Title: Evaluating Community Capacity Building Using a Participatory Partnership Approach: Lessons From a Co
1Evaluating Community Capacity Building Using a
Participatory Partnership Approach Lessons From
a Collaboration with Rural Latino Communities
- Karen E. Peters, DrPH, Benjamin C. Mueller, MS
- Marcela Garces, MD MSPH, Sergio Cristancho, PhD
- Illinois Prevention Research Center
- School of Pubic Health
- National Center for Rural Health Professions
- College of MedicineRockford
- University of Illinois at Chicago
2Overview
- Background
- Hispanic Health Disparities
- Partnership and CBPAR Approaches
- Evaluation of Capacity Building Efforts
- Partnership profile
- Involvement
- Levels of satisfaction / dissatisfaction
- Dissemination of information
- Community impact and outcomes
- Strengths
- Barriers
- Lessons learned
- Plans for the future
3Hispanics in Illinois
- 1,530,262 Hispanics in Illinois (12.3)
- 1,253,670 Spanish speakers
- 74.8 Mexican
- 11.7 Caribbean
- 2.6 Central American
- 2.5 South American
- 8.4 Other
- 121.5 is the growth rate of Hispanics in
Illinois between 1990-2000
4Health Disparities in Illinois Behavioral Risk
Factors/Diseases/ Conditions
- Hispanics less likely to have had cholesterol
checked within last five years (50) compared to
White (75) or African American (70) - Hispanics less likely to participate in physical
activities in past month (59) compared to White
(77) or African American (70) - Hispanics more likely to be current smokers (21)
compared to White (20) or African American
(16) - Hispanics less likely to have been told to have
diabetes by physician (6.5) compared to White
(6.8) or African American (16.2) - Hispanics less likely to have been told to have
high blood pressure by physician (14) compared
to White (26) or African American (36) - Source Centers for Disease Control and
Prevention (CDC). Behavioral Risk Factor
Surveillance System Survey Data. Atlanta,
Georgia U.S. Department of Health and Human
Services, Centers for Disease Control and
Prevention, 2005
5Community Based Participatory Action Research
(CBPAR)
- PAR
- Commitment to social transformation
- Origins in Latin America
- Focus on oppressed and underserved populations
- CBPR
- Commitment to evidence-based scientific rigor
- Emphasis on diverse partnership building
- Requires resource sharing between academic and
community partners - Grounding in ecological model of health
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7Some Benefits of Participatory Research in
Practice-Based Evidence
- Results are relevant to interests, circumstances,
and needs of those who would apply them - Results are more immediately actionable in local
situations for people and/or practitioners - Helps to reframe issues from health behavior of
individuals to encompass system and structural
issues. - Generalizable findings more credible to people,
practitioners and policy makers elsewhere because
they were generated in partnership with people
like themselves - Green LW, Mercer SL.. Am J Public Health Dec.
2001
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9An Iterative Approach Stages within Phases
- Each Phase (Partnership Formation, Assessment,
Implementation, Evaluation, Dissemination)
includes the following Stages - Exploration
- Approach
- Reflection
- Communication
- Additional Key Ingredients (generally in Approach
Stage) - Technical Assistance (Academic partner oriented)
- Capacity Building (Community partner oriented)
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12How to use the CBPAR Methods in Partnership
Formation Phase
- Stages
- Exploration
- Approach
- Reflection
- Communication
13Partnership Formation Phase1. Exploration Stage
Assess communities for potential partnership
opportunities
- Develop community profiles to determine which
communities have significant growth in Hispanic
immigrants - Identify potential champion organization (e.g.
University of Illinois Extension) to coordinate
committee formation - Organize initial meetings with Extension County
Directors and other potential advocate
organizations
14Partnership Formation Phase2. Approach Stage
Present case for CBPAR method and cost/benefit of
participation in Hispanic Health Advisory
Committees
- Develop presentation of the Hispanic health
profiles - Explain the philosophy of CBPAR
- Develop ownership in the project
- Clearly outline and negotiate with the community
agreed upon roles and responsibilities
15Partnership Formation Phase2. Approach Stage
Technical Assistance
- Assist committee in determining
relevance/feasibility of conducting health
disparity research with focus on Hispanic
residents - Encourage committee to identify potential
partnership organizations - Help in recruitment/involvement of Hispanic
community leaders/advocates
16Partnership Formation Phase2. Approach Stage
Capacity Building
- Dialogue with committee members about the stages
of CBPAR - Discuss Hispanic cultural competency issues
- Introduce the basic fundamentals of community
research (e.g. IRB issues, community assessment
approaches, research terminology) - Develop plans for dissemination to maintain
involvement of committee members and inform
stakeholders/larger community about the project.
17Partnership Formation Phase3. Reflection Stage
Strengthen organizational leadership development
of committee
- Improve the participation of all the committee
members in decision making - Develop a sense of ownership with committee
members sharing responsibilities - Create an environment of cooperation and trust by
honoring the principles of diversity friendly
communities
18Partnership Formation Phase4. Communication
Stage Use local media to build and strengthen
partnership
- Develop communication strategies that are
appropriate and appealing to the target audiences
- Use press releases, informational breakfasts etc.
to engage community stakeholders and formal
leaders - Recruit when possible local media representatives
into the partnership
19Results Partnership Formation Phase -
Communities Involved
- Beardstown
- Belvidere
- Carbondale / Cobden
- Champaign / Urbana
- Danville
- DeKalb / Sycamore
- Effingham
- Galesburg
- Monmouth
- Rochelle
- Rockford
20Results Partnership Formation Phase - Hispanic
Health Advisory Committees
- Formed and supported 11 Hispanic Health Advisory
Committees (HHAC) in 14 IL communities - Stakeholders involved
- Community Hospitals
- State/County Gov Org
- School Districts
- Higher Education Org
- Community Foundations
- Hispanic CBOs
- FBOs
- Non-Hispanic CBOs
- City Officials
- Social Service Org
- State Legislator
- Private Healthcare Providers
- Private Clinics)
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23How to use the CBPAR Methods in Assessment Phase
- Stages
- Exploration
- Approach
- Reflection
- Communication
24Assessment Phase1. Exploration Stage Define
data needs and appropriate research questions
- Examine existing data (epidemiological,
behavioral, archival, ethnographic, etc) and
identify data needs - Develop exploratory research questions in
collaboration with the partnerships - What?
- How?
25Assessment Phase2. Approach Stage Define
appropriate research tools and procedures
- Define the target group(s) for the assessment
- Identify appropriate quantitative, qualitative or
(ideally) mixed methods of data collection - Survey
- Focus groups
- Community small group discussions
- Interviews
- Additional epidemiological data?
- Data triangulation
26Assessment Phase2. Approach Stage Technical
Assistance
- Design of reliable and culturally-appropriate
methods of data collection - Seek IRB approval
- Support in data entry and analyses
- Development of survey and/or focus group reports
for the committees
27Assessment Phase2. Approach Stage Capacity
building
- Develop community capacity to
- Identify local health and healthcare disparities
- Assess reliability and cultural-appropriateness
of various assessment tools - Design instruments of data collection
- Develop procedures for data collection that are
sensitive to the characteristics of the target
population - Understand, interpret, and prioritize assessment
findings
28Assessment Phase3. Reflection Stage
- Reflect on the appropriateness and effectiveness
of assessment method selected - Request additional data analysis to further
define assessment results - Review results of assessment reports to identify
key community health disparity issues
29Assessment Phase4. Communication Stage
- Create community assessment reports for
distribution - Share data with community health providers and
county health departments - Distribute assessment results to local media via
press releases, newsletters, and radio/television
interviews
30Results Assessment Phase-Assessment Strategies
31Results Assessment Phase- Community Assessment
Results Overall (Community Specific)
- Community health needs assessment surveys
indicated that major health concerns for rural
Illinois Hispanics surveyed include Oral
Health, Diabetes, Cardiovascular Disease,
Arthritis, Mental Health, and associated risk
factors - Major barriers to access healthcare include
language differences, low insurance coverage, and
high costs of services
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34How to use the CBPAR Methods in Implementation
Phase
- Stages
- Exploration
- Approach
- Reflection
- Communication
35Implementation Phase1. Exploration Stage
Minigrant Proposal Development
- Identify priority areas
- Prioritize actions (interventions) based on
assessment results - Identify an administrative champion and seek
additional institutions to partner with in the
minigrant proposal - Identify opportunities to leverage funds
36Implementation Phase1. Exploration Stage
Minigrant Proposal Development
- Develop a minigrant proposal based on the
findings from the Assessment phase - Problem description (use of assessment results)
- Partnership description
- Proposed activities
- Budget
- Timeline
- Technical assistance needs
37Implementation Phase2. Approach Stage Conduct
Minigrant Program
- Hold series of briefings to announce minigrant
award - Develop strategic plan for minigrant
implementation - Obtain support from additional community partners
to successfully carry out minigrant activities
38Implementation Phase2. Approach Stage Technical
Assistance
- Provide technical assistance for community
minigrant programs for example - Feedback given to minigrant draft proposals
- Find evidence-based programs and interventions
- Assist in developing implementation plan
- Assist the community in identifying indicators of
success - Decision-making about prioritization of actions
- Organization of training workshops
- Information about additional funding
opportunities - Dissemination through news releases, community
stakeholder meetings, and conferences
39Implementation Phase2. Approach Stage Capacity
building
- Build community capacity to
- Improve inter-institutional and interpersonal
communication - Bring all interested parties to the table
- Establish indicators of success
- Ensure commitment from partners
- Use an inclusive approach to decision-making
- Consult with bilingual and bicultural partners
about feasibility of proposed strategies
40Implementation Phase3. Reflection Stage
Minigrant Program
- Monthly assessment of progress during committee
meetings - Analysis of minigrant activity
- Engage in activity specific reflection
- Rich environment for co-learning exists
41Implementation Phase4. Communication Stage
Minigrant Program
- Information dissemination
- Newsletters (English/ Spanish)
- Community Reports (English/ Spanish)
- Local newspaper articles (English/ Spanish)
- Mass Media Radio in Spanish (www.nuevoshorizontes
.org)
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45How to use the CBPAR Methods in Evaluation Phase
- Stages
- Exploration
- Approach
- Reflection
- Communication
46Evaluation Phase1. Exploration Stage Use
Guiding Questions
- EXTERNAL What impacts do local communities have
on local efforts to address the issue of health
disparity in rural communities? How and Why? - INTERNAL What impacts does a university located,
grant funded Community Outreach initiative have
on national, state and local efforts to address
the issue of health disparity in rural
communities? How and Why?
47Evaluation Phase2. Approach StageConsider
Mixing Evaluation Frameworks and Models
- Community Comparison Case Stud(ies) (Yin, 1994)
- Evaluate each of the 14 communities
- Organizational (Donabedian, 1966)
- Structure Process Outcomes
- Impact REAIM (Glasgow, 1999)
- Reach, Effectiveness, Adoption, Implementation,
Maintenance
48Evaluation Phase2. Approach StageTechnical
Assistance in Evaluation
- Provide training in basic purpose/uses of
evaluation for various projects - Assist in the development of instruments to
measure the impact of the work of the project - Provide analysis of data and share results
49Evaluation Phase2. Approach StageCapacity
Building in Evaluation
- Promote community re-assessment through
reflection during evaluation activities - Encourage community independence and self
determination during evaluation discussions - Support communities towards sustainability
through identification of other funding sources
(both community and university sources)
50Evaluation Phase3. Reflection StageIdentify
Evaluation Areas/Levels
- 1. Hispanic Health Advisory Committee Evaluation
- 2. Community Activities and Implementation
Efforts - a. Individual activities
- b. Individual mini-grant implementation
- 3. Global Community Impact
- a. Mini-grant Cluster Evaluation
- b. Community Oral History Evaluation
- c. Community Comparative Case Study
51Evaluation Phase4. Communication
StageEvaluation Products Outcomes (Community
Specific- DeKalb)
- EXTERNAL
- Medical Interpreters Training (daily, final 6
month follow-up) - Diabetes Program Evaluation
- Workshop on Depression and Anxiety
- Provider Resources Guide
- INTERNAL
- Key Informant Interviews
- Faculty and Staff
- Administrators
- Periodic SCOR (Strengths, Challenges,
Opportunities, Recommendations)
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54How to use the CBPAR Methods in Dissemination
Phase
- Stages
- Exploration
- Approach
- Reflection
- Communication
55Dissemination Phase1. Exploration Stage
Frameworks
- Translational Research Framework
- Translation Research characterizes the sequence
of events (i.e., process) in which a proven
scientific discovery is successfully
institutionalized integrated into established
practice and policy. Comprised of dissemination
research, implementation research and diffusion
research. - Dissemination Research is the systematic study of
how the targeted distribution of information and
intervention materials to a specific public
health audience can be successfully executed to
increase spread of knowledge. - Implementation Research is the systematic study
of how a specific set of activities and designed
strategies are used to successfully integrate an
evidence-based public health intervention within
specific settings. -
- Diffusion Research is the systematic study of the
factors necessary for successful adoption by
stakeholders and the targeted population of an
evidence-based intervention which results in
widespread use.
56Dissemination Phase2. Approach
StageDissemination Process
- How targeted distribution of information and
(intervention) materials to a specific public
health audience can be successfully executed so
that increased spread of knowledge about the
information (intervention) achieves greater use
and impact (CDC, 2007) - Community, Practitioners, and Academic audiences
57Dissemination Phase3. Reflection Stage
Mini-grant Evaluation Summary (ongoing)
- 71 HHAC participants from 8 communities
- General Findings
- Top 3 collaborating partners Public Health
Departments U of I Extension Hospitals - Top 3 resources for project success Funding,
Community Leadership, Support from EXPORT staff - Project Increased credibility of commiittee
with community 96 - Success in reaching intended audience 83
- Satisfaction in overall minirant quality 83
- Minigrant provided doorstep to move forward to
address other needs in the Hispanic community - Minigrants assist this area of community that
was otherwise not be able to receive this type of
information - We really enjoy this project and hope to
continue helping the community! ?
58Dissemination Phase4. Communication Stage
Dissemination Activities
59Dissemination Phase4. Communication Stage
ALIANZA
- Formation of the Alianza (Alliance), a
partnership among the Community Health Advisory
Committees (CHACs) located in each of the Project
communities throughout Illinois. - The Alianza provides a centralized structure
for each Committee to be represented and to
network - Formation of the Alianza is viewed as a
natural next phase in the community based
participatory action research model being
implemented in each community - The Alianza is being co-chaired by two
members representing two of the current CHACs.
60Evaluation of Capacity Building Objectives
- Evaluation of HHACs is one of the more important
components of the CBPAR evaluation phase - Evaluation utilizes the Structure-Process-Outcomes
framework (Donabedian, 1980) - Assists HHACs and Project to determine
- HHACs membership profile
- Lessons learned and suggestions to improve the
partnership work - HHACs short and long term plans
- Perceived community impact
- Best ways to support the HHACs work
61Evaluation Methods Instrument
- Evaluation survey was developed in
- partnership among Project
- evaluation experts, community outreach
- advisory committee, and HHAC members
- Final version consisted of 35-items
- Paper-based and self-administered in English
- or Spanish, depending on respondents language
preference
62Evaluation Methods Procedure
- Survey data collection took place after the
committee started the mini grant implementation - Surveys were distributed by mail or through
regular HHAC meetings with detailed instructions
in a cover letter - Completed surveys were mailed back to team for
data analysis - Only combined results from the various
communities are presented here. Individual HHAC
reports produced
63Preliminary Results (n 60 8 Committees)
64Results Partnership Profile (Cont.)
- FBOs
- Church groups
- LOCAL POLITICIANS
- Local political representatives (township)
- BUSINESS SECTOR
- Hispanic businesses
- EDUCATION SECTOR
- College Professors
- Public libraries
- ESL teachers
- HHACs need to expand involvement of
- COMMUNITY MEMBERS
- More Hispanic representation
- HEALTHCARE PROVIDERS
- FQHC
- Individual doctors
- Regional health departments
- Providers of health care
- COMMUNITY AGENCIES
- County Youth Service Bureau
- County Human Resource Center
- Community Services Department
- Counseling agencies
65Results Involvement
66Results Involvement
- Hope to use gains in improved health to extend
help to other areas of need within Latino
communities - Improve quality of life in the community
- To convey needs and experiences of Hispanic
populations served in my organization, and to
convey barriers experienced by providers working
with the Hispanic population as they attempt to
access health care
67Results Levels of satisfaction / dissatisfaction
- Our HHAC is lt 1 year old. We lack financial and
educational resources. We especially need Spanish
Health books for our resource library (bilingual)
and brochures - Progress has been slow, but the end result is
good - Smaller groups need to feel able to make
decisions and report to larger group instead of
waiting until the meeting and discussing
-discussing more
68Results Community impact and outcomes
69Results Community impact and outcomes
- IMPROVED KNOWLEDGE (Providers)
- Health providers now know what areas are of more
concern to the population what the perceived
barriers are to accessing health care - Survey work and interpreter training benefit
these groups - AWARENESS BUILDING (Community)
- Increased knowledge of available resources
- Todos estamos a dar mas información para le
gente hispana - INFORMATION SHARING
- HHAC has established a strong base/clearing
house for getting information to the Hispanic
Community - Through information sharing about critical needs
70Results Community impact and outcomes
- IMPROVED ACCESS TO PREVENTIVE SERVICES
- Mobile health screenings for school physicals,
increased awareness of area health providers to
need for improved services using first language
support - We have offered workshops gathering
opportunities for Hispanic community cultural
awareness advancement for the community in
general - IMPROVED QUALITY OF HEALHCARE COMMUNICATION
- Through Project partnership with other
organizations led to improved health services for
clients - The mini grant has allowed us to send seven
people to receive training as medical
interpreters
71Results Strengths
- A desire to work together and increase awareness
of needs - A lot of local interest
- Buena organizacion
- Caring people who embrace diversity
- Collaboration across many diverse community
groups - Collaboration with a local grassroots Hispanic
community group that was underway prior to
development of our HHAC - Commitment to assist community
- Common goal, technical support from Project team
- Common/focused response to needs survey
- Patience, flexibility, follow through, a sense of
genuine caring abut target population - The diversity of the group - willingness of all
to participate to address the issues.
72Results Challenges
- A few of the meetings seem to get hung up on
small issues - Accessibility to targeted population because of
language differences - Dominant personality of one member
- El mantenerse firme en el plan
- Facilitators are disorganized
- Falta de comunicacion
- Group could use more members, especially from
Latino groups - Group needs stronger direction
- Need more health care providers to participate
some organization representatives do not have the
ability to impact barriers - n-ed different reps
at the table some issues have been approached
too generically with not enough specific local
focus. - No creo tener ninguna barrera
73Results Lessons learned
- Can identify and address needs via resources some
of which are known but others will be discovered - How extensive the community diversity is
- It's hard to get word out
- It is hard to get everyone together
- Many agencies share the same concerns. By
involving local foundations on committee it is
much easier to secure funding - More about culture and needs
- Need is great
- Need to help more people
- Needs of Hispanic - helped in many ways to open
eyes and to see possibilities. - Pues me ayuda para mi colegio tambien mas
networking bringing more projects into the
Hispanic culture
74Results Lessons learned
- That different Hispanic groups can work together
to improve health and that it helps to meet for
purposes other than health in culture and current
events - That diversity really does add good dynamics to a
group - we learn from each other - The diversity of the needs of the Hispanic
population as well as the various obstacles in
reaching their needs - The extreme need of the Hispanic population for
interpretive services - The needs of the Hispanic community are
overwhelming and it is good to chip away a little
at a time - The power of caring when people came together
around a common mission. The need to clarify
committee structure and leadership early on - There are many groups interested in assisting the
Latino population - Working together avoids reinventing the wheel
we all can inform each other - Working with a "grass roots" organization can
present many challenges-while at the same time
provide a close-up view of the needs of the
community
75Results Plans for the future
76Results Plans for the future
- Activities with health providers might help build
financial support for future - Coordination of dental services
- Direct technical assistance with grant writing
(beyond the mini-grants) continue to support and
develop the Alianza - My opinion is efforts should be directed at
expanding funding for local providers already
attempting to meet existing needs, but they are
under-funded. Outreach, health ed and screenings
should not be priority until primary
care/advocacy needs are met - Provide direct primary care
77Acknowledgements
- Illinois Prevention Research Center
- HHAC Coordinators
- HHAC members
- National Center on Minority Health and Health
Disparities, National Institutes of Health - University of Illinois College of Medicine at
Rockford - National Center for Rural Health Professions
- This presentation was supported by Cooperative
Agreement Number 1-U48-DP-000048 from the Centers
for Disease Control and Prevention. The findings
and conclusions in this presentation are those of
the authors and do not necessarily represent the
official position of the Centers for Disease
Control and Prevention. - http//uic-ihrp.org/iprc