Developing a Sample Frame from Multiple Sample Frame Sources and Fielding a Survey to State and City Leaders

A critical driver of population health, well-being, and equity is making health a shared value, or the belief that health is a priority for oneself and one’s community. For people in positions of influence, attitudes regarding their organization’s perspective may result in decisions that advance health equity or reinforce inequities, yet little is known about leaders’ attitudes regarding their organization’s perspective on what shapes health, or how their attitudes translate into actions that improve population health. We conducted a mixed-mode survey from fall 2020 to spring 2022. The objectives of the survey were (1) to understand leaders’ attitudes regarding their organization’s perspective on population health and (2) to identify the attitudes associated with leaders’ perspectives regarding their organization’s intention to engage in behaviors that advance population health. Findings from this survey will fill the gaps in the evidence base regarding what people in positions of influence think about social determinants of health and health equity, as well as their attitudes regarding their organization’s perspective. A major challenge for the study was identifying the sample frame, meant to provide a list of all U.S. leaders at the city and state level covering ten sectors. We identified five sample frame sources from which we pulled and constructed a sample frame. We sampled 17,400 organizations and obtained completed surveys from 5,450 leaders, achieving a 32 percent response rate. We used the best sample frame sources we knew of to develop our sample frame. The percent of contact information we obtained from the five sample frame sources was high, and rates of ineligibility were low. Response rates varied widely by sector. Survey respondents tended to be slightly more male and very slightly more White compared to the full eligible sample, and more liberal than the general population.