1. Noel Chrisman, PhD, MPH University of Washington School of Nursing
HSERV 576/NURS 557 Health, Culture, and Community Coalitions and Evaluation
Honor and pleasure to be here.
Respect for faculty and institution.
Sorry I have to leave at 3:30. I must teach tomorrow.
I’m here as a non-nurse, a person who is not a nurse, but knows it and knows how important nurses are. Gail Worden at Henry Ford Health System.
Noel Chrisman, PhD, MPH University of Washington School of Nursing
HSERV 576/NURS 557, Chrisman, week 5

2. PRIMARY CARE LONG TERM CARE
COMMUNITY
NGOCBOSHG
Temple,
Church
NGOCBOSHG
COALITION
Pharmacy
Clinics
Schools
Business
Local Gov’t
Media
HOSPITAL
PRIMARY CARE LONG TERM CARE
PUBLIC HEALTH
CONTINUUM OF CARE
Academia
Chrisman 2006

3. Community Partnership: Interlocking Dynamics
Community Competence
Felt Needs
Community Assessment and Evaluation
mobilization
capacity building
Participation
Empowerment
success
Noel Chrisman., 1997

4. Community Partnership Research
Community Assessment
Evaluation, Feedback Loop
Involve Community, Set Priorities
Sustain
Implement Program
Culture, Involvement, Capacity Building, Shared Power
Noel Chrisman, University of Washington, 1996

5. Assess
Health Needs: Distribution of Health Problems, Understanding of “Risks,” Demographic Data.
Perceived and Felt Needs: Perceived, what is noted; Felt, what people feel strongly about.
Stakeholders, Assets, Resources.
HSERV 576/NURS 557, Chrisman, week 5

6. Involve/Prioritize/Plan
Assessment done with and returned to community.
Community sets priorities: winnable, simple, specific.
Joint planning.
Mobilize assets and resources.
Assess barriers.
HSERV 576/NURS 557, Chrisman, week 5

7. Implement the Plan Use community personnel.
Use community assets and resources.
Essential to have an evaluation and feedback system.
Sustainability plan must be in place.
HSERV 576/NURS 557, Chrisman, week 5

8. Sustain Local economic development. Community board.
Community personnel.
Celebrations.
Outreach for new participants.
HSERV 576/NURS 557, Chrisman, week 5

9. Evaluation, Feedback to the Community
Qualitative and quantitative research.
Understandable analysis.
Continuous communication with community board.
Integrate with assessment data.
HSERV 576/NURS 557, Chrisman, week 5

10. Collaborative Coalition Network Types of PARTNERSHIPS Structure
A well organized, differentiated structure with great longevity.
A more enduring and highly structured organization of diverse groups working together to achieve multiple goals over time.
Collaborative
Additional structural strength and longevity with some effects on each organization’s actions. Perhaps a limited time period.
"An organization of individuals representing diverse organizations, factions, or constituencies who agree to work together in order to achieve a common goal”
(Wandersman et al., 1996)
Coalition
Organizationally loose, and very flexible. Perhaps an initial step toward other structures
The set of linkages among people or organizations. Network structure may have effects on the behavior of network members.
Network
Can include any of the structures below
An organizational form in which member agencies or individuals possess equal power over decision making
Types of PARTNERSHIPS
Structure
Definition
Organization
Honor and pleasure to be here.
Respect for faculty and institution.
Sorry I have to leave at 3:30. I must teach tomorrow.
I’m here as a non-nurse, a person who is not a nurse, but knows it and knows how important nurses are. Gail Worden at Henry Ford Health System.
Chrisman et al., 2002

11. Plotting Coalition Growth
Stages/Elements of success*
Organizational structure
Heterogeneity of participants
Resources
Activities
Accomplish-ments
Formation
Implementation
Maintenance
Outcome
*Formation: Initiation of funding, recruit members, est. structure and training, task identification
Implementation: Needs assessment and progress. Development and implementation
Maintenance Monitoring and upkeep of membership and planned activities
Outcome: Impact that results from deployment of community-wide strategies.
(Butterfoss et al. 1996)
HSERV 576/NURS 557, Chrisman, week 5

12. Table 8: Coalition Phase I Products
Strategy
Measure
Asset map and needs assessment
existing public health data
key informant interviews
focus groups
community forums
use of defined planning process (Green 1991)
asset mapping (McKnight 1992)
written needs assessment which includes assets and goals of included communities
Defined priorities
formal priority setting process
written priorities
Intervention plan
build from existing community assets
blend community knowledge and expert approaches
written intervention
HSERV 576/NURS 557, Chrisman, week 5

13. Table 9: Current and Future Actions to Promote Sustainability:
Element
Action
Money
ADA has just received a grant for API community outreach
State DOH has been ongoing contributor to Community Diabetes Initiative
Health Action Plan has pledged $30,000 towards diabetes activities
Seeking additional funding from local and national foundations
Seeking additional funding from local and state government
Shared Goals
See Table 8 above
Mature subsystem
Multiple partners have extensive coalition experience
No Brokering
Funds will go directly to community or clinical interface organizations
Trust
Past history of partnership
Public support
Effective use of media
Effective advocacy with local government officials
Community outreach
HSERV 576/NURS 557, Chrisman, week 5

14. Phase I Timeline
HSERV 576/NURS 557, Chrisman, Feb 7, 09

15. Participation
Involvement of people to define their own needs, set their own priorities, control their own solutions, and evaluate their own progress.
Green 1996, p. 212
HSERV 576/NURS 557, Chrisman, week 5

16. Participation To be part of the project.
Have some part of the benefits.
Work in the project.
Decision-making role in the project.
Work on monitoring and evaluation.
Develop and implement the project.
Stone 1992
HSERV 576/NURS 557, Chrisman, week 5

17. Aspects of Participation: From the Literature
Relationships between researchers and CBOs & communities: >consultation >planning >implementation
Within an organization: >degree to which the community has an influence; >degree to which staff members affect direction.
HSERV 576/NURS 557, Chrisman, week 5

18. Aspects of Participation: SPHC Community Collaboration Principles
Early involvement
Real influence
Involved with projects
Respect of values, confidentiality
Benefit the community
HSERV 576/NURS 557, Chrisman, week 5

19. Common Organizational Schemes for Community Feedback
Advisory Board/Steering Committee -offers advice -range of power and control
Broker, like Seattle Partners
Grass roots committee
Focus groups/surveys/other assessment
Town Meetings
HSERV 576/NURS 557, Chrisman, week 5

21. Mission and Goals are Crucial Elements
SPHC Mission: work to improve the health and quality of life of urban, disadvantaged Seattle communities by promoting activities which are effective in preventing disease, promoting healthy behaviors and environments, and influencing the underlying social factors which affect health such as education, income, housing and economic development.
HSERV 576/NURS 557, Chrisman, week 5

22. Evaluation
Is a research process to assess and monitor the degree to which stated goals are reached
HSERV 576/NURS 557, Chrisman, week 5

23. Three Types of Evaluation
Outcome. Did the project have the effects that it projected?
Intermediate (“impact”). Were the correct steps taken to fulfill the theory/method of the project?
Process. How was the project carried out?
HSERV 576/NURS 557, Chrisman, week 5

24. Levels of Outcome
Individual level. E.g., personal knowledge and skill.
Risk factors. E.g., diet, smoking, seat belts.
Community level. E.g., organizational change, sustainable coalitions.
Social determinants of health. E.g., poverty, education, environmental toxicity.
HSERV 576/NURS 557, Chrisman, week 5

25. Conceptual Model, Process Evaluation of Seattle Partners
Participation: joint action, members and researchers.
Relationships: growth of personal networks.
Capacity Building: skill acquisition.
Empowerment: belief in future success.
Products: publications, projects, evaluations.
Policy change: influence policy makers.
Community work: involvement in projects.
Chrisman et al., 2002

26. SPHC Process Evaluation Model
Variable
Definition
Indicator
Participation
Joint action for community needs
Involvement
Relationships
Social bonds
Network description
Capacity Building
Enhance abilities and skills
Training sessions, TA
Empowerment
Community belief in future control
Interview, observation
Products
Concrete achievements
Publications, evaluations, grants
Policy change
Influence other to make policy change
Community organizing
Define, mobilize, and sustain community
Designate communities, activities

27. Glue Relationships Stringer Networks Individual level
Master Variables
Variables
Data Source
Analysis Tool
Added Benefit
Reference
Relationships
Networks
Individual level
Organization level
Technical Assistance Form (TAF)
Meeting notes
Network analysis
Include informal social relationships
Granovetter
Mitchell 1969
Collaboration (working united)
Coalition
Partnerships (equal power)
Grant proposals
New interviews?
Project evaluation (individual projects)
PAR checklist
Discussion of PAR
Pew-Morse
Aagard-Hansen
Himmelman (collaboration)
Francisco, Payne & Fawcett
Glue
Interviews i.e. SIP
1. Did you make contacts? Will you work with them again?
2. What are the concrete actions taken to precipitate cohesion/organizing?
Pub vs. midwife (catalyst/community organizer) vs. middleman (e.g. asthma)
Stringer

28. Mission and Goals are Crucial Elements
SPHC Goals: find existing programs and draw lessons from them, create and/or evaluate new programs, foster mutually beneficial relationships, work to change institutions to make them more responsive to communities, provide technical assistance and create new models for community participation in health.
HSERV 576/NURS 557, Chrisman, week 5

29. Process evaluation provides data to describe whether and how:
We found existing programs from which to derive lessons.
We have created and/or evaluated new programs.
We have fostered mutually beneficial relationships.
We have worked to change institutions and increase community responsiveness.
We have provided technical assistance.
We have created new models for community participation in health.
HSERV 576/NURS 557, Chrisman, week 5

30. Other goals from successful community organizations
Successful coalition development (collaboration).
Power sharing.
Set and act on priorities.
Identify and work with community assets.
Community involvement.
Cultural competence.
HSERV 576/NURS 557, Chrisman, week 5

32. REACH 2010 Coalition Agencies Public Health Quality Assurance
University/HMC
Clinics
Diverse Partnership at the Table: Average attendance in 2000 was 25; 17 in 2005.
HSERV 576/NURS 557, Chrisman, week 5

33. Evaluation Criteria for Community Boards
Competent leadership
Perceived Benefits of participation
Perceived Costs
Active participation and accountability
Retain staff/ define member-staff relations
Trust
Communication
Decision Making
Diverse and Appropriate Membership
Cultural Competence
Shared purpose/mission
Formalization of rules/procedures
HSERV 576/NURS 557, Chrisman, week 5

34. REACH 2010 Coalition
HSERV 576/NURS 557, Chrisman, week 5

35. REACH 2010 Coalition
HSERV 576/NURS 557, Chrisman, week 5

36. Asian/Pacific Islander
REACH 2010 Coalition
Community Clinics
African American
Asian/Pacific Islander
Latino
Clinic/Health Provider Change
DEMS Registry
Case Management
Provider Training
Patient Education
Individual Behavior Change
Peer Educators
Support Groups
Education Classes
Self Management Training Classes
Community Systems Change
Make community environment more favorable to diabetics
Community Capacity Building
REACH Coalition
Organizational Networking
Provider/Patient Training
Environment & Systems Change
Interventions

37. Skills involved in REACH 2010 Process Evaluation
Participant observation (and training)
Depth interviewing (and training)
Moderate focus groups (and training)
Document analysis
Network analysis
Research design
IRB competence
HSERV 576/NURS 557, Chrisman, week 5

38. Focus Group Questions: REACH 2010 Process Evaluation
Do you talk about diabetes differently as the result of the project?
How do you feel about the amount of information you have received about diabetes?
What have been the most significant events to you during your involvement in this group or class?
Tell us about the involvement of your family and friends in helping you manage you diabetes.
Is there anything you would like to change?
HSERV 576/NURS 557, Chrisman, week 5

39. Findings REACH 2010 Process Evaluation
“This class is very helpful, helps us gain a better understanding of the disease.” Vietnamese woman
Causes, how to control diabetes and how to handle high blood sugar
A great deal about diet.
The importance of exercise and how to exercise.
And what to do when meeting with physicians.
HSERV 576/NURS 557, Chrisman, week 5

40. Findings REACH 2010 Process Evaluation
“It was a lot of information. I learned about so many different kinds of food and where to get them.” African American woman
Managing diabetes through diet
What to eat
How much food to eat
How to prepare food
How to read labels
Where to shop for food (learn from each other)
HSERV 576/NURS 557, Chrisman, week 5

41. Findings REACH 2010 Process Evaluation
“When I eat fish, I don’t even use the kind of sugar they teach us here. I use onion, pepper and a tiny bit of fish sauce. I cannot eat salty food and I steam it My children say ‘How can you eat stuff like that’? and I say I have to. . . I eat much simpler than before because I am sick. I eat to live, not to enjoy myself.” Vietnamese woman
“Before I didn’t know what to eat or what time. Now I know to control the portion size.” Latino man
HSERV 576/NURS 557, Chrisman, week 5

42. Findings REACH 2010 Process Evaluation
“How do I exercise? I walk; I walk. In the past, I walk for an hour each day. Now, I still walk for an hour, but I also do Tai Chi. Before, I didn’t know Tai Chi. Because I have this illness, I forced myself to learn Tai Chi. I don’t learn anything else, I just learned Tai Chi.” Cantonese man
How to exercise
The importance of exercise for controlling Diabetes
HSERV 576/NURS 557, Chrisman, week 5

43. Findings REACH 2010 Process Evaluation
“It is surprising the information you don’t get from the doctor. Most of what I learned was from this class.” African American woman
“I’ve learned to be ready for the doctor When I go to the doctor’s office and I go into the examining room, I take off my shoes and socks. I don’t wait to for him to tell me On the counter I lay my monitor book with all my blood pressures and all my sugar. So it’s all there so he don’t have to walk out and come back. I’m getting every bit of the minutes he’s supposed to be giving me.” African American man
HSERV 576/NURS 557, Chrisman, week 5

44. Coalition Evaluation Approach
The use of multiple methods to discover and monitor:
Involvement in and reactions to the project
Aspects to celebrate and those to remedy
Desires and directions for change
HSERV 576/NURS 557, Chrisman, week 5

45. Coalition Evaluation Approach
Open-ended questions to discover:
Relationships with other members;
Description of recent activities; future suggestions
Feelings about participation
HSERV 576/NURS 557, Chrisman, week 5

46. Coalition Evaluation Approach
I use these data, theory and best practices from the literature, and my experience to offer suggestions for change.
This happens in reports, in to members, and in coalition and committee meetings.
HSERV 576/NURS 557, Chrisman, week 5

47. Theoretical Perspective for the REACH Evaluation
Power-sharing: all voices heard, participation in decisions.
Partnership: coalition structure, wide reach to community sectors (strength of weak ties), participation, benefits, capacity building.
Cultural competence: culturally appropriate projects, solid connections with ethnic communities, interpersonal relationships.
HSERV 576/NURS 557, Chrisman, week 5

48. Theoretical Perspective for the REACH Evaluation
Communication: vertical with the intervention and with policy makers; horizontal with partners.
Relationships: among coalition members, interinstitutional.
Dynamics of change: personnel, function, structure (Firth); innovation.
HSERV 576/NURS 557, Chrisman, week 5

49. Where we’ve been; how we did; what to do next.
Evaluation
Where we’ve been; how we did; what to do next.
HSERV 576/NURS 557, Chrisman, week 5