October 1997

Grant Results

National Program

Old Disease, New Challenge: Tuberculosis in the 1990s

SUMMARY

From 1995 to 1998, researchers at the University of California, San Francisco, carried out a qualitative evaluation of the Old Disease, New Challenge program to monitor and evaluate five demonstration strategies.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Old Disease, New Challenge: Tuberculosis in the 1990s.

The evaluation was designed to study all aspects of the model strategies and to examine the nature of the process for individuals, groups, and institutions.

Key Findings
Preliminary findings include:

  • There are factors that facilitate successful collaboration, such as:
    • Recognizing and understanding that all of the participating organizations have their own institutional culture, goals, and target populations.
    • Assuring that organizations selected for participation in the coalition represent the community and understand the community's needs.
  • Some projects needed to pilot-test assumptions and proposed approaches and then make the indicated changes.
  • Project personnel, especially project coordinators, who were willing to take professional risks to change institutionalized processes and push traditional boundaries to establish new procedures, contributed to project success.
  • The role of community health workers/outreach workers was an important component of all the projects.

Funding
RWJF supported the study with a two grants totaling $452,653 between August 1995 and March 1998.

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THE PROBLEM

Because a relatively small number of Americans have tuberculosis, measuring the impact of the five demonstration projects would not have been as helpful to the elimination of the epidemic as understanding the processes, successes, and failures of the model projects.

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EVALUATION

A qualitative evaluation of the Old Disease, New Challenge Program is currently being conducted to monitor and evaluate the five demonstration strategies. The evaluation was designed to study all aspects of the model strategies and to examine the nature of the process for individuals, groups, and institutions.

Judith Justice, Ph.D. (University of California at San Francisco) developed and is directing the evaluation. Each of the five program sites has an evaluator (all five are anthropologists by training) using ethnographic methods including in-depth interviewing and observation, to study the day-to-day functioning of each demonstration project.

The collection of qualitative descriptive data will supplement the quantitative data related to screening activities collected by each demonstration project. It is anticipated that the evaluation will provide a holistic picture and will help identify barriers and factors facilitating the development, implementation, and sustainability of the five model projects. Particular attention is being given to monitoring efforts to build information systems and coalitions among the participating groups.

The evaluation also is looking at the RWJF-supported demonstration projects within the broader context of TB services in each of the five geographic areas. Although the evaluation was still in process when this report was written, some of the preliminary key findings are outlined below.

  • Some factors found to facilitate successful collaboration included:
    • Recognizing and understanding that all of the participating organizations had their own institutional culture, goals, and target populations, in addition to individual/group expectations from participation in the model strategy.
    • Involving all participating organizations as equal partners in the development of the proposal and implementation of the demonstration project.
    • Keeping the goals of the coalition clear and uncomplicated, in addition to focusing on shared goals.
    • Assuring that organizations selected for participation in the coalition represent the community and understand the community's needs.
  • Projects addressing marginalized populations, including bi-national groups, encountered unanticipated delays and in some cases, needed to pilot-test assumptions and proposed approaches, and then make the indicated changes. The most successful projects were flexible enough to make necessary changes to their original plan.
  • Merging computer database networks was not as easy as anticipated. Many problems were encountered including incompatible computer systems and disputes over ownership of information.
  • Placing the RWJF-supported project within the framework of the community's overall tuberculosis efforts and involving, from the beginning of project development, individuals and organizations who were "major players" in other tuberculosis and health-related activities was found to facilitate the sustainability of project activities when RWJF funding ended.
  • Long-term relationships between participating organizations were an influential factor, both positive and negative, in some projects. Historical conflicts between the lead organization and the target community presented a barrier to collaboration and coalition building. Thus, where relationships were historically bad, grantees had to give special attention to overcoming this obstacle. When organizations were able to overcome their local stereotyped reputation by genuinely reaching out to the target population, community relationships were improved and active participation in the demonstration strategy was achieved.
  • Project personnel, especially project coordinators, who were willing to take professional risks to change institutionalized processes and push traditional boundaries to establish new procedures and ways of doing things, contributed to project success.
  • The role of community health workers/outreach workers was an important component of all the projects. Projects that ensured that community health workers represented their target population, and included them in project management and decision-making were more likely to be successful.
  • Race and social class were issues in all key relationships, including those between the project's home institution, administrative staff and the community, and between community health workers and the community.
  • The bureaucracy and regulations encountered when attempting to work with many government organizations (i.e. public health departments) often served as barriers to collaboration. Some grantees and other project participants, therefore, found it easier to develop partnerships with private and non-profit organizations.
  • The cross-border project (the County of San Diego and Tijuana) encountered special difficulties. In addition to cultural and language barriers, and national and international regulations, many activities and procedures that are usually taken for granted lead to mistaken assumptions and misunderstandings which served as barriers to long-term collaboration.

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GRANT DETAILS & CONTACT INFORMATION

Project

Evaluation of Old Disease, New Challenge: Tuberculosis in the 1990s

Grantee

University of California, San Francisco (San Francisco,  CA)

Institute for Health Policy Studies

  • Amount: $ 324,994
    Dates: August 1995 to July 1997
    ID#:  026838

  • Amount: $ 127,659
    Dates: April 1997 to March 1998
    ID#:  031676

Contact

Principal Investigator: Judith Justice, Ph.D.
(415) 476-9814

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Report prepared by: Marie P. Lyons
Reviewed by: Marian Bass
Program Officer: Marilyn Aguirre-Molina
Evaluation Program Officer: James Knickman

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