The Coalition Training Institute

Assessing Rural Health Coalitions Using the Public Health Logic Model: A Systematic Review

CONTEXT

Rural communities face unique challenges including fewer healthcare providers and restricted access to nutritious foods, likely leading to poor health outcomes. Community health coalitions are groups of local organizations partnering to address local health needs. Employing such coalitions is one strategy for implementing policy-system-environment changes for improving rural health. However, their success is variable without standardized evaluation. In this review, rural community health coalitions were retrospectively assessed using the W.K. Kellogg Foundation Logic Model. Community health coalition-reported pathways through this model were explored using market basket analysis.

EVIDENCE ACQUISITION

During Spring 2018, PubMed, Web of Science, ScienceDirect, CINAHL, and PsycINFO were searched for (coalition) AND (rural) AND (health) AND (effectiveness OR impact OR outcome OR logic model). Full-text, peer-reviewed, English articles meeting PICOS criteria (Population, rural communities; Intervention, presence of a community health coalition; Comparator, the coalition over time; Outcomes, logic model pathways) were reviewed. During Summer and Fall 2018, coalition-reported pathways were categorized according to logic model inputs and resources; internal and external activities; outputs; short-, medium-, and long-term outcomes; and impact. Market basket analysis was conducted during Winter 2018.

EVIDENCE SYNTHESIS

The 10 most frequently reported pathway items were partner diversity; organizational structures; implementing pilot studies, programs, and interventions; funding; community engagement and outreach; university partners; holding regular meetings; having working groups and subcommittees; operating under or partnering with a regional research initiative; and conducting a community health and needs assessment. Half of community health coalitions reported 4 or more of the following: funding; partner diversity; university partners; organizational structures; community engagement and outreach; and implementing pilot studies, programs, and interventions.

CONCLUSIONS

Many rural community health coalitions reported inputs and capacity building; few impacted health. Recommending common early phase logic model pathways may facilitate downstream success.

From Roots to Results: A Qualitative Case Study of the Evolution of a Public Health Leadership Institute Building Capacity in Collaborating for Equity and Justice

Policy, systems, and environmental change are now widely accepted as critical to sustaining improvements in community health. Evidence suggests that such systems-level change is most effective when driven by community-based partnerships. Yet, after more than three decades of building community-based partnership work, health inequities have continued to deepen. To address health inequities, current and historical distributions of power are increasingly recognized as important considerations in efforts to ensure all individuals have the opportunity to attain their full health potential (i.e., achieving health equity). Building on social determinants of health literature, social injustice and powerlessness are put forth as fundamental causes of health inequities. Focusing on power as a root cause of health and health equity through application of Wolff and colleagues' six principles requires substantial changes in contemporary public health practice. This case study uses document analysis of a single case, the Community Teams Program, to assess the evolution of a statewide public health leadership program's efforts to build the capacity of coalition-based teams to catalyze community change in line with Wolff and colleagues' principles. Deductive, selective coding of the materials surface four themes in the program adaptations: (1) the need to focus on power as a root cause, (2) shifting power through relationship building, (3) storytelling as a way to shift narrative, and (4) building mechanisms into the curriculum that hold coalitions accountable for applying and sustaining learned skills. The themes demonstrate philosophical, pedagogical, and organizational changes to center power building approaches in health promotion. Findings are triangulated by reflections from the program director and recorded reflections of participants captured in existing evaluation data.

Policy and system change and community coalitions: outcomes from allies against asthma

Objectives. We assessed policy and system changes and health outcomes produced by the Allies Against Asthma program, a 5-year collaborative effort by 7 community coalitions to address childhood asthma. We also explored associations between community engagement and outcomes. Methods. We interviewed a sample of 1,477 parents of children with asthma in coalition target areas and comparison areas at baseline and 1 year to assess quality-of-life and symptom changes. An extensive tracking and documentation procedure and a survey of 284 participating individuals and organizations were used to ascertain policy and system changes and community engagement levels. Results. A total of 89 policy and system changes were achieved, ranging from changes in interinstitutional and intrainstitutional practices to statewide legislation. Allies children experienced fewer daytime (P = .008) and nighttime (P = .004) asthma symptoms than comparison children. In addition, Allies parents felt less helpless, frightened, and angry (P = .01) about their child's asthma. Type of community engagement was associated with number of policy and system changes. Conclusions. Community coalitions can successfully achieve asthma policy and system changes and improve health outcomes. Increased core and ongoing community stakeholder participation rather than a higher overall number of participants was associated with more change.

Developing leaders in priority populations to address tobacco disparities: results from a leadership institute

CONTEXT

Few published evaluations documenting the results of community health leadership programs exist. Furthermore, few leadership programs specifically address cross-cultural issues or priority populations, and none have focused on the area of tobacco control.

OBJECTIVE

The goal of the evaluation was to determine the effectiveness of the Leadership and Advocacy Institute to Advance Minnesota's Parity for Priority Populations Institute. Institute Fellows were recruited from 5 priority populations, including African/African American, American Indian, Asian American, Chicano Latino and Lesbian, Gay, Bisexual, and Transgender. The Institute's impact on the acquisition and application of particular leadership skills was assessed, along with its impact in building priority population capacity to engage in tobacco control activities. DESIGN AND MEASURE: Findings are based on mixed methods, including Fellows' completion of paper surveys prior, during, and post-Institute, and telephone interviews conducted post-Institute.

RESULTS

Perceived skills increased in all areas assessed. Fellows reported applying specific skills acquired 16 months after the Institute. Furthermore, a high number of Fellows were more intensely involved in tobacco control work compared to baseline and reported involvement in cross-cultural collaborations or initiatives post-Institute.

CONCLUSION

The Institute achieved both short-term and intermediate outcomes; skills were acquired during the Institute and sustained and applied in areas of tobacco control over 1 year later.

An initial attempt at operationalizing and testing the Community Coalition Action Theory

The Community Coalition Action Theory (CCAT) blends practice wisdom with empirical data to explain how community coalitions achieve community change and community capacity outcomes. The current study uses data from an evaluation of 20 California Healthy Cities and Communities coalitions to test relationships between coalition factors and outcomes as predicted by CCAT in two stages of coalition development. Data are from two rounds of coalition member surveys, interviews with local coalition coordinators, and semiannual progress reports. Consistent with CCAT predictions and prior research, shared decision making and leadership were correlated with participation; staff competence, task focus, and cohesion were correlated with member satisfaction. Coalition size was associated with participation and dollars leveraged. Also, consistent with CCAT, diversity of funding sources was associated with new leadership opportunities and program expansion; dollars leveraged was correlated with new leadership opportunities and new partners. Findings provide preliminary support for many, but not all, of the relationships predicted by CCAT.

Policy and system change and community coalitions: outcomes from allies against asthma

OBJECTIVES

We assessed policy and system changes and health outcomes produced by the Allies Against Asthma program, a 5-year collaborative effort by 7 community coalitions to address childhood asthma. We also explored associations between community engagement and outcomes.

METHODS

We interviewed a sample of 1477 parents of children with asthma in coalition target areas and comparison areas at baseline and 1 year to assess quality-of-life and symptom changes. An extensive tracking and documentation procedure and a survey of 284 participating individuals and organizations were used to ascertain policy and system changes and community engagement levels.

RESULTS

A total of 89 policy and system changes were achieved, ranging from changes in interinstitutional and intrainstitutional practices to statewide legislation. Allies children experienced fewer daytime (P = .008) and nighttime (P = .004) asthma symptoms than comparison children. In addition, Allies parents felt less helpless, frightened, and angry (P = .01) about their child's asthma. Type of community engagement was associated with number of policy and system changes.

CONCLUSIONS

Community coalitions can successfully achieve asthma policy and system changes and improve health outcomes. Increased core and ongoing community stakeholder participation rather than a higher overall number of participants was associated with more change.

The Culture of Health Survey: a qualitative assessment of a diabetes prevention coalition

In the past two decades, the fields of public health and social services have increasingly turned toward collaborative and community-based approaches to address complex health and social issues. One aspect of these approaches has been the development and implementation of community coalitions. Coalitions have been used to successfully address a wide range of issues, including cancer prevention, tobacco use, HIV/AIDS, youth violence, heart disease, diabetes, and sexual exploitation of youth runaways. In south Tucson, Arizona the SEAH coalition was developed to address diabetes and substance abuse prevention. Using a qualitative interview guide, the Culture of Health Survey, this study was aimed at identifying community perceptions of the coalition and its effectiveness in the areas of community leadership, partnerships, trust, and movement towards positive change. We also sought to document the dissemination, throughout a community, of information on the activities and functioning of a community based coalition and whether or not it was seen as one that held fast to the community values and not to individual agendas. Results highlight the importance of outreach, education, trust, and partnerships in promoting diabetes prevention through a community coalition.

The Hmong Youth Task Force: evaluation of a coalition to address the sexual exploitation of young runaways

The Minnesota Wheel of Public Health Nursing Interventions identifies coalition building and community organizing as effective strategies for addressing population health issues. One program that exemplifies these strategies is the Hmong Youth Task Force, a coalition formed to address a growing issue of young Hmong girls in a Midwest state running away from home, being truant from school, and experiencing subsequent sexual exploitation. This is an evaluation of the Task Force. It draws on existing records and semi-structured interviews with Task Force members from various sectors of government, health services, and community organizations, including public health nurses. The results, evaluated in the context of best practices identified by the Wheel of Interventions, document the Task Force's development, accomplishments, challenges faced, and community changes that have resulted from the coalition's efforts to date.

A Conceptual Model for Understanding Effective Coalitions Involved in Health Promotion Programing

Funding agencies are increasingly focused on community coalitions as effective entities for promoting public health programs. Yet, there has been no conceptual model for understanding how effective coalition infrastructure works to facilitate a learning environment, wherein coalition members and leaders receive ongoing training and technical assistance needed to accomplish their external programming goals. This article presents a conceptual model for measuring the internal effectiveness of coalitions [Internal Coalition Outcome Hierarchy (ICOH)]. The ICOH model served as the basis for development of the evaluation instrument, Internal Coalition Effectiveness, which measures internal coalition effectiveness based on achievement of organizational outcomes at each of the model's seven hierarchical levels. The ICOH conceptual model has broad application for public health nurses who are frequently called on to serve as evaluators for community coalitions engaged in health programming. The model has implications for evaluators to use in teaching coalition members and leaders about their internal strengths and areas for improvement, so that coalitions can develop more effective internal structures and thereby promote long-term sustainability.

Developing a community science research agenda for building community capacity for effective preventive interventions

Research has shown that prevention programming can improve community health when implemented well. There are examples of successful prevention in local communities, however many continue to face significant challenges, demonstrating a gap between science and practice. Common strategies within the United States to address this gap are available (e.g., trainings), but lack outcomes. Building community capacity to implement high quality prevention can help communities achieve positive health outcomes, thereby narrowing the gap. While there is ample research on the efficacy of evidence-based programs, there is little on how to improve community capacity to improve prevention quality. In order to narrow the gap, a new model of research-one based in Community Science-is suggested that improves the latest theoretical understanding of community capacity and evaluates technologies designed to enhance it. In this article, we describe this model and suggest a research agenda that can lead to improved outcomes at the local level.