Collaborative Community Health Research Articles

Binational Academic-Service-Community Partnership: A Program to Train, Provide Services and Conduct Research for Sustainable Community Health in Rural Baja, California, Mexico

Background: Viaje Interinstitucional de Integración Docente, Asistencial y de Investigación (VIIDAI) is a binational community health collaboration involving transdisciplinary education, field training, and research efforts that promotes health and provides services to underserved populations in rural Mexico, while also fostering cultural competency in medical and public health students from the Mexico-U.S. border region. Purpose: This paper describes the development and operation of the VIIDAI academic-community-service organization partnership and clinical and public health training program, and highlights the impact, challenges, road map, and powerful lessons of this binational effort. Methods and Approaches: The VIIDAI partnership is a collaboration between San Diego State University, School of Public Health; Universidad Autónoma de Baja California Tijuana, School of Medicine and Psychology; University of California San Diego, School of Medicine; and Old Mission Rotary. Since 1998, VIIDAI has cooperatively implemented projects using a community-based participatory research approach, integrating community members with faculty, students, and health practitioners from the three universities alongside the Rotary to balance research and action for the mutual benefit of all partners involved. Epidemiologic investigations and interventions, health promotion, and clinical care are conducted with active community engagement during semiannual trips. Field activities are conducted in San Quintín, Baja California, Mexico within a rural, predominately indigenous community, targeting a variety of population-specific public health issues. Results: Since its inception, over 3,300 faculty and students have participated in VIIDAI. The community has responded enthusiastically, with over 14,000 clinic visits and broad participation in health promotion interactions. These efforts have led to improvements in multiple indicators of community health, such as decreased prevalence of anemia; improved access to free potable water; increased numbers of students advancing to secondary schools; reduced family sizes and older age of first pregnancy; increased community interest and engagement in health issues and disease prevention; and increased visibility and empowerment among community leaders. Conclusion: The success of the VIIDAI partnership can be attributed to five key elements: (1) stable, long-term leadership; (2) guidance from the host country; (3) equal partnership with the local community; (4) support from a non-academic service organization to help fulfill unmet needs; and (5) mutually beneficial involvement across all participants.

An action research partnership in an urban Texas county to explore barriers and opportunities for collaborative community health needs assessments.

The Affordable Care Act mandated triennial community health needs assessments (CHNAs) for greater nonprofit hospital accountability in responding to community health needs. Over 10 years later, hospital spending on community benefits remains largely unchanged. While greater collaboration in CHNA implementation can increase hospital investment in community-based initiatives, nonprofit hospitals in conservative states are subject to policy, political, and economic factors that inhibit public health partnerships and magnify existing disparities in health care access. This participatory action research study explores the decision-making environment of collaborative CHNA implementation within a group of nonprofit hospitals in a north Texas urban county. In 2017 faculty from an urban anchor institution initiated an academic-community partnership with a coalition of nonprofit hospitals, public health departments, and academic institutions. An interdisciplinary research team engaged in multi-method document review and qualitative data collection to describe historical barriers for local CHNA processes and develop practical strategies for joint CHNA initiatives. Local CHNA documents were first reviewed through team-based content analysis and results applied to develop a qualitative study protocol. Key informants were recruited from county-based nonprofit hospitals, community-based nonprofit organizations, and public health systems. Seventeen senior- and mid-level professionals participated in semi-structured research interviews to describe their perspectives relating to CHNA-related planning and implementation decisions. Through iterative data collection and analysis, the research team explored CHNA-related knowledge, experiences, and processes. A constructivist lens was subsequently applied to examine historical barriers and future opportunities for local collaboration. Findings reveal CHNA implementation is a multi-stage cyclical process in organizational environments with accountability to a wide range of public and private stakeholders. This promotes varied levels of inclusivity and conservatism in data collection and community benefit implementation. Decisions to collaborate are hindered by competing priorities, including compliance with existing guidelines, administrative simplicity, alignment with health care service delivery, and efficient resource use. Efforts to promote greater CHNA collaboration may be facilitated through intentional alignment with organizational priorities and clearly communicated benefits of participation for leaders in both public and private nonprofit health systems. We consider implications for policymakers and health systems in restrictive political environments and advance a conceptual framework for greater CHNA collaboration.

Sidebar: Deepening Roots : The ACA as a Catalyst for Meaningful Community Health Collaboration

Sidebar: Deepening Roots : The ACA as a Catalyst for Meaningful Community Health Collaboration

Promoting community health collaboration between CTSA programs and Cooperative Extension to advance rural health equity: Insights from a national Un-Meeting.

Addressing rural health disparities has unique challenges that require cross-sector collaborations to address social determinants of health and help those in need to get connected to care continuum. We brought the Clinical and Translational Science Award, Institutional Development Award Program Infrastructure for Clinical and Translational Research, and Cooperative Extension System Programs together for a one-day semi-structured meeting to discuss collaborative opportunities to address rural health disparities. Session notes and event materials were analyzed for themes to facilitate collaboration such as defining rural, critical issues, and organizational strengths in support of collaboration. Across 16 sessions, there were 26 broad topics of discussion. The most frequent topics included "barriers and challenges," "strategies and opportunities," and "defining rural." There is a growing understanding of the opportunity that collaboration between these large programs provides in addressing rural health disparities.

Collaborative Community Health Needs Assessments.

Collaborative Community Health Needs Assessments.

Patient Engagement in Type 2 Diabetes: A Collaborative Community Health Initiative.

Purpose The purpose of this study was to describe the effects of an innovative rural community-based, diabetes self-management education and support (DSMES) program on patient behaviors and outcomes. Methods A 12-month pre-post study design with physiological data collection at program initiation, 16 weeks, and 6 and 12 months postenrollment was used for program assessment. The program consisted of an American Diabetes Association-accredited curriculum provided by the hospital and interfaced with a YMCA curriculum promoting lifestyle change. The 28-session program was delivered over a 1-year period. Results The sample size was 115. Participants were primarily white and female, with a mean age of 57 years. Mean body mass index (BMI) at program initiation was 37; mean A1C was 8.5 (69.4 mmol/mol). Significant reductions were obtained in weight, BMI (at 16 weeks), and A1C (at 6 months); these reductions were sustained at 12 months. Medication intake was significantly reduced, and diabetes-related emergency department visits were below national averages. Conclusions Results support the positive impact of a year-long, community-based, healthy behavior, DSMES program on health outcomes and overall costs of care delivery in the rural setting.

Accredited Health Department Partnerships to Improve Health: An Analysis of Community Health Assessments and Improvement Plans

The Public Health Accreditation Board (PHAB) Standards & Measures require the development and updating of collaborative community health assessments (CHAs) and community health improvement plans (CHIPs). The goal of this study was to analyze the CHAs and CHIPs of PHAB-accredited health departments to identify the types of partners engaged, as well as the objectives selected to measure progress toward improving community health. The study team extracted and coded data from documents from 158 CHA/CHIP processes submitted as part of the accreditation process. Extracted data included population size, health department type, data sources, and types of partner organizations. Health outcome objectives were categorized by Healthy People 2020 Leading Health Indicator (LHI), as well as by the 7 broad areas in the PHAB reaccreditation framework for population health outcomes reporting. Participants included health departments accredited between 2013 and 2016 that submitted CHAs and CHIPs to PHAB, including 138 CHAs/CHIPs from local health departments and 20 from state health departments. All the CHAs/CHIPs documented collaboration with a broad array of partners, with hospitals and health care cited most frequently (99.0%). Other common partners included nonprofit service organizations, education, business, and faith-based organizations. Small health departments more frequently listed many partner types, including law enforcement and education, compared with large health departments. The majority of documents (88.6%) explicitly reference Healthy People 2020 goals, with most addressing the LHIs nutrition/obesity/physical activity and access to health services. The most common broad areas from PHAB's reaccreditation framework were preventive health care and individual behavior. This study demonstrates the range of partners accredited health departments engage with to collaborate on improving their communities' health as well as the objectives used to measure community health improvement. This illustrates the collaborative nature in which accredited health departments tackle community priorities.

Rhythms of the Heart: An interprofessional community health collaboration to increase cardiovascular health knowledge

Objectives: Cardiovascular health continues to be a leading cause of morbidity and mortality in the USA. An interprofessional collaborative team comprising university faculty and undergraduate students developed and presented a community outreach event to provide education and health screening to a diverse group of local residents. Design: An event entitled Rhythms of the Heart was planned and implemented to reach community members. Setting: The event took place on the campus of a private college in Central Florida, USA. Methods: Clinical services, including health screening for blood pressure and body fat, were provided, along with information on the benefits of smoking cessation, physical activity, weight management, healthy diet alternatives and stress reduction. Local community resources and educational materials were supplied to event participants. Results: The event attracted approximately 275 guests. An analysis of feedback from attendees indicated a greater appreciation of music to enhance one’s understanding of cardiovascular health. Students and attendees perceived the Rhythms of the Heart concert as ‘smart and creative’, ‘cleverly conceived’ and ‘well thought out’. Conclusion: This interprofessional outreach event provided a novel means by which to undertake community education and health screening.

Collaborative Community Health Research

Abstract Many medical students and faculty researchers have had little or no experience working with community groups on health-related research. These resources are meant to provide guidelines and...

Health and Taxes: Hospitals, Community Health and the IRS

The Affordable Care Act created new conditions of federal tax exemption for nonprofit hospitals, including a requirement that hospitals conduct a community health needs assessment (CHNA) every three years to identify significant health needs in their communities and then develop and implement a strategy responding to those needs. As a result, hospitals must now do more than provide charity care to their patients in exchange for the benefits of tax exemption. The CHNA requirement has the potential both to prompt a radical change in hospitals' relationship to their communities and to enlist hospitals as meaningful contributors to community health improvement initiatives. Final regulations issued in December 2014 clarify hospitals' obligations under the CHNA requirement, but could do more to facilitate hospitals' engagement in collaborative community health projects. The Internal Revenue Service (IRS) has a rich opportunity, while hospitals are still learning to conduct CHNAs, to develop guidance establishing clear but flexible expectations for how providers should assess and address community needs. This Article urges the IRS to seize that opportunity by refining its regulatory framework for the CHNA requirement. Specifically, the IRS should more robustly promote transparency, accountability, community engagement, and collaboration while simultaneously leaving hospitals a good degree of flexibility. By promoting alignment between hospitals' regulatory compliance activities and broader community health improvement initiatives, the IRS could play a meaningful role in efforts to reorient our system towards promoting health and not simply treating illness.

The proof's in the partnerships: Are Affordable Care Act and Local Health Department accreditation practices influencing collaborative partnerships in community health assessment and improvement planning?

The strengthened requirement for nonprofit hospitals to complete a community health needs assessment and implementation plan in the Affordable Care Act, concurrent with a new voluntary accreditation process for local health departments that requires collaborative community health assessments and community health improvement plans, have led to a resurgence of interest in assessment and improvement planning. This study provides baseline data that will help determine whether the Affordable Care Act and public health accreditation will result in more collaborative community assessment and community health improvement activity by describing trends in collaborative community health assessment and community health improvement plan activities. Data sources include the National Profile of Local Health Departments studies and a database of community health assessment, community health needs assessment, community health improvement plan, and other implementation planning reports from across the country. The study finds that collaborative community assessment activity is positively associated with population size, governance type, and local health department and coalition-led efforts.

Using a Web-Based Tool to Evaluate a Collaborative Community Health Needs Assessment

Despite the fact that community assessment has been identified as a core function of public health for more than 2 decades, evaluations of the impact of the practice of community health assessment are few in number and have only recently been published. This article describes an evaluation of a 2011-2012 community health needs assessment (CHNA) of Kane County, Illinois. The evaluation customized and used a reliable and valid Web-based survey, the New York State Community Health Assessment Usefulness Survey, to measure Kane County CHNA user perceptions of content, format, and impact utility of the assessment. Survey respondents were community leaders and members from a diverse set of professional backgrounds and were nearly evenly divided between those who had actively participated in the CHNA and those that had not. Respondents were overwhelmingly positive in their evaluation of the Kane CHNA, with an average per item score of greater than 3 on a 4-point Likert scale, although respondents who were not involved in the CHNA process were less positive than those directly involved. Implications for public health practitioners and researchers are discussed.

The Central Massachusetts Oral Health Initiative (CMOHI): a successful public-private community health collaboration

The Central Massachusetts Oral Health Initiative (CMOHI) aimed to improve access to quality oral health care in central Massachusetts. A broad-based public and private organization partnership with local and national funding created a steering committee to organize school administrators, community leaders, and a medical school to collaborate on five goals: advocate for changes in oral health policy, increase oral health care access, provide school-based dental services for underserved children, establish a Dental General Practice Residency, and educate medical professionals about oral health. A state legislative Oral Health Caucus helped secure sought-after policy improvements; more regional dentists now accept Medicaid; community health center capacity to provide dental services was expanded; school-based programs were designed and delivered needed dental services; a dental residency was created; and methods of educating medical professionals were established. Significant sustainable gains in oral health care access were created through our multifaceted approach, ongoing evaluation and communication, coordination of CMOHI partner resources, and collaboration with other involved parties.

The use of Goal Attainment Scaling in a community health promotion initiative with seniors.

BackgroundEvaluating collaborative community health promotion initiatives presents unique challenges, including engaging community members and other stakeholders in the evaluation process, and measuring the attainment of goals at the collective community level. Goal Attainment Scaling (GAS) is a versatile, under-utilized evaluation tool adaptable to a wide range of situations. GAS actively involves all partners in the evaluation process and has many benefits when used in community health settings.MethodsThe purpose of this paper is to describe the use of GAS as a potential means of measuring progress and outcomes in community health promotion and community development projects. GAS methodology was used in a local community of seniors (n = 2500; mean age = 76 ± 8.06 SD; 77% female, 23% male) to a) collaboratively set health promotion and community partnership goals and b) objectively measure the degree of achievement, over- or under-achievement of the established health promotion goals. Goal attainment was measured in a variety of areas including operationalizing a health promotion centre in a local mall, developing a sustainable mechanism for recruiting and training volunteers to operate the health promotion centre, and developing and implementing community health education programs. Goal attainment was evaluated at 3 monthly intervals for one year, then re-evaluated again at year 2.ResultsGAS was found to be a feasible and responsive method of measuring community health promotion and community development progress. All project goals were achieved at one year or sooner. The overall GAS score for the total health promotion project increased from 16.02 at baseline (sum of scale scores = -30, average scale score = -2) to 54.53 at one year (sum of scale scores = +4, average scale score = +0.27) showing project goals were achieved above the expected level. With GAS methodology an amalgamated score of 50 represents the achievement of goals at the expected level.ConclusionGAS provides a "participatory", flexible evaluation approach that involves community members, research partners and other stakeholders in the evaluation process. GAS was found to be "user-friendly" and readily understandable by seniors and other community partners not familiar with program evaluation.

Regional Osteoporosis Screening, Referral, and Monitoring Program in Community Pharmacies: Findings from Project ImPACT: Osteoporosis

(1) To identify patients at risk for osteoporosis through community pharmacy-based bone mineral density (BMD) screening, to refer at-risk patients to primary care and/or specialty practice physicians, and to follow-up with at-risk patients; (2) to treat and manage osteopenic and osteoporotic patients referred to the pharmacy for medication therapy management services; and (3) to test a payment methodology for pharmacists who deliver community health management services to a population at risk for or diagnosed with osteoporosis. Single-cohort observational study. Ukrop's Super Markets, Inc. Grocery and Pharmacy, a 29-store chain with 22 pharmacy locations in Richmond, Virginia. Consumers with one or more known risk factors for osteoporosis in Ukrop's customer service area. During the initial phase (health promotion and disease prevention) of the project, pharmacy-based osteoporosis screening with referral and follow-up was provided to consumers who responded to Ukrop's screening promotions. The second phase-provision of collaborative community health management services focused on osteoporosis monitoring and management--is ongoing and includes patients who are at risk for or diagnosed with osteoporosis and are covered by a regional payer. Results of screenings; responses of patients and physicians to notifications; and long-term results during collaborative care. The pharmacists screened 532 patients and were able to contact 305 of these patients for follow-up interviews 3 to 6 months later. The stratification for risk of fracture was 37%, high risk; 33%, moderate risk; and 30%, low risk. A total of 78% of patients indicated that they had no prior knowledge of their risk for future fracture. In the moderate- and high-risk categories, 37% of patients scheduled and completed a physician visit, 19% had a diagnostic scan, and 24% of those patients were initiated on osteoporosis therapy subsequent to the screening. Participating pharmacies received payment for both the osteoporosis screening and the collaborative health management services. Pharmacists can play a useful role in the identification, education, and referral of patients at risk for osteoporosis through pharmacy-based BMD screening. Patients are willing to pay for pharmacy-based osteoporosis screening services. Third-party payers are willing to compensate pharmacists for collaborative community health management services.

Leadership in Collaborative Community Health Partnerships

AbstractThis article examines key leadership issues in community health partnerships. We assert that leadership in a partnership is differentiated from that in a traditional, hierarchical organization in that participation is voluntary and egalitarian and often entails cooperation by organizations with different cultures and agendas. Partnership leaders, accordingly, often lack formal control over members and their actions. Using qualitative analysis of 115 site‐visit interviews of participants in four partnerships in the Community Care Networks demonstration program, we identify and discuss five themes of collaborative leadership: systems thinking, vision‐based leadership, collateral leadership, power sharing, and process‐based leadership. We then discuss the multiple challenges that collaborative leadership faces in a community health partnership.

Community health collaboration models for the 21st century.

The development of partnerships with physicians and other health professionals is a key strategy to improving the community's health. This article reviews the role of nurse leaders as advocates for health care improvement and leading community improvement efforts.

Health promotion in a museum: a collaborative community partnership.

A collaborative community health education project connecting a science and history museum and a university school of nursing is described. This highly successful partnership connected senior community health nursing students with public education programs of the museum that focused on human body functioning, health promotion, risk reduction, and disease prevention. This project serves as a model for various other educational partnerships, including programs in the sciences, arts, humanities, and history.