Results

Table of Contents

Introduction
Method
Analysis
Results
Discussion
Directions for Future Research

The following graph presents the dates of establishment for the 33 coalitions responding to the survey.

Membership
The 33 asthma coalitions ranged in size from 4 members to 325 members (both organizational and individual members) with an average size of 80. The number of official organizational partners ranged from 1 to 180. Across all 33 asthma coalitions, approximately 55% of the membership represented the health sector (35% health-care providers, 14% individual medical professionals, 6% pharmaceutical companies). Social service agencies (both public and private) were represented by 10% of the members and 10% represented nonprofit, nongovernment organizations. The education sector was represented by 10% of the members. Approximately 9% of the members were from associations such as ALA, advocacy groups, and others. Businesses/corporations and child-care providers were the least represented groups, 2.5% and 2%, respectively, (Table 1).

Table 1

A variety of membership recruitment strategies was given by the coalitions with the two most frequently reported methods being word-of-mouth (39%) and networking activities (39%), followed by personal contacts (25%) and mailings (including e-mails) (18%). Networking activities included presentations and program events, professional conferences, and specific ALA contacts. Other less frequently used strategies included direct phone calls (7%) and publicity (7%). Approximately 18% of the coalitions indicated specifically that they would seek out interested persons and would invite these people to meetings.

Membership participation
Approximately 68% of the coalitions believed that responsibilities were divided among members and 86% indicated that there was a participative climate among members. The majority of coalitions (65%) reported member input in developing an action plan. Some types of input reported by coalition directors and the processes for developing action plans included:

• The local foundation proposal became action plan; it was written by two or three people, but presented by the steering committee to the membership for approval before it was submitted.
• Coalition conducted an asthma "conference" to determine out if a viable response to asthma could be developed. Groups were formed and people experienced facilitated sessions to determine how to address the asthma problem in the state. The groups came up with a product that was used to put together a planning grant from which emerged a strategic plan and action plan.
• Organizers put out a call to people throughout the region, who were either experts in the field or had a significant interest in asthma. A series of conference calls was conducted to identify what needed to be done. Conference calls were the impetus for creating an asthma summit open to anyone connected to asthma care management, education, business, etc. The purpose of the summit was to create a statewide plan by finding people, getting them interested and giving them the opportunity for input into a plan. Four work groups were formed to do the plan.
• The coalition started as a work group and developed an asthma summit where everybody contributed to the development of a plan. Priorities were established and a core group developed a draft. The final version of the plan was presented to the membership for adoption.
• Regional coalitions were created around three major goals. Groups met to get acceptance of the goals as well as objectives that had been written. A summit meeting was conducted where action groups worked on each goal to develop action plans for each region.
• Data are released at the end of each fiscal year which might impact on the direction of the coalition. The action plan is revised by a committee of the whole. Each member gets a copy of the plan through the minutes.

Target population
Coalitions were asked to indicate specific groups being served or being targeted by the coalition’s activities. Multiple responses were allowed. The majority of the coalitions (88%) indicated the focus of their efforts was on children. Health-care provider was the next highest indicated target population (72%), followed by minorities and school personnel (69%). High-risk groups and inner-city groups were the focus of approximately 63% of the coalitions, followed by low-income populations (59%). Parents were included in the target group by approximately 53% of the coalitions. The child care industry was part of the target population for 31% of the coalitions. Table 2 presents the percentage of coalitions serving specific target groups.

Table 2

Scope of coalition
Coalitions were asked to indicate the scope of their efforts in terms of geographic area(s) served. Multiple responses were allowed. The majority of coalitions responding to the survey served urban areas (72%). Approximately 41% of the coalitions indicated they served multiple areas including urban, suburban, rural, regional, and in some cases statewide. Thirteen percent of the coalitions served rural areas exclusively. Overall 47% of the coalitions were serving rural areas.

Organizational structure
Although 25% of the coalitions had obtained nonprofit, tax-exempt status, the majority of coalitions were not organized as a legal entity. Approximately 9% were in the process of applying for tax-exempt status. The majority of coalitions had coordinators or directors (91%), with approximately 35% of these positions being held pro bono. Approximately 28% of the people holding the coordinator or director position were accountable to one of the coalition partners. Approximately 69% of the coalitions had staff; staff size ranged from 1 to 25 with an average staff size of 2.8. Thirty-one percent of the coalitions had full-time staff and 38% had part-time staff. Approximately 41% of the coalitions had paid staff and 28% had any volunteer staff.

The most common organizational structure consisted of a director or chairperson and board of directors or steering/oversight committee, and specific standing committees that corresponded to the coalition’s primary goals, such as professional education, schools, public awareness, research, and evaluation, etc. Approximately 15% of the coalitions indicated that they had ad hoc project groups or action teams that worked on a project specific basis; the group or team disbanded when the project was completed. An informal laissez faire organizational structure was reported by 11% of the coalitions.

Coalition implementation factors
Table 3 presents correlations between those coalition factors found to facilitate implementation and the perceptions of key informants on determinants of member satisfaction and participation in a coalition. Implementation factors included: ability to provide a shared vision; staff with skills and time to work with the coalition; frequent and productive communication; cohesion or a sense of belonging on the coalition; complexity of the coalition structure; goals, objectives and action plan; evaluation of successes and challenges (Kegler et al). Determinants of member satisfaction and participation in a coalition include: leadership roles identified; shared decision making [input into action plan]; linkages with other organizations; and a participative climate among members (Butterfoss et al).

Table 3

*Note: cell entries refer to the correlations between the specified factors. An asterisk indicates that the correlation is statistically significant (n=33); *P<0.01, **P<.001.

Coalitions with defined leadership roles were more likely to have developed a shared vision. Coalitions with defined leadership roles also had memberships involved in frequent and productive communication, and there was the perception that members had a sense of belonging or cohesion. Coalitions with defined leadership roles had staff with skills necessary to work with the coalition. These coalitions also had a structure that provided access to coalition partners. Having goals, objectives, and a timetable (member-developed action plan) was significantly correlated with defined leadership roles, shared decision making, and a participative climate among members.

Communication was also significantly correlated with shared decision making. Linkage with other organizations was correlated with having staff with skills to work with the coalition as well as having access to coalition partners without constraint by management level or structure. Coalitions having staff with skills to work with coalitions contributed to a positive organizational climate among its members. A positive organizational climate was also correlated with a shared vision and access to coalition partners. Coalitions that measured their successes and identified their challenges were positively correlated to community leadership and linkages with community organizations.

Interventions or services provided
The majority of coalitions indicated involvement in educational activities (52%). Approximately 36% of coalitions provided some level of professional education activity; 29% provided general asthma education and 18% specified school-based education programs. Two coalitions had developed specialized curricula for day care provider programs. Other types of educational activities were provided to the general public. Twenty-four percent of the coalitions indicated they were involved in direct dissemination of information through specific activities, i.e., newsletters, resource directories, Web sites, brochures. Development of special projects was listed by 24% of the coalitions, e.g., Open Airways program, Asthma Camp. Asthma awareness activities which included an asthma expo, speaker’s bureau, community events, media campaigns, and community forum were listed by 21% of the coalitions. Activities related to evaluation and data collection were listed by 21% of the coalitions. Specific training was provided by 18% of the coalitions. Fifteen percent of the coalitions listed legislation and public policy activities as a primary service. Asthma screening was provided by 7% of the coalitions (Table 4).

Table 4

Primary goals
Coalitions were asked to indicate their primary goals. Approximately 43% of the coalitions indicated a primary goal related to improving care and treatment for children with asthma. This was followed by a goal of reducing the rate of morbidity and mortality (25%). Twenty-five percent of the coalitions also indicated the provision of some form of education or training as a primary goal. Approximately 21% of the coalitions listed a goal related to dissemination or networking. Other goals listed by less than 15% of the coalitions included:

• raise awareness
• improve policies and procedures
• reduce absenteeism
• conduct evaluation and research (data collection)
• reduce rate of hospitalizations
• conduct asthma screenings
• conduct needs assessments
• improve environmental factors

Major accomplishments
Coalitions were asked to indicate major accomplishments. Approximately 43% of the coalitions indicated a training or educational program as a major accomplishment. The programs included the following:

• training health professionals
• providing on-site educational programs
• developing curricula for day care providers
• developing home intervention strategy
• developing asthma care program for Medicaid population
• providing training for public housing administrators

Dissemination of information through various strategies was accomplished by 40% of the coalitions. Some of the strategies used included:

• newsletters
• speakers bureau
• reports with recommendations
• media campaigns

Thirty-two percent of the coalitions believed one of their major accomplishments was the development of new partnerships. Approximately 29% of the coalitions had developed or impacted policy or legislation. Specific references were made to conducting or hosting an asthma summit or conference/forum by 21% of the coalitions. Other major accomplishments reported by at least 11% of the coalitions were:

• securing funding
• reducing hospitalizations or ER visits
• sharing or gathering data through prevalence surveys, data workshops, or specific reports
• developing state asthma plan

Challenges
Over one half of the coalitions (54%) indicated that their major challenge related to securing and maintaining funding. Other challenges listed by at least 15% of the coalitions included:

• lack of staff
• need for physician education
• sustaining, developing, and broadening membership
• coordinating coalition projects and activities

Financial resources
Annual budgets for coalitions ranged from zero to $350,000 with over 38% of the coalitions reporting no annual budget. The median annual budget was $9,000. Thirty-five percent (35%) of the coalitions reported annual budgets over $100,000 and 27% had budgets less than $20,000. Those coalitions with no annual budget operated primarily on volunteer efforts and with financial support from a sponsoring agency such as the local American Lung Association. Table 5 presents a frequency distribution for coalitions reporting annual budgets.

Table 5

Coalitions were asked to indicate the source of their financial support. Ongoing in-kind institutional support was reported by approximately 65% of the coalitions with support ranging from 10% to 100% of their total funding. Pharmaceutical companies or organizations provided financial support to 41% of the coalitions. Approximately 14% of the coalitions reported receiving financial support from local government grants or contributions, 17% received support from state government sources, and 21% received support from federal government grants. Approximately 17% of the coalitions received a portion of their financial support from private foundation sources and less than 10% received support from community foundations or trusts. Private industry (other than pharmaceutical companies) provided support to approximately 7% of the coalitions and individual contributions provided financial support to 10% of the coalitions (Table 6).

Table 6

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