Operationalizing health equity: a mixed-methods approach to measuring organizational capacity in public health...

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.

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.

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).

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.