A Mixed-methods, Multi-Level Evaluation of Statewide Chronic Disease Coalitions
Abstract
Indiana has one of the worst health rankings in the nation at 41. The Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, among others have recognized that comprehensive, multi-disciplinary approaches are necessary to improve health in communities. No single organization, large or small, has the capacity to solve chronic disease, and thus coalitions have been touted as a solution to engage communities to better health. Evaluation of coalitions are critical to provide evidence of efficacy and identify factors required to build successful and sustainable health coalitions. A novel partnership between the Indiana State Department of Health (ISDH) and the Indiana Clinical and Translational Sciences Institute (CTSI) called Connections IN Health (CINH), integrates three Indiana chronic disease coalitions to improve the health of Indiana residents. A unique mission of this partnership is to integrate work from the three different disease areas of the coalitions (obesity, cardiovascular disease, and asthma) to enhance community engagement in Indiana counties. Coalition leads for each disease area were hired, as well as a manager to oversee integration of the coalitions. The coalitions are being re-built by increasing and diversifying membership, working together with funders to engage Indiana communities, and providing strong and formalized leadership to coalition members. Assessment of CINH is crucial to provide evidence that this approach of integrated coalition leadership is an archetype for successful health department/clinical translational science award (CTSA) collaboration for other CTSAs, and could be a reproducible approach to improve the translation of research from benchto-bedside. Traditional evaluations of coalitions focus on singular process and formative assessments, which fail to capture the dynamic and inherently relational aspects of coalition functioning. Thus, I evaluated CINH coalitions using a mixed-methods, multi-level evaluation framework that includes coalition functioning and effectiveness surveys and social network analysis. Using linear and logistic regression models, I found that after CINH was implemented, perceptions of coalition functioning and effectiveness significantly increased among coalition members one- and two-years after the partnership was implemented. I found from a comprehensive social network analysis that CINH was successful in growing and diversifying its coalition networks, that partnership networks became more centralized, and that the networks demonstrated traits of effectiveness based on other coalition network effectiveness studies. We suggest that coalition evaluation researchers move towards a unified evaluation approach that includes perception surveys, social network analysis, external community development, and health outcomes. In addition, an integral part of my work was to share findings back to the coalitions to enhance evaluation and help coalitions achieve their goals. In this thesis, I discuss: evidence that community coalitions can improve health, current evaluation methods for health coalitions, the Connections IN Health partnership, and implementation of a mixed-methods, multi-level evaluation framework. Finally, I present findings from my longitudinal network analysis of the CINH statewide chronic disease coalitions.
Degree
Ph.D.
Advisors
Savaiano, Purdue University.
Subject Area
Medicine|Public health
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