Minority community health demonstration grant program: multiple case study.

Between 1986 and 1989, the Office of Minority Health (OMH) awarded twenty-six two-year grants in support of community coalitions which actively promoted health risk reduction at the community level among minority populations. Compared to the general population, African Americans, Asians/Pacific Islanders, Hispanics, and Native Americans/Alaska Natives are at higher risk of health problems, such as accidental injuries, hypertension, cancer, diabetes, cardiovascular disease, low infant birth weight, AIDS, violence, and alcoholism. This report determines how coalitions can effectively promote health risk reduction among minority populations. The report examines the process of coalition and intervention development, project outcomes, factors which lead to project success or failure, and OMH administration and operation of the program. It also recommends ways in which projects can enhance their health promotion efforts and OMH can maximize program effectiveness. The positive outcomes examined are: the achievement of project objectives; the continuation of the coalition past the funding period; the continuation of the intervention program; community empowerment; and spread effects of the project beyond its original target population and health problem focus. Whether these positive outcomes are realized depends in large part on the level of community involvement in the project's design, implementation, decision making, and activities. Community leaders, volunteers, and the target group must all be recruited in support of the project. The project design and implementation must also be culturally appropriate, and the composition of the project staff must reflect the ethnicity of the target community. Finally, it is also important that early attention be paid to project evaluation, that OMH offer consistent technical assistance to project staff, that the project design and implementation be flexible, and that a community-based organization serve as the project grantee and the coalition's lead organization. The report recommends that OMH consider extending the grant period to five years, strengthen its application review process, strengthen evaluation guidelines, provide more timely and effective technical assistance, and improve coordination and information sharing within the Department of Health and Human Services and with other federal agencies that provide assistance and support to racial and ethnic minorities.