1. Engaging, Involving & Linking Key Stakeholders in Community Coalitions: The Allies Against Asthma Experience Noreen M. Clark, PhD Linda Jo Doctor, MPH Laurie Lachance, PhD Xin Geng, MS Amy R. Friedman, MPH Christy Houle, MPH National Program Office University of Michigan School of Public Health

2. Asthma Continues as a Major Public Health Problem In 2001, 31.3 million people reported at some time of their life being diagnosed with asthma. Asthma affects 5% to 8% of children under 18 years of age; is most common reason for childhood hospitalizations. Asthma-associated work absence days have increased by 50% since 1980 to 14 million in 1996. In 2000, estimated direct and indirect cost of illness related to asthma was $14 billion, (direct medical costs 9.4 billion). (NCHS,2002) (Mannino et al, 2002) (NHLBI, Chart book, 2002)

3. Asthma control requires putting patients at the center of efforts

4. Management by Patient Family Involvement Clinical Expertise Work/School Support Community Awareness, Support & Action Community-Wide Environmental Control Measures Conducive Policies Clark, 2001

5. Coalition: A group of individuals representing diverse organizations, factions, or constituencies within the community who agree to work together to achieve a common goal. (adapted from Feighery, Rogers, 1990)

7. Goals of AAA: Assist coalitions to develop and prosper creating sustainable community-wide asthma control and prevention systems. Describe processes/relationships congenial to success of coalitions. Assess outcomes of coalition activities. Learn as much as possible about coalitions as a means to improve asthma control.

8. Allies Against Asthma Coalitions Alianza Contra el Asma Long Beach Alliance Pediátrica en Puerto Ricofor Children with Asthma San Juan, Puerto Rico Long Beach, California Marielena Lara, MD Elisa Nicholas, MD, MSPH Consortium of Infant and Fight Asthma Milwaukee Allies Child Health Asthma Workgroup Milwaukee, Wisconsin Hampton Roads, Virginia John Meurer, MD, MBA Cynthia Kelly, MD Fran Butterfoss, PhD King County Asthma ForumPhiladelphia Allies Against Asthma Seattle/King County, Washington Philadelphia, Pennsylvania Jane Peterson, PhD Robert Groves, MA, MPH James Krieger, MD, MPH DC Asthma Coalition Washington, D.C. Lisa Gilmore, MBA, MPH

9. Measuring Coalition Impact coalition development & structure planning/assessment programs and policy development collaboration self-management skills institutional arrangements organization of care quality of life health status healthcare use Processes and Products Intermediate Outcomes Health Outcomes

10. Methods Coalition self-assessment survey (CSAS) to 7 sites in 2002 to a total of 294 coalition members Interviews and reports from each coalition provided qualitative data

11. Coalition Self-Assessment Survey Methods –View of community members described –Indices were constructed based on factor analysis of individual items –Chi-square analysis performed to compare different groups with the membership on both indices and individual items Perception of health care providers and other members Perceptions of community members and other members –Data is being analyzed by site and overall

12. Allies Against Asthma Stakeholders Survey N~ 294 Health Care Provider 38% (32-45%) Community 22% (8-48%) School 11% (2-21%) Other 13% (6-21%) HMO 7% (3-12%) Health Department 15% (3-34%) CSAS, 2002

13. Indices Decision Making Conflict Leadership Vision Benefits to Participation Support Problems with Participation Trust Butterfoss, F in Emerging Theories in Health Promotion Practice and Research: Strategies for Improving Public Health, 2002 Israel B, Schulz AJ, Parker EA, and Becker AB. Annu Rev Public Health 1998. 19:173-202 Kegler M, Steckler A, McLeroy K & Malek S. Health Education and Behavior 1998. 25:338-353 Kenney E and Sofaer S. School of Public Affairs, Baruch College City University of New York

14. Vision CSAS, 2002

15. Benefits

16. Trust 84%86%88%90%92%94%96% Opinion Considered Respect for Viewpoints Comfortable sharing new ideas Comfortable expressing point of view Talk openly & honestly Comfortable requesting assistance Extended Relationships CSAS, 2002

17. Presentations –Engaging the Stakeholders John Meurer, MD, MBAFight Asthma Milwaukee Medical College of Wisconsin Elisa Nicolas, MD, MPHLong Beach Alliance for Children With Asthma The Children’s Clinic Barbara Cooper, BAKing County Asthma Coalition Seattle School District –Decision Making Michael Rosenthal, MDPhiladelphia Allies Against Asthma Thomas Jefferson Hospital Fran Butterfoss, PhDCINCH Center for Pediatric Research –Coalitions as a Tool For Coordination and Integration James Krieger, MD, MPHKing County Asthma Forum Seattle/King County Public Health Department