# Extreme heat preparedness and response implementation: a qualitative study of barriers, facilitators, and needs among local health jurisdictions in the United States

## TL;DR

This study explores how local health jurisdictions in the U.S. prepare for and respond to extreme heat events, identifying key factors that help or hinder their efforts.

## Contribution

The study introduces a framework of four factors influencing extreme heat preparedness and response in local health jurisdictions.

## Key findings

- Local conditions, such as environment and politics, significantly influence EHE preparedness.
- Community engagement and partnerships are crucial for effective heat response strategies.
- Scalable resources and tailored plans are needed to address the unique needs of each jurisdiction.

## Abstract

Extreme heat events (EHEs) are the deadliest weather hazards in the United States (U.S.). Local health jurisdictions (LHJs) in the U.S. are frontline responders during EHEs and other public health emergencies. This study aims to clarify the factors influencing EHE preparedness and response implementation. From January to March 2023, we conducted and thematically analyzed four focus group discussions with 17 representatives from U.S. LHJs. The Consolidated Framework for Implementation Research was used to guide the discussion. Participants described barriers, facilitators, and needs surrounding extreme heat preparedness and response implementation. The focus group discussions identified four factors that influence EHE preparedness and response implementation: local conditions (environmental, political, planning); engaging communities and tailoring strategies; partnerships and relational connections; and available resources. Focus group discussions emphasized the need for EHE preparedness and response activities to be targeted and scaled to the unique climate, population, and needs of the implementing jurisdiction. Local conditions, community engagement, partnerships, and available resources shape LHJ priorities. The study emphasizes the need for scalable resources and comprehensive plans, and identifies research gaps to be addressed in the future.