Learning From Coalitions' Efforts to Promote Equity and Justice.

Coalitions and collaboratives are working to address many of the most pressing contemporary health and social issues. The articles in this special issue provide numerous insights into these complex collaborative processes across different contexts and focal issues. All emphasize and scrutinize the strategies that groups are using in their work.

Strengthening Our Collaborative Approaches for Advancing Equity and Justice.

The Principles for Collaborating for Equity and Justice are explicit about addressing social and economic injustice, structural racism, and community organizing to facilitate resident power and ownership. They also focus on structural change, an acknowledgment of complexity, and the need to thoughtfully build on decades of practice and scholarship on collaborating for community change. This special theme issue of includes 10 articles that highlight these principles and provide insight into the complexities, challenges, and rewards of collaborating in ways that are intentional about advancing health equity through inclusive processes and shared goals to address social determinants of health.

Evaluating partnerships to prevent and manage chronic disease.

To be effective and sustain themselves over time, public-private partnerships must make evaluation a priority. Specifically, partnerships should evaluate 1) their infrastructure, function, and processes; 2) programs designed to achieve their mission, goals, and objectives; and 3) changes in health and social status, organizations, systems, and the broader community. This article describes how to 1) develop a comprehensive evaluation strategy based on partnership theory; 2) select short-term, intermediate, and long-term indicators to measure outcomes; 3) choose appropriate methods and tools; and 4) use evaluation results to provide accountability to stakeholders and improve partnership function and program implementation.

Social validation of goals, procedures, and effects in public health.

By relying solely on tests of statistical significance as the measure of success for interventions in public health, and in community-based participatory research, we can miss important social dimensions of the project. These dimensions include how our interventions might affect the lives of participants (social validity) and the lives of people more broadly (clinical or public health significance). Social validation procedures were originally developed to assess the acceptability of procedures and effects of behavioral interventions among clients and consumers.

Providing asthma care in elementary schools: understanding barriers to determine best practices.

School nurses play a critical role in the management of children's asthma, yet they face barriers in their efforts to deliver quality care. In this qualitative study involving focus groups with school nurses, we identified key barriers in order to inform best practices. School nurses identified 4 main barriers to effective asthma care in elementary schools: lack of education, lack of communication, lack of resources, and lack of respect.

What providers from general emergency departments say about implementing a pediatric asthma pathway.

The goal of this study was to assess institutional climate and providers' readiness to adopt pediatric pathways for asthma treatment and management. Twelve focus groups were held with 24 physicians/physicians' assistants, 20 nurses, and 17 emergency medical technicians from emergency departments in 4 general hospitals from July to October 2002. Positive experience with previous pathways, open communication and buy-in from clinicians and administrators, comprehensive training on pathways, and adapting standards to fit specific emergency department environments were identified as necessary elements for pathway adoption.

The coalition process at work: Building care coordination models to control chronic disease.

Asthma is a highly prevalent and frequently misunderstood chronic disease with significant morbidity. Integrating client services at the patient-centered level and using coalitions to build coordinated, linked systems to affect care may improve outcomes. All seven Allies Against Asthma coalitions identified inefficient, inconsistent, and/or fragmented care as issues for their communities.

Allies community health workers: Bridging the gap.

Allies Against Asthma coalitions each employ a community health worker (CHW) program as part of its community action plan. The structure and management of CHW programs vary in response to the resources and needs of the local community, as do the roles and characteristics of the CHWs hired. All programs utilize CHWs to provide community-based education and/or outreach to community members, primarily in their homes.

Childhood asthma surveillance by community coalitions.

Multiple benefits can accrue when community coalitions conduct asthma surveillance activities. Surveillance data are used to identify children with asthma, assess disease burden and needs in the community, understand the illness and risk factors, identify children with asthma who are undertreated, plan community interventions, evaluate the effect of interventions, and monitor trends. These data, which are used to inform coalition and program decisions and to evaluate asthma interventions, can also be used to strengthen state and national asthma surveillance efforts and to inform clinical practice and public health policies.

Engaging the community in coalition efforts to address childhood asthma.

For health improvement efforts to effectively address community needs, community members must be engaged in planning and implementing public health initiatives. For Allies Against Asthma's coalitions, the community included not only the subpopulation of individuals who suffer disproportionately from asthma but also the individuals and institutions that surround them. Through a quantitative self-assessment survey, informal discussion among coalition leadership, and interviews with key informants, data relevant to community engagement identified a number of important ways the Allies coalitions approached community involvement.

From formation to action: How allies against asthma coalitions are getting the job done.

Coalitions develop in and recycle through stages. At each stage (formation, implementation, maintenance, and institutionalization), certain factors enhance coalition function, accomplishment of tasks, and progression to the next stage. The Allies Against Asthma coalitions assessed stages of development through annual member surveys, key informant interviews of 16 leaders from each site, and other evaluation tools.

Building allies coalitions: Why formation matters.

This article describes how formation of the Allies Against Asthma coalitions was influenced by community context, history, leadership, membership, structure, processes, and other factors. Based on member surveys, key informant interviews, and self-assessment tools, results indicate that three coalitions developed from existing coalitions, and four formed in response to funding. The coalitions took an average of 12 months to form and completed 98% of formation tasks.

Process evaluation for community participation.

This review provides a synthesis of published public health and social science literature to determine how process evaluation has been used to examine community participation and its intermediary role in health and social change outcomes. Community participation is defined, and its relationship to other community-development principles and evaluation and research methods is described. Then, case studies and research initiatives help answer questions such as who participates and why? What are the benefits and challenges of community participation? What qualitative and quantitative methods are used in process evaluations to measure community participation? What measures are used to help define the influence of community participation in community-based interventions? A better understanding of these issues is needed to ensure that community participation is valued and used effectively to plan and implement health-promotion initiatives and evaluate their processes and outcomes.

State Plan Index: a tool for assessing the quality of state public health plans.

Introduction: The State Plan Index is an evaluation instrument that uses a Likert scale to assess 60 indicators of the quality of state public health plans. The State Plan Index was needed to enable evaluation of plans that were developed using a variety of public health planning models.

Methods: Federal, state, and academic partners participated in developing and testing the instrument.

Using the State Plan Index to evaluate the quality of state plans to prevent obesity and other chronic diseases.

Introduction: Implicit in public health planning models is the assumption that good public health plans lead to good programs, and good programs lead to desired health outcomes. Despite considerable resources that are devoted to developing plans, public health agencies and organizations have lacked a tool for evaluating the finished product of their planning efforts -- the written plan itself -- as an important indicator of progress. To address the need for an instrument to assess the quality of state plans designed to prevent and control chronic diseases, we created and tested the State Plan Index and used it to evaluate the quality of nine state plans aimed at preventing and reducing obesity.

Health planning that magnifies the community's voice: allies against asthma.

Allies Against Asthma, a working group of the Consortium for Infant and Child Health (CINCH), conducted a comprehensive asthma needs assessment in Hampton Roads, Virginia, in 2001. Results from extant data and parent surveys indicated that asthma prevalence was high (15% to 18%), 45% to 50% of children received primary care for asthma in the emergency department, 30% had been recently hospitalized, and most children were not adequately medicated. Focus groups revealed inadequate asthma education, low income, lack of resources and consistent care, disparities in insurance coverage, and noncompliance with national asthma guidelines.

The coalition technical assistance and training framework: helping community coalitions help themselves.

Coalition staff, leaders, and members need training to promote coalition building and maintenance as well as ongoing technical assistance. The Coalition Technical Assistance and Training Framework uses a 6-step process to diagnose coalition strengths and challenges and provide a prescription for action. Re-evaluation after a specified time period helps determine whether a coalition adopted recommended changes in coalition participants, structures, and/or processes and progressed through stages of development.

Evaluating community partnerships and coalitions with practitioners in mind.

Evaluation plays a key role in developing and sustaining community partnerships and coalitions. We recommend focusing on three levels of coalition evaluation that measure (a) processes that sustain and renew coalition infrastructure and function; (b) programs intended to meet target activities, or those that work directly toward the partnership's goals; and (c) changes in health status or the community. A tendency to focus on quick wins and short-term effects of programs may explain why some coalitions are not able to achieve systems and/or health outcomes change.

How do we know if we are making a difference with our program or community initiative?

In this article, the authors discuss issues related to knowing if health workers are making a difference with their community initiatives or programs being delivered in a community setting. Issues relating to the choice of evaluation questions, relevance of data sets used to answer those questions, and the rigor by which the answer can be evaluated--and the ability to generalize to other communities or populations--are explored. Finally, relevant resources to help you pursue these issues are provided.

The Coalition Training Institute: training for the long haul.

Public-private partnerships are integral to our public health paradigm. The Coalition Training Institute (1995-1998) trained 283 participants from 29 U.S.