Evaluation for Community Empowerment and Program Improvement

Assessing Cultural Competency in Community Health Centers

SHIRE’s principal purpose, in support of the Office of Minority Health and the Bureau of Primary Health Care, was to make a contribution to the development of a curriculum for health professionals in community health centers (CHCs) to enhance their cultural competence. This was to be done by collecting data on culturally competent clinical practices as reported by key stakeholders, including CHC medical and other staff, administrators, Board members and consumers served by the CHCs. SHIRE held 19 focus group discussions at five CHCs in California, Colorado, Indiana and Mississippi. In addition, SHIRE conducted focus group sessions with participants at a national farm workers conference representing 8 states. Participants generally viewed cultural competence as “a willingness to try to understand the patient” and recommended the establishment of supporting/enforcing policies and creation or strengthening of an infrastructure to support the integration of cultural competence into health care delivery.

Tracking and Evaluating Progress of Community Action Teams in Reducing Health Disparities

Building on previous work with Diabetes Action Teams, SHIRE has formulated an approach whereby DATs and other community projects can assess their progress toward achieving set goals and objectives. SHIRE recommended in a report prepared for the Bureau of Primary Health Care, a modified version of the “empowerment evaluation” model, which calls for an ongoing working partnership between external evaluators and program personnel. Another recommendation entailed increasing funding for DATS so that they can be full partners with CHCs in promoting health and preventing diabetes complications.

Environmental Scan of Consumer Advocacy Needs and Requirements in the District of Columbia

Engaged by the Annie E. Casey Foundation and Consumer Health Foundation, SHIRE generated a report for consideration by these and other foundations to assess the current state of organizations engaged in advocacy by and on behalf of consumers in Washington, DC. The scan entailed review of historical records, as well as approximately 30 interviews with knowledgeable participants and observers. The resulting report addressed the need for a consumer voice as reported by respondents; , pressing advocacy needs; an assessment of advocacy organizations currently active in the District, their needs and issues; prerequisites for capacity and structure among consumer advocacy organizations; and types/amounts of resources needed to support effective advocacy work in the District of Columbia.

Addressing Chronic Diseases in Communities of Color

Prevention of Perinatal HIV Transmission among Pregnant Women of Color
Focusing on pregnant women of color and the health providers who serve them, SHIRE has published materials that highlight the importance of testing for HIV before and during childbirth. Client brochures have been prepared in English, Spanish and French. SHIRE has distributed these educational materials to residents and immigrants, along with posters and guidelines about rapid testing for providers in Baltimore, Maryland, Washington, DC, Prince George’s County, Maryland and the United States Virgin Islands. Innovative Health Solutions, Inc. (IHS) has served as collaborator and co-creator of these products. Through SHIRE’s and IHS’ efforts, a health facility in the Virgin Islands was able to secure resources for rapid testing for HIV for the first time, hence greatly decreasing the likelihood that HIV-positive pregnant women would transmit the virus to newborns. This five-year project (1999-2004) was sponsored by the Office of Minority Health, HHS.

Bridging the Gap and Related Initiatives
Pfizer Pharmaceuticals has engaged SHIRE to provide consultation, planning, outreach and logistical support for a series of seminars and symposia, involving health providers, health advocates, representatives of educational institutions and the private sector to increase awareness and knowledge of the prevalence of health disparities among communities of color; the impact of cardiovascular disease in those communities; and the relationship of mental health to heart-related and other chronic diseases. Seminars have been held in Maryland, Pennsylvania, California and Washington, DC to date. A related initiative, funded by Bristol-Meyer Squibb, entailed providing expert consultation, conducting a feasibility study and holding discussions with key stakeholders in North Carolina for the purpose of directing pharmaceutical rebate dollars into improved health services to address chronic diseases among African Americans and other populations at risk in that state.