Evaluation of the NC Health

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Evaluation of the NC Health Wellness Trust Fund
InitiativeEliminating Health DisparitiesAntoine
tte Brown, PhDInstitute for Health, Social and
Community ResearchShaw University

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Health and Wellness Trust Fund

• Created by the General Assembly to invest North
  Carolinas portion of the Tobacco Master
  Settlement Agreement
• HWTF receives one-quarter of the states tobacco
  settlement funds
• Invests in programs and partnerships to address
  access, prevention, education and research that
  help all North Carolinians achieve better health

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The Ending Health Disparities Initiative

• In 2004 the HWTF Commissioners voted to address
  the growing problem of health disparities by
  offering grants to Eliminate Health Disparities.
• This initiative seeks to reduce disparities for
  children, youth and adults related to obesity and
  chronic diseases including but not limited to
  cardiovascular disease, diabetes, and cancer.

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The Award Process
HWTF received 107 applications from organizations
statewide to initiate new activities or expand
existing services and programs. Based on an
extensive external review process, 23
organizations were awarded 9.2 million in grant
funding. Grants were awarded for a three-year
period starting July 1, 2006 and ending on June
30, 2009. Four additional grantees were awarded
additional funds in August, 2006 bringing the
total to 27 grantees.
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The Focus of the Initiative

• Applied responses to interpersonal, behavioral,
  institutional and structural inequities that lead
  to disparate health status for the targeted
  populations.
• Collaboration among community stakeholders to
  develop culturally appropriate outreach, case
  management, and other initiatives that improve
  access to resources that are available or
  developed to serve the targeted populations.

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The Grantees

• The 27 grantees represent a diverse geographic,
  organizational and ethnic mix
• Community-based minority organizations
• Historically Black Colleges and Universities
• Faith-based approach.

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The Populations Targeted

• The majority of the grants awarded address
  obesity and chronic diseases related to obesity
  among African-Americans Native American, and
  Hispanic populations with low socioeconomic
  status.

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Topical Areas

• Diabetes control and/or prevention
• Obesity
• Cardiovascular disease
• Physical activity
• Healthy behaviors
• Asthma
• Breast cancer
• Culturally appropriate services.

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Intervention Designs

• Partnerships are consistent with the initiatives
  goals and objectives
• Action plans are based on evidence-based
  strategies appropriate for the population served
• Services are projected to reach adequate numbers
  of community members/clients
• Grantees demonstrate the ability to build
  sustained community support

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Intervention Strategies

• Community outreach
• Communication campaigns
• Screening for risks
• Education
• Case management
• Physical activity
• Cultural competence training

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Measuring Change

• Indicators of changes in behavior and health
  status
• Standard indicators
• Uniform collection techniques

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Indicators of Behavior and Physical Change

• Required Indicators
• Optional Indicators

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Indicators for Diabetes Programs

• Hemoglobin A1c or fasting blood glucose
• Weight or BMI
• Physical activity

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Indicators for Obesity Programs

• Weight or BMI
• Physical activity
• Fruit and vegetable consumption

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Indicators for CVD Programs

• Cholesterol levels
• Physical activity
• Smoking
• Weight or BMI

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Indicators for Physical Activity Programs

• Physical activity
• Smoking
• Weight or BMI
• Fruit and vegetable consumption

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Partners and Technical Assistance

• Institute for Health, Social and Community
  Research at Shaw University
• North Carolina Central University (NCCU)
• NCDHHS Office of Minority Health and Health
  Disparities
• Brogan Partners

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Evaluation Framework

• Outcome evaluation
• What works case studies
• Economic Analysis
• Progress monitoring

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Evaluation Framework 1. Outcomes

• The evaluation will measure the following
  outcomes
• changes in health status
• support for the initiative
• policy changes initiated or supported by
  grantees.

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Outcome Changes in Health Status

• Changes in
• participant behavior
• participant health status
• health disparities

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Outcome Support for the Initiative

• Support from community, corporate sponsors and
  other donors
• Volunteer hours
• In-kind contributions
• Monetary donations, grants and awards

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Outcome Policy Change

• Policy change at any level
• Community
• Region
• State

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Evaluation Framework2. What Works Case Studies

• To promote successful interventions the
  evaluation will focus after the first year on
• What works
• Success stories
• Lessons learned

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Evaluation Framework3. Economic Analysis

• Costs of Health Disparity
• Health care costs
• Lost days of productivity
• Savings that result from reductions in health
  disparity

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Evaluation Framework4. Progress Monitoring

• Grantees will report on their activities and the
  outcomes of the activities related to their goals
  and objectives on a monthly basis.
• Grantees will be asked about their satisfaction
  with the support they have received from the HWTF
  and from the technical assistance providers.

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HDI Data Base

• Web-based real time data capture
• Adapted from Progress Check
• Adaptations funded by HWTF contract
• Grantees enter data and generate reports
• Evaluation team generates reports for HWTF

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SUMMARY

• Focuses on outcomes
• Monitors progress
• Uses case studies to capture what works