Community Health Coalitions Research Articles

270 Four Pillars of Community Health and Research Engagement: The UT Southwestern CTSA Program’s Innovative Approach to Putting the Community Health Science Model into Practice

OBJECTIVES/GOALS: Goals: Engage in collaborative approaches that target health disparities, especially among communities experiencing poverty or ethnic/racial minorities. Develop and sustain effective community-academic partnerships that foster trust through bidirectional communication and shared leadership leading to improved translational research. METHODS/STUDY POPULATION: The Community Health Science model was developed at UTSW over the past 20 years in efforts to integrate practices across 3 component areas – clinical practice, population health, and community organizations – into a single collaborative effort to improve health and reduce disparities. As part of the CTSA Program’s translational science efforts, we have extended this model to promote community engagement in research as an additional strategy needed to achieve health equity. Our Office of Community Health & Research Engagement operates 9 programs that each fit within one or more of 4 overarching conceptual pillars - Education/Resources, Collaboration/Partnership, Outreach/Service, Priorities/Perspectives - serving to bridge the community-academic divide and build strong, trusting relationships. RESULTS/ANTICIPATED RESULTS: The implementation of our model has resulted in measurable outcomes. To date, we have hosted 23 HealthStreet community events resulting in 464 health screenings, 203 health needs assessments completed, and 123 individuals joining our Community Research Registry allowing for future contact to participate in research. Our Community Health Coalition, comprised of 32 organizations, provides a forum for co-learning between researchers and stakeholders. We have awarded 9 grants ($175,800) for community-engaged projects. Our Community Advisory Panel has participated in 8 sessions with research teams. A total of 13 projects utilized the Spanish Language Resource, for a total of 30,617 translated words. Finally, we have hosted 9 Community Engagement Grand Rounds lectures, which included a total of 559 attendees. DISCUSSION/SIGNIFICANCE: Our model strengthens our capacity to build trust with communities and facilitate sustained community-academic partnerships. By prioritizing community engagement in research, we improve health equity by understanding community perspectives and increasing diversity in trials. We hope our model can be disseminated and scaled for greater impact.

How COVID-19 Impacted Community Health Coalition Functioning and Strategies Used to Adapt

Background/Objective: Community health coalitions are important resources for positively impacting health. Recent research analyzed how COVID-19 affected health coalition operations. This literature review examined both gray and peer reviewed literature to investigate the effect.
 Methods: A manual search of the Association for Clinical and Translational Science’s (ACTS) – Journal of Clinical and Translational Science (JCTS) 2022 Abstract Supplemental Volume 6 – Issue – s1 and the American Public Health Association’s (APHA) 2021 Poster Session – PS1042.0 School Health & Wellness: Promoting School Health through Innovative Programs and Partnerships was performed. Additionally, the Journal of the American Medical Association (JAMA), PubMed, and OVID databases were searched for relevant articles. In total, 3393 articles were provided by the search strategy and 114 remained after removal of the duplicates, title, and abstract screening. After full-text examination, 52 were included for analysis.
 Results: Of the 52 articles analyzed, 19 discussed pausing in-person coalition activities, 7 discussed member commitment or enthusiasm, 6 indicated decreased funding, 4 indicated a change in meeting frequency, and 1 indicated decreased attendance. Additionally, 42 articles mentioned incorporating technologies to communicate virtually. The three most common virtual communication methods were phone [voice call] (22), email (19), and unspecified (18). Twenty-three articles indicated new or existing health coalition partnerships were leveraged to rapidly establish trust with communities.
 Conclusions: Incorporating virtual communication technologies was commonly used to avoid communication disruptions during the pandemic, but the variable impacts should be considered in future public health crises. Furthermore, the study determined a viable option to rapidly establish trust with new communities may be leveraging existing−or creating new−partnerships with organizations that have long-standing ties with target communities.
 Impact and Implications: This paper serves as a resource for possible strategies that health coalitions can incorporate into their operations to potentially improve resilience in public health crises until additional research is conducted.

Qualitative Exploration of Cultural Influence on a Rural Health-Promotion Initiative

ObjectiveTo develop a conceptualization of cultural influence on perceptions of a rural food and physical activity policy, systems, and environmental (PSE) change project to inform public health research and practice. DesignBasic qualitative research design, semistructured phone interviews with community health coalition members. SettingFive rural Southern counties (obesity prevalence > 40%). ParticipantsThirty-nine community coalition members. InterventionThe Centers for Disease Control and Prevention High Obesity Program. PSE initiatives to increase access to healthy food and physical activity opportunities through a community coalition model. Phenomenon of InterestSocial norms and cultural influences surrounding community members’ food preferences, physical activity behavior, and future hopes for community development. AnalysisAbductive content analysis. ResultsMajor categories on food social norms (subcategories: physical health, eating habits, and food preference), race relations, generational factors, physical activity social norms, and hopes for the community (subcategories: increased engagement, health, awareness, cohesion, and inspiration) were discussed in relation to the progress of PSE initiatives. Conclusions and ImplicationsBecause of community member perceptions, PSE initiatives became associated with factors beyond food and fitness, such as race relations, generational differences, and community cohesion. A focus on increased youth and church involvement, community values, relationship building, and input from diverse voices can be foundational to culturally-appropriate PSE efforts in rural settings.

Impact of COVID-19 on a Community Health Coalition and Its Residents in Allegheny County, Pennsylvania: Insights Into Adaptation From Focus Groups and Evaluation Reports.

Live Well Allegheny: Lifting Wellness for African Americans (LWA2) is a coalition in Allegheny County, Pennsylvania, funded by the Centers for Disease Control and Prevention's (CDC) Racial and Ethnic Approaches to Community Health (REACH) initiative. LWA2 consists of partner organizations addressing chronic disease prevention in six Black communities through nutrition, physical activity, and community-clinical linkage strategies. This analysis focuses on qualitative data exploring the influence of COVID-19 on coalition functioning and communities. We conducted focus groups with residents in REACH communities and collected evaluation reports from partner organizations. Three focus groups assessed awareness of and participation in the REACH initiative, feedback, and the impact of COVID-19 when applicable. An additional focus group included questions related to flu vaccine messaging and the COVID-19 vaccine. These data sources provided insight regarding how COVID-19 affected planned tasks. Evaluation team members analyzed focus groups and collated summaries as part of a larger comprehensive evaluation. Partner organizations experienced an increase in food stamp applications, delays in opening farmers' markets, a shift to virtual preventive health programs, canceled in-person events, and programmatic interruptions that shifted long-term goals. Community resident concerns included difficulty accessing public transportation, decreased physical activity, fear of in-person interactions, and increased wait times for mental health services. Coalition members developed methods to continue functioning and sustaining program activities. Residents were able to engage differently with chronic illness prevention techniques. Reports from the ongoing analysis will be used to adapt coalition functioning.

The Immokalee Community Health Coalition: Operationalizing Trust.

The COVID-19 pandemic disproportionately affected migrant farmworker communities in the United States in case rates and deaths. In rural Immokalee, Florida, human rights, health care, and social support organizations with different strengths joined together to form a coalition that provided health information, tests, vaccines, and social supports. This report offers practical advice on how similar coalitions can overcome barriers to care, improve outcomes, and overall increase trust in the health system.

Assessing Community-Based Public Health Plans: An Example From US Army Injury Prevention.

The US Army requires community health coalitions to develop action plans for their top public health priorities. To date, the US Army has not implemented a standardized review process for community action plans. This project used the Plan Quality Index (PQI), an evidence-based, standardized tool, to evaluate injury prevention action plans created by injury prevention teams (IPTs). 17 Army installations. 17 IPT leads; 5 Health Promotion Program Officers. Implementation of the PQI to evaluate the strength of injury prevention action plans and make recommendations for quality improvement to drive reductions in injuries at 17 Army installations. PQI total scores for high- (≥50 points on the PQI) and low-ranking plans (<50 points on the PQI) were assessed for differences using t tests of the mean PQI score. Chi-square tests were employed to identify differences in meeting criteria between high- and low-scoring plans. PQI total scores ranged from 9 to 78 points out of 80. The weakest planning elements among all plans were lack of use of SMART objectives (18%), lack of identification of responsible parties (18%), absent evaluation plan (24%), and lack of timelines (35%). The mean score for the high-ranking plans (64.6 ± 9.5) was significantly higher than the mean score for the low-ranking plans (26.2 ± 12.7) ( P < .001). Mean scores for clarity, effectiveness, and quality were all significantly higher for the high-ranking plans than for the low-ranking plans ( P = .014, P = .002, and P < .001, respectively). The PQI tool provides a framework for objective, standardized, and evidence-based feedback and recommendations for improving community health plans. The project identified examples of high-quality action plans and provided actionable recommendations for plan improvement to facilitate sustainability of initiatives addressing injuries, which have long posed a threat to military health and readiness.

125 Galveston County Youth Risk Survey: A Glimpse into Our Children’s Health and Wellbeing

OBJECTIVES/GOALS: The 2020-2021 Galveston County Youth Risk Survey continues past efforts to characterize behavioral risks for local youth, identify disproportionate risks among groups, and provide the data needed for action and intervention to improve the health and safety of our youth in Galveston, Texas. METHODS/STUDY POPULATION: While the survey is based on the CDC Youth Risk Behavior Surveillance System (YRBSS), there was community need for an expanded survey and thus a workgroup was formed to create the Galveston Youth Risk Survey, including members from UTMBs Institute for Translational Sciences, a number of other UTMB departments and Centers, the Research, Education, and Community Health (REACH) Coalition, several school districts, Teen Health Clinic, and a variety of other community health organizations with vested interest. The survey was administered in November 2020 via ScanTron and REDCap to two local high schools with populations greater than 2,000. CDC guidelines for administration of the YRBSS were followed. RESULTS/ANTICIPATED RESULTS: A total of 2,428 students completed the survey from GISD and DISD. The survey provided insight into the following categories, with mental health emerging as a pressing issue, specifically stress and depression, particularly among females. All results are reported in several contexts, including comparisons by gender, grade, and ethnicity, a comparison to state and national statistics when available, as well as risk trends from previous surveys. Demographics Safety, including driving, violence, and bullying Mental Health: stress, depression, suicidal ideation, and ACEs Human Trafficking Substance Use, including smoking, alcohol, marijuana, and other drug use Sexual Behaviors, including contraceptive use Body Weight and Body Image Health Conditions Home Life: Support and Security DISCUSSION/SIGNIFICANCE: The report has been presented to the school districts, immediate stakeholders, REACH membership, and the general public. Several presentations have been given to groups to report the findings. Workgroups will now be formed to address the needs of our students, as well as a possible follow-up survey to look at data specific to COVID-19 and mental health.

Assessment of Action Plans as a Guide for Equity-Focused Coalition Work.

Collaborative capacity within coalitions is required to promote healthy communities and create systemic change. The purpose of this study was to evaluate the quality of three Tobacco Prevention and Control Coalitions' action plans for their likely ability to address health equity through tobacco cessation efforts. To do this, the Butterfoss State Plan Index was adapted for relevance to community-oriented coalitions, with a focus on health disparities and tobacco control. This study compares three tobacco control coalitions in Texas to quantify their efforts on addressing health disparities through a standardized measurement process. The results of this assessment indicate that there are gaps in existing coalition assessment tools, and action plan norms and requirements, specifically as it pertains to addressing health disparities in a systematic way. Through a systematic analysis of coalition action plans and supporting documents, it is clear that there is a need for more standard inclusion of disparities-focused work within action plans. Community health researchers, coalition members, and coalition funders should consider action plans to be living, iterative documents that are subject to adjustments. Systems-thinking perspective should be used to develop action plans adapted to environmental, community, policy, and other changes. Lessons learned from this study can provide an example of how to incorporate strategies for reducing health disparities within coalition action planning.

The Impact of Community Health Coalitions On Preventative Health Outcomes: A Systematic Review

Background/Objective: Six out of ten deaths in the United States are caused by chronic diseases. There are multiple approaches to prevention and/or early detection of chronic diseases through screenings, nutrition, physical activity, and more. Unfortunately, a large portion of the US population have low rates of preventative care. Community health coalitions have the potential to improve preventative health outcomes by partnering with key members of communities to design programs that best fit community needs. In this systematic review, we examine evidence that community health coalitions can improve preventative health outcomes.&#x0D; Methods: PubMed, WebofScience, CINAHL, and PsycINFO were searched for (outcome OR health outcome) AND (prevention) AND (diabetes OR hypertension OR cancer OR prenatal) AND (community-based participatory research OR community coalition OR coalition OR health coalition). After screening 490 articles, 30 full-text, peer-reviewed, English articles meeting inclusion criteria of health coalition, prevention, health outcomes reported, and conducted in the United States were reviewed.&#x0D; Results: 27 of the 30 studies showed community health coalitions having a positive impact. Roughly half of the articles were randomized control trials. Community members and academia were represented in 80% and 77%, respectively, of the coalitions described, while other representations included faith-based organizations, health care, public health, industry, and education. Diabetes and cancer represented 74% of the targeted preventions addressed. 90% of the interventions focused on educating the community, and 33% focused on increasing health screening rates. 60% utilized trained community members to deliver interventions. 60% reported health measurements, 33% reported screening rates, and 30% reported knowledge and awareness.&#x0D; Conclusion, Impact, &amp; Implications: While the evidence suggests community health coalitions are effective in improving preventative health outcomes, the quality of the studies remain low. There is a need for increased rigor of study design and assessment in order to determine the true efficacy of community health coalitions. The majority of the randomized-control trials in this review were rated as low-quality, highlighting the difficulty of designing a randomized, controlled study in a community. Inadequate funding, lack of rigorous design, or ethical challenges can limit the quality of the assessment. Further, although prenatal care was included as a search term, there were no coalitions found that addressed this type of preventative care. This points to a future need for the creation of or increased publications from prenatal health coalitions.

Are Community Coalitions a Better Mechanism to Advance Health Equity? A Narrative Review

Background/Objective: Despite increasing emphasis on health equity in policy, leadership, and program development, meaningful advancement in health equity remains a challenge. A comprehensive review of community health coalition efforts to improve health equity has not been conducted. In this narrative review, we examine what evidence exists that community health coalitions can advance health equity, and whether coalitions are a preferred approach to address health equity.&#x0D; Methods: PubMed, CINAHL, PsycINFO, and Web of Science were searched for peer-reviewed, English articles with no date restrictions. In total, 1256 records were screened, of which 1163 were excluded for duplicate publications, no coalition or coalition-based intervention, no relevant outcomes, no emphasis on health equity or disparities, not primary literature, or unavailable full text. The remaining 93 articles are presented as a table of interventions based on outcomes. Further, evaluations of coalition effectiveness with controls are reviewed.&#x0D; Results: Populations of interest were racial and ethnic minorities, women and girls, low socioeconomic status communities, rural and urban areas, older adults, and LGBTQ groups. The most commonly reported results were changes in health outcomes or behaviors and community or organizational policy. Few studies were randomized, double-blinded, or controlled trials. This is not unexpected given the difficult nature of evaluating community interventions. Very few studies evaluated the effectiveness of a coalition-based intervention as compared to organizational interventions.&#x0D; Conclusion, Impact, &amp; Implications: Available literature suggests that health coalitions influence health outcomes, policies, and important social determinants of health in populations affected by health inequity. However, community intervention studies pose a unique challenge for high quality evaluation. While health coalitions have a positive influence on health equity, more research is needed to determine the advantages of health coalition interventions versus organizational interventions.

We’re in This Together: Community Coalition Approaches to Treating Depression

Background and Objective: Depression is the leading cause of disability worldwide, yet approximately one-third of adults diagnosed with major depressive disorder do not receive treatment. Health coalitions are one strategy towards addressing this issue through collaborative, multi-sector interventions implemented within community organizations. In this narrative review, we examine what evidence exists that coalitions may improve outcomes of depression. &#x0D; &#x0D; Methods: A search for peer-reviewed literature was conducted using PubMed, CINHAL, MEDLINE, and PsychINFO databases. The search was limited to studies published in the English language. No limitations were placed on location or date of publication. Initial search produced a total of 236 articles. Of these, 34 met inclusion criteria. Papers that did not address depression interventions in the context of community health coalitions were excluded. &#x0D; &#x0D; Results: Community Partners in Care, a double-blinded randomized control trial, is the primary model in literature that describes outcomes of coalitions in addressing depression. 6-month outcomes revealed that participants treated through a coalition model (n=504) as opposed to those in a non-coalition approach (n=512) had significantly improved self-reported mental health related quality of life and a reduced number of behavioral health hospitalizations. 3-year and 4-year outcomes revealed participants in the coalition model had increased odds of clinical depression remission. While many other studies documented coalition-based interventions, there was little to no report of treatment effectiveness. &#x0D; &#x0D; Project Impact: Current literature suggests that coalitions may be an effective method of addressing depression, particularly in under-resourced areas where community members are more likely to access care through social services. In addition, churches and schools were identified as key partners for coalitions, as trusted informal networks for mental health support. While results support coalition utility for mental health intervention, more research is needed to determine what, if any, unique attributes of coalitions are necessary to insure effective mental health interventions.

82003 Network Evaluation of a Community-Campus Partnership: Applying a Systems Science Lens to Evaluating Collaboration and Translation

ABSTRACT IMPACT: Using network analysis and a systems science lens, UTMB’s Institute for Translational Sciences is able to quantify the evolution of REACH (its Community-Campus Partnership) as measured by the creation of new partnerships among member entities, promoting the translation and sharing of ideas and resources, and formalization of relationships among members. OBJECTIVES/GOALS: o Present how network analysis and systems science can inform evaluation of community-campus partnerships o Describe results from our experience with evaluating the REACH coalition o Summarize lessons-learned and likely improvements we are considering for our methodology METHODS/STUDY POPULATION: In 2016, we administered a network survey to core members of the Research, Education, and Community Health (REACH) coalition. The survey captured attributes about each organization, including size, populations served, etc. The survey also captured data on the relationships among these organizations, including joint meeting attendance, joint event planning, shared tangible resources, shared information, and formal legal agreements between organizations. These data were analyzed using network analysis methods. The survey was again repeated in 2018, and comparisons were made to evaluate how the network structure had evolved from 2016 to 2018. RESULTS/ANTICIPATED RESULTS: Joint meeting attendance was high in both 2016 and 2018; however, there was evidence of increased sharing of information and tangible resources in 2018. We also observed an increase in joint event planning among partnering agencies. Most strikingly, we observed that the number of formalized agreements (in the form of Memoranda of Understanding or more formalized contracts) between agencies more than doubled between 2016 and 2018. By measuring the evolution of our network of partners, we are able to document the evolution of a community-campus partnership over time. DISCUSSION/SIGNIFICANCE OF FINDINGS: Over the course of 2 years, the coalition signaled an increase in deeper collaborations beyond simply meeting together. The use of network analysis demonstrated utility and provided another dimension for evaluating the development of teams, partnerships, and coalitions.

The Usability of the Plan Quality Index to Support Evaluation of Community Health Action Plans.

The U.S. Army requires community health coalitions to develop targeted action plans in order to more effectively address top public health priorities. Reviews of community action plans indicate that they are often poorly developed and not fully implemented. To date, the U.S. Army has not implemented a standardized tool or process to evaluate action plans and provide recommendations for improvement to local installations. The Plan Quality Index (PQI) is an evidence-based, standardized tool that has been used successfully by technical experts to review and improve community action plans related to the prevention of obesity, injury and violence, and cancer. The objective of this project was to determine the usability of the PQI and to provide recommendations for improving community health action plans focused on injury prevention for the U.S. Army. Five Health Promotion Project Officers and one Health Promotion Project Assistant at Army Public Health Center were trained on the PQI and reviewed injury prevention action plans for 17 installations. After using the PQI to assess injury prevention action plans, the individuals were given a System Usability Scale (SUS) survey to assess the usability of the PQI. Results of the SUS survey can range from 0 to 100, but do not represent percentages. A score of 65 indicates "greater than average" usability. Participant scores on the SUS demonstrated that the PQI has a high degree of usability. Mean usability was calculated at 83.3 (range 72.5-97.5, median 85, sd +/- 9.3). The PQI demonstrated a high level of usability by technical experts for providing feedback and recommendations regarding community health action plans for injury prevention in the U.S. Army. As a result, the PQI may be beneficial as a standard tool for community health improvement planning and consultation throughout the Army Public Health Center.

4034 Can Connections IN Health become a research-based model to improve health outcomes through community health coalitions?

OBJECTIVES/GOALS: Connections IN Health’s goal is to coordinate, integrate, and enrich health coalition work through extended connections among community and academic stakeholders within and across coalitions and geographies within Indiana. We aim to evaluate stakeholder connections to assess coalition effectiveness and the quality of partnership networks. METHODS/STUDY POPULATION: We will collect data longitudinally to evaluate Connections IN Health using a unique triangulation of effectiveness surveys, social network analysis, and health data. Cross-sectional functioning and social network analysis surveys were distributed to coalition members before the transition to Connections IN Health engagement (baseline) and will be distributed again each year thereafter to identify changes in coalition perceived effectiveness and changes in the structure/nature of partnership networks after implementation of the partnership. We plan to utilize publicly available health data to measure proximal changes in health outcomes at the neighborhood level and use Pearson’s correlations to check for associations between perceived coalition effectiveness and health outcomes. RESULTS/ANTICIPATED RESULTS: We found low baseline scores in perceived effectiveness, especially in the areas of leadership, operational understanding, and satisfaction, from the coalition members. From our social network analysis, we found relatively low cohesion scores (measured as network density) among each of the coalition networks, and even lower scores for collaboration among coalition members. We expect to see positive increases in perceived coalition effectiveness, as well as an increase in the density and level of collaboration among coalition networks as Connections IN Health develops. Finally, we expect to see positive changes in proximal health outcomes associated with our measures of coalition effectiveness. DISCUSSION/SIGNIFICANCE OF IMPACT: The results of our project will be distributed back to the coalition leaders and members in order to sustain and improve the coalitions. The visualization of the coalition member’s network can be used to demonstrate opportunities for enhanced partnerships and collaboration.

Scaling Community Health Coalitions: The Well Connected Communities Pilot Initiative

We outline the process and development of the Well Connected Communities health initiative as undertaken in three Utah communities. This transformative community-focused alternative to addressing public health issues through Extension situates local communities as the origin for health decision making. The initiative recognizes the need for varied community statuses (i.e., planner, implementer, and innovator) based on varying levels of readiness and diversity of populations. We concluded that the Utah Well Connected Communities initiative aligns well with the 2014 Extension Committee on Organization and Policy National Framework for Health and Wellness. Replication requirements and implications for other Extension programs are presented.

The Policy and Practice Legacy of the New Jersey Medicaid ACO Demonstration Project.

The New Jersey Medicaid Accountable Care Organization (ACO) Demonstration was created with a unique combination of features regarding ACO geography, involvement of managed care organizations (MCOs), and shared savings parameters. Ultimately, the Demonstration did not lead to a sustainable accountable care financing model and shared savings were deemphasized. Instead, the ACOs evolved into community health coalitions focused on coordinating and enhancing a wide range of activities in partnership with state government, private health systems, community leaders, and MCOs. Currently, the state is developing policy parameters to reposition the ACOs as regional partners to implement state-directed population health initiatives.

NACCHO's Follow-up Assessment of Disability Inclusion Within Local Health Departments.

NACCHO's Follow-up Assessment of Disability Inclusion Within Local Health Departments.

A mixed-methods evaluation using effectiveness perception surveys, social network analysis, and county-level health statistics: A pilot study of eight rural Indiana community health coalitions

Community health coalitions (CHCs) are a promising approach for addressing disparities in rural health statistics. However, their effectiveness has been variable, and evaluation methods have been insufficient and inconsistent. Thus, we propose a mixed-methods evaluation framework and discuss pilot study findings. CHCs in our pilot study partnered with Purdue Extension. Extension links communities and land grant universities, providing programming and support for community-engaged research. We conducted social network analysis and effectiveness perception surveys in CHCs in 8 rural Indiana counties during summer 2017 and accessed county-level health statistics from 2015-16. We compared calculated variables (i.e., effectiveness survey k-means clusters, network measures, health status/outcomes) using Pearson’s correlations. CHC members’ positive perceptions of their leadership and functioning correlated with interconnectedness in their partnership networks, while more centralized partnership networks correlated with CHC members reporting problems in their coalitions. CHCs with highly rated leadership and functioning developed in counties with poor infant/maternal health and opioid outcomes. Likewise, CHCs reporting fewer problems for participation developed in counties with poor infant/maternal health, poor opioid outcomes, and more people without healthcare coverage. This pilot study provides a framework for iterative CHC evaluation. As the evidence grows, we will make recommendations for best practices that optimize CHC partnerships to improve local health in rural areas.

P38 - Obesity-Related Health Statistics Correlate More Strongly to Coalition Network Indices than Typical Effectiveness Evaluations

Background (Background, Rationale, Prior Research, and/or Theory): Community health coalitions (CHCs) aim to improve local food/physical activity environments. Traditional CHCs evalutions measure perceived effectiveness, failing to quantify network structures or health outcomes. Thus, we applied a mixed-methods evalution; triangulating the Coalition Self-Assessment Survey (CSAS), social network analysis (SNA), and obesity-related county-level health statistics (ObCLHS). Objective: To improve CHCs evalution by exploring relationships between network structures, perceived effectiveness, and obesity-related social-behavioral factors. Study Design, Setting, Participants, Intervention: We administered CSAS and SNA in eight rural CHCs during summer 2017 and accessed the latest available (2015-16) ObCLHS. We conducted factor analysis on CSAS responses and compared ObCLHS, SNA, and CSAS factors using Pearson's correlations. Outcome Measures and Analysis: ObCLHS included adult BMI (aBMI), daily sugar-sweetened soda intake (Soda), daily sugar-sweetened beverage intake excluding soda (SSB), no physical activity in 30 days (noPA), and food insecurity (FoodIns). We conducted SNA on CHCs partnership, trust, and communication networks using the following indices: density (number of actual connections/all possible), eigenvector centralization (presence of a network broker), mean indegree (average number of connections members hold), indegree centralization (whether there is a central person). CSAS factors loaded on leadership, operating norms, actionable outcomes, personal problems for participation (PPP), and lack of common goals (LCG). Results: ObCLHS correlations to SNA: FoodIns negatively correlated to partnership, trust, and communication network density; Soda, aBMI, and noPA positively correlated to partnership, trust, and communication network indegree centralization; SSB and FoodIns negatively correlated to partnership, trust, and communication network mean indegree. ObCLHS correlations to CSAS: Soda negatively correlated to PPP; FoodIns positively correlated to leadership and negatively correlated to LCG. Conclusions and Implications: To assess CHCs impact on health, evalution should include SNA. ObCLHS were more strongly correlated (greater number of and consistently higher correlations) to SNA indices of CHCs than typical effectiveness evalution surveys. We are pursuing statewide evalutions, longitudinally, to clarify trajectories and validate this model for effective and sustainable CHCs. Funding: None.

Collaboration Challenges and Opportunities: A Survey of School Foodservice Directors and Community Health Coalition Members.

The Healthy, Huger-Free Kids Act (HHFKA) presents challenges for foodservice directors (FSDs) in sourcing and preparing foods that meet nutrition standards. Concurrently, community health coalition members (CHCs) are engaging schools through community and school nutrition initiatives. We hypothesized significant differences in perceptions between FSDs and CHCs related to implementation of HHFKA such that FSDs would perceive greater foodservice challenges, while CHCs would be more supportive of community nutrition initiatives. A perceptions survey was administered by email to 528 FSDs and 334 CHCs during summer 2016. Experience, education level, urban/rural differences, school demographics, and involvement between FSDs and CHCs were compared. Overall, 132 FSDs and 80 CHCs responded (29.5% FSDs, 24.7% CHCs). Overall perception of HHFKA foodservice challenge ranged between neutral (eg, neither challenging nor unchallenging) to somewhat challenging, and did not differ between groups. CHCs were significantly more supportive of community nutrition initiatives, while FSDs responded neutrally. FSDs awareness of CHCs desire for collaboration may increase FSDs support for broader school nutrition initiatives such as school gardens, farm to school, and student/community engagement. There is great potential for integrating student and community health programs through partnerships.