Background and Hypothesis: Asthma and its appropriate treatment is a public health issue in Indiana that Indiana Joint Asthma Coalition (InJAC), a partnership within CTSI, is attempting to address. This is done through state-wide coalition building, which unifies efforts regarding asthma health and education and promotes interprofessional collaboration. Because time and resources are limited, InJAC must choose the areas that would benefit most from their focused work. A matrix was developed to establish the 10 counties with poorest asthma health and high vulnerability to social determinants to aid in this choice. We hypothesize that the 10 counties with the highest vulnerability to social determinants of health will have the worst asthma health. Project Methods: Asthma health outcomes, contributing asthma-related variables, and social determinants of health were identified in all 92 counties in Indiana. Counties were compared by composite z scores to determine the top 10 counties with the poorest health statistics for asthma and social determinants. In addition, qualitative data will be used to identify local health coalitions that have the capacity and desire to work with InJAC to improve asthma treatment. InJAC will begin sessions with these counties to determine if long-term, sustainable, health promotions are feasible. Results: The top 10 counites that were identified as having the poorest asthma health and factors were Lake, Grant, Madison, Marion, Huntington, Vanderburgh, Howard, La Porte, Blackford, and Noble. The top 10 counties with highest vulnerability to social determinants were Owen, Ripley, Daviess, La Grange, Fayette, Wayne, Elkhart, Newton, Switzerland, and Marion. Potential Impact: The data from this matrix will help direct InJAC to the areas of Indiana with the most need for asthma coalition efforts. This will be done through improvement on education, awareness, and quality of care based on the Indiana State Asthma Plan.
Background/Objective: Despite increasing emphasis on health equity in policy, leadership, and program development, meaningful advancement in health equity remains a challenge. A comprehensive review of community health coalition efforts to improve health equity has not been conducted. In this narrative review, we examine what evidence exists that community health coalitions can advance health equity, and whether coalitions are a preferred approach to address health equity. Methods: PubMed, CINAHL, PsycINFO, and Web of Science were searched for peer-reviewed, English articles with no date restrictions. In total, 1256 records were screened, of which 1163 were excluded for duplicate publications, no coalition or coalition-based intervention, no relevant outcomes, no emphasis on health equity or disparities, not primary literature, or unavailable full text. The remaining 93 articles are presented as a table of interventions based on outcomes. Further, evaluations of coalition effectiveness with controls are reviewed. Results: Populations of interest were racial and ethnic minorities, women and girls, low socioeconomic status communities, rural and urban areas, older adults, and LGBTQ groups. The most commonly reported results were changes in health outcomes or behaviors and community or organizational policy. Few studies were randomized, double-blinded, or controlled trials. This is not unexpected given the difficult nature of evaluating community interventions. Very few studies evaluated the effectiveness of a coalition-based intervention as compared to organizational interventions. Conclusion, Impact, & Implications: Available literature suggests that health coalitions influence health outcomes, policies, and important social determinants of health in populations affected by health inequity. However, community intervention studies pose a unique challenge for high quality evaluation. While health coalitions have a positive influence on health equity, more research is needed to determine the advantages of health coalition interventions versus organizational interventions.
