Initial conditions and functioning over time among community coalitions.

Developing operationally strong community coalitions is critical to actualizing their potential for public health improvement. The purpose of this study was to measure how substance use prevention coalitions in Mexico functioned across their first 1.5 years, and to test associations between initial community contextual factors and subsequent coalition functioning and outcomes. Members of 19 coalitions participated in three waves of surveys about coalition context and functioning. We used paired t-tests to assess changes in coalition functioning and outcomes. Regression models estimated associations between coalition functioning and outcomes and initial community context. Among coalition functioning factors, over coalitions' first 1.5 years, member engagement increased, as did coordinator skill and participatory leadership style. Two initial community context factors - community support for prevention and community champions - predicted several measures of process competence, but only community champions predicted perceived community improvement. Thus, community champions may play a pivotal role in later coalition success. The observed increases in member engagement and process competence may support subsequent coalition sustainability, a crucial component to realizing their potential impact on public health.

Establishing a local coalition for addressing social determinants of hypertension in Quibdó (Colombia): a description and reflection on the process.

One-fourth of the adult population of Colombia is estimated to have hypertension. However, there has been relatively little attention to participatory approaches that address the social determinants of hypertension at the local level in Colombia. Early stages of a coalition for addressing hypertension in Quibdó (Colombia) included a stakeholder analysis and engagement of local organizations. This was followed by defining mutual goals, agreement of rules for decision making, and refining a shared vision. Based on a unified understanding of factors influencing hypertension risk, 12 organizations joined the local coalition. They developed an action plan for preventing hypertension and eliminating social disparities in its distribution. Lessons learned during this process suggest that, in marginalized urban areas of middle- and low-income countries, particular attention should be paid, at early implementation stages of coalition, to context specific challenges and opportunities, coalition membership and structure, reframing health, and strengthening capacity.

Effects of Sectoral Diversity on Community Coalition Processes and Outcomes.

Collaboration with diverse partners is challenging but essential for the implementation of prevention programs and policies. Increased communication with partners from diverse sectors may help community coalitions overcome the challenges that diversity presents. We examined these issues empirically in a study of 17 substance use prevention coalitions in Mexico. Building on coalition and workgroup literatures, we hypothesized that sectoral diversity would improve outcomes but undermine coalition processes. Conversely, we expected uniformly positive effects from higher levels of intersectoral communication. Data are from a 2015 survey of 211 members within the 17 community coalitions. Regression models used sectoral diversity and intersectoral communication to predict coalition processes (cohesion, leader-member communication, efficiency) and outcomes (community support, community improvement, sustainability planning). Sectoral diversity was negatively associated with coalition processes and was not associated with coalition outcomes. Intersectoral communication was positively associated with two of the three measures of coalition outcomes but not associated with coalition processes. Our findings concur with those from prior research indicating that sectoral diversity may undermine coalition processes. However, more communication between sectors may facilitate the coalition outcomes of community support and sustainability planning. Skilled team leaders and participatory decision making may also help coalitions promote intersectoral communication, thereby engaging diverse community sectors to implement preventive interventions and actualize sustained public health impact.

Using a participatory evaluation design to create an online data collection and monitoring system for New Mexico's Community Health Councils.

We present the collaborative development of a web-based data collection and monitoring plan for thirty-two county councils within New Mexico's health council system. The monitoring plan, a key component in our multiyear participatory statewide evaluation process, was co-developed with the end users: representatives of the health councils. Guided by the Institute of Medicine's Community, Health Improvement Process framework, we first developed a logic model that delineated processes and intermediate systems-level outcomes in council development, planning, and community action. Through the online system, health councils reported data on intermediate outcomes, including policy changes and funds leveraged. The system captured data that were common across the health council system, yet was also flexible so that councils could report their unique accomplishments at the county level. A main benefit of the online system was that it provided the ability to assess intermediate, outcomes across the health council system. Developing the system was not without challenges, including creating processes to ensure participation across a large rural state; creating shared understanding of intermediate outcomes and indicators; and overcoming technological issues. Even through the challenges, however, the benefits of committing to using participatory processes far outweighed the challenges.

Programa de promoción de la salud en una comunidad nativa de Alaska:: un caso de planificación estratégica y colaboración comunitaria / A program for health promotion in Alaska Native Community:: a case os strategic planning and community collaboration

En este trabajo se describe una iniciativa de promoción de la salud en una comunidad nativa de Alaska. La etnia Yupik vive en condiciones de aislamiento en la zona occidental de Alaska y tiene dificultades de acceso a servicios públicos, además de problemas de salud relacionados con los hábitos de vida. El proyecto "Healthy Living Through a Healthy Lifestyle" se basó en la planificación estratégica de servicios de salud y en la implementación de iniciativas de promoción de la salud en un asentamiento de esta etnia. Para ello se organizó un comité compuesto por miembros de la comunidad, profesionales de los servicios y personal investigador de la universidad. Además se contó con dos mediadores comunitarios de salud para facilitar el acceso de las familias a los servicios públicos. El programa puso el acento en la adaptación cultural de sus contenidos, en la colaboración entre los investigadores y los participantes y en la implicación de la comunidad en el diseño, implementación y evaluación del programa.

In this paper, we describe a health promotion initiative in a native community in Alaska. The Yupik ethnic group lives in isolation in Western Alaska and has poor access to public services, as well as health problems related to lifestyle. The "Healthy Living Through a Healthy Lifestyle" project was based on the strategic planning of health services and on the implementation of health promotion initiatives in a settlement of this ethnic group. For this, it was organized a committee of community members, service professionals and University researchers. It included also two community health mediators to facilitate families' access to public services. The program emphasizes cultural adaptation of contents, collaboration between researchers and participants and community involvement in the design, implementation and evaluation of the program.