1. Using Appreciative Inquiry to Evaluate and Promote Partnerships for TB Control and Prevention
Vidya Venkataramanan2, Kai Young1, Awal Khan1
1. Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, USA 2. Association of Schools of Public Health, Washington DC, USA
BACKGROUND AND GOALS
METHODS & KEY FINDINGS
KEY FINDINGS
APPRECIATIVE INQUIRY
PRIMARY NON-ALA PARTNERS
National and state policies encourage health departments to engage in partnerships and collaboration to achieve core tuberculosis (TB) program objectives
As TB morbidity decreases, partnerships become more crucial to achieve TB elimination
The American Lung Association (ALA) has a well established history in TB prevention
Appreciative inquiry is an approach to conducting organizational studies that identifies what is working well and helps discover opportunities for positive change; it acts in contrast to the traditional “problem-solving approach” to organizational change
The goals of this evaluation were to:
Gain insight into how TB programs engage in partnerships with the ALA
Assess the context and characteristics of TB programs’ on-going partnerships
Inform partnership-building among stakeholders including
State and local TB control programs
Community organizations connected to TB control
TB patients
CDC Division of TB Elimination
ALA chapters
Appreciative inquiry techniques incorporated into question structure
Placing emphasis on factors that enabled partnership successes instead of just describing problems helped provide participants with a positive vision for the future
Some participants who initially struggled to describe their partnerships had an easier time once the interview focused on successful approaches
Open-ended questions also allowed participants to discuss variety of perspectives regarding partnerships and TB program activities
Private doctors
University medical centers and schools
Schools of Public Health
Correctional Facilities
Other disease control groups (ex. Refugee Health, HIV) within health departments
SAMPLE INTERVIEW QUESTIONS
What do you consider to be three main factors that contribute to your successful partnership with ALA?
How important do you consider partnerships to be for ensuring efficiency, quality, and/or effectiveness of TB control activities? Choose from: Not important; Somewhat important; Moderately important; Very important. Feel free to elaborate.
What programmatic, financial, and logistical challenges do you face in improving the quality of your partnership? How do you deal with these challenges?
11 sites (4 with ALA partnerships and 7 without ALA partnerships) mentioned that TB is no longer an ALA priority, affecting some programs’ ability to work with ALA:
“We’ve been trying, but TB doesn’t seem to be a priority…and I guess all the individuals that were there at the time when the relationship was in existence aren’t there anymore, so they weren’t really even aware of the activities that ALA provided in conjunction with the state program.”
– Low TB incidence state that used to have formal partnership with ALA
THEMES FOR SUCCESSES AND CHALLENGES IN TB CONTROL PARTNERSHIPS
MOST COMMON ACTIVITIES WITH ALA
Top Factors for Successful Partnerships
Top Challenges Faced in Partnerships
Advocacy and community outreach activities
Incentives and enablers for TB patients
Hosting TB advisory committee meetings
Hiring contractual staff
Event planning for conferences, workshops, TB trainings
METHODS
“We always use our subcontract [with ALA] to pay freelancers or individual contractors because it’s a lot easier than going through the state bureaucracy.”
- High TB incidence state
Recent organizational changes and regionalization of ALA were mentioned by 5 of the sites (45%) with ALA partnerships, but only one described a positive impact on its TB program:
SUMMARY AND IMPLICATIONS
“It has increased the number of people that we can communicate with. If someone was out sick in one office and wasn’t able to help us with an immediate need, we have a resource in another office as well. So I think it’s been very positive.”
– Medium TB incidence state
Appreciative inquiry facilitated collection of successes in partnership building as well as in identification of areas for improvement and growth. This method avoided focus on negative aspects, which traditional open-ended questions might not have been able to prevent
Interviews revealed various experiences and characteristics of partnerships across TB programs, indicating need for variety of best practice models to help programs without strong partnerships
ALA’s organizational changes and perceived loss of priority for TB noticeably affected partnerships with state TB programs
For all partnerships (including non-ALA), most commonly noted factor for success was commonality of goals and mission, while most commonly noted challenge was insufficient funding
Therefore, more advocacy is needed to further strengthen relationships between some TB programs and their local ALA chapters by highlighting these successes and overcoming challenges uncovered through this evaluation
Some sites with strong partnerships with ALA were eager to provide suggestions:
“I would be happy to share information…start with something with very specific deliverables. [For us] I think it started out as a very targeted—not rigid—but very targeted agreement that was probably smaller in scope than what we have now.”
- Low TB incidence state with strong partnership with ALA
Purposive sampling used to select study sample from 68 TB programs
Matching comparison sites for each group selected based on similar epidemiological characteristics, including population size and incidence of TB
Engaged with CDC TB Program Consultants to facilitate phone interview process
Conducted semi-structured interviews with designated staff in TB programs with subject-specific questions regarding TB control activities and partnerships with external organizations, including ALA
24 telephone interviews conducted
Out of 12 intervention sites, 3 sites (25%) no longer had partnership with ALA
Out of 12 comparison sites, 3 sites (25%) revealed partnerships with ALA during interview
MOST COMMON REASONS FOR PARTNERING WITH ALA
Circumvent government bureaucracy
Utilize ALA’s expertise in certain areas
Insufficient capacity in state TB program
MOST COMMON REASONS FOR NOT PARTNERING WITH ALA
Insufficient funding
Lack of interest from ALA
Already have other strong partnerships
ACKNOWLEDGEMENTS
Interviewees: TB Controllers, Public Health Advisors, Other TB Program Staff; CDC Program Consultants
The findings and conclusions in this poster are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention