Abstract
Promoting interdisciplinary, participatory approaches to address childhood asthma disparities in an urban African American community
Nida Ali, PhD, MPH1, Ryan Combs, Ph.D., M.A.2, Rishtya Kakar, MBBS1, Baraka Muvuka, MPH1 and Jennifer Porter, MD3
(1)University of Louisville, Louisville, KY, (2)University of Louisville School of Public Health & Information Sciences, Louisville, KY, (3)University of Louisville Hospital, Department of Pediatrics, Louisville, KY
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Introduction: Across the U.S., racial disparities in asthma are pervasive. Asthma continues to disproportionately affect low-income, minoritized children, with African American children twice as likely to have asthma as Caucasian children. African American children are particularly susceptible due to the interplay of socioeconomic, historical, and industrial factors. This uneven burden results in poor adherence to recommended treatments for asthma management. Health literacy is an important determinant of asthma management, as it affects parents' ability to recognize, manage, and prevent their child's asthma. National guidelines suggest asthma action plans (AAPs) as a tool for patient self-management. Yet, AAPs remain largely underutilized. Boot Camp Translation (BCT) -a unique approach rooted in interdisciplinary and participatory action- provides opportunities to plan an intervention to promote the utilization of AAPs in improving asthma management for African American children. Description: West Louisville (WL) faces substantial social and health disparities, including those related to asthma. Using the BCT approach, researchers, health/public health professionals, and community members developed a health communication campaign to promote the uptake of evidence-based, low-literacy AAPs for children with asthma in WL. The campaign will be disseminated through publicly accessible channels across WL. To ensure campaign effectiveness, the research team collaborated with healthcare providers serving children of WL to encourage the consistent use of an easy-to-use AAP as part of their routine asthma care. Providers were also asked to collect specific evaluation information to measure campaign impact, such as patients' zip code, age, race/ethnicity, asthma severity, whether the AAP was initiated by the provider or parent/guardian, and whether the parent/guardian was familiar with our campaign. Conclusions: A process and outcome evaluation provided iterative feedback about campaign development, implementation, and outcomes. Tapping the power of local knowledge and expertise, the BCT process enabled us to build sustainable, interdisciplinary partnerships to promote a promising tool for enhancing asthma-related health literacy in WL. Recommendations: There is value in leveraging interdisciplinary partnerships to standardize AAPs as part of a national, comprehensive strategy to improve asthma management among children. Bridging the childhood asthma disparity gap will require integrated, multifaceted strategies to build on the existing evidence-base in asthma care.
Administer health education strategies, interventions and programs Advocacy for health and health education Chronic disease management and prevention Communication and informatics Conduct evaluation related to programs, research, and other areas of practice Public health or related research
Abstract
Champion Provider Fellowship: Enhancing Healthcare Provider Engagement in Obesity Prevention Efforts Through Facilitated Partnerships
Vanessa Thompson, MD1, L. Elizabeth Goldman, MD2, Wagahta Semere, MD, MHS2, Alicia Fernandez, MD2, Alana Pfeffinger, MPH1 and Dean Schillinger, MD3
(1)University of California, San Francisco, San Francisco, CA, (2)UCSF, San Francisco, CA, (3)University of California San Francisco, San Francisco, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Introduction to problem being addressed: In 2012, the IOM urged healthcare providers to prevent obesity by advocating for change in their communities; yet many clinicians lack the skills necessary to play this expanded role.
Evidence used to inform program development: Successful health advocates recognize the importance of addressing health advocacy by working collaboratively with community groups. We developed a two-year fellowship program to train physicians and dentists to partner with local health departments (LHDs) and community-based organizations (CBOs) to advance policy, systems, and environmental (PSE) change interventions.
Description of program activities and outcomes: Thirty-six fellows and twenty-eight LHD representatives participated in a two-day training focused on skills for effective advocacy including: media training, advocacy writing, engaging decision-makers, and partnership development. Subsequent activities included technical assistance, an in-person training, PSE webinar, and two LHD technical assistance calls. Trainings were designed to reinforce fellows’ advocacy skills, PSE knowledge, and partnership development skills. Fellows’ activities were monitored through quarterly online surveys, telephone and email outreach, and webinar participation.
Of the 36 fellows onboarded in May 2017, eight were dentists and 28 were physicians from 20 unique counties in California . Two online surveys captured their activities over the first six months of the project. Thirty-five fellows reported activities over this period with an average survey response rate of 86%. Thirty-four fellows (97%) reported communication with LHDs during the initial 6-month period. Twenty-two fellows (63%) reported being interviewed or providing professional opinion/perspective for a media outlet (e.g. radio, newspaper, TV, blog, social media). The most frequently reported activities were: meeting with stakeholders (67%), attending community meetings (60%), and starting a program or intervention (53%). Thirty-one fellows (89%) reported that partnering with LHDs was helpful in supporting their PSE-related work.
Conclusion: At six-months, the majority of healthcare providers were actively involved in obesity prevention PSE activities and partnerships with LHDs appearing to play a facilitative role.
Recommendations for practice: Innovative programs that focus on the development of advocacy skills through partnerships between clinicians and local health departments can lead to physician and dentist engagement in PSE-level initiatives to prevent obesity.
Advocacy for health and health education Chronic disease management and prevention Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Program planning Public health or related public policy
Abstract
Supporting Partnerships between State Health and Housing Agencies through the Medicaid Innovation Accelerator Program (IAP)
Olivia S. Jung, AM1, Sara Galantowicz, MPH1, Gretchen Locke, MA1, Beth Waldman, JD, MPH2, Deepti Kanneganti2, Erin Taylor, MPH2, Rosanna M. Bertrand, PhD1 and Katharine Witgert, MPH1
(1)Abt Associates, Cambridge, MA, (2)Bailit Health, Needham, MA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
The Centers for Medicare and Medicaid launched the Medicaid Innovation Accelerator Program (IAP) to support states’ Medicaid payment and delivery system reform. One IAP component, Promoting Community Integration through Long-Term Services and Supports, Housing-Related Services and Partnerships, aimed to develop partnerships between Medicaid and housing agencies. This study examined how multi-pronged targeted support (TS), utilizing group learning and individualized consultation, facilitated collaboration between Medicaid and housing agencies to improve access to affordable housing.
We used the Kirkpatrick Model to frame the evaluation and explored state participants’ reaction, learning, behavior, and results due to IAP participation. TS included in-person meetings, coaching, and performance improvement tools (e.g., driver diagrams). Data collection included webinar and meeting observations, interviews and focus groups with state participants and TS providers, and a summative survey.
Eight states participated in the program. Each state team included representatives from Medicaid, housing development and financing agencies, and non-profit organizations supporting housing development and homeless populations. Various modes of TS fostered collaboration across organizations; site visits by TS providers enabled health and housing leaders, Continuum of Care leaders, and other stakeholders to meet (often for the first time) to discuss data linking, managed care, and stakeholder engagement. Participants reported learning specific, actionable knowledge that they applied to efforts such as building a business case for supportive housing, inserting housing incentives into managed care organization contracts, and using 1915c waivers. Ten months after the program, participants continued their collaborative work to enhance and expand housing-related by executing data-sharing agreements, engaging in data-matching between Medicaid and housing agencies, and applying for an 1115 waiver that will support the provision of housing-related services.
The IAP’s strategic support to create partnerships between Medicaid and key housing partners facilitated interagency collaboration toward the common goal of expanding access to community housing. Resulting partnerships energized cooperation between agencies and organizations to integrate housing and supportive services. Concerted efforts like those that IAP helped to initiate are pivotal for states to capitalize on initiatives such as the Section 811 Project Rental Assistance Program that jointly support housing and health and promote community living for Medicaid beneficiaries with disabilities.
Administration, management, leadership Conduct evaluation related to programs, research, and other areas of practice Social and behavioral sciences
Abstract
Health Equity Promotion in a Partnership to Promote Healthy Environments: Results from a Formative Evaluation
Melanie Ward, MPH1, Barbara Israel, DrPH, MPH2, Amy Schulz, PhD2, Kristina Rice, MSW, MUP3, Donele Wilkins4 and Angela Reyes, MPH5
(1)University of Michigan School of Public Health, Southfield, MI, (2)University of Michigan, School of Public Health, Ann Arbor, MI, (3)University of Michigan School of Public Health, Ann Arbor, MI, (4)Green Door Initiative, Detroit, MI, (5)Detroit Hispanic Development Corporation, Detroit, MI
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background:
A core focus of community-based participatory research (CBPR) partnerships is promoting both equitable relationships within partnerships and health equity as an outcome of partnership efforts. Formative evaluation of partnership processes and outcomes can help CBPR partnerships develop strategies to promote equity within partnerships and critically examine efforts to improve health equity in communities more broadly.
Objective:
To describe results from a formative evaluation assessing health equity promotion in partnership processes and outcomes and discuss strategies to strengthen equity promotion based on evaluation results.
Methods:
Community Action to Promote Healthy Environments (CAPHE) is an interdisciplinary CBPR effort bringing together community and academic partners from multiple fields, including public health, environmental justice, epidemiology, sociology, public policy, and law to develop and implement a scientifically informed public health action plan to improve air quality and health in Detroit. Closed-ended questionnaires, project documentation, and field notes were used to evaluate: 1) equity in partnership processes (e.g., decision making); 2) partnership focus on addressing health equity; 3) efforts to strengthen the capacity of communities facing inequity to engage in future analyses and decision-making; 4) partnership contributions to shifts in power that benefit communities facing inequity; and 5) reductions in health inequities related to air quality.
Results:
Evaluation findings identified several strengths of CAPHE related to equity, including: prioritization of community-identified issues; action strategies that reflect community concerns; partnership goals, research questions and methods that focus on addressing health equity principles and impacts; and specific actions (e.g., policy education trainings) which strengthen capacity of partners and community members to work with decision-makers to improve air quality and health. Evaluation findings identified opportunities to strengthen partnership efforts toward equitable engagement of a broader range of Detroit residents and decision-makers. Discussion of these results identified a number of strategies for action.
Conclusion:
Formative evaluation of partnership efforts to promote health equity can engage partners in identification of strategies to strengthen efforts to promote health equity.
Implications for Public Health:
Formative partnership evaluation processes offer opportunities for explicit discussion of equity in partnership activities. We will discuss lessons learned and implications for reduction of health inequities.
Conduct evaluation related to programs, research, and other areas of practice Environmental health sciences Other professions or practice related to public health Program planning Public health or related research