Evaluation

Since 2000, Bronx Health REACH has been committed to a community-based participatory approach to our work. Coalition members have been deeply involved in all of the Coalition’s work – setting priorities, designing initiatives, developing and implementing a research and evaluation agenda, reviewing findings and making them available to the community, co-authoring papers, and attending and presenting at conferences and meetings.

Over the past few years, we have studied:

Knowledge, beliefs, and behavior of community residents with diabetes

Community members trained by CHPSR implemented a door-to-door survey of over 1,000 residents, a quarter of whom had been diagnosed with diabetes. We learned about the challenges people face in eating a healthy diet and exercising, and the dramatic impact of diabetes on the health of local residents, including vision loss, foot problems, and the frequent need for urgent medical care (42% reported that they had a problem with their diabetes in the past six months that required them to see a doctor that day). These findings helped shape the Coalition’s work on nutrition, fitness, and health care access, and the work of our Faith-based Outreach Initiative. (See Kaplan SA, Dillman KN, Calman NS, Billings J. Opening Doors and Building Capacity: Employing a Community-Based Approach to Surveying, J Urban Health 2004; 81:291-300)

Building sustainable community change

Through interviews with leaders and staff, the Coalition studied the impact of its work on its member organizations. Many of the partners indicated that they had made changes in policies and procedures that affected their constituencies and staff, such as wellness programs for staff, changes in food served, and restructuring programs for homeless patients. Others made changes in their organization’s mission and the role of the leadership, such as using health disparities as a platform for state and national coalition of churches. Factors that facilitated or hindered these kinds of changes are discussed in Fostering Organizational Change. (See Kaplan SA, Calman NS, Golub M, Ruddock C, Billings J. Fostering Organizational Change Through a Community-Based Initiative, Health Promotion Practice 2006; 7:1-10)

Access to specialty care and patient sorting in the health care system

Numerous studies have documented racial and ethnic disparities in access to high-quality specialty care, as well as patient sorting by insurance status. In New York City, more than 50% of blacks and 60% of Latinos are uninsured or on Medicaid, compared to 25% of whites, so people of color are disproportionately affected by such barriers to care. The Coalition assessed the accessibility of specialty services through a telephone survey, and also examined how hospital patients are sorted by source of payment throughout NYC hospitals, using the Universal Data Set of NY’s Statewide Planning and Research Cooperative System (SPARCS.) This work resulted in a detailed description of the differences in care available to the privately and publicly insured, the development of a presentation called Inequality by Design, and the publication of a monograph titled Separate and Unequal: Medical Apartheid in New York City, and an article in a health law journal, all of which informed subsequent policy change efforts.(See Calman NS, Golub M, Kaplan S. “Separate and Unequal: Health Care in New York City” Journal of Health Care Law and Policy. University of Maryland School of Law, Vol 9:1:2006)

Community-wide impact

The Coalition uses data from annual telephone surveys performed by both CDC and the NYC Department of Health to assess community-wide trends. We track changes in knowledge, beliefs, and behaviors among residents in the southwest Bronx, with a particular focus on preventive behaviors and disease management. We also analyzed hospital discharge data, emergency department data, and vital statistics to measure any changes in diabetes-related health outcomes.

Community perspectives on barriers to good health

In the Coalition’s planning year, we held nine focus groups of community residents. Major themes emerged which informed the Coalition’s subsequent work: widespread distrust and fear of the health care system, difficulty in communicating with doctors, the importance and difficulty of self-advocacy, the impact of stress on health and health behavior, and the obstacles to changing to a healthier lifestyle. (See Kaplan SA, Calman NS, Golub M, Davis JH, Billings J. Racial and Ethnic Disparities in Health: A View from the South Bronx, J Health Care for the Poor and Underserved 2006; 17:116-127)