Evaluation Results From the Healthy Work Collaborative: A Cross-Sectoral Capacity Building Partnership to Address Precarious Employment.

BACKGROUND: The COVID-19 pandemic has illuminated the profound health and safety risks of precariously employed workers, many of whom are disproportionately Latinx and Black. Precarious employment (PE) is a social determinant of health (SDOH) characterized by low wages, hazardous conditions, unstable work schedules, no termination protection, and few benefits. Even before COVID-19, calls for more effective health promotion efforts to address SDOH like PE existed. PURPOSE: The University of Illinois at Chicago Center for Healthy Work, Healthy Communities Through Healthy Work developed the Healthy Work Collaborative (HWC) as an evidence-informed capacity building policy, systems, and environmental change (PSE) initiative. The HWC aimed to facilitate cross-sectoral partnerships between health and labor sector partners. The labor sector provided technical assistance (TA) to participants to improve their ability to address PE through PSE. METHODS: This article reports findings from a mixed-methods evaluation using the Kirkpatrick training model including participants' reactions, learning, behavior, and outcomes. A pre-post survey was administered to participants (N = 21) and analyzed descriptively; 3-month post HWC interviews were conducted (N = 13) and thematically analyzed. CONCLUSION: Findings included positive results at all Kirkpatrick levels. Participants' reported that the HWC curriculum and delivery was valuable and well received; they demonstrated gains toward addressing PE through PSE knowledge and skills and increased or strengthened health/labor partnerships. In addition, HWC influenced participants' application of HWC concepts, and in a few cases, participants' made changes in policies and plans in their organizational settings. The HWC may serve as a model to address other SDOH through cross-sectoral PSE change.

Development of the Healthy Work Collaborative: Findings From an Action Research Study to Inform a Policy, Systems, and Environmental Change Capacity-Building Initiative Addressing Precarious Employment.

Precarious employment (PE) is a complex problem that affects an increasing number of workers across all economic sectors who experience low wages, hazardous conditions, and few benefits, and results in adverse health outcomes. PE is characterized by nontraditional work arrangements, precluding workplace-based interventions. Policy, systems, and environmental initiatives that engage cross-sectoral stakeholders may be an applicable health promotion approach to address PE. The University of of Illinois at Chicago Center for Healthy Work's Healthy Communities through Healthy Work (HCHW) is an outreach project of the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health-funded Center of Excellence for Total Worker Health that conducted a multiphased qualitative action research (AR) study. AR designs may be a novel approach to develop initiatives to address problems like PE. This article reports on HCHW's first AR phase to answer four research questions: (1) What are participants' perceptions of PE? (2) What are participants' perceptions of their roles in addressing PE? (3) What initiatives are under way that address PE? and (4) How can the findings be used to facilitate opportunities for healthy work? Key informant interviews with health (public health and health care; N = 23) and labor sector organizations (worker centers, worker advocacy organizations, and unions; N = 21) were conducted. Data were thematically analyzed alongside a chart-based content analysis, and shared in 11 key stakeholder meetings. Findings revealed an opportunity for the labor sector to improve health sector readiness to address PE in the context of health, and were used to develop the Healthy Work Collaborative, a cross-sectoral health promotion capacity building policy, systems, and environmenta change initiative to address PE.

Applying Theory of Change to a Structural Change Initiative: Evaluation of Model Communities in a Diverse County.

Structural change approaches, also called policy, systems, and environmental change approaches, have been increasingly promoted and adopted by public ealth agencies in the past decade. These interventions require attention to multilevel, complex and contextual influences on individual and community health outcomes, requiring a sound theoretical framework that links the many processes and outcomes over time. The Model Communities program of Cook County, Illinois Communities Putting Prevention to Work program employed a theory of change (ToC) framework to inform the evaluations' design and execution. The main objective of this study was to apply findings from the longitudinal multiple case study evaluation to develop an adapted ToC. We conducted 97 key informant interviews across three waves, with a focus on Model Communities program participants', Communities Putting Prevention to Work staff, and technical assistance providers' experiences over time. Four analysts organized and coded the data using qualitative software; exploratory functions and data matrices were employed throughout three waves of analysis. Adaptations to the ToC included the addition of a construct, "change readiness," as well as refinements to constructs: organizational capacity (human capital, technical assistance, informal and formal leadership), local partnerships, and the importance of sustainability. The findings offer a data-informed theoretical framework that may be considered for use in evaluations of structural change interventions in complex and diverse counties.