title: Policy and system change and community coalitions: outcomes from allies against asthma.
abstract: Objectives. We assessed policy and system changes and health outcomes produced by the Allies Against Asthma program, a 5-year collaborative effort by 7 community coalitions to address childhood asthma. We also explored associations between community engagement and outcomes. Methods. We interviewed a sample of 1,477 parents of children with asthma in coalition target areas and comparison areas at baseline and 1 year to assess quality-of-life and symptom changes. An extensive tracking and documentation procedure and a survey of 284 participating individuals and organizations were used to ascertain policy and system changes and community engagement levels. Results. A total of 89 policy and system changes were achieved, ranging from changes in interinstitutional and intrainstitutional practices to statewide legislation. Allies children experienced fewer daytime (P = .008) and nighttime (P = .004) asthma symptoms than comparison children. In addition, Allies parents felt less helpless, frightened, and angry (P = .01) about their child's asthma. Type of community engagement was associated with number of policy and system changes. Conclusions. Community coalitions can successfully achieve asthma policy and system changes and improve health outcomes. Increased core and ongoing community stakeholder participation rather than a higher overall number of participants was associated with more change.
authors.affiliation: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA nmclark@umich.edu.
authors.forename: Noreen M
authors.initials: NM
authors.lastname: Clark
authors.affiliation: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Laurie
authors.initials: L
authors.lastname: Lachance
authors.affiliation: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Linda Jo
authors.initials: LJ
authors.lastname: Doctor
authors.affiliation: Academy for Educational Development, Washington, DC, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gilmore
authors.affiliation: Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Kelly
authors.affiliation: Department of Public Health, Seattle and King Country, WA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Krieger
authors.affiliation: RAND Health, Santa Monica, CA, USA.
authors.forename: Marielena
authors.initials: M
authors.lastname: Lara
authors.affiliation: Medical College of Wisconsin, Children's Hospital and Health System, Milwaukee, WI, USA.
authors.forename: John
authors.initials: J
authors.lastname: Meurer
authors.affiliation: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Amy Friedman
authors.initials: AF
authors.lastname: Milanovich
authors.affiliation: Long Beach Children's Clinic, Long Beach, CA, USA.
authors.forename: Elisa
authors.initials: E
authors.lastname: Nicholas
authors.affiliation: Department of Family Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rosenthal
authors.affiliation: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Shelley C
authors.initials: SC
authors.lastname: Stoll
authors.affiliation: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Wilkin
mesh_terms: D001249:Asthma / Q000266:history*; D017028:Caregivers / Q000266:history; D002648:Child; D002675:Child, Preschool; D019058:Community Networks / Q000266:history*; D005260:Female; D006291:Health Policy / Q000266:history*; D049674:History, 21st Century; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D010290:Parents / Q000523:psychology*; D036301:Qualitative Research; D011788:Quality of Life; D011795:Surveys and Questionnaires