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Innovative Strategies for Addressing Disparities: Lessons learned from Implementation through Evaluation Jennifer Rienks, PhD,* Virginia Smyly, MPH,** Geraldine Oliva, MD, MPH,* Judith Belfiori, MPH, MA,* Sandra Johnson, BS**

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  1. Innovative Strategies for Addressing Disparities: Lessons learned from Implementation through Evaluation Jennifer Rienks, PhD,* Virginia Smyly, MPH,** Geraldine Oliva, MD, MPH,* Judith Belfiori, MPH, MA,* Sandra Johnson, BS** *Family Health Outcomes Project (FHOP), University of California, San Francisco **Health Promotion and Prevention, San Francisco Dept. of Public Health

  2. Background • San Francisco Department of Public Health received a REACH 2010 Grant from the Centers for Disease Control to create the SevenPrinciples for African American Infant Survival and Community Unity Project • Family Health Outcomes Project at the University of California, San Francisco contracted as the evaluator

  3. Seven Principles of Kwanza • Used to guide the values and strategies of the project • Includes unity, self-determination, collective work and responsibility, cooperative economics, purpose, creativity, and faith

  4. Project Strategies • Social marketing based community awareness campaigns • Cultural competency trainings and Undoing Racism Workshop for health and social service providers • Community Action Teams (CATS) to address underlying causes of disparities, create unity, lead / participate in community change • Dinner and Movie Events to create community connections and social support

  5. Awareness Campaigns: • African American babies in SF are 2 times more likely than white babies to die in the first year of life • Babies sleep best on their backs • Take action to stop African American babies from dying

  6. Campaigns Mediums • Ads on bus shelters, the backs of buses and inside buses in targeted neighborhoods Bus ads • Posters and hand cards distributed (delete) at San Francisco clinics, daycare sites, doctor offices, agency waiting rooms, delete, put in notes and community organizations. • Church fans distributed to 50 places of worship • Radio spots were on KMEL and KBLX, radio stations popular with African Americans in the SF

  7. Evaluation Methodology • Time 1 and Time 2 telephone surveys conducted with African Americans between 18-65 years old in 4 target neighborhoods • Time 1 telephone survey -- 804 respondents prior to awareness campaigns • Time 2 telephone survey -- 654 respondents at conclusion of awareness campaigns

  8. Exposure to Mediums by Age * Percentages significantly different (p<.05)

  9. Heard of San Francisco Black Infant Mortality Disparity – Time 1 & 2

  10. Awareness of Disparity and Sleep Position • Significant increase in % of African Americans who have ever heard of SF Black Infant Mortality Disparity (39.6% vs. 62.7%, OR = 2.5, CI 2.1-3.2) • No overall significant increases in knowledge of proper sleep position (70.4% vs. 71.7%) • Significantly higher level of awareness of proper position for those exposed to campaign vs. not exposed (79.7% vs. 64.3%, OR = 2.2, CI 1.5-3.1)

  11. Undoing Racism Workshop • Conducted by Peoples Institute West • 227 people attended 1 of 7 workshops • Face to face interviews of 14 participants • 80% (11/14) used tools provided at workshop to make changes in their workplace or community • 67% (8/12) of agencies adopted new practices and made efforts to improve organizational cultural competency and decrease institutional racism. • 100% (14/14) of participants reported trying to take action to address or undo racism on a personal level.

  12. Cultural Competency Training Components • Didactic session on disparities • Didactic session on cultural humility: • Small group exercises on cultural awareness • List of resources for continuing information and education on cultural issues • Packet of client education materials and local referral resources for clients • Article on components of culture for medical students education Evaluation • Pre-Post Tests, Baseline Assessments and 3 and 6 follow-up assessments

  13. Training Participants • 193 providers have attended 1 of 5 trainings over 15-months • Included African-Americans, Latinos, whites, Asian and the others of mixed race/ethnicity • Included MDs (17.1%), NPs (3.1%), RNs and PHNs (19.2%), social workers (23.8%), health educators (13.0%), and others such as mental health professionals, administrators, clinic assistants and managers (21.8%) • 82% of participants were very likely to use tools presented in workshop • 85.3% rated the training as good or excellent

  14. Cultural Competency Pre-Post Test Findings Increased confidence in their ability to: • Identify credible medical and social resources that can assist with lifelong learning about African American - 72.7% • Describe how the health provider bias of race and culture can negatively impact the patient encounter - 58.2% • Use communication tools taught in the workshop in clinical encounters with African Americans - 64.8% • Describe the elements of culturally competent health care - 66.5% • Describe the social conditions that impact rates of African American infant mortality - 65.8%

  15. Results: Snowball Effect

  16. Community Action Teams (CATS) • Mini-grants for CBOs to address African-American community-identified economic, social and/or environmental problems that contribute to poor community health. Evaluation Methods: • Process evaluation measures (i.e. number meetings attended, documenting activities and training through tracking form) • Questionnaires administered at the beginning and end of the CATS work • Case study of selected CATS that includes interviews and evaluator observation

  17. CAT Findings • 14 CATs have been funded and participated in the evaluation (8 youth, 6 adult) • 108 Baseline surveys, 79 follow-up surveys, 50 baseline and follow-ups can be linked • CAT Experiences - 39% Chaired a meeting; 33% attended Bd of Sup mtg.; 84% represented CAT at meeting; 56% lead a special project; 63% did public speaking How about bullet these on their own slide?

  18. CAT Evaluation Challenges • Low response rates make generalizing findings difficult • Notable variations in CATs based on agency, coordinator, and membership impacted success • Difficult to implement a structured evaluation around community improvement activities – hard to get consistent efforts and buy-in to implement evaluation tools

  19. Dinner And A Movie (DAAM): Goal • Previously: African American women and men of reproductive age and their families will be healthy through strengthened social support networks in their neighborhoods. • Present: Develop within the project staff, the Partnership, community and the network of community members and community agencies the skills and capacity to improve the health of the community. Current evaluation method: Observation

  20. Evaluation: Progress to Date Mean Attendance:Booker T. = 8, BCA = 6, OMI FRC = 27

  21. Key Lessons Awareness Campaigns • Involving target audience in developing campaigns and reviewing messages resulted in culturally appropriate campaigns that reached a large number of San Francisco’s African American residents Cultural Competency Training and Undoing Racism Workshop • Health and social service providers are open to trainings on these important topics, will utilize materials provided in their workplace, and will often try to take action to address racism

  22. Key Lessons (Cont.) CATS • Team members feel a sense of belonging with their CAT and enjoy participating • Success of CATs highly influenced by coordinator • Different experiences in each group plus low response rates make generalizations difficult Dinner and A Movie • Attendance dependent on venue location and outreach efforts by agencies • With the right venue and sufficient outreach, people will attend we have no proof of that

  23. FHOP website and contact informationhttp://www.ucsf.edu/fhop(415) 476-5283

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