|Engagement and action for health: the contribution of leaders' collaborative skills to partnership success.|
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|PMID: 19440289 Owner: NLM Status: MEDLINE|
|A multi-site evaluation (survey) of five Kellogg-funded Community Partnerships (CPs) in South Africa was undertaken to explore the relationship between leadership skills and a range of 30 operational, functional and organisational factors deemed critical to successful CPs. The CPs were collaborative academic-health service-community efforts aimed at health professions education reforms. The level of agreement to eleven dichotomous ('Yes/No') leadership skills items was used to compute two measures of members' appreciation of their CPs' leadership. The associations between these measures and 30 CPs factors were explored, and the partnership factors that leadership skills explained were assessed after controlling. Respondents who perceived the leadership of their CPs favourably had more positive ratings across 30 other partnership factors than those who rated leadership skills less favourably, and were more likely to report a positive cost/ benefit ratio. In addition, respondents who viewed their CPs' leadership positively also rated the operational understanding, the communication mechanisms, as well as the rules and procedures of the CPs more favourably. Leadership skills explained between 20% and 7% of the variance of 10 partnership factors. The influence of leaders' skills in effective health-focussed partnerships is much broader than previously conceptualised.|
|Walid El Ansari; Reza Oskrochi; Ceri Phillips|
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|Type: Journal Article; Multicenter Study Date: 2008-01-21|
|Title: International journal of environmental research and public health Volume: 6 ISSN: 1660-4601 ISO Abbreviation: Int J Environ Res Public Health Publication Date: 2009 Jan|
|Created Date: 2009-05-14 Completed Date: 2009-08-20 Revised Date: 2013-06-02|
Medline Journal Info:
|Nlm Unique ID: 101238455 Medline TA: Int J Environ Res Public Health Country: Switzerland|
|Languages: eng Pagination: 361-81 Citation Subset: IM|
|Faculty of Sport, Health & Social Care, University of Gloucestershire, Gloucester, United Kingdom. email@example.com|
|APA/MLA Format Download EndNote Download BibTex|
Community Networks / organization & administration*
Education, Professional / standards
Outcome Assessment (Health Care)
Reproducibility of Results
Journal ID (nlm-ta): Int J Environ Res Public Health
Journal ID (publisher-id): 101238455
Publisher: Molecular Diversity Preservation International (MDPI)
? 2009 by the authors; licensee Molecular Diversity Preservation International, Basel, Switzerland.
open-access: This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
Received Day: 29 Month: 12 Year: 2008
Accepted Day: 20 Month: 1 Year: 2009
Print publication date: Month: 1 Year: 2009
Electronic publication date: Day: 21 Month: 1 Year: 2008
Volume: 6 Issue: 1
First Page: 361 Last Page: 381
PubMed Id: 19440289
Publisher Id: ijerph-06-00361
|Engagement and Action for Health: The Contribution of Leaders? Collaborative Skills to Partnership Success|
|Walid El Ansari1*|
1 Faculty of Sport, Health & Social Care, University of Gloucestershire, Gloucester, United Kingdom
2 School of Technology, Department of Mathematical Sciences, Oxford Brookes University, Wheatley, Oxford, United Kingdom; E-mail:
3 Institute for Health Research, School of Health Science, Swansea University, Singleton Park, Swansea, Wales, United Kingdom; E-mail:
|Correspondence: * Author to whom correspondence should be addressed; Tel.: +44 (0) 1242 715274; Fax: +44 (0)1242 715222; E-mail:
The objective of this paper is to further the understanding of the links between leadership skills and a wide range of process and outcome factors of effective partnerships in public health. Collaboration across professional and agency boundaries has taken many approaches, involving shared decision-making, pooled budgets and integrated provision [1?6]. Partnerships are becoming the norm for capacity building and development in public health, health education and disease prevention [7?11]. Many granting Foundations such as W.K. Kellogg  have supported local partnerships for community-wide planning to achieve health objectives.
We use the terms ?coalition? and ?partnership? interchangeably to indicate the process by which stakeholders invest themselves with ideas, experiences and skills that collectively bear upon problems through joint decision-making and action . Community partnerships (CPs) of professionals and community-based grassroots agencies influence long-term health and welfare, nurture social inclusion, reduce inequalities, and instil a sense of community . However, these community-wide initiatives require extra effort and time where professionals and ?lay? people collaborate on an equal power basis, with respected inputs and similarly heard expressions . Such partnerships face multiple internal and external ?dynamic tensions? [16, 17], and require effective leadership [18, 19].
Leadership is a ?coalition-building? factor associated with implementation, maintenance, organisation and effectiveness [20?22]. Leaders advance equal status, encourage joint working and enhance partners? involvement in decision-making. Such actions increase members? participation, satisfaction and commitment [23, 24]. Leaders? characteristics, personal features and decision-making styles influence positive team outcomes , while leadership qualities, knowledge, commitment, competence, communication and interpersonal relations are critical in realising objectives . In empowering agencies, leaders promote members? cohesion and involvement in planning [27, 28].
In addition, successful CPs build on other factors: broad stakeholder and community representation, administrative/ management skills and quality communication [7, 29?31]; and staff and lay members? expertise and experience [11, 32, 33]. The costs and benefits of participation are important [34, 35], as they enhance member and resource allocation satisfaction . A supportive organizational climate with clear rules, procedures and roles promotes operational understanding in CPs , while collaborative decision-making and positive interactions build equitable staff-constituency relationships  that endorse a sense of ownership and community [37, 38].
This study was informed by multiple conceptual frameworks for successful CPs. These included membership, organisational and structure characteristics, resources and support, and function and roles [39?41]. The frameworks also addressed operational parameters (leadership and management skills, communication, decision making processes) [27, 28, 42?44] that require democratic, visible and supportive leaders .
Four aspects emerged from the literature: 1) CPs are vital in tackling common health concerns across partners and communities; 2) effective leadership is essential for CPs to achieve their health outcomes; 3) leadership does not exist in isolation and many non-leadership factors neatly interlace in effective CPs; 4) leadership is related to team efficacy, satisfaction, and outcomes , but current models fail to fully explain relationships between leadership and the factors that contribute to successful CPs.
Few have systematically examined the relationships between leadership and partnership outcomes . Kumpfer et al.  emphasised the lack of understanding of the influence of leadership, proposing a model where leadership was related to team efficacy, satisfaction, and outcomes. This paper builds on Kumpfer?s model to further the understanding of leadership?s influence. It hypothesises that leadership will not only influence team efficacy, satisfaction, and outcomes, but also many other factors critical to successful CPs. The term ?factor? describes any given feature of effective CPs (e.g. flow of information, communication, interaction, or commitment factors), and ?item? indicates the number of questions that comprised each factor.
We explored relationships between CPs? leadership qualities and many operational, functional and organisational partnership factors. The analysis is part of a wider survey into 5 CPs in South Africa . The objectives were to:
- describe the CPs? aims and outcomes
- compute each participant?s level of agreement on 11 dichotomous (?Yes/ No?) questionnaire items relating to leadership skills in their CPs; employ this to generate two related measures: a continuous Leadership Skills Score (LSS) and a Leadership Skills Category (LSC); and, explore the relationship between them. [LSS was employed to explore the association between leadership skills and CP factors measured with 2 or 3 categories; LSC was employed to explore the association between leadership skills and CP factors with continuous scales and categorical scales measured with more than 4 categories].
- test the assumption that the LSC would differentiate among participants? levels of engagement and involvement in the CPs by employing 10 confirmatory items to confirm the predicted direction of the results prior to the main analyses
- assess whether members with greater level of LSC would also experience more positive perceptions of 26 partnership factors, as well as a greater benefit-cost ratio for their participation
- assess whether participants with greater LSS would also experience more positive perceptions of another three partnership factors (operational understanding, communication mechanisms, and rules and procedures)
- explore the partnership factors that leadership skills contribute to explaining across the participating CPs and their implications; and
- use the findings to revisit Kumpfer et al.?s  model where leadership was a major factor related to team efficacy, satisfaction, and outcomes.
Access to public services in South Africa was skewed , and a policy aim was to increase the number of students who enter primary care and work with disadvantaged communities. Kellogg Foundation facilitated this by establishing CPs of tripartite academic-health service-community stakeholders who leveraged institutional change from outside through partnering with the communities for more primary care practitioners. Similar efforts elsewhere were effective .
The CPs were delivering many outcomes across all stakeholders. For example, HPE outcomes included knowledge acquisition and socialisation, premised on what students experienced, and the setting in which this happened , while curricula were redesigned to be more community-based, and linked with community resources/settings that enabled students? participation [13, 49, 50]. Service outcomes focussed on multi-professional teams for community-responsive primary care . Health professions student outcomes comprised educational shifts to ?generalist? training that prepared community-appreciative providers [52, 53]. Community outcomes included active lay involvement in HPE, specific roles in the educational process  and better understanding of the university [54, 55]. Policy outcomes were the collective impact of CPs on HPE policy change away from traditional clinical training . Sustainability outcomes included partner involvement, role clarity, relationships and group ownership [5, 40] for long-term viability with the reallocation of resources . Finally, structural change outcomes were service delivery reforms and community linkages to facilitate the changes for lay and professional agencies involved in the efforts [55, 58].
Participants (N = 668) were members of five CPs, each serving populations ranging between 35,000 and 300,000. The study tool was a self-administered questionnaire compiled from surveys of health coalitions and Kellogg evaluation tools [27, 39, 40, 59 ? 61]. Some items were slightly modified to fit the objectives of the CPs under study. The instrument is detailed elsewhere . Box (1) depicts 11 items that comprised the leadership skills factor, to include leaderships? incentives, styles, actions and management .
Box 1. Leadership skills: eleven items.
The Partnership leadership
All are categorical dichotomous items, scored on (?Yes/No?) format; two items inquired about information provision/reporting of achievements; three items inquired about consultation, recognition and solicitation of opinions; three items were about involvement skills and welcoming of views of those within/outside the CP; three items queried leaderships? promotion of continuing education, social gatherings and group activities.
Table 1 comprises description, number of items and internal consistency of 30 factors that addressed CPs? characteristics, processes, structures and outcomes thus reflecting the breadth of this inquiry.
In addition to leadership skills (1 factor) and another 30 partnership factors, 10 further items of engagement and involvement were included as confirmatory items (e.g. time since joining the CP; percentage of CP meetings attended; time spent on CP activity; number of times stakeholders recruited new members, served as CP?s representatives, implemented CP-sponsored events, worked on CP committees, or held CP committee or team leadership positions). As a safety check prior to the main analyses, these were employed in the initial analysis to confirm that LSC differentiates among participants in the predicted direction.
The Statistical Package (SPSS v14) was used to generate two indicators that captured how members gauged the skills of their CPs? leadership.
- Leadership Skills Score (LSS): a quantitative score for each respondent premised on percentage of ?Yes? answers to 11 leadership items. LSS ranged from 0?1, where the closer it was to 1 (if all responses were ?Yes?), the higher was the respondent?s assessment of their CP?s leadership (assuming all items are equal in weight). LSS was then employed to explore the association between leadership skills and 3 CP factors measured with few (2 or 3) categories (see Table 5).
- Leadership Skills Category (LSC): LSS was used to generate a measure with 4 categories of leadership skills: ?Low? LSC (?3 positive ratings); ?Moderate? (4?6 positive ratings); ?High? (between 7?8); and ?Excellent? LSC (>8 positive ratings). LSC was employed to explore the association between leadership skills and CP factors with continuous (Tables 2 & 3) and categorical scales (Table 4).
Cronbach?s ? indicated the internal consistency for multi-item factors. Pearson correlation matrix assessed correlations between factors. Independent sample t-tests or Analysis of Variance (ANOVA) explored associations between LSC and CP factors measured with continuous scale (Table 3) or between LSS and CP factors measured with few categorical scales (Table 5). Chi-square (?2) tests explored associations between the LSC and CP factors measured with categorical scales (Table 4). Significance level was P <0.05. Regression analysis was undertaken in order to explore the contribution of leadership skills to the range of partnership factors under investigation.
The denominators required for response rates were difficult to ascertain. Some ?potential? respondents had not attended any CP meetings (inclusion criterion). Others (academicians on CPs? Boards) apologized that they were not wholly involved. Core Staff (CPs? paid employees) numbers were verifiable and their response rate was ? 90%. For academics/ health services, usually representatives of given units actively participated in the CPs, so ?snowballing? helped to reach, follow up and survey eligible members (response rate >90%). The questionnaire?s multi-item scales had excellent/ very good reliability, where for >80% of the scales, ? was ? 0.70 (range 0.93?0.66, very few sections between 0.70?0.66). All items within each factor contributed positively to internal consistency in all multi-item scales and were retained (Table 1).
The sample (N=668) comprised community constituencies (n = 367) of civic organisations or attending on their own behalf; academic institutions (n = 130); health services (n = 111); and core staff (n = 60). Membership ?size? differences existed across CPs and stakeholders. Members? mean age was 40 years (range 18?78), with differences across CPs (p<0.002), where 90% of sample was >25 years old. There were more females (M= 64%), with variations across CPs (42% ? 79% of membership, p<0.001). Overall 78% of respondents reported ?Black? ethnicity, which varied (40% ? 98%, p<0.001) by the location of CPs within South Africa.
Few (11%) members had previous experience of partnership working (Mean = 3.5 years), but the number of these individuals varied across sites (range 4% ? 16% of respondents, p<0.004). Members joined their CPs since ? 22 months, but duration varied (range 18 ? 27, p<0.001) due to differences in the periods that community (p<0.001) and health services members (p=0.04) had been involved. Academics showed the earliest involvement (M=27.4 months), followed by core staff (M=22 months), and community and health services (M=21 months for both).
Across sites, 45% ? 76% of respondents reported ?Moderate? or ?Low? involvement in their CPs (p<0.001). Participants attended about half CPs? meetings that they were expected to attend, and attendance varied across CPs (range 38% ? 71%, p<0.001). There was disparity in the number of hours per month that members spent on CP work (range 11.7 ? 53 hours, p<0.001). Finally, 27% of the sample reported their authority to make decision on behalf the agencies they represented at CP meetings, but with variations across sites (range 14% ? 45%, p<0.001).
Table 1 depicts the description and reliability of the partnership factors. Members felt the management capabilities in their CPs? to be above average, but the CPs needed broader representation of local stakeholders. They perceived favourably the staff-community communication, while communication between community members was good, with useful information exchange.
Although partnership work is often voluntary respondents reported above average level of benefits from participation. General satisfaction with their CPs was also average, but satisfaction with resource allocation was lower. Members valued the expertise that health services and academics brought to the CPs slightly more than the skills of civic and community members. They felt that their CPs? engagement in policy activities could be improved, although they positively rated the partners? involvement/ effectiveness in some policy areas. However, there were higher levels of engagement in HPE than in policy activities, and good partner involvement/ effectiveness in educational efforts.
Stakeholders had sense of ownership and fair commitment to the efforts. Interactions and consultative decision-making were above average, accompanied by consensus that CPs would achieve their intended outcomes. Generally, members did not feel their material, time and effort contributions to the CPs as excessive, and reported them to be at modest affordable costs. Members perceived the organizational/personnel barriers as minor problems, but felt that CPs? effectiveness could be enhanced, and rated their individual CPs? activity in the prior 2 years as moderate. There was role clarity in the inputs that partner agencies typically had in advice on and development of CPs? operations, and above average operational understanding of CPs? committees, mission and structure. Members felt that CPs? communication mechanisms could be enhanced, although a reasonable number of members knew their CPs? rules/ procedures.
Across 10 confirmatory items, higher LSC was associated with mainly positive perceptions to the items (except for the first item, see Table 2 below). Members with higher LSC had joined their CPs for longer periods than those with lower LSC, attended more meetings, and spent more time on CP activity. Since joining their CPs, they recruited more new members to the CPs, served more times as CP?s representatives and on more CP-sponsored events, worked on more CP committees and held more leadership positions. In many instances there was an ascending pattern in the ratings of engagement/ involvement items as one moved from lower to higher LSC. These findings confirmed LSC as a valid indicator that distinguished, in the predicted direction, among members with various involvement levels. Interestingly, more members with past CP experience were associated with low/ moderate LSC. This suggested that past experience in partnership settings could cause members to be more critical in their assessment of leadership skills in their current CPs. However, the differences were not significant (Table 2, first row)
Respondents who rated LSC in their CPs as ?High? or ?Excellent? consistently scored better on 26 other different partnership factors than those who reported ?Low? or ?Moderate? LSC (Table 3). In most cases, there was more positive perception across the 26 CP factors as one moved from ?Low? leadership skills to those who felt ?Excellent? LSC. Positive feelings about leadership were consistently accompanied by partners? positive perceptions of other CP factors.
Table 4 shows that members who reported ?Low?-?Moderate? LSC were more likely to feel that their participation entailed more difficulties and costs than benefits. Conversely, those who reported ?High?-?Excellent? LSC felt that their involvement had more benefits than difficulties.
As regards day-to-day operations, Table 5 depicts that respondents who rated positively the operational understanding, communication mechanisms and rules and procedures of CPs exhibited, generally, a higher LSS than those who rated these less favourably. Positive perceptions about the CPs? leadership (higher LSS) were associated with more positive perceptions about CPs? procedures/ operations, and that communication mechanisms between partners and stakeholders were good and varied.
Leadership Skills contributed explanatory power to the variance of 10 CP factors after controlling for all the partnership factors (Figure 1). It explained 20% and 19% of the variance of communication mechanisms and respondents? perceptions of the benefits to difficulties of being a CP member; and contributed 15% to another three factors (management capabilities, operational understanding, and effectiveness of the CPs? educational activities). It also explained the variance of participation benefits (14%), community members? communication (12%), effectiveness of the CPs? general activities (11%), flow of information (9%), and outcomes of the partnerships (7%). Favorable perceptions of the partnership leaders by the members were critical to a range of factors of effective partnerships.
In CPs, local political, business, grassroots and civic leaders unite around a community agenda to develop coordinated responses to community health and social challenges . Successful partnering requires effective leadership , and leadership style was consistently associated with effectiveness . The CPs influenced health practitioners to be more community sensitive, so partnership leaders need an understanding of the health care system, providers, universities and communities to develop strategies to influence the health system . Leadership is critical in coalitions , where leaders relate to their environment, building teams or collaborations [66, 67]. Besides authority, power and influence to guide members to goals  leaders require training and technical assistance to promote coalition building/sustainability [69, 70].
In this cross-site evaluation of 5 CPs  the tool addressed operational and organisational ?process? and ?outcome? factors, balancing process measures of how coalitions work and outcome indicators of whether CPs make a difference . Process measures show how close coalitions are connected to the grassroots , and are essential to assess effectiveness [5, 73].
For some stakeholders, response rates were challenging to compute. This was not unusual: frequently in collective action, only a fraction of people/organisations with shared interests become involved [74, 75], usually at the minor level of belonging to an agency and paying dues.
The survey tool displayed excellent internal consistency, essential in evaluations of partnerships  (?>0.60 is acceptable, but values >0.80 are preferred). In this study, >80% of scales of multi-item measures had ? ? 0.70 (range 0.66 ? 0.93), supporting values reported by others [37, 40, 41, 76]. However leadership is often measured in different ways: incentive management , task focused , shared leadership , empowering or collective , or embracing multiple features . The 11 features of leadership employed in the present analysis catered for a variety of leadership aspects, behaviours and styles.
In terms of the first objective, the CPs targeted many educational, social, and community development objectives, as with similar efforts elsewhere [10, 47, 65, 79]. The initiative was sharing of models of academic-community partnering collectively focussed on the health needs of the population groups, communities and individuals concerned. Hence, academics had participated slightly longer, reflecting their initial involvement in the ?pre-formation? phase [80, 81].
Secondly, it has been shown that it was appropriate to use LSS and LSC when exploring associations between the leadership skills and CP factors. Thirdly, LSC was valid in differentiating among participants across 10 confirmatory items, where higher LSC was associated with positive perceptions to the items. The findings were in the predicted direction, and confirmed the consistency of LSC in differentiating among participants with different engagement levels. An exception was in relation to past CP experience.
Fourthly, affirmative feelings of partners about their leadership were consistently accompanied by positive perceptions across many factors of CPs? functioning. Others  similarly identified 27 measures of coalition characteristics, where many measures were related to leadership performance. Indeed successful university-community collaborations for health curricula reforms require leadership strategies (e.g. consistency, range of leadership behaviours, participative governance) that are associated with positive outcomes .
These findings support that member, staff and organisational factors are intertwined in CPs [12, 39?41]. For instance, high LSC partners felt the personnel barriers in their CPs to be less threatening, a critical perspective for a coalition?s internal functioning, where high member turnover, low interest or infighting is disruptive . Further, high LSC participants rated the CPs? interactions more agreeably, confirming that CPs are flexible/ permeable structures interacting with their environments rather than tightly-bounded entities . Similarly, high LSC members felt more sense of ownership, which promotes greater community participation , and valued the staff and community skills, highlighting that member expertise is vital for effective CPs [39, 77, 85].
High LSC members reported an effective information flow and that communication between staff and community members was good - a significant predictor of coalition satisfaction [18, 39]. They reported that their constituencies were more committed, an important factor as CPs? leaders motivate their members? commitment, nurturing it into a vision [77, 86, 87]. Different commitment levels result in varied investments of time, effort and resources [28, 88].
Partners with lower LSC felt that their participation entailed more difficulties and costs than benefits than those with higher LSC. Such reciprocity provides insights into whether to participate , the benefits/costs of alternative modes of structuring coalitions , and the importance of a favourable benefit/cost ratio [27, 89]. Active leaders may accept an equal ratio of benefits to costs .
For objective five, higher LSS partners felt positive perceptions on operational understanding of the CPs? operations, communication mechanisms, and knowledge of CPs? rules/ procedures. These findings are supported by other studies. Communication is a predictor of intermediary measures of coalitions , where open, frequent and varied communication channels are valued [77, 91]. Similarly, knowledge of the CPs? rules/ procedures is critical, where members? knowledge of coalition functioning affected later sustainability , awareness of rules/ procedures was predictive of agency commitment , and both were indicators of CP effectiveness [78, 93].
Regarding the last 2 objectives, leadership skills contributed to explaining the variance of 10 partnership factors ranging between 20% (communication mechanisms) to 7% (outcomes). This represents a ?net? effect, after controlling for all the factors under study . The outcomes were provision of primary care services; influencing HPE; and increasing the medical, nursing and other health professions who practice primary care in underserved areas. Revisiting Kumpfer?s  model where leadership was related to three factors (team efficacy, satisfaction, and outcomes), the hypothesis of the paper is affirmed: leadership was not only associated with these three factors, and this study extended the associations of leadership to 30 factors, highlighting the importance of leaders? skills in effective health-focussed partnerships.
In CPs public/private agencies, community leaders, academic and health services come together to tackle public health. Voluntary participation between partners who traditionally have not collaborated together requires skilled leadership. Members who perceived favourably the leadership of their CPs consistently scored better on 30 different partnership factors than those who rated leadership skills less favourably. The findings systematically examined relationships between leadership and many partnership processes and outcomes to emphasise the relevance of leadership skills. For researchers, this highlights the importance of including leadership features when undertaking coalition inquires in order to further the understanding of its intricate relationships and pre-requisites as regards stages of coalition formation. For CP practitioners, administrators, directors and coordinators, the findings demonstrate that their inputs, decision-making, interactions, communication and engagement are carefully viewed by partnership constituencies and simultaneously influence CP?s success. For policy makers, this highlights the need for developing and nurturing structures that provide appropriate leadership skills that are supportive and conducive to effective leaders from diverse stakeholders; as well as instilling appropriate incentives for leadership development at different levels. For grant-making bodies, this translates to highlighting the effects of appropriate leadership to potential grantees, encouraging and ensuring the inclusion of leadership technical assistance and training within a partnership?s budget as appropriate, as well as promoting the assessments of leadership aspects in partnership evaluations. Collectively such actions should make a difference.
This research would not have been possible without the active involvement of the South African Community Partnerships. The authors extend the appreciation to all those who contributed: directors, chairpersons and project management staff; health service personnel; academics from a range of disciplines; and, community leaders, workers and members who participated in this study.
|1..||National Treatment Agency for Substance Misuse (NTA)Working in partnership 2005Available at: http://www.nta.nhs.uk/frameset.asp?u=http://www.nta.nhs.uk/publications/Drug_service_policies_8.htm) (accessed September 15, 2008).|
|2..||National Audit OfficeGetting Citizens Involved: Community Participation in Neighbourhood Renewal;. National Audit Office; London, UK: 2004|
|3..||Riley PL,Koplan JP. Prevention research centers: the academic and community partnershipAm. J. Prev. Med 1999;16:5–6. [pmid: 10198669]|
|4..||Clark NM. Community/practice/academic partnerships in public healthAm. J. Prev. Med 1999;16:18–19. [pmid: 10198675]|
|5..||El Ansari W,Phillips CJ. Empowering health care workers in Africa: partnerships in health - beyond the rhetoric towards a modelCrit. Public Health 2001;11:231–252.|
|6..||Levin E,Davey B,Iliffe S,Kharicha K. Research across the social and primary health care interface: methodological issues and problemsRes. Policy Plan 2002;20:17–29.|
|7..||Erwin K,Blumenthal DS,Chapel T,Allwood LV. Building an academic-community partnership for increasing representation of minorities in the health professionsJ. Health Care Poor Underserved 2004;15:589–602. [pmid: 15531817]|
|8..||El Ansari W. Collaborative research partnerships with disadvantaged communities: challenges and potential solutionsPublic Health 2005;119:758–770. [pmid: 15950252]|
|9..||D?tterweich JA. Building effective community partnerships for youth development: lessons learned from ACT for YouthJ. Public Health Manag. Pract. 2006;(1):S51–S59. [pmid: 17035903]|
|10..||Mastro E,Jalloh MG,Watson F. Come on back: enhancing youth development through school/community collaborationJ. Public Health Manag. Pract 2006;(1):S60–S64. [pmid: 17035904]|
|11..||Peake K,Gaffney S,Surko M. Capacity-building for youth workers through community-based partnershipsJ. Public Health Manag. Pract 2006;(1):S65–S71. [pmid: 17035905]|
|12..||El Ansari W. Educational partnerships for health: do stakeholders perceive similar outcomes?J. Public Health Manag. Pract 2003;9:136–156. [pmid: 12629914]|
|13..||MUCPP (Mangaung-University of Orange Free State Community Partnership Programme)Health For All: Building our Nation Together. MUCPP; Bloemfontein, South Africa: circas1995|
|14..||Centre for Urban and Community ResearchInvestors in Communities: Final evaluation report on pilot phase. Joseph Rowntree Foundation; York, UK: 2005|
|15..||El Ansari W,Phillips CJ,Zwi AB. Narrowing the Gap Between Academic Professional Wisdom and Community Lay Knowledge: Partnerships in South AfricaPublic Health 2002;116:151–159. [pmid: 12082597]|
|16..||Mizrahi T,Rosenthal B. Managing dynamic tensions in social change coalitionsMizrahi T,Morrison JCommunity organization and social administration: advances, trends, and emerging principles. Haworth Press; New York, USA: 1992|
|17..||Barnes HM. Collaboration in community action: a successful partnership between indigenous communities and researchersHealth Promot. Int 2000;15:17–25.|
|18..||Alexander MP,Zakocs RC,Earp JA,French E. Community coalition project directors: what makes them effective leaders?J. Public Health Manag. Pract 2006;2:201–209. [pmid: 16479236]|
|19..||El Ansari W. Community development and professional education in South AfricaMitchell SEffective educational partnerships: experts, advocates, and scouts. Praeger; Westport, USA: 2002|
|20..||Zakocs RC,Edwards EM. What Explains Community Coalition Effectiveness? A review of the literatureAm. J. Prev. Med 2006;30:351–361. [pmid: 16530624]|
|21..||Feighery E,Rogers T. Building and Maintaining Effective Coalitions, Published as guide No. 12 in the series How-To Guides on Community Health PromotionHealth Promotion Resource Center, Stanford Center for Research in Disease Prevention; Paolo Alto, CA., USA: 1990|
|22..||Zapka JG,Marrocco GR,Lewis B,McCusker J,Sullivan J,McCarthy J,Birch FX. Interorganisational responses to AIDS: a case study of the Worcester AIDS ConsortiumHealth Educ. Res 1992;7:31–46. [pmid: 10148731]|
|23..||Giamartino GA,Wandersman A. Organisational climate correlates of viable urban organisationsAm. J. Commun. Psychol 1983;11:529–541.|
|24..||Steenbergen G,El Ansari W. The power of partnership. Stop TB Partnership, World Health Organization; Geneva, Switzerland: 2003|
|25..||Knoke D,Wood JR. Organizing for Action: Commitment in Voluntary Associations. Rutgers University Press; New Brunswick, NJ., USA: 1981|
|26..||Sheaff R,Schofield J,Mannion R,Dowling B,Marshall M,McNally R. Organisational factors and performance: a review of the literature. NHS Service Delivery and Organisation R&D Programme. Programme of Research on Organisational Form and Function; London, UK: 2004 (Reference number: WS15)|
|27..||Prestby JE,Wandersman A,Florin PR,Rich RC,Chavis DM. Benefits, costs, incentive management and participation in voluntary organisations: a means to understanding and promoting empowermentAm. J. Commun. Psychol 1990;8:117–149.|
|28..||Prestby JE,Wandersman A. An empirical exploration of a framework of organisational viability: maintaining block organisationsJ. Appl. Behav. Sci 1985;21:287–305.|
|29..||Haynes MA. Professionals in the community confront changesAm. J. Public Health 1970;60:519–523.|
|30..||Shortell SM,Zukoski AP,Alexander JA,Bazzoli GJ,Conrad DA,Hasnain-Wynia R,Sofaer S,Chan BY,Casey E,Margolin FS. Evaluating partnerships for community health improvement: tracking the footprintsJ. Health Polit. Policy Law 2002;27:49–91. [pmid: 11942419]|
|31..||Partnership work: the health service-community interface for the prevention, care and treatment of HIV/AIDS. Report of a WHO consultation 5?6 December 2002. Goede H,El Ansari WWorld Health Organization; Geneva, Switzerland: 2003|
|32..||Garland B,Crane M,Marino C,Stone-Wiggins B,Ward A,Friedell G. Effect of community coalition structure and preparation on the subsequent implementation of cancer control activitiesAm. J. Health Promot 2004;18:424–434. [pmid: 15293928]|
|33..||Crowley KM,Yu P,Kaftarian SJ. Prevention actions and activities make a difference: a structural equation model of coalition buildingEval. Program Plann 2000;22:381–388.|
|34..||Mansergh G,Rohrbach LA,Montomery SB,Pentz MA,Johnson CA. Process evaluation of community coalitions for alcohol and other drug abuse prevention: a case study comparison of researcher- and community initiated modelsJ. Commun. Psychol 1996;24:118–135.|
|35..||El Ansari W,Phillips CJ. The Costs and benefits of participants in community partnerships. A paradox?Health Promot. Pract 2004;5:35–48. [pmid: 14965434]|
|36..||Weiss ES,Anderson RM,Lasker RD. Making the most of collaboration: exploring the relationship between partnership synergy and partnership functioningHealth Educ. Behav 2002;29:683–98. [pmid: 12456129]|
|37..||McMillan B,Florin P,Stevenson J,Kerman B,Mitchell RE. Empowerment praxis in community coalitionsAm. J. Commun. Psychol 1995;23:699–727.|
|38..||Armbruster C,Gale B,Brady J,Thompson N. Perceived ownership in a community coalitionPublic Health Nurs 1999;16:17–22. [pmid: 10074818]|
|39..||Rogers T,Howard-Pitney B,Fieghery EC,Altman DG,Endres JM,Roeseler AG. Characteristics and participation perceptions of tobacco control coalitions in CaliforniaHealth Educ. Res 1993;8:345–357.|
|40..||Gottlieb NH,Brink SG,Gingiss PL. Correlates of coalition effectiveness the Smoke Free Class of 2000 ProgramHealth Educ. Res 1993;8:375–384. [pmid: 10146475]|
|41..||Kumpfer KL,Turner C,Hopkins R,Librett J. Leadership and team effectiveness in community coalitions for the prevention of alcohol and other drug abuseHealth Educ. Res 1993;8:59–74.|
|42..||Wandersman A. Citizen ParticipationPsychology and Community Change: Challenges of the Future. (2ed) 2ed. Heller K,Price RH,Reinharz S,Riger S,Wandersman AThe Dorsey Press; Homewood, Illinois, USA: 1984:337–379.|
|43..||Goodman RM,Steckler AB. A framework for assessing program institutionalizationInt. J. Knowl. Transfer 1989;2:57–71.|
|44..||Florin PR,Wandersman A. An introduction to citizen participationAm. J. Commun. Psychol 1990;18:41–54.|
|45..||TurningPointCollaborative leadership and health a review of the literatureSeattle, WATurningPoint. Available at: http://www.turningpointprogram.org/toolkit/pdf/Devlead_lit_review.pdf (accessed August 21, 2008).|
|46..||Brixen P,Tarp F. South Africa: macroeconomic perspectives for the medium termWorld Develop 1996;24:989–1001.|
|47..||Goodrow B,Olive KE,Behringer B,Kelley MJ,Bennard B,Grover S,Wachs J,Jones J. The community partnerships experience: A report of the institutional transition at East Tennessee State UniversityAcad. Med 2001;76:134–141. [pmid: 11158831]|
|48..||Richards RM. From problems to solutions: a bridge between culturesBuilding partnerships: educating health professionals for the communities they serve. Richards RWJossey Bass; San Francisco, USA: 1996|
|49..||Henry RC. An update on the community partnershipsBuilding partnerships: educating health professionals for the communities they serve. Richards RWJossey Bass; San Francisco, CA, USA: 1996|
|50..||Lazarus J,Meservey PM,Joubert R,Lawrence G,Ngobeni F,September V. The South African community partnerships: Towards a model for interdisciplinary health personnel educationJ. Interprof. Care 1998;12:279–288.|
|51..||Langley AL,Maurana CA,Le Roy GL,Ahmed SM,Harmon CM. Developing a community-academic health center: strategies and lessons learnedJ. Interprof. Care 1998;12:273–278.|
|52..||Seifer SD,Maurana CA. Health professions education, civic responsibility and the overall health of communities: realising the promise of community-campus partnershipsJ. Interprof. Care 1998;12:253–257.|
|53..||El Ansari W,Phillips CJ. Community development for a changing world? Innovative joint working in health care?a South African partnership modelInter. J. Public Private Partnership 2001;3:269–275.|
|54..||Gelmon SB,Holland BA,Shinnamon AF,Morris BA. Community-based education and service: the HPSISN experienceJ. Interprof. Care 1998;12:257–272.|
|55..||El Ansari W,Phillips CJ. Interprofessional collaboration: a stakeholder approach to evaluation of voluntary participation in community partnershipsJ. Interprof. Care 2001;15:351–368. [pmid: 11725582]|
|56..||W. K. Kellogg FoundationEvaluation HandbookBattle Creek, MichiganW. K. Kellogg Foundation 1998Available at: http://www.wkkf.org/Publications/evalhdbk/default.htm (accessed September 27, 2008).|
|57..||Foley HA. How public funds are spentBuilding partnerships: educating health professionals for the communities they serve. Richards RWJossey Bass; San Francisco, CA, USA: 1996|
|58..||Kagan SL. United We Stand: Collaboration for Child Care and Early Education ServicesTeachers College Press, Teachers College, Columbia University; New York, USA: 1991|
|59..||Minnesota Department of HealthA Self-Assessment Form For Use By A Community Health Committee. (Community Health Services Administration Work Group Draft Interim Report); Department of Health; Minneapolis, USA: 1990|
|60..||W. K. Kellogg FoundationHealth Profession Education and Community Partnership Study. Survey Research Division of the Institute for Public Policy and Social Research; Michigan State University, Michigan, USA: 1994|
|61..||W. K. Kellogg FoundationImproving Cluster Evaluation Information: Some Areas for Consideration. W.K. Kellogg Foundation; Battle Creek, MI., USA: 1994|
|62..||Jellinek PS,Hearn RP. Fighting drug abuse at the local levelIssues Sci. Technol 1991;7:78–84. [pmid: 10170798]|
|63..||Hallfors D,Cho H,Livert D,Kadushin C. Fighting back against substance abuse are community coalitions winning?Am. J. Prev. Med 2002;23:237–245. [pmid: 12406477]|
|64..||Knott, JH. Building Sustainable Partnerships. Paper prepared for the W.K. Kellogg Foundation conferenceBuilding Partnerships: An Agenda for Health Around the WorldMiami, USAMarch 22, 1995. Miami, USA, 1995|
|65..||Bland CJ,Starnaman S,Hembroff L,Perlstadt H,Henry R,Richard R. Leadership behaviors for successful university-community collaborations to change curriculaAcad. Med 1999;74:1227–1237. [pmid: 10587687]|
|66..||Size T. Leadership development for rural healthN. C. Med 2006;67:71–76.|
|67..||Bamberg R,Layman E. Approaches to leadership development used by deans of allied healthJ. Allied Health 2004;33:113–124. [pmid: 15239409]|
|68..||Jooste K. Leadership: a new perspectiveJ. Nurs. Manag 2004;12:217–223. [pmid: 15089960]|
|69..||Osborn LM,DeWitt T. The HRSA-APA Faculty Development Scholars Program: executive leadership trackAmbul. Pediatr 2004;4:98–102. [pmid: 14731084]|
|70..||Feinberg ME,Gomez BJ,Puddy RW,Greenberg MT. Evaluation and Community Prevention Coalitions: Validation of an Integrated Web-Based/Technical Assistance Consultant ModelHealth Educ. Behav 2006;35:9–21. [pmid: 16740500]|
|71..||Yin RK,Kaftarian SJ,Yu P,Jansen MA. Outcomes from csap?s community partnership program: findings from the national cross-site evaluationEval. Program Plann 1997;20:345–355.|
|72..||Lachance LL,Houle CR,Cassidy EF,Bourcier E,Cohn JH,Orians CE,Coughey K,Geng X,Joseph CLM,Lyde MD,Doctor LJ,Clark NM. Collaborative design and implementation of a multisite community coalition evaluationHealth Promot. Pract 2006;7:44S–55S. [pmid: 16636155]|
|73..||El Ansari W,Weiss E. uality of Community Partnership Research: Developing the Evidence BaseHealth Educ. Res 2006;21:175–180. [pmid: 16109765]|
|74..||Olson M. The Logic of Collective Action: Public Goods and the Theory of Groups. University Press; Cambridge, MA., USA: 1965|
|75..||Mcarthy JD,Zald MN. Resource mobilization and social movements: a partial theoryAm. J. Sociol 1977;82:601–610.|
|76..||Hays CE,Hays SP,DeVille JO,Mulhall PF. Capacity for effectiveness: the relationship between coalition structure and community impactEval. Program Plann 2000;23:373–379.|
|77..||Kegler MC,Steckler A,Malek SH,McLeroy K. Factors that contribute to effective community health promotion coalitions: a study of 10 project assist coalitions in North CarolinaHealth Educ. Behav 1998;25:338–353. [pmid: 9615243]|
|78..||Butterfoss FD,Goodman RM,Wandersman A. Community coalitions for prevention and health promotion: factors predicting satisfaction, participation and planningHealth Educ. Q 1996;23:65–79. [pmid: 8822402]|
|79..||Starnaman S,Henry RC,Weissert CS,Bland CJ. W. K. Kellogg Foundation Community Partnerships for Community Health Education: Sustainability Study, 1999. Report to the W. K. Kellogg Foundation. W. K. Kellogg Foundation; Battle Creek, MI. USA: 1999|
|80..||Kreuter MW,Lezin NA,Young LA. Evaluating Community-Based Collaborative Mechanisms: Implications for PractitionersHealth Promot. Pract 2000;1:49–63.|
|81..||Lexau C,Kingsbury L,Lenz B,Nelson C,Voehl S. A community-wide approach for promoting farming health and safetyAAOHN J 1993;41:440–449. [pmid: 8259948]|
|82..||Granner ML,Sharpe PA. Evaluating community coalition characteristics and functioning: a summary of measurement toolsHealth Educ. Res 2004;19:514–532. [pmid: 15150134]|
|83..||Feinberg ME,Greenberg MT,Osgood DW. Readiness, functioning, and perceived effectiveness in community prevention coalitions: a study of communities that careAm. J. Commun. Psychol 2004;33:163–176.|
|84..||Drach-Zahavy A,Baron-Epel O. Health promotion teams? effectiveness: a structural perspective from IsraelHealth Promot. Int 2006;21:181–190. [pmid: 16723386]|
|85..||Florin P,Mitchell R,Stevenson J,Klein I. Predicting intermediate outcomes for prevention coalitions: a developmental perspectiveEval. Program Plann 2000;23:341–346.|
|86..||Butterfoss FD. The coalition technical assistance and training framework: helping community coalitions help themselvesHealth Promot. Pract 2004;5:118–126. [pmid: 15090166]|
|87..||Mitchell SM,Shortell SM. The governance and management of effective community health partnerships: A typology for research, policy and practiceMilbank Q 2000;78:241–289. [pmid: 10934994]|
|88..||Kisil M,Chaves M. Linking the university with the community and its health systemMed. Educ. Res 1994;7:31–46.|
|89..||Butterfoss FD,Goodman RM,Wandersman A. Community coalitions for prevention and health promotionHealth Educ. Res 1993;8:315–330. [pmid: 10146473]|
|90..||Freidmann R,Florin P,Wandersman A,Meier R. Local action on behalf of local collectives in the US and Israel how different are leaders from members in voluntary associations?J. Volunt. Action Res 1988;17:36–54.|
|91..||Kegler MC,Wyatt VH. A multiple case study of neighborhood partnerships for positive youth developmentAm. J. Health Behav 2003;27:156–169. [pmid: 12639073]|
|92..||Gomez BJ,Greenberg MT,Feinberg ME. Sustainability of community coalitions: an evaluation of communities that carePrev. Sci 2005;6:199–202. [pmid: 16079961]|
|93..||Weiner BJ,Alexander JA,Shortell SM. Management and governance processes in community health coalitions: a procedural justice perspectiveHealth Educ. Behav 2002;29:737–754. [pmid: 12462195]|
|94..||El Ansari W,Phillips CJ,Hammick M. Collaboration and partnerships: developing the evidence baseHealth Soc. Care Commun 2001;9:215–227.|
Keywords: Partnership, coalition, community-based, inter-professional, multi-site evaluation, health professions education, leadership.
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