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Kegler MC, Dekanosidze A, Torosyan A, Grigoryan L, Rana S, Hayrumyan V, Sargsyan Z, Berg CJ. Community coalitions for smoke-free environments in Armenia and Georgia: A mixed methods analysis of coalition formation, implementation and perceived effectiveness. PLoS One 2023; 18:e0289149. [PMID: 37535574 PMCID: PMC10399883 DOI: 10.1371/journal.pone.0289149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023] Open
Abstract
Effective models for aligning public health and civil society at the local level have the potential to impact various global health issues, including tobacco. Georgia and Armenia Teams for Healthy Environments and Research (GATHER) is a collaboration between Armenia, Georgia and U.S. researchers involving a community randomized trial testing the impact of community coalitions to promote smoke-free policy adoption and compliance in various settings. Community Coalition Action Theory (CCAT) was used to guide and describe coalition formation, implementation and effectiveness. Mixed methods were used to evaluate 14 municipality-based coalitions in Georgia and Armenia, including semi-structured interviews (n = 42) with coalition leaders and active members, coalition member surveys at two timepoints (n = 85 and n = 83), and review of action plans and progress reports. Results indicated successful creation of 14 multi-sectoral coalitions, most commonly representing education, public health, health care, and municipal administration. Half of the coalitions created at least one smoke-free policy in specific settings (e.g., factories, parks), and all 14 promoted compliance with existing policies through no-smoking signage and stickers. The majority also conducted awareness events in school, health care, and community settings, in addition to educating the public about COVID and the dangers of tobacco use. Consistent with CCAT, coalition processes (e.g., communication) were associated with member engagement and collaborative synergy which, in turn, correlated with perceived community impact, skills gained by coalition members, and interest in sustainability. Findings suggest that community coalitions can be formed in varied sociopolitical contexts and facilitate locally-driven, multi-sectoral collaborations to promote health. Despite major contextual challenges (e.g., national legislation, global pandemic, war), coalitions were resilient, nimble and remained active. Additionally, CCAT propositions appear to be generalizable, suggesting that coalition-building guidance may be relevant for local public health in at least some global contexts.
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Affiliation(s)
- Michelle C. Kegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Ana Dekanosidze
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia, United States of America
| | - Arevik Torosyan
- National Institute of Health, Ministry of Health, Yerevan, Armenia
| | - Lilit Grigoryan
- National Institute of Health, Ministry of Health, Yerevan, Armenia
| | - Shaheen Rana
- Intervention Development, Dissemination and Implementation Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, United States of America
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de Jong M, Tijhuis Y, Koelen M, Wagemakers A. Intersectoral collaboration in a Dutch community health promotion programme: building a coalition and networks. Health Promot Int 2023; 38:daab207. [PMID: 34999774 PMCID: PMC10405043 DOI: 10.1093/heapro/daab207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In health promotion programmes (HPP), it is crucial to have intersectoral collaboration within coalitions and to build networks between health and other societal sectors. A health broker role is recognized as being helpful in connecting the coalition with the broader network, and participatory action research (PAR) is deemed supportive because it facilitates evaluation, reflection, learning and action. However, there is a lack of insight into how processes that affect collaboration develop over time. Therefore, this study aimed to provide insights into the coalition's processes that facilitate building and maintaining intersectoral collaboration within a HPP coalition and network and how these processes contribute to the coalition's ambitions. As part of PAR, the coalition members used the coordinated action checklist (CAC) and composed network analysis (CNA) in 2018 and 2019. The CAC and CNA results were linked back into the coalition in five group sessions and used for reflection on pro-gress and future planning. Coalition governance, interaction with the context, network building and brokerage, and generating visibility emerged as the most prominent processes. Important insights concerned the health broker's role and positioning, the programme coordinator's leadership and the importance of visibility and trust leading to investment in continuation. The combined research instruments and group sessions supported discussion and reflection, sharing visions and adjusting working strategies, thereby strengthening the coalition's capacity. Thus, PAR was useful for evaluating and simultaneously facilitating the processes that affect collaboration.
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Affiliation(s)
- Marja de Jong
- GGD IJsselland, Zeven Alleetjes 1, 8011 CV Zwolle, The Netherlands
| | - Yvon Tijhuis
- GGD IJsselland, Zeven Alleetjes 1, 8011 CV Zwolle, The Netherlands
| | - Maria Koelen
- Health and Society, Wageningen University and Research, PO Box 8130, 6700 EW Wageningen, The Netherlands
| | - Annemarie Wagemakers
- Health and Society, Wageningen University and Research, PO Box 8130, 6700 EW Wageningen, The Netherlands
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Schultz JA, Collie-Akers VL, Fawcett SB, Strauss WJ, Nagaraja J, Landgraf AJ, McIver KL, Weber SA, Arteaga SS, Nebeling LC, Rauzon SM. Association between community characteristics and implementation of community programmes and policies addressing childhood obesity: the Healthy Communities Study. Pediatr Obes 2018; 13 Suppl 1:93-102. [PMID: 29921032 PMCID: PMC6197889 DOI: 10.1111/ijpo.12432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 04/20/2018] [Accepted: 05/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about whether characteristics of communities are associated with differential implementation of community programmes and policies to promote physical activity and healthy eating. This study examines associations between community characteristics (e.g. region and race/ethnicity) and the intensity of community programmes and policies implemented to prevent childhood obesity. It explores whether community characteristics moderate the intensity of community efforts to prevent childhood obesity. OBJECTIVE The objective of this study is to investigate associations between community characteristics and the intensity of community policies and programmes to prevent childhood obesity documented in the Healthy Communities Study that engaged a diverse sample of US communities. METHOD Programmes and policies were documented in 130 communities across the USA, reporting over 9000 different community programmes and policies to prevent obesity among children ages 4-15. We examined associations between community characteristics and the intensity of community programmes and policies implemented (i.e. their amount and reach, duration and strength of change strategy). CONCLUSION Community characteristics explain 25% of the variability in the intensity of community programmes and policies implemented in communities. Particular characteristics - urbanicity, region, being a large county and the per cent of African-Americans in a community - contributed to more (over 18% of the 25%) of the observed variability.
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Affiliation(s)
- Jerry A. Schultz
- Work Group for Community Health and Community Development, University of Kansas, Lawrence, Kansas
| | - Vickie L. Collie-Akers
- Work Group for Community Health and Community Development, University of Kansas, Lawrence, Kansas
| | - Stephen B. Fawcett
- Work Group for Community Health and Community Development, University of Kansas, Lawrence, Kansas
| | | | | | | | - Kerry L. McIver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - S. Sonia Arteaga
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Suzanne M. Rauzon
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
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Boyer CB, Greenberg L, Chutuape K, Walker B, Monte D, Kirk J, Ellen JM. Exchange of Sex for Drugs or Money in Adolescents and Young Adults: An Examination of Sociodemographic Factors, HIV-Related Risk, and Community Context. J Community Health 2018; 42:90-100. [PMID: 27498094 DOI: 10.1007/s10900-016-0234-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The goal of this research was to examine associations among sociodemographic factors, HIV risk, and community context (e.g., economic insecurity, job training, housing instability, crime victimization, and perceived community norms) in adolescents and young adults who ever exchanged sex for drugs or money. Anonymous survey data were collected using ACASIs at community venues where adolescents and young adults congregate in resource-challenged, STI prevalent, urban, US neighborhoods. Conventional descriptive statistics, Fisher's exact tests, and generalized estimating equations approaches were used to examine associations. Participants (1818, 95.5 % of those screened eligible) were, on average, aged 21.0 years; 42.2 % were males, and 4.6 % were transgender. Almost one-third (32.1 %) identified as gay or lesbian, 18.1 % identified as bisexual; 66.2 % were Black and 21.0 % were Hispanic; 1.3 % was 'living on the street'. A sizeable proportion reported HIV-related risk: 16.3 % exchanged sex, 12.6 % had sex with someone they knew to be HIV-infected, 7.8 % had sex with someone who injected drugs, and 1.3 % injected drugs. Multivariate comparisons identified a number of variables (e.g., being male or transgender, homelessness, sex with a partner who has HIV, STI history, unemployment, job training access, housing instability, crime victimization, perceived community norms) that were significantly associated with exchange of sex (p < 0.05). This research contributes to the knowledge-base regarding exchange of sex among adolescents and young adults, particularly as it relates to community context. Longitudinal studies to describe the trajectory of social, health, and physical risks and consequences are needed for development of effective evidence-based prevention strategies.
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Affiliation(s)
- Cherrie B Boyer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA, 94118, USA.
| | | | - Kate Chutuape
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Bendu Walker
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Jonathan M Ellen
- All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA
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Miller RL, Reed SJ, Chiaramonte D, Strzyzykowski T, Spring H, Acevedo-Polakovich ID, Chutuape K, Cooper-Walker B, Boyer CB, Ellen JM. Structural and Community Change Outcomes of the Connect-to-Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention, Testing, and Medical Care. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 60:199-214. [PMID: 28851064 PMCID: PMC5678968 DOI: 10.1002/ajcp.12162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community.
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Affiliation(s)
| | - Sarah J. Reed
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine
| | | | | | | | | | - Kate Chutuape
- Johns Hopkins University School of Medicine, Department of Pediatrics
| | | | - Cherrie B. Boyer
- University of California, San Francisco, Department of Pediatrics
| | - Jonathan M. Ellen
- Johns Hopkins University School of Medicine, Department of Pediatrics
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Miller RL, Boyer CB, Chiaramonte D, Lindeman P, Chutuape K, Cooper-Walker B, Kapogiannis BG, Wilson CM, Fortenberry JD. Evaluating Testing Strategies for Identifying Youths With HIV Infection and Linking Youths to Biomedical and Other Prevention Services. JAMA Pediatr 2017; 171:532-537. [PMID: 28418524 PMCID: PMC5540008 DOI: 10.1001/jamapediatrics.2017.0105] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Most human immunodeficiency virus (HIV)-infected youths are unaware of their serostatus (approximately 60%) and therefore not linked to HIV medical or prevention services. The need to identify promising and scalable approaches to promote uptake of HIV testing among youths at risk is critical. OBJECTIVE To evaluate a multisite HIV testing program designed to encourage localized HIV testing programs focused on self-identified sexual minority males and to link youths to appropriate prevention services after receipt of their test results. DESIGN, SETTING, AND PARTICIPANTS Testing strategies were evaluated using an observational design during a 9-month period (June 1, 2015, through February 28, 2016). Testing strategies were implemented by 12 adolescent medicine HIV primary care programs and included targeted testing, universal testing, or a combination. Data were collected from local youth at high risk of HIV infection and, specifically, sexual minority males of color. MAIN OUTCOMES AND MEASURES Proportion of sexual minority males and sexual minority males of color tested, proportion of previously undiagnosed HIV-positive youths identified, and rates of linkage to prevention services. RESULTS A total of 3301 youths underwent HIV testing. Overall, 35 (3.6%) of those who underwent universal testing in primary care clinical settings, such as emergency departments and community health centers, were sexual minority males (35 [3.6%] were males of color) compared with 236 (46.7%) (201 [39.8%] were males of color) who were tested through targeted testing and 693 (37.8%) (503 [27.4%] were males of color) through combination efforts. Identification of new HIV-positive cases varied by strategy: 1 (0.1%) via universal testing, 39 (2.1%) through combination testing, and 16 (3.2%) through targeted testing. However, when targeted tests were separated from universal testing results for sites using a combined strategy, the rate of newly identified HIV-positive cases identified through universal testing decreased to 1 (0.1%). Rates of new HIV-positive cases identified through targeted testing increased to 49 (6.3%). Youths who tested through targeted testing (416 [85.1%]) were more likely to link successfully to local HIV prevention services, including preexposure prophylaxis, compared with those who underwent universal testing (328 [34.1%]). CONCLUSIONS AND RELEVANCE The findings suggest that community-based targeted approaches to HIV testing are more effective than universal screening for reaching young sexual minority males (especially males of color), identifying previously undiagnosed HIV-positive youths, and linking HIV-negative youths to relevant prevention services. Targeted, community-based HIV testing strategies hold promise as a scalable and effective means to identify high-risk youths who are unaware of their HIV status.
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Affiliation(s)
- Robin Lin Miller
- Department of Psychology, Michigan State University, East Lansing
| | - Cherrie B. Boyer
- Department of Pediatrics, University of California, San Francisco
| | | | - Peter Lindeman
- Department of Psychology, Michigan State University, East Lansing
| | - Kate Chutuape
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | | | - Bill G. Kapogiannis
- Maternal and Pediatric Infectious Disease, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - Craig M. Wilson
- Department of Epidemiology, University of Alabama, Birmingham
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Miller RL, Janulis PF, Reed SJ, Harper GW, Ellen J, Boyer CB. Creating Youth-Supportive Communities: Outcomes from the Connect-to-Protect® (C2P) Structural Change Approach to Youth HIV Prevention. J Youth Adolesc 2016; 45:301-15. [PMID: 26534775 PMCID: PMC4714586 DOI: 10.1007/s10964-015-0379-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/25/2015] [Indexed: 12/01/2022]
Abstract
Reducing HIV incidence among adolescents represents an urgent global priority. Structural change approaches to HIV prevention may reduce youth risk by addressing the economic, social, cultural, and political factors that elevate it. We assessed whether achievement of structural changes made by eight Connect-to-Protect (C2P) coalitions were associated with improvements in youth's views of their community over the first 4 years of coalitions' mobilization. We recruited annual cross-sectional samples of targeted youth from each C2P community. We sampled youth in neighborhood venues. We interviewed a total of 2461 youth over 4 years. Males (66 %) and youth of color comprised the majority (52 % Hispanic/Latinos; 41 % African Americans) of those interviewed. By year 4, youth reported greater satisfaction with their community as a youth-supportive setting. They reported their needs were better met by available community resources compared with year 1. However, these findings were moderated by risk population such that those from communities where C2P focused on young men who have sex with men (YMSM) reported no changes over time whereas those from communities focused on other at-risk youth reported significant improvements over time in satisfaction and resource needs being met. Internalized HIV stigma increased over time among those from communities serving other at-risk youth and was unchanged among those from YMSM communities. The very different results we observe over time between communities focused on YMSM versus other at-risk youth may suggest it is unreasonable to assume identical chains of structural causality across youth populations who have such different historical relationships to HIV and who encounter very different kinds of entrenched discrimination within their communities.
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Affiliation(s)
| | | | - Sarah J Reed
- Michigan State University, East Lansing, MI, USA.
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Eggert LK, Blood-Siegfried J, Champagne M, Al-Jumaily M, Biederman DJ. Coalition Building for Health: A Community Garden Pilot Project with Apartment Dwelling Refugees. J Community Health Nurs 2015. [PMID: 26212466 DOI: 10.1080/07370016.2015.1057072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Refugees often experience compromised health from both pre- and post-migration stressors. Coalition theory has helped guide the development of targeted programs to address the health care needs of vulnerable populations. Using the Community Coalition Action Theory as a framework, a coalition was formed to implement a community garden with apartment-dwelling refugees. Outcomes included successful coalition formation, a community garden, reported satisfaction from all gardeners with increased vegetable intake, access to culturally meaningful foods, and evidence of increased community engagement. The opportunity for community health nurses to convene a coalition to affect positive health for refugees is demonstrated.
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Affiliation(s)
- Lynne K Eggert
- a Duke University School of Nursing, Durham, North Carolina
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Sánchez V, Sanders M, Andrews ML, Hale R, Carrillo C. Community health coalitions in context: associations between geographic context, member type and length of membership with coalition functions. HEALTH EDUCATION RESEARCH 2014; 29:715-729. [PMID: 24974218 DOI: 10.1093/her/cyu028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The coalition literature recognizes context (geography, demographics and history) as a variable of interest, yet few coalition evaluation studies have focused on it. This study explores the association between geographic context and structures (e.g. member type) with functional characteristics (e.g. decision making or levels of conflict) in a statewide system of community health councils (coalitions). The study was part of a multiyear, statewide evaluation of New Mexico's health councils' contributions to systems-level changes. We adapted the Coalition Self-Assessment Survey (CSAS) for all county health council members and paid council coordinators. Both multilevel univariate and multivariate procedures were used to compare index scores, summaries of CSAS questions used to characterize council functions, with selected demographic variables and region. Member type was associated with decision making and policy capacity; paid staff expressed higher levels of agreement than voting members for both items. Length of membership was associated with decision making, positive leadership and shared vision. Results indicated that geographic context was significantly associated with many functional characteristics. The study highlights the idea that geographic context may influence coalition functioning. Understanding how geographic context influences coalition planning and actions may help explain differences among coalitions that on the surface share common organizational characteristics and external goals.
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Affiliation(s)
- V Sánchez
- Department of Family and Community Medicine, Public Health Program, MSC 09_5060, 1 University of New Mexico, Albuquerque, NM 87131, USA and New Mexico Department of Health Public Health Division, 300 San Mateo NE, Suite 902, Albuquerque, NM 87108, USA.
| | - M Sanders
- Department of Family and Community Medicine, Public Health Program, MSC 09_5060, 1 University of New Mexico, Albuquerque, NM 87131, USA and New Mexico Department of Health Public Health Division, 300 San Mateo NE, Suite 902, Albuquerque, NM 87108, USA
| | - M L Andrews
- Department of Family and Community Medicine, Public Health Program, MSC 09_5060, 1 University of New Mexico, Albuquerque, NM 87131, USA and New Mexico Department of Health Public Health Division, 300 San Mateo NE, Suite 902, Albuquerque, NM 87108, USA
| | - R Hale
- Department of Family and Community Medicine, Public Health Program, MSC 09_5060, 1 University of New Mexico, Albuquerque, NM 87131, USA and New Mexico Department of Health Public Health Division, 300 San Mateo NE, Suite 902, Albuquerque, NM 87108, USA.
| | - C Carrillo
- Department of Family and Community Medicine, Public Health Program, MSC 09_5060, 1 University of New Mexico, Albuquerque, NM 87131, USA and New Mexico Department of Health Public Health Division, 300 San Mateo NE, Suite 902, Albuquerque, NM 87108, USA
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