Harlem Health Advocacy Partners (HHAP)
Launched in 2014 through the New York City (NYC) Mayor’s Office, the Harlem Health Advocacy Partnership (HHAP) is a place-based initiative that seeks to improve the health outcomes of New York City Housing Authority (NYCHA) residents in East and Central Harlem by connecting residents to community health workers (CHWs) and Health Advocates (HA). The intervention, a partnership between the NYC Health Department, NYC public housing authority, community-based organizations, and the NYU-CUNY Prevention Research Center, aims to reduce the proportion of residents with uncontrolled diabetes, hypertension, and/or asthma, while also activating the community to develop broad wellness and prevention capacity. The initiative provides residents who have these three chronic conditions with one-on-one health coaching sessions, group-level workshops, referrals and linkages to community organizations and health providers, and health insurance enrollment and post-enrollment navigational assistance to help them better manage their health and prevent more conditions from developing. To this end, the goals of HHAP are to address health disparities by:
- Reducing rates of chronic disease through culturally relevant health education and counseling
- Coaching residents to increase self-efficacy for healthy behavior change
- Increasing the use and satisfaction with social services and health care, and helping to minimize systemic barriers that impede use
- Building leadership and capacity to address health needs among community residents though community organizing, health education, and community advocacy and engagement
The NYU-CUNY PRC is leading the evaluation of this initiative.
Evaluation Study Design
The HHAP Evaluation includes two parts: a community needs assessment conducted prior to the intervention to inform its design, and a longitudinal component.
Community Needs Assessment
The community needs assessment included a representative community survey and several focus groups designed to capture the current needs and health priorities of NYCHA residents in East and Central Harlem. The assessment was conducted before the intervention, and allowed researchers to analyze the care and health outcomes differences experienced by residents in majorly represented socio-demographic groups in this community, with an emphasis on subgroups of residents who are at greatest risk for poor health and impeded access to care. The community survey was conducted via telephone using the official telephone numbers of randomly selected NYCHA residents. Data were collected from more than 1,600 individuals aged 35 and older from ten public housing developments in East and Central Harlem. Intervention participants were enrolled from the five selected developments: King Towers, Taft, Johnson, Clinton and Lehman Village, each selected for their high rates of diabetes and other chronic conditions. Five nearby developments were selected as comparison sites: Carver, East River, Wagner, Washington and St. Nicolas, which, collectively, have comparable demographic make-up to the intervention developments. Six focus groups were also conducted among 55 residents living with diabetes, hypertension, and/or asthma to better understand their specific challenges. Participants discussed disease management, barriers and facilitators to healthy behaviors, health promotion within their culture, and the role of the CHWs.
View the Community Needs Assessment Report by clicking the image below.
To assess the impact of the intervention on individual behaviors, self-efficacy and health outcomes, the NYU-CUNY PRC enrolled the first 224 residents opting into the intervention during the first 7 months of operation, as well as 176 residents from the comparison developments. All evaluation participants had a reported diagnosed condition of diabetes, hypertension, and/ or asthma and agreed to take part in four repeated individual health assessment surveys over the course of one year after the start of services, including a baseline health assessment, as well as follow-up assessments at 3-, 6-, and 12-months post-baseline. Data from the longitudinal component will be analyzed to evaluate the following feasibility measures: CHW/HA service satisfaction and successful goal-setting; disease management self-efficacy and self-monitoring behavior; medication management and adherence; behavioral risk factors, including physical activity, diet, and smoking; and smoking cessation referrals.