State legislative activities related to elimination of health disparities.

How have state legislatures acted to address racial and ethnic disparities in health care? This article examines trends over time in state legislation related to disparities in care and access, proposed legislation during one biennial session, and contemporary legislative attitudes and awareness of the issue. The mix of strategies adopted across the states reflects the differing ways that states understand gaps in minority health and changing strategies over time. Historically, California, Florida, and Louisiana (all states with substantial minority populations) have been the most active in dealing with minority health issues through statutes. In the eighteen months of the 2001-2002 legislative session that we studied, the most common bills called for studies of disparities and appropriations for identifiable minority health initiatives. Measures that successfully cleared the legislature include measures related to cultural competence and minority health awareness month. Finally, the article discusses issues and limitations in using legislative action to measure the level of state policy activity with regard to health disparities. To ground the description of trends in disparity legislation, the authors integrated comments by state legislators with a discussion of problems in interpreting legislative activity.

Using theories of action to guide national program evaluation and local strategy in the community care network demonstration.

Evaluations of multisite community-based projects are notoriously difficult to conceptualize and conduct. Projects may share an overarching vision but operate in varying contexts and pursue different initiatives. One tool that can assist evaluators facing these challenges is to develop a "theory of action" (TOA) that identifies critical assumptions regarding how a program expects to achieve its goals. Community Care Network (CCN) evaluators used the TOA to refine research questions, define key variables, relate questions to each other, and identify when we might realistically expect to observe answers. In this article, the authors present their national-level CCN TOA. They also worked with sites to help them "surface" their local TOA; the article analyzes the results to determine the content, clarity, extent of evidence base, and strategic orientation of theories articulated by different sites.