A Holistic Evaluation of a Community Health Improvement Plan.

Guided by an integrated conceptual framework made up of social cognitive theory, the theory of fundamental causes, and community organizing theory, the author synthesizes quantitative and qualitative findings from process and outcomes evaluations in order to discern a holistic picture of the success and shortcomings of a Community Health Improvement Plan (CHIP), implemented in a Mid-Western region of the United States from 2016 to 2018. The aggregation and configuration of findings from a variety of data categories presented holistic meaning from evaluation results that would not be obvious in each method alone or each evaluation type alone. Findings from holistic analysis suggest a connection between social dimensions including partnership, participation, and community organizing strategy, and both plan implementation effectiveness and outcomes achievements. The results suggest that underlying contextual factors such as deficits in democratic participation, timid community organizing approaches, underlying socio-economic trends, and resource limitations might be hindering success in achieving plan outcomes and completing implementation activities. Community Health interventions should include strategies, goals, and activities that seek to build and/or improve partnerships and democratic participation related to the Community Health Improvement Plan. In addition, long-term and sustained efforts should be made to intensify collective efforts to build up resources related to capacity and poorly resourced social, economic, and health systems in the region.

Using an Integrated Conceptual Framework to Clarify Health Problems and Assess A Community Health Planning Process: A Mid-Western USA Case Study.

Within a case study design, this paper clarifies community problems, and assesses a Community Health Improvement Plan development process using a framework of explanatory models and change theories that links the macro social model, the materialistic model, social cognitive theory, theory of fundamental causes, and community organizing theory. Properties of demographic and health status artifacts are consistent with the core constructs in both the macro social and the materialistic models. The constructs in social cognitive theory and the theory of fundamental causes seem to influence program strategies even as socio-economic factors were only minimally addressed. At the organizing level, the Plan excelled in locality development and social planning but was short on social action. The findings suggest a need for social action as a model of practice in solving persistent social and health problems, and for research that investigates if social action practice can predict success in resolving these problems.

Mixed Methods in Prostate Cancer Prevention and Service Utilization Planning: Combining Focus Groups, Survey Research, and Community Engagement.

This article reports on the use of sequential and integrated mixed-methods approach in a focused population and small-area analysis. The study framework integrates focus groups, survey research, and community engagement strategies in a search for evidence related to prostate cancer screening services utilization as a component of cancer prevention planning in a marginalized African American community in the United States. Research and data analysis methods are synthesized by aggregation, configuration, and interpretive analysis. The results of synthesis show that qualitative and quantitative data validate and complement each other in advancing our knowledge of population characteristics, variable associations, the complex context in which variables exist, and the best options for prevention and service planning. Synthesis of findings and interpretive analysis provided two important explanations which seemed inexplicable in regression outputs: (a) Focus group data on the limitations of the church as an educational source explain the negative association between preferred educational channels and screening behavior found in quantitative analysis. (b) Focus group data on unwelcoming provider environments explain the inconsistent relationship between knowledge of local sites and screening services utilization found in quantitative analysis. The findings suggest that planners, evaluators, and scientists should grow their planning and evaluation evidence from the community they serve.

Provider perceptions of the social work environment and the state of pediatric care in a downsized urban public academic medical center.

The author's purpose through this study was to document and analyze health provider perceptions of their social work environment and the state of pediatric care at Los Angeles County King/Drew Hospital and Medical Center in 2000, after the restructuring and downsizing of the hospital and its community clinics. The research results showed nurses and physicians reporting that both the quality of pediatric care and the provider social work environment were poor. Negative factors in the social work environment included: low employee morale, poorly staffed clinical teams, lack of professional autonomy, perceptions of low quality of care for pediatric patients, and interpersonal issues of poor communication and collaboration among providers. Providers also perceived a non-supportive work environment, sense of powerlessness, poor quality of work, lack of goal clarity from leadership, lack of fairness in leadership behavior, and an organizational leadership that is abandoning its core mission and values, thereby making it difficult for providers to carry out their professional functions. The author's findings in this study suggest a relationship between intra-role conflict, social employment environment and quality of care at King/Drew Medical Center in 2000. Lessons for practice are presented.

A two-dimensional equity proposal for self-sufficiency in municipal safety-net hospitals.

This article advances a two-dimensional equity approach for self-sufficiency in municipal safety-net hospitals that will strengthen provider self-sufficiency and protect the safety-net mission of providing a dignified floor of health services to the most disadvantaged members of the society. The model responds to the failure of current delivery strategies to effectively cope with the changing market configurations in safety-net systems that have eliminated the possibility of cross-subsidization which has long been the mainstay of safety-net systems. The identified pathway to self sufficiency is made up of (1) a differential service delivery framework which includes a two-tier patient system, uniform standards of care and service levels, and the creation of a community health campus; (2) independent sector ownership; and (3) intergovernmental policy actions restricting ownership of safety-net hospitals to nonprofit entities. Although this model is explained by demonstrating potential application in safety-net hospitals, it is believed that the model is applicable in ambulatory care settings. Future work can focus on the construction of an ambulatory variation of the model and the empirical testing of the hospital and ambulatory models.