that formed in response to COVID-19, we illuminate the impacts different organizations may have on information/misinformation, prevention behaviors, and, ultimately, health. Public health researchers and practitioners must understand, and work within, this complex decision landscape when responding to COVID-19 and future community health challenges.

Keywords: COVID-19; community health; crisis response; cross-sector collaboration; decision-making.

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Conflict of interest statement

JS reported receiving compensation from Georgia Institute of Technology and Zoetis, Inc. in the prior 12 months. The remaining authors declared that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Network map of cross-sector partnerships formed in North Carolina's local COVID-19 pandemic response. This figure shows the network map developed from the collaboration described by interviewees. Each node in the map represents an organization type, color-coded by sector and sized by closeness metric (larger nodes more connected to other nodes in the network map). A full, interactive network map can be found (24).
Figure 2
Figure 2
Central roles of local health departments in coordinating local COVID-19 pandemic response across sectors.
See this image and copyright information in PMC

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