Transcript Role of Social Behavioral Sciences in Public Health

Coalitions: A Promising Way
to Enhance Asthma Control
Noreen M. Clark, Ph.D.
School of Public Health
University of Michigan
Patient SelfManagement
Family Involvement
Clinical Expertise
Work/School Support
Community Awareness & Action
Environmental Measures
Conducive Policies
Some Assumptions about Effective
Asthma Coalitions:
 integrate
expertise of health
professionals, patients, and lay
persons
 derive momentum from community
interest and concern
 coordinate asthma - directed
initiatives
Some Assumptions about Effective
Asthma Coalitions:
 produce
intermediate outcomes (e.g.
across institutions/sectors,
management skills, referral systems)
 intermediate outcomes contribute to
alternate desired health outcomes
(e.g. patient health status, health
care use)
Coalition
Coalition
Processes
Input
Outputs
more anti membership  clinician
inflamm. use
 leadership
education  patient action
plans provided
 participation  patient
 relationships education  increased
patient self
 etc.
 redesign of mgmt.
services
 availability of
reimbursement
 educate
payors/
 more continuity
fiduciaries of care
 surveillance
 policy
systems
initiatives
 using meds at
 etc.
school
 etc.

Health Related
Outcomes
fewer
symptoms
 less health care
use
 better quality of
life
 improved
school
attendance
 etc.

Existing research (see e.g. Wickizer
(1998), Kenney and Sofaer (2000),
Laurett et. al (1997), Mayer et al
(1997), Buftterfosset et al (1993)
describes coalitions structures and
provides tools for assessing coalition
processes and functioning.
Few data are available to
describe intermediate or final
health related outcomes
associated with coalition efforts
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NHLBI and RWJF Collaboration to
Explore Coalitions
 NHLBI
- support and assistance to 8
coalitions
 RWJF: Allies Against Asthma - funding
and technical assistance to 8 coalitions
 Jointly: Coalition meetings, shared
information, coordinated assistance,
etc.
Allies Against Asthma
National Advisory
Committee - Members
Michele Carrick
Parent and family advocate
Barbara Israel, Ph.D.
(community participatory research)
Professor, University of Michigan
School of Public Health
Guy Parcel, Ph.D.
(School Health) Professor,
University of Texas School of
Public Health
Mary desVignes-Kendrick, M.D.,
M.P.H.
Director, City of Houston
Health Department
Talmadge King, M.D.
(Pulmonologist) Professor,
University of California at San
Francisco
Stephen Redd, M.D.
Chief, Air Pollution and Respiratory
Health Branch, Centers for Disease
Control and Prevention
Susan Downey, M.Ed.
(former director of community
coalition) Community Prevention
Specialist, Boston, MA
Floyd Malveaux, M.D.
(Allergist)
Dean, Howard University
College of Medicine
Jeanne Taylor, Ph.D.
Director, Ambulatory Care and
Community Health Services
University of Chicago
Robinson (Rob) Fulwood,
M.S.P.H.
Senior Manager, National Heart,
Lung and Blood Institute
Robert Mellins, M.D.
(Pediatric Pulmonologist)
Professor, Columbia University
School of Medicine
Abe Wandersman, Ph.D.
(evaluation of coalitions) Professor,
University of South Carolina
Rachel A. Gonzales-Hanson
CEO, Uvalde County Clinic,
Community Health Center
Uvalde, TX
Stephen Page, M.P.A.
Director, Radiation and Indoor Air
Environmental Protection Agency
Sandra Wilson, Ph.D.
(self management expert)
Senior Staff Scientist
Stanford Lung Disease Center
Physician Asthma Care
Education (PACE)
RWJF funded exploration of two
pronged dissemination
(national/local) of an NHLBI
funded model for clinician
training. Potential clinical
education component for
coalitions.
Coalitions hold promise for
contributing to asthma control
but questions remain that
require careful study.
Research questions:
 Are
coalition activities associated
with desired health outcomes?
 In what ways do coalitions produce
results different/better than other
types of intervention?
 What characterizes a successful
coalition?
Research questions:
 What
elements of coalition activity
are most effective?
 How can coalition effectiveness be
enhanced?
 How can coalition efforts be
institutionalized?