Grassroots Public Health Management in Managed Care

Dr Mantravadi’s research interests are in health economics research, outcomes research, modeling, pharmacoeconomics, and economic evaluation. Dr Mantravadi conducts research on the application of econometric techniques. Other research interests include healthcare application of biostatistics, health information technology/GIS, and health administration/ management.
Community coalitions are a backbone of public health, and offer a unique perspective towards implementation of managed care disease management/case management programs.
Community coalitions are a backbone of public health, and offer a unique perspective towards implementation of managed care disease management/case management programs. Community coalitions have successfully addressed a variety of health issues, such as asthma, chronic disease, and substance abuse.1-3 Key strengths of the coalition approach include creating economies of scale, increasing access to/sharing of resources, and enhancing sustainability.2,3 In order to generate and sustain such results, coalitions rely on engaging the human resource skills of their members.

Member engagement is key for coalitions to build capacity and address health needs.4 The coalition’s main asset to survival is its members, and the sustainment of a coalition depends on member participation.2 Sustained engagement allows time for people to build trust in each other, as well as collaborative capacity; however, it is often challenging because of competing demands on people’s time and turnover in health and human service organizations.   
Ensuring that members are effectively engaged and satisfied is related to effective coalition organization, shared leadership, and decision-making styles.2 As community coalitions build partnerships, sustained engagement fosters pooled resources, improvement in health and inter organizational collaboration. Member engagement is measured as participation and satisfaction, as conceptually defined by the Community Coalition Action Theory (CCAT).2,5 Leadership and staffing—human resources—build member engagement.5

Member engagement in coalitions depends on individual motivations to participate and volunteer towards coalition goals. These key predictors are involved in creating committed and satisfied coalition members. In turn, coalition members who are satisfied and committed will have higher levels of participation.4 The predictors that will be considered here are participatory leadership, cohesion, task focus/meeting efficiency, perceived participant benefits, and participant difficulties.

Participatory Leadership. The coalition climate is enhanced when participants have an increased degree of influence in decision-making process.2 The degree of collaborative input by the member can range from small advisory roles to more collaborative roles.6 Participatory leadership styles and shared decision making generates greater commitment to the coalition, subsequently increasing participation.2 The leadership and decision making process present within the coalition affects member satisfaction, and the likelihood and extent of participation, including the number of hours contributed.2,7

Cohesion. Positive relationships and organizational climate affect satisfaction.2 Member relations have a role in organization climate, and subsequent coalition participation. Theoretically, these cohesive relationships promote collaboration and trust.7 Cohesive coalitions have been shown to increase member satisfaction, subsequently increasing participation.2  

Task Focus. Task focus enables members to efficiently “progress” towards on coalitions goals while minimizing inefficiencies, influencing group culture.5 In addition, task focus aligns member incentives with organizational goals, encouraging engagement. Organizations must be able to balance task focus and shared decision-making processes to optimize cohesive organizational culture.5 Member engagement is additionally bolstered when coalition goals and objectives are achieved. 

Perceived Benefits and Barriers. The empirical and conceptual literature has consistently supported that barriers to and benefits of participation in coalitions are predictors of member engagement.8-11 Benefits and costs predict participation and the type of roles that members take on during participation in coalitions.2,12,13 Volunteering and participating in a coalition provides perceived personal benefits towards personal development, including values, understanding/new skills, career, social, protective (ego), and/or enhancement.14,15 The CCAT also suggests that member perception of participation benefits outweighing costs increases satisfaction.16

Barriers to member engagement also exist, such as personal time costs, loss of autonomy, issues with scheduling, loss of status, inefficiencies, and scarce resources.2,12,16-13 If coalition participation is perceived as costly, members will be unlikely to sustain their engagement in the coalition.2 Perceived time costs are an especially important consideration for member engagement in community coalitions for managed care disease management programs.

1. Kegler MC., Rigler J, Honeycutt S. How does community context influence coalitions in the formation stage? a multiple case study based on the Community Coalition Action Theory. BMC Public Health. 2010;10:90. doi:10.1186/1471-2458-10-90
2. Butterfoss FD, Goodman RM, Wandersman A. Community coalitions for prevention and health promotion. Health Edu Res. 1993;8(3)315-330.
3. Valente TW, Chou CP, Pentz MA. Community coalitions as a system: Effects of network change on adoption of evidence-based substance abuse prevention. Am J Public Health. 2007;97(5), 880-886. doi:10.2105/AJPH.2005.063644
4. Butterfoss F, Kegler M. The community coalition action theory. In: DiClemente R, Crosby R, Kegler M, editors. Emerging Theories in Health Promotion Practice and Research. 2nd ed. San Francisco, CA: Jossey-Bass; 2009.
5. Kegler MC, Swan DW. Advancing coalition theory: the effect of coalition factors on community capacity mediated by member engagement. Health Edu Res. 2012;27(4), 572-584. doi:10.1093/her/cyr083
6. Wandersman A. A Framework of participation in community organizations. J Appl Behav Sci. 1981;17:17-58
7. Butterfoss FD, Goodman RM, Wandersman A. Community coalitions for prevention and health promotion: Factors predicting satisfaction, participation, and planning. Health Edu Behav. 1996;23(1), 65-79.
8. Chinman MJ, Anderson CM, Imm PS, Wandersman A, Goodman RM. The perceptions of costs and benefits of high active versus low active groups in community coalitions at different stages in coalition development. J Community Psychol. 1996;24(3), 263-274.
9. McMillan B, Florin P, Stevenson J, Kerman B, Mitchell RE. Empowerment praxis in community coalitions. Am J Commun Psychol. 1995; 23(5), 699-727.
10. Prestby JE, Wandersman, A., Florin P, Rich R, & Chavis, D. Benefits, costs, incentive management and participation in voluntary organizations: A means to understanding and promoting empowerment. Am J Commun Psychol. 1990;18(1), 117-149.
11. Rogers T, Howard-Pitney B, Feighery EC, Altman DG, Endres JM, Roeseler AG. Characteristics and participant perceptions of tobacco control coalitions in California. Health Edu Res. 1993;8:345–357.
12. Chinman MJ, & Wandersman A. The benefits and costs of volunteering in community organizations: Review and practical implications. Nonprof Volunt Sec Q. 1999;28(1), 46-64.
13. Chinman MJ, Wandersman A, Goodman RM. A Benefit-and-Cost Approach to Understanding Social Participation and Volunteerism in Multilevel Organizations. In: Omoto AM, editor. Processes of community change and social action. Mahwah, NJ US: Lawrence Erlbaum Associates Publishers; 2005. pp. 105–125.
14. Clary EG, Snyder M, Ridge R, et al.  Understanding and Assessing the Motivations of Volunteers: A Functional Approach. J Pers Soc Psychol. 1998;74(6), 1516-1530.
15. Houle B, Sagarin B, Kaplan M. A Functional Approach to Volunteerism: Do Volunteer Motives Predict Task Preference? Basic Appl Soc Psych. 2005;27(4), 337-344.
16. Wolff T. A practitioner’s guide to successful coalitions. Am J Commun Psychol. 2011;29(2). 173-191.   

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