Coalitions for impacting the health of a community: the Summit County, Ohio, experience

Unpacking participation in healthcare governance: Lessons from two local health councils in Brazil and Spain

This paper describes and compares the integration of cross-sector actors' participation into the governance of two local health councils, one located in Salvador de Bahia (Brazil) and the other in the Canary Islands (Spain). Based on the cross-national comparative research conducted as part of a doctoral thesis, a qualitative design based on secondary data analysis was proposed on the three stages of the organisational integration process of participation. We used information from individual semi-structured interviews (n = 70), situational observation, focus groups, literature review, and field notes to understand participatory processes of networking between multiple cross-sector actors and to show how such processes might be associated with innovative practices. For these innovations to be successfully implemented, stakeholders need to acquire adequate competencies in cross-sector collaboration, enabling them to learn about new organisational practices and to adapt the network of actors to the often unpredictable influences of contextual factors.

Using dialogue-centered approaches to community-engaged research: an application of dialectical inquiry

Rural communities across the United States experience increased risk and prevalence of chronic diseases associated with both individual and community-based factors. Thus, there is a need for rural capacity development for chronic disease prevention. Traditional health promotion and intervention approaches often focus on diet-related health disparities from a positivist, evidence-based paradigm. To counter positivist bias within health promotion research, a hybridized approach is proposed using a critical-constructivist paradigm incorporating dialectical thinking, appreciative inquiry, and dialectical inquiry to address cultural and structural barriers, as well as community-based social norms, through evaluation of community-based health promotion interventions. Three dialectical models were identified through interviews with community coalition members: social ties, infrastructure, and worldviews, examining underlying assumptions and counter assumptions. By revealing the dialectic assumptions and counter assumptions within project implementation, practitioners can engage in constructive dialogue with communities to determine more effective and culturally responsive pathways for project development.

The Social Context: Social and Behavioral Factors That Affect Health Outcomes

To achieve understanding and best care, screening and treating patients should consider the patient's social environment. Social and behavioral factors influence both positive and negative health behaviors that influence mental and physical health. Primary care providers continually navigate barriers faced by patients and seek solutions that take into consideration social and behavioral factors. The role of the PCP begins with an understanding of common barriers and community resources, then by assessing and responding to the patient's own challenges, and finally by advocating in the clinic and public for changes to the underlying social and structural causes of morbidity and mortality.

A coalition-driven examination of organization capacity to address food insecurity in Greater Houston: a qualitative research study

Background

Economic and social hardships have worsened food insecurity, particularly among low income and racial-ethnic minority groups. Given the core goal of the 150+ member Houston Health Equity Collective (HEC) to reduce food insecurity by 5% in 2025, we explored member organizations' capacity and challenges faced in screening and responding to food insecurity through care coordination efforts.

Methods

A twice-administered Qualtrics XM survey (Provo, Utah) with 76 organizations, followed by five focus groups with 22 of these organizations, explored reach and response efforts to food insecurity. Qualitative assessments lasted between 0.5 to 1.5 h, were audio-recorded, cleaned, coded, and thematically analyzed using NVivo, version 11 (Burlington, Massachusetts). The qualitative study was guided by a general inductive approach. In total, over 6 h of audiovisual recording were extracted, and over 100 pages of text exported to NVivo for data analysis. The research team read and coded transcripts independently using the codebook, and met routinely to discuss and resolve codes -resulting in numerous revisions to the codebook. Coding structure was discussed at multiple meetings and differences were addressed through consensus. Predominant qualitative themes impacting food insecurity screening were "stigma and cultural-related barriers", "clinic capacity and attitudes", "need to focus on upstream influences of food insecurity and SDOH needs", "impact of COVID-19", and "need for HEC system responses". Main recommendations to enhance screening and reach included improving staff culture, enhancing cultural sensitivity across organizational practices, and using shared technology to coordinate care. Respondents stated that the HEC can drive these recommendations through networking opportunities, use of shared resource directory, and placing focus on upstream factors.

Conclusions

Recommendations to target food insecurity must focus on organizational staff responsiveness and sensitivity to patients' needs. Of equal importance is the need for increased attention to the upstream influencers and integration of systems-level interventions to holistically target the barriers impacting food insecurity.

Using Cross-Cultural Collaboration to Establish a Working Coalition for An Equitable COVID-19 Vaccine Program

Coalitions and collaborations with African Americans in the United States are often between people with equal humanity but unequal power. Endeavors between historically harmed communities and representatives of systems that continue to harm them frequently lead to intentional and unintentional miscommunication, mistrust, and distrust. The causes for health inequity are complex and should include consideration of systemic racism. In most standard public health models, departments typically take the lead and invite select members of the community to help. This article describes a collaboration that took place in Marin City, California, between African American churches, the department of public health, and community-based organizations during the COVID-19 pandemic. This example focuses on the value of African American history and cosmology as a foundation for respectful cross-cultural collaboration in implementing a COVID-19 vaccination effort. A cross-cultural collaborative model was developed for use by this coalition to guide the development and implementation of community response teams. Unique and shared responsibilities provided by the coalition partners are examined. Humanistic principles, including empathy, positive regard, trust, and grace, are held as central to the model when planning, implementing, and evaluating activities undertaken by cross-cultural coalitions. Sustainability issues are considered concerning staffing, funding, and public policy.

Social Work Care in Traumatic Brain Injury and Substance Use Disorder Treatment: A Capacity-Building Model

Co-occurring traumatic brain injury (TBI) and substance use disorders (SUD) are a major public health concern, yet TBI is often underrecognized within SUD treatment organizations. Social workers in these organizations are well positioned to deliver tailored treatment, but little is known about what social workers are doing to address the needs of these clients. The purpose of this study was to examine current social work practices in providing care to clients with co-occurring TBI and SUD. Using grounded theory methodology, authors conducted semistructured interviews with 17 licensed social workers employed in various SUD treatment settings. Transcript coding was conducted through an iterative process and data were analyzed using NVivo (version 12.0). Results demonstrated that social workers lack basic knowledge on the relationship between TBI and SUD. Additional barriers to providing care included lack of skills to identify history of TBI, lack of community resources, poor agency collaboration, and access-to-care restrictions. Social workers identified their primary roles as advocacy, care coordination, and serving on multidisciplinary teams. These results informed development of a capacity-building model, with recommendations for social work situated in each level of the socioecological framework. This study has important implications for building workforce capacity and collaborative care systems to improve client outcomes.

Implementing community-based health promotion in socio-economically disadvantaged areas: a qualitative study

BACKGROUND

There is a gradient relationship between socio-economic status and health. We investigated the views and perceptions of health promotion service providers regarding factors that affect lack of engagement in public health initiatives by residents in socio-economically disadvantaged (SED) communities.

METHODS

We conducted semi-structured interviews with a purposive sample of key providers (n = 15) of community-based health promotion services to elicit their views about engagement-related factors and their experiences of the provision, delivery and impact of health promotion in SED areas. Interviews were analysed using thematic analysis.

RESULTS

Failure to (i) recognise within SED communities, socio-cultural norms of health-related behaviour and (ii) communicate to local residents an understanding of complex lifestyle influences appeared to affect adversely service engagement and contribute to the development of negative attitudes towards health promotion. Engagement is more likely when services are delivered within familiar settings, peer support is available, initiatives are organized within existing groups, external incentives are offered and there are options regarding times and locations. Collaborative working between providers and communities facilitates efficient, context-sensitive service delivery.

CONCLUSIONS

Knowledge of a local community and its socio-environmental context alongside a collaborative, facilitative and tailored approach to delivery are required to ensure successful engagement of SED communities in health promotion.

Doctors as disseminators? Practicing physicians as multipliers for community-based prevention networks in a large city in western Germany

Aim

Practicing physicians have a special position as disseminators of community-based prevention for children. However, it is unclear to what extent physicians inform parents about programs. The study investigated: To what extent do physicians disseminate information about community-based prevention for children aged 0–7? Do differences exist along family’s socioeconomic position (SEP) and immigrant background?

Subject and methods

We conducted a retrospective cohort study in a German school entrance examination. Parents were invited to participate in a survey on community-based prevention with information about their awareness and information source. SEP was measured by parental education, immigrant background by country of birth. For nine services types, we counted how often parents named physicians and other professional groups as information sources. To estimate social differences, we calculated adjusted odds ratios (OR) with 95% confidence interval (CI).

Results

Survey participants included 6480 parents (response 65.49%). Compared to other information sources, physicians were mentioned less frequently. For example, regarding language therapy, 31.2% of parents were informed by healthcare/social services, and 4.4% by physicians. Lower educated parents were less frequently informed by physicians about counseling services (OR 0.58; 95% CI 0.46–0.73) compared to higher educated parents. Parents with immigrant background were informed less often about parenting skills courses (OR 0.79; 95% CI 0.70–0.90) compared to parents without immigrant background, but more often about language therapy (OR 1.47; 95% CI 1.13–1.91). No further social differences were observed.

Conclusion

The role of physicians as disseminators for community-based prevention is expandable. They should promote parenting skills courses in a socially sensitive way.

The Empower Action Model: A Framework for Preventing Adverse Childhood Experiences by Promoting Health, Equity, and Well-Being Across the Life Span

The empower action model addresses childhood adversity as a root cause of disease by building resilience across multiple levels of influence to promote health, equity, and well-being. The model builds on the current evidence around adverse childhood experiences and merges important frameworks within key areas of public health-the socio-ecological model, protective factors, race equity and inclusion, and the life course perspective. The socio-ecological model is used as the foundation for this model to highlight the multilevel approach needed for improvement in public health. Five key principles that build on the protective factors literature are developed to be applied at each of the levels of the socio-ecological model: understanding, support, inclusion, connection, and growth. These principles are developed with actions that can be implemented across the life span. Finally, actions suggested with each principle are grounded in the tenets of race equity and inclusion, framing all actionable steps with an equity lens. This article discusses the process by which the model was developed and provides steps for states and communities to implement this tool. It also introduces efforts in a state to use this model within county coalitions through an innovative use of federal and foundation funding.

Individual health outcomes secondary to a nurse-led coalition-based health promotion program for underserved diverse populations

OBJECTIVE

This study describes the impact of various levels of participation in a nurse-led coalition-based wellness program on participant outcomes related to body mass index, blood pressure, diabetes risk, and lifestyle behaviors in a Midwest rural county.

DESIGN

This descriptive study used de-identified data collected by program staff over a 26-month period to evaluate participant outcomes.

SAMPLE

Participants were predominantly female with a mean age of 49 years; 41% identified as Hispanic.

MEASUREMENTS/ANALYSIS

Lifestyle behavior surveys and biometric screenings were used to collect data. Latent Growth Class Analysis and logistic regression were used to analyze the data.

INTERVENTION

Monthly wellness programming including screenings, health education and referrals were provided to participants at various sites in a rural community.

RESULTS

Over a 26-month period, 3,004 visits were made by 820 participants. Four clusters for participants (n = 287) who had made three visits or more were identified, providing insight into meaningful interindividual differences for repeat participants. Overall, repeat participants either maintained or improved their blood pressure over time. Indirect outcomes including policy, system, and environmental changes were also noted.

CONCLUSIONS

Coalitions can positively affect the health of populations through these types of programs at the individual and population level.

Recognition: key to the entrepreneurial strategies of rural coalitions in advancing access to health care

OBJECTIVES

Considerable evidence has advanced the role of citizen-led coalitions (CLC) in supporting the health and social needs of rural citizens. There has been little research focusing on the experiences and strategies of coalitions, with their limited resources and status, in targeting health inequities in their rural communities. The aim of this study was to understand the entrepreneurial strategies and experiences of rural coalitions to effect change in the delivery of health services for their older adult populations.

METHOD

A qualitative descriptive study method was used to generate understanding of the entrepreneurial experiences and strategies of CLCs in advancing health services to meet the health and social needs of their citizens. Seven diverse CLCs (n = 40) from different rural communities participated in focus groups and in individual and coalition-level surveys. Thematic analysis was used to construct themes from the data.

RESULTS

Two over-riding themes emerged: entrepreneurial strategies and societal recognition. CLCs engaged in numerous entrepreneurial strategies that enabled actions and outcomes in meeting their health care needs. These strategies included: securing quick wins, leveraging existing resources, and joining forces with stakeholder groups/individuals. However, despite these strategies and successes, coalitions expressed frustration with not being seen and not being heard by decision-makers. This pointed to a key structural barrier to coalition successes -- a broader societal and institutional problem of failing to recognize not only the health needs of rural citizens, but also the legitimacy of the community coalitions to represent and act on those needs.

CONCLUSIONS

Despite the potential for coalitions to mobilize and effect change in addressing the inequities of rural health service access for older adults, broader barriers to their recognition, may undermine their entrepreneurial strategies and success.

A systematic scoping review of asset-based approaches to promote health in communities: development of a framework

Asset-based approaches to health promotion have become increasingly popular as a way to tackle health inequalities by empowering people in more disadvantaged communities to use local resources and increase control over health and its determinants. However, questions remain about how they work in practice. This article presents the findings from a systematic scoping review of the empirical literature on asset-based approaches in communities. The aim was to identify the key elements of asset-based approaches, and how they are operationalised in interventions aimed at promoting health and reducing inequalities in local communities. Four databases were searched (Medline, PsycINFO, CINAHL, ASSIA) and papers were included if they described interventions explicitly adopting an asset-based approach but excluded if limited to asset identification. Thirty articles were included in the review. Data were extracted on the type of assets that the intervention built upon, how assets were mobilised, the expected outcomes and evaluation methods. A framework is presented that synthesises the key characteristics of asset-based interventions to promote health in communities. Three main approaches to mobilising assets were identified in the literature: (A) connecting assets, (B) raising awareness of assets and (C) enabling assets to thrive. It is argued that asset-based approaches to health promotion take a wide variety of forms, making it difficult to anticipate outcomes and to evaluate interventions. The framework presented here can be used to better understand the processes through which asset-based approaches work in practice to promote health and reduce inequalities.

Evaluating Effective Leadership and Governance in a Midwestern Agricultural Safety and Health Coalition

Agricultural Centers are a coalition of organizations and individual members with a common purpose: to improve the health and safety of the agricultural community. Successful leadership and governance are essential in accomplishing these goals. This article examined the effectiveness of a midwestern Agricultural Health and Safety Center (Ag Center) leadership and governance structure. The Internal Coalition Outcomes Hierarchy (ICOH) framework and the Internal Coalition Effectiveness (ICE©) instrument were used, with field visit interviews conducted to gain further insight. Combined comparative findings from both research methods showed that scores in each of the categories increased. Adjustments led to stronger collaborative leadership, vital to successful population health improvement programs. This study showcases coalition qualities in a broader environment, capturing a clearer depiction of leadership and member interaction. Field visit interviews confirmed that this midwestern Ag Center continued to have strong levels of effectiveness in each of the conceptual constructs of a coalition.