- Connecting Boston's Public Housing Developments to Community Health Centers:Who's Ready for Change?
What Is the Purpose of This Study?
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• Compare the readiness of housing developments versus health centers to address community-identified health priorities using the Community Readiness Model developed by the Tri-Ethnic Center for Prevention Research.
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• The Community Readiness Model scores a community's readiness on a scale of 1 to 9 across six dimensions of readiness; each community receives one composite readiness score.
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• Readiness score determines the types of actions that are appropriate to address health priority in that community.
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• Identify community-specific barriers to primary care for public housing residents.
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• Bridge prevention efforts in two unique communities targeting similar populations.
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• Engage public housing residents and community health center staff in research process through a community-based participatory research approach.
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• Determine appropriate strategies for larger intervention study to link public housing residents with primary care.
What Is the Problem?
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• Public housing residents bear a heavy burden of chronic health problems, including high rates of asthma, cancer, obesity, hypertension, and diabetes.
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• Public housing residents underutilize care despite close proximity to several health centers and academic medical centers in Boston.
What Are the Findings?
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• Findings indicate a mismatch in communities' readiness to address health priorities; readiness was significantly higher for health centers than housing developments.
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• Housing development overall readiness stage: Vague awareness; local concern but no immediate motivation to take action.
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• Health center overall readiness stage: Preparation; community leaders have begun planning in earnest, but the community itself offers modest support of these efforts.
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• Both health centers and housing developments scored highest in existing programs/policies and resources.
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• Health centers scored lowest in leadership and community knowledge of efforts.
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• Housing developments scored lowest in community knowledge of efforts and community knowledge of the issue.
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• Housing development key informants repeatedly reported barriers to health that are attributable to basic life needs, including violence/safety, substance abuse, financial issues, insurance, and housing conditions.
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• Housing development key informants reported tremendous variability in where residents get their care. [End Page 231]
Who Should Care Most?
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• Health center administrators.
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• Health center staff involved in program planning and community outreach.
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• Public housing development management.
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• Public housing resident leaders.
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• Community health workers who work with community health centers and/or public housing residents.
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• Researchers interested in the health of underserved populations.
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• Community members interested in addressing a health priority within their own community.
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• Program planners interested in implementing a health intervention within a particular community.
Recommendations for Action
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• These data can help us to better prepare for successful partnerships between community organizations and to understand why they fail when they do.
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• This type of data collection and application is a great benefit to the intervention planning group as it struggles to implement a full intervention in communities with limited budget and staff.
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• Develop intervention strategies based each communities' unique readiness score and focus on stage-specific goals to better align housing development readiness with health center readiness.
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• Goal for housing development strategies: Continue to gather information and work with key leaders to introduce information about the issue and current efforts to the target population.
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• Example housing development strategy: Visit existing small groups within the developments to inform them about heart health.
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• Goal for health center strategies: Raise awareness that the community can do something
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• Example health center strategy: Conduct patient interviews and surveys to identify service gaps, improve existing services and identify key places to post information.
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• Strategies targeting public housing residents must address multiple barriers around basic life needs to be successful. [End Page 232]