Cross-sector decision landscape in response to COVID-19: A qualitative network mapping analysis of North Carolina decision-makers
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Abstract
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.
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SciScore for 10.1101/2022.03.09.22272160: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: This study was determined to be exempt from review by the UNC Institutional Review Board (#20-2087). Sex as a biological variable One member of the study team (KTJ), a white, male graduate research assistant with qualitative interview experience, conducted semi-structured interviews between October 2020 and January 2021 using a secure web-based video-conferencing platform. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We …SciScore for 10.1101/2022.03.09.22272160: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: This study was determined to be exempt from review by the UNC Institutional Review Board (#20-2087). Sex as a biological variable One member of the study team (KTJ), a white, male graduate research assistant with qualitative interview experience, conducted semi-structured interviews between October 2020 and January 2021 using a secure web-based video-conferencing platform. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:These findings should be viewed in the context of several limitations. While we were intentional in ensuring diverse representation of interviewees across sectors, organization type, and geography (across North Carolina), the sample does not represent an exhaustive list of organization types involved in the COVID-19 response. The snowball sampling technique employed increases the potential that the opinions uncovered were more homogenous than they would be otherwise. However, we were explicit when asking for recommendations that we were interested in uncovering a more complete and broader perspective on the subject. Thematic saturation was based on generalizable themes that emerged across sectors. Future research should investigate specific instances of cross-sector collaboration, interviewing more stakeholders involved, to gain a more detailed understanding. The timing of interviews with respect to official guidance, transmission rates, and vaccination rollout undoubtedly influenced participant responses. We incorporated timing into interviews and analysis. Additionally, participant responses may be subject to self-report bias, given limitations of recall and the potential for selective reporting. Lastly, decision-makers willing to participate in public health research may have differed from those who refused in the extent to which they valued and trusted scientific information. However, participants described a range of perspectives on how they incorporated scientific infor...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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