Assessing Public Health Jurisdictional Use of the Model Aquatic Health Code From the Centers for Disease Control and Prevention: A Mixed-Methods Approach.

The Model Aquatic Health Code (MAHC) from the Centers for Disease Control and Prevention (CDC) provides scientifically based recommendations that state, tribal, local, and territorial (STLT) public health partners can use to ensure healthy and safe experiences in public aquatic venues. Our study aimed to characterize MAHC use and implementation and identify facilitators and barriers to MAHC use across STLT jurisdictions. A mixed-methods approach was used, combining a web-based survey with virtual focus groups that included public health professionals from STLT health departments working on aquatic venue safety, regulation, and inspection. In total, 88 participants from 35 STLT health departments completed the survey that was distributed to 13,887 recipients via CDC-administered and nongovernmental listservs. In total, 47 (53%) respondents reported using the MAHC to justify existing code, 34 (39%) to provide guidance for sections not covered in their code, and 31 (35%) to grant code exceptions. Further, 13 (15%) respondents reported they frequently incorporate or have adopted the MAHC in full, and 34 (39%) reported they do not incorporate the MAHC but are considering incorporating the MAHC into code. Facilitators to MAHC use included the need for updated regulations, political will, and collaboration. Barriers included slow regulatory processes, resource constraints, and insufficient staff training. MAHC users indicated that an up-to-date MAHC provides flexibility for jurisdictions to adopt or reference it to best fit jurisdictional needs. Overall, MAHC use varies, and a multifactorial approach beyond code adoption might be needed to measure MAHC use. Moreover, implementation and adoption tracking support could improve MAHC use. Respondents generally agreed that the MAHC should be kept up-to-date, but that future update cycles could extend beyond every 3 years.