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Kegler MC, Hayrumyan V, Dekanosidze A, Grigoryan L, Torosyan A, Sargsyan Z, Sturua L, Bazarchyan A, Berg CJ. Examining the creation of synergy in community coalitions for smoke-free environments in Armenia and Georgia. Health Promot Int 2024; 39:daae058. [PMID: 38907528 DOI: 10.1093/heapro/daae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
Community coalitions depend on their members to synergistically pool diverse resources, including knowledge and expertise, community connections and varied perspectives, to identify and implement strategies and make progress toward community health improvement. Several coalition theories suggest synergy is the key mechanism driving coalition effectiveness. The Community Coalition Action Theory (CCAT) asserts that synergy depends on how well coalitions engage their members and leverage their resources, which is influenced by coalition processes, member participation and satisfaction and benefits outweighing costs. The current study used mixed methods, including coalition member surveys (n = 83) and semi-structured interviews with leaders and members (n = 42), to examine the process of creating collaborative synergy in 14 community coalitions for smoke-free environments in Armenia and Georgia. Members, typically seven per coalition representing education, public health, health care and municipal administration sectors, spent an average of 16 hr/month on coalition-related work. Common benefits included making the community a better place to live and learning more about tobacco control. The greatest cost was attending meetings or events at inconvenient times. Members contributed various resources, including their connections and influence, skills and expertise and access to population groups and settings. Strong coalition processes, greater benefits and fewer costs of participation and satisfaction were correlated with leveraging of member resources, which in turn, was highly correlated with collaborative synergy. Consistent with CCAT, effective coalition processes created a positive climate where membership benefits outweighed costs, and members contributed their resources in a way that created collaborative synergy.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30033, USA
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramyan Ave., 0019 Yerevan, Armenia
| | - Ana Dekanosidze
- Department of Noncommunicable Diseases, Georgia National Center for Disease Control and Public Health, 99 Kakheti Highway, Tbilisi, Georgia
- International School of Public Health, Tbilisi State Medical University, 33 Vazha Pshavela Ave, Tbilisi 0186, Georgia
| | - Lilit Grigoryan
- National Institute of Health named after academician S. Avdalbekyan, Ministry of Health, Komitasi Ave 49/4 Building, 0051 Yerevan, Armenia
| | - Arevik Torosyan
- National Institute of Health named after academician S. Avdalbekyan, Ministry of Health, Komitasi Ave 49/4 Building, 0051 Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramyan Ave., 0019 Yerevan, Armenia
| | - Lela Sturua
- Department of Noncommunicable Diseases, Georgia National Center for Disease Control and Public Health, 99 Kakheti Highway, Tbilisi, Georgia
| | - Alexander Bazarchyan
- National Institute of Health named after academician S. Avdalbekyan, Ministry of Health, Komitasi Ave 49/4 Building, 0051 Yerevan, Armenia
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, 800 22nd Street NW, Washington, DC 20052, USA
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Lo K, Lockwood C. Improving cross-sector collaborations in place-based population health projects. PUBLIC HEALTH IN PRACTICE 2022; 4:100285. [PMID: 36570389 PMCID: PMC9773052 DOI: 10.1016/j.puhip.2022.100285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/20/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The objective of this study is to develop a practice-orientated partnership framework that can enable effective population health collaborations in rural areas, and to gain ground insights on the role and policies of the Department of Families, Fairness and Housing (DFFH) in administering population health projects. Study design Rapid evidence review and case study interviews with stakeholders. Methods The framework development started with a rapid review to identify evidence-based practices on collaboration for population health stakeholders. Best-practices from DFFH's policy document for place-based projects were also incorporated into the framework. After a preliminary draft of the framework was ready, semi-structured interviews were conducted with stakeholders to seek practitioner insights to validate the framework and contextualise it to local needs. Results Inputs from the stakeholder interviews were organised into two categories: "Inputs for framework" which contained responses that improved the framework, and "inputs for DFFH" which contained insights on the role and policies of DFFH in administering population health projects. Conclusions With its list of actionable activities and enablers organised into logical project phases, the framework provides a practical and intuitive guide that can help stakeholders navigate through complex place-based population health projects. The inputs for DFFH provided the department with valuable ground insights into the dynamics of cross-sector collaborations for further reflection about their roles and policies. Through the consultative interview process which meaningfully engaged key stakeholders, a level of understanding and support for the framework was gained, which would encourage future implementations of place-based population health projects.
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Affiliation(s)
- Kenneth Lo
- Faculty of Health and Medical Sciences, The University of Adelaide, SA, 5005, Australia,College of Medicine and Public Health, Flinders University, SA, 5042, Australia,Corresponding author. Faculty of Health and Medical Sciences, The University of Adelaide, SA, 5005, Australia.
| | - Craig Lockwood
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
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Loban E, Scott C, Lewis V, Law S, Haggerty J. Improving primary health care through partnerships: Key insights from a cross-case analysis of multi-stakeholder partnerships in two Canadian provinces. Health Sci Rep 2021; 4:e397. [PMID: 34632097 PMCID: PMC8493238 DOI: 10.1002/hsr2.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS Multi-stakeholder partnerships offer strategic advantages in addressing multi-faceted issues in complex, fast-paced, and rapidly-evolving community health contexts. Synergistic partnerships mobilize partners' complementary financial and nonfinancial resources, resulting in improved outcomes beyond that achievable through individual efforts. Our objectives were to explore the manifestations of synergy in partnerships involving stakeholders from different organizations with an interest in implementing organizational solutions that enhance access to primary health care (PHC) for vulnerable populations, and to describe structures and processes that facilitated the work of these partnerships. METHODS This was a longitudinal case study in two Canadian provinces of two collaborative partnerships involving decision makers, academic representatives, clinicians, health system administrators, patient partners, and representatives of health and social service organizations providing services to vulnerable populations. Document review, nonparticipant observation of partnerships' meetings (n = 14) and semi-structured in-depth interviews (n = 16) were conducted between 2016 and 2018. Data analysis involved a cross-case synthesis to compare the cases and framework analysis to identify prominent themes. RESULTS Four major themes emerged from the data. Partnership synergy manifested itself in the following: (a) the integration of resources, (b) partnership atmosphere, (c) perceived stakeholder benefits, and (d) capacity for adaptation to context. Synergy developed before the intended PHC access outcomes could be assessed and acted both as a dynamic indicator of the health of the partnership and a source of energy fuelling partnership improvement and vitality. Synergistic action among multiple stakeholders was achieved through enabling processes at interpersonal, operational, and system levels. CONCLUSIONS The partnership synergy framework is useful in assessing the intermediate outcomes of ongoing partnerships when it is too early to evaluate the achievement of long-term intended outcomes. Enabling processes require attention as part of routine partnership assessment.
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Affiliation(s)
- Ekaterina Loban
- St. Mary's Research CentreMontrealQuebecCanada
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
| | - Catherine Scott
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Virginia Lewis
- Australian Institute for Primary Care & AgeingLa Trobe UniversityMelbourneVictoriaAustralia
| | - Susan Law
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Jeannie Haggerty
- St. Mary's Research CentreMontrealQuebecCanada
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
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Alhassan JAK, Gauvin L, Judge A, Fuller D, Engler-Stringer R, Muhajarine N. Improving health through multisectoral collaboration: enablers and barriers. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:1059-1068. [PMID: 34105113 PMCID: PMC8651820 DOI: 10.17269/s41997-021-00534-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 04/26/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Multisectoral partnerships (MPs) are increasingly viewed as an excellent strategy for promoting population health, although the Canadian evidence on MPs remains scant. The objective of this research was to identify enablers and barriers to multisectoral collaboration across three MPs (focused on food systems, urban development, and active transportation) in a Canadian urban centre. METHODS This study is part of a pan-Canadian research program-MUSE (Multisectoral Urban Systems for health and Equity in Canadian cities). A qualitative case study methodology was used to explore enablers and barriers to collaboration among three MPs in a mid-sized Canadian city. Key strategy documents of the MPs and 13 in-depth, semi-structured interviews were conducted with stakeholders from each MP. Interview data were transcribed and subjected to thematic analysis using NVivo 12 software, with rigour ensured through member checking. RESULTS Enablers to collaboration included agenda and goal alignment among partners, quality of relationships in MPs, and external enabling factors. Barriers to multisectoral collaboration included agenda and priority differences, factors related to partnership structure, constitution and processes, and external barriers. Based on these factors, we developed a multisectoral collaboration matrix that dichotomizes enablers and barriers into intrinsic/internal and extrinsic/external to increase understanding of health-promoting MPs in Canada. CONCLUSION Various enablers and barriers promote or inhibit multisectoral partnerships. By casting these factors into a matrix, members of ongoing or emerging MPs could take advantage of the factors that promote their work and are in their control (intrinsic enablers) or outside their control (extrinsic enablers) while working to overcome challenges presented by collaboration barriers.
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Affiliation(s)
- Jacob Albin Korem Alhassan
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada
| | - Lise Gauvin
- École de santé publique, Université de Montréal, Montréal, QC, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Allap Judge
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Daniel Fuller
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Rachel Engler-Stringer
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada.
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada.
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Corbin JH, Jones J, Barry MM. What makes intersectoral partnerships for health promotion work? A review of the international literature. Health Promot Int 2018; 33:4-26. [PMID: 27506627 PMCID: PMC5914378 DOI: 10.1093/heapro/daw061] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A Health in All Policies approach requires creating and sustaining intersectoral partnerships for promoting population health. This scoping review of the international literature on partnership functioning provides a narrative synthesis of findings related to processes that support and inhibit health promotion partnership functioning. Searching a range of databases, the review includes 26 studies employing quantitative (n = 8), qualitative (n = 10) and mixed method (n = 8) designs examining partnership processes published from January 2007 to June 2015. Using the Bergen Model of Collaborative Functioning as a theoretical framework for analyzing the findings, nine core elements were identified that constitute positive partnership processes that can inform best practices: (i) develop a shared mission aligned to the partners’ individual or institutional goals; (ii) include a broad range of participation from diverse partners and a balance of human and financial resources; (iii) incorporate leadership that inspires trust, confidence and inclusiveness; (iv) monitor how communication is perceived by partners and adjust accordingly; (v) balance formal and informal roles/structures depending upon mission; (vi) build trust between partners from the beginning and for the duration of the partnership; (vii) ensure balance between maintenance and production activities; (viii) consider the impact of political, economic, cultural, social and organizational contexts; and (ix) evaluate partnerships for continuous improvement. Future research is needed to examine the relationship between these processes and how they impact the longer-term outcomes of intersectoral partnerships.
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Affiliation(s)
- J Hope Corbin
- Department of Health and Community Studies, Western Washington University, Miller Hall, 317B, MS 9091, Bellingham, WA 98225, USA
| | - Jacky Jones
- Member of Healthy Ireland Council, 5 Presentation Rd., Galway, Ireland
| | - Margaret M Barry
- Research School of Health Sciences, National University of Ireland Galway, Galway, Ireland
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Jones J, Barry MM. Factors influencing trust and mistrust in health promotion partnerships. Glob Health Promot 2016; 25:16-24. [DOI: 10.1177/1757975916656364] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Partnerships between sectors can achieve better outcomes than can be achieved by individual partners working alone. Trust is necessary for partnerships to function effectively. Mistrust makes partnership working difficult, if not impossible. There has been little research into partnership functioning factors that influence trust and mistrust. This study aimed to identify these factors in health promotion partnerships. Data were collected from 337 partners in 40 health promotion partnerships using a postal survey. The questionnaire incorporated multi-dimensional scales designed to assess the contribution of factors that influence partnership trust and mistrust. Newly validated scales were developed for trust, mistrust and power. Multiple regression analysis was used to identify the significance of each factor to partnership trust and mistrust. Power was found to be the only predictor of partnership trust. Power, leadership, and efficiency were the most important factors influencing partnership mistrust. Power in partnerships must be shared or partners will not trust each other. Power-sharing and trust-building mechanisms need to be built into partnerships from the beginning and sustained throughout the collaborative process.
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Affiliation(s)
| | - Margaret M. Barry
- World Health Organization Collaborating Centre for Health Promotion Research, NUI, Galway, Republic of Ireland
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Drummond J, Wiebe N, So S, Schnirner L, Bisanz J, Williamson DL, Mayan M, Templeton L, Fassbender K. Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial. Trials 2016; 17:343. [PMID: 27449358 PMCID: PMC4957834 DOI: 10.1186/s13063-016-1444-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 06/28/2016] [Indexed: 12/28/2022] Open
Abstract
Background Increasing access to health and social services through service-integration approaches may provide a direct and sustainable way to improve health and social outcomes in low-income families. Methods We did a community-based randomized trial evaluating the effects of two service-integration practices (healthy family lifestyle and recreational activities for children) among low-income families in Alberta, Canada. These two practices in combination formed four groups: Self-Directed (no intervention), Family Healthy Lifestyle, Family Recreation, and Comprehensive (Family Healthy Lifestyle plus Family Recreation programs). The primary outcome was the total number of service linkages. Results We randomized 1168 families, 50 % of which were retained through the last follow-up visit. The number of service linkages for all three intervention groups was not significantly different from the number of linkages in the Self-Directed group (Comprehensive 1.15 (95 % CI 0.98–1.35), Family Healthy Lifestyle 1.17 (0.99–1.38), and Family Recreation 1.12 (0.95–1.32) rate ratios). However, when we explored the number of linkages by the categories of linkages, we found significantly more healthcare service linkages in the Comprehensive group compared to the Self-Directed group (1.27 (1.06–1.51)) and significantly more linkages with child-development services in the Family Healthy Lifestyle group compared to the Self-Directed group (3.27 (1.59-6.74)). The monthly hours of direct intervention was much lower than the assigned number of hours (ranging from 5 to 32 % of the assigned hours). Conclusions Our findings are relevant to two challenges faced by policymakers and funders. First, if funds are to be expended on service-integration approaches, then, given the lack of intervention fidelity found in this study, policymakers need to insist, and therefore fund a) a well-described practice, b) auditing of that practice, c) retention of family participants, and d) examination of family use and outcomes. Second, if child-development services are widely required and are difficult for low-income families to access, then current policy needs to be examined. Trial registration ClinicalTrials.gov, NCT00705328. Registered on 24 June 2008. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1444-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jane Drummond
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, T6G 1C9, Alberta, Canada.
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Sylvia So
- Alberta Health Services, Edmonton, Canada
| | | | - Jeffrey Bisanz
- Department of Psychology, University of Alberta, Edmonton, Canada
| | | | - Maria Mayan
- Faculty of Extension, University of Alberta, Edmonton, Canada
| | - Laura Templeton
- Faculty of Extension, University of Alberta, Edmonton, Canada
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