EXPLAINING RACIAL AND ETHNIC DISPARITIES IN ACCESS TO MEDICAL CARE

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Community-based Organizations Capacity to Plan,
Implement, and Evaluate Success

• Robert M. Mayberry, M.P.H., Ph.D.
• Chairman and CEO
• ?2 Health Research Consultants
• AcademyHealth
• June 9, 2008

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(No Transcript)
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What are the Objectives?

• improve access and quality of care.
• improve health status.
• prevent disease onset.
• insure fairness and justice.

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Reducing the Racial/Ethnic Disparities Framework?
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Improving Quality, Reducing Disparities
Sehgal JAMA 2003 289(8) 996-1000.
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Hypothetical Framework
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Social Support Intervention to Prevent Low
Weight Birth among African American Women
Birthweight Intervention Group
Control Group 2500 grams or more
50 (90.9) 45
(77.6) Less than 2500 grams 5 (9.1)
13 (22.4)

Fishers Exact Test (1-tail), P lt 0.05
Norbeck JS et al. Soc. Sci. Med.
199643(6)947-954.
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A Three-Level Approach to Promoting Community
Health
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Pfizer Southern HIV/AIDS Prevention Initiative

• A 3-year initiative (2004 to 2006) designed to
  address the growing epidemic of HIV/AIDS in the
  Southern region of the U.S., primarily among
  racially/ethnically diverse communities in urban
  and rural areas.
• Funds granted to small and mid-size
  community-based organizations (CBOs) supporting
  underserved multi-cultural communities in nine
  southern states AL, FL, GA, LA, MS, NC, SC, TN,
  TX.
• Partnership with Morehouse School of Medicine
  Prevention Research Center (MSM PRC) to
  strengthen the evaluation capacity of Initiative
  CBOs.

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Characteristics of CBOs of the Pfizer Foundation
Southern HIV/AIDS Prevention Initiative
Organizational Characteristic (Per Question Posed) Participant Responses (N 39)
Yes
Do you have community volunteers? 89.7 (35)
Does your project have an established advisory committee? 59 (23)
Have you identified all appropriate resources needed to implement proposed activities? 61.5 (24)

Community Partnerships Community Partnerships
Churches 53.8 (21)
Community-based Organizations 84.6 (33)
Colleges and Universities 56.4 (22)
Local Clinics, Hospitals/Health Departments 69.2 (27)
No Community Partnerships Exist 2.6 (1)
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Survey Responses of Program Staff Regarding the
Technical Assistance Needs of Community-Based
Organizations
Technical Assistance Needs Yes Reponses (n39)
Logic Model Development 48.7
Data Management 48.7
Data Collection Tool Development 61.5
Protocol Development 53.8
Qualitative/Quantitative Methods 64.1
Evaluation Development 84.6
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Cross-site Program Assessment Survey (C-PAS)
Knowledge Level for Steps in Community Program
Development
Item mean score on a Likert scale of 0 (none) to
4 (extensive).
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Cross-site Program Assessment Survey (C-PAS)
Skills Level for Steps in Community Program
Development
Item mean score on a Likert scale of 0 (none) to
4 (extensive).
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Cross-site Program Assessment Survey (C-PAS)
Summary Scores of Organizational Skills,
Knowledge, and Abilities
C-PAS Administrations Skills Median (IQR) Knowledge Median (IQR) Abilities Mean (SD)
1st (n 39) 2.83 (0.67) 2.83 (1.33) 3.88 (0.42)
2nd (n 36) 3.00 (0.75) 3.00 (0.66) 4.07 (0.45)
3rd (n 41) 3.16 (0.83) 3.17 (0.34) 4.21 (0.46)
Skills and knowledge based on a Likert scale of
0 (none) to 4 (extensive) summary score of six
items. Abilities based on Likert score of 1
(low) to 5 (high) summary score of 20 items. IQR
interquartile range. SD standard deviation.
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Pfizer InitiativePrivate-Academic-Community
Partnership

• Initiative CBOs
• Community-based Programs and Partners
• Innovative Approaches to Health Promotion
  and Prevention

• Pfizer Foundation
• Fiscal Resources
• Organizational Will

• MSM PRC
• Evaluation Expertise
• Cultural Competence

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Evaluation Capacity BuildingRecommended
Approaches

• Conduct Systematic Needs Assessment
• Adopt Practical Hands-on Learning Opportunities
• Employ Quantitative and Qualitative Methods
• Facilitate On-Going TA
• Provide Opportunities to Share Evidence-based
  Practice

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Pfizer InitiativePrivate-Academic-Community
Partnership

• Critical partnership processes included
• Cooperative Decision-making
• Systematic Communication Strategies
• Navigation of Unique Needs of Each Collaborative
  Partner.