Evidence from the field: Findings on issues related to planning,implementing and evaluating gender-based programs

An Initiative of the United States Department of Health and Human Services’ Office on Women's Health (OWH), Coalition for a Healthier Community (CHC), supports ten grantees across the U.S. in the implementation of gender-based health interventions targeting women and girls. A national evaluation is assessing whether gender-focused public health systems approaches are sustainable and cost effective in addressing health disparities in women and girls. To inform the evaluation, a systematic examination was conducted of literature in both the public and private sector designed to track, assess, understand, and improve women's health, public health systems approaches, and the cost-effectiveness and sustainability of gender-based programs. A two-person team assured the quality of the results following the review of abstracts and full-text articles. Of 123 articles meeting eligibility criteria (See inclusion criteria described in Section 2.2 below), only 18 met inclusion criteria specific to a focus on a systems approach, cost-effectiveness and/or sustainability. Studies assessing systems approaches suggested their effectiveness in changing perceptions and increasing knowledge within a community; increasing involvement of local decision-makers and other community leaders in women's health issues; and increasing community capacity to address women and girls’ health. Further evaluation of the cost-effectiveness and sustainability of gender-based approaches is needed.     

Assessing local capacity for health intervention

Because of their location within the practice realm, participatory, community-based public health coalitions offer many lessons about implementing and sustaining local interventions. This paper presents a case study of capacity assessment at the local level. Capacity evaluation methods are presented, with emphasis on the theoretical framework used to guide the evaluation. The capacity evaluation framework presented herein was theoretically based and designed to generate practical information to facilitate the adoption of a locally tailored youth obesity prevention program, VERB Summer Scorecard (VSS). Using multiple methods, four aspects of community capacity were assessed, including community, knowledge and skills, resources, and power. Within each category, factors that facilitated or impeded program implementation were distinguished. The evaluation protocol was designed to generate information increasing community capacity to sustain a community-based obesity prevention program. Capacity tables were used as a program-planning tool and as a system for sharing implementation and sustainability requirements with potential adopters. This case study also explores how to use capacity assessment results to empower coalitions to serve as catalysts for development of local programs in other communities.     

Gender-based health interventions in the United States: An overview of the coalition for healthier community initiative

Health disparities by gender constitute an important yet often overlooked aspect of health around the globe. Within the United States, there is both a paucity of research as well as planned programs that take into account how socio-cultural roles and expectations for men and women may differentially affect symptoms, access to care, and treatment. Viewing women's health exclusively as a function of sex (i.e., biological) differences represents a narrow understanding that does not fully explain gaps in health disparities between men and women. In September 2010, the U.S. Department of Health and Human Services (DHHS) launched a national initiative entitled the Coalition for a Healthier Community (CHC) to employ a gender-based framework in several urban, suburban and rural communities across the nation. The Office on Women's Health (OWH) within the DHHS funded 10 coalitions to ultimately improve the health of women and girls utilizing a gender-based approach. This article provides an overview of the initiative and the focus of the special issue.     

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.     

Event Coalitions in the Pittsburgh G20 Protests

Protests at events such as the 2009 Group of Twenty (G20) Summit in Pittsburgh frequently require activists to engage in some type of coalition work. This article examines two event coalitions created to organize the Pittsburgh G20 protests: the Pittsburgh G20 Resistance Project (PGRP), consisting of local anti‐authoritarians, and a loose alliance of individuals and organizations brought together by the Thomas Merton Center (TMC), a local peace and justice movement center. I show how the organizational structure and early decisions of the PGRP made it more effective than the TMC alliance and how those choices were affected by preexisting network structures, social movement organizations, ideological alignments, and relationships in the local movement community. The experiences of activists in event coalitions, both positive and negative, then affect the shape of the movement community and subsequent coalitions and campaigns.     

Incentives Programs for Girl Children in India: Global Experiences,Local Reflections

ABSTRACT

Success of incentive transfers programs in South America has encouraged policymakers in India to adopt similar demand-driven approaches to reward behaviors that invest in girls and eventually change negative cultural attitudes toward them. Embrace of this approach, however, needs to be nuanced by a closer scrutiny of the gendered impact of such programs; an understanding of the differential sociocultural and public policy contexts; and a questioning of the design of the incentive transfer programs in India. Despite their political uptake, such programs address the practical needs of girls and women while neglecting their strategic interests. Furthermore, without adequate critical engagement, the programs can have unintended consequence of reinforcing gender stereotypes. Rather than importing developmental shortcuts, India should turn its gaze inward to supply-side interventions and homegrown mobilization experiences of the women’s movement.     

Community-based behavioral health interventions: Developing strong community partnerships

The popularity of community-based interventions has experienced a revival over the last two decades. The general theme behind this trend is that greater community involvement provides researchers and practitioners with culturally relevant information to make interventions successful. This involvement is usually solicited through the formation of community coalitions and advisory boards. Although the positive influence of community partnerships is well established, strategies for successfully developing and sustaining these partnerships are less clear. To address this gap, this paper presents evaluation findings from The Making Connections Initiative, a national effort emphasizing community-level prevention strategies for improving the mental health of men/boys. Sixteen grantees were tasked with developing a coalition of community organizations to provide input into the development and implementation of a local prevention initiative. An evaluation of the 16 grantees’ planning activities identified four themes related to developing and sustaining successful community partnerships. This article reports on the strategies that were found most successful across grantees. With the increasing popularity of community-based programs, strategies for successfully partnering with local organizations are particularly important. This study adds to the limited research on best practices for forming community partnerships and should serve as a guide for community-based evaluators and program planners.     

Organizational structure,leadership and readiness for change and the implementation of organizational cultural competence in addiction health services

Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.     

The We-Lead Model for Bridging the Low-Income Community Leadership Skills-Practice Gap

There are several community leadership development programs that devote tremendous resources to help improve the vitality and wealth of individuals and communities through the development of local leadership capacities. One great challenge is that these programs fail to coordinate existing community resources to create opportunities to engage program graduates. This article interrogates the effectiveness of leadership development programs in creating opportunities for engagement. Expanding on U-Lead model, the article proposes a WE-Lead model that can bridge the skills-practice gap by emphasizing the importance of aligning community leadership development programs with community needs through building community coordinated coalitions.     

Evidence-Based Programs for Older Adults: A Disconnect Between U.S. National Strategy and Local Senior Center Implementation

While U.S. national policies have been developed to support evidence-based (EB) lifestyle programs for older adults, there has been limited research to determine the extent to which these programs actually reach local communities. This study sought to identify factors that impact the implementation of EB physical activity, nutrition, and chronic disease management programs at regional (Area Agencies on Aging [AAAs]) and community levels (senior Centers [SCs]). Interviews were conducted with directors of four AAAs and 12 SCs to understand their perspectives on EB program implementation. Narratives revealed differences between AAAs and SCs regarding knowledge about EB programs and reasons to promote and adopt these programs. The only agreement occurred when discussing concerns about funding and program inflexibility. Substantial gaps exist between how EB lifestyle programs are promoted and implemented at the regional and community levels.     

The Longevity of Community Aging Initiatives: A Framework for Describing NORC Programs’ Sustainability Goals and Strategies

Naturally Occurring Retirement Community Supportive Services programs (NORC programs) aim to bring together stakeholders within a local area with a large number of older adults (e.g., a neighborhood or apartment building) to facilitate activities and services that promote aging in place. Despite enthusiasm for these programs, there is ongoing concern regarding their long-term sustainability, especially as federal funding to support NORC programs nationally has dwindled in recent years. This exploratory study aimed to develop a framework to describe NORC programs’ sustainability goals and strategies. As part of a statewide study in New Jersey, this study drew on data from semi-structured in-depth interviews with staff of 10 lead organizations that represented 15 NORC programs. Using a grounded theory analytic approach, findings revealed three types of sustainability goals: continuing the program indefinitely within the lead agency (described by eight organizations); integrating the program functions across other organizations (described by one organization); and defining the program as a finite project (described by one organization). Lead organizations implemented and developed their programs in ways that reflected their goals. This framework can be used to guide efforts to maintain, expand, and evaluate NORC programs and related community aging initiatives.     

Youth tobacco sales-to-minors and possession-use-purchase laws: a public health controversy

Tobacco use among youth remains one of our nation's most significant public health problems, and yet available evidence from prevention and cessation person-centered approaches has been mixed. Given these disappointing outcomes, some have recommended more public health approaches, and these include tobacco sales-to-minors and possession-use-purchase laws. While community members and police officials have endorsed these types of public health initiatives, many within the public health community have been either guarded or even oppositional to such approaches. The primary reasons for this controversy are reviewed in this article. Outcome studies indicate that sales-to-minors laws can be an effective step toward the reduction of youth access to commercial sources of tobacco. However, even with these laws in place, many youth indicate that they continue to have easy access to tobacco, often by means of social sources. Advocates of these approaches have argued that more comprehensive public health interventions are needed, such as programs that combine youth access and possession-use-purchase laws. This article reviews the ongoing debate behind these types of public health efforts, and examines the evidence of such programs to reduce youth tobacco use.     

Opportunity,Context, and Action: Understanding the Divergent Strategies of Two Mexican Social Movement Coalitions in a Time of Tremendous Change

Evidence suggests collective action success is aided by organizations working in conjunction. Recent scholarship has refocused attention on what factors foster or impede coalition work. This article builds on the literature to show how the context in which coalitions emerge and act may be multiple and contradictory. Using data from extended field research, we examine two Mexican NGO coalitions to analyze how the intersection of national and local opportunity structures influenced their emergence and strategic action. We find that the impact of such influences may be contradictory. Democratization posed both threats and opportunities for the coalitions, providing impetus for their emergence, but limiting strategic choices as co-optation and neoliberalism undermined the opportunities created by democratization. We argue that the coalition members' interpretation of the local political context explains the divergent paths the two coalitions took over time.     

Support for Waste Facility Siting: Differences between Community Leaders and Residents

Abstract Decisions regarding hazardous waste facility siting are now open to extensive public debate. Efforts on the part of public officials and private companies to site waste management facilities have been thwarted by public opposition. Using survey data from leaders and residents in communities which are hosting or siting facilities, this study examines their sociodemographic characteristics, knowledge, levels of trust, perceptions of risk, perceptions of economic impacts, perceptions of equity issues and the differential effects of these factors on acceptance of local waste facility siting. Leaders in these communities were more supportive of local waste facility siting than were other community residents. The major determinant of leaders' acceptance of waste siting was their perceptions of the economic benefits of a facility to the community. Although this was also important to residents, perceptions of health, safety, and environmental contamination risks had larger effects on their acceptance of such facilities.     

Community College Health Service Programs: A Progress Report

Abstract

What progress has been made in improving the health service programs available to the millions of students attending the nation's public community colleges? This question was investigated by sending a follow-up survey to deans of students in 1977; the original study was done five years earlier and resulted in a national profile of health service programs at public two-year institutions.

Some of the significant findings were: the percent of colleges offering health service programs has increased from 41.5% to 51.3%; the campus nurse continues to be the most common health professionals available to students; facilities are considered to be adequate and accessible; and a broad range of student health needs are met. New elements in the survey covered health education and mental health services, and these were positively evaluated.

On the basis of survey results it was concluded that community colleges have made considerable progress in improving student health services, but there is still much to be done.     

National and local public relations campaigns during the 1946 steel strike

Although scholars recognize the importance of public relations in the process of negotiations between management and organized labor, few have attempted to document such efforts or to analyze their effects. This review of public relations activities at the local and national levels during the 1946 steel strike indicates that national public relations campaigns, conducted by the union and the steel trade association, had virtually no impact on the resolution of the strike at the local level, and local public relations programs, conducted by the union local and a small manufacturing company, did little to further management or union goals at the national level. If anything, the national programs only confused the community by offering messages that did not necessarily correspond to the local situation.     

A multi-level examination of how the organizational context relates to readiness to implement prevention and evidence-based programming in community settings

Prior theoretical and empirical research suggests that multiple aspects of an organization's context are likely related to a number of factors, from their interest and ability to adopt new programming, to client outcomes. A limited amount of the prior research has taken a more community-wide perspective by examining factors that associate with community readiness for change, leaving how these findings generalize to community organizations that conduct prevention or positive youth development programs unknown.Thus for the current study, we examined how the organizational context of the Cooperative Extension System (CES) associates with current attitudes and practices regarding prevention and evidence-based programming. Attitudes and practices have been found in the empirical literature to be key indicators of an organization's readiness to adopt prevention and evidence-based programming. Based on multi-level mixed models, results indicate that organizational management practices distinct from program delivery may affect an organization's readiness to adopt and implement new prevention and evidence-based youth programs, thereby limiting the potential public health impact of evidence-based programs. Openness to change, openness of leadership, and communication were the strongest predictors identified within this study. An organization's morale was also found to be a strong predictor of an organization's readiness. The findings of the current study are discussed in terms of implications for prevention and intervention.     

Thinking about "culture": some programme pointers

This article exhorts development workers to develop an understanding of their own cultural heritage in order to understand how cultural subjectivity influences their work. While not endorsing "cultural relativism," the authors stress that women must work within their own cultures to develop empowerment and combat culturally legitimized practices which are harmful to women. Cultural constructs must be examined in order to understand such issues as the Northern tendency to encourage personal individualism and the Southern tendency to organize along communal lines. Gender identity is also a social construction which calls for a consideration of each situation (or harmful practice) as uniquely based in a given cultural context. General agreement exists, however, that in order to tackle gender oppression, women must be empowered and their status must be improved. Thus development initiatives should support longterm investment in research and programs, illiteracy rates must be decreased, and educational opportunities must be sought in every program. Women's groups must link up to share resources with each other and with traditional nongovernmental organizations. Governments should 1) integrate a gender component into every Ministry; 2) emphasize literacy for girls and women; 3) support local women's initiatives; 4) provide gender-sensitive training for professionals in critical fields; 5) increase attention to the needs of young women; and 6) offer more women visible official posts in public service.