CCPH utilized both process and outcome evaluation criteria as part of their participant action research model to measure both the effectiveness of their activities and provide meaningful data to inform staff and collaborating partners on how to modify practices to improve outcomes (i.e., quality improvement). As stated in earlier sections, the goal and objectives of the HEDA project were developed in consultation with the Minnesota Department of Health. The specified goal for the HEDA project was to identify and address the health disparities and inequities that exist within the community. In order to both accurately identify and effectively address the health disparities and inequities with communities of Carver County, CCPH and it collaborating partners needed to: 1) better understanding the concept of health and the conditions that create health; 2) strengthen community capacity to provide the needed services and mindset” to effective address mental health concerns; 3) utilize information learned from this process to inform future Statewide Health Improvement Partnership (SHIP) work plans (AKA data-informed decision making); 4) identify new and strengthen existing partnerships; and 5) build community engagement and facilitation skills of public health staff (this is also tied to organizational capacity). The primary purpose of the Carver County HEDA project was to answer the question, What contributes to the differences in mental health outcomes between people with lower incomes compared to those with higher incomes?”
CCPH were able to meet all of HEDA program objectives. CCPH gained insights into the differences in mental health outcomes between people with lower incomes compared to those with higher incomes and expanded our understanding of health. The project strengthened both the LPH and the community's capacity to identify and respond to health disparities. Community partners were informed of the project's findings. CCPH 2018-2019 SHIP work plan had significant changes from the previous years and included aspects of mental health in every strategy. CCPH strengthened its partnerships with CLT members and others, and they developed new partnerships with Carver County Workforce Center and the AMHI. Lastly, three different LPH agency staff members enhanced their focus groups facilitation, action research, and presentation skills.
In addition to the extensive review of existing quantitative data, CCHP obtained primary data from a series of key informant interviews and three focus groups. The focus groups were recorded and responses were transcribed using a transcription service. Comments from key informant interviews were recorded directly by CCHP staff conducting the interviews. Transcriptions of the focus groups removed filler words such as um”, uh”, so”, and like”. The transcriptions also did not include stutters, stammers, false starts, or repetitions. Once transcribed, each focus group was coded. At least two members of the HEDA Team coded each focus group transcription. Codes were revised throughout the process and constant communication between the HEDA Team led to the development of over thirty different codes. Coded focus group transcriptions were reviewed for consistency and differences in coding were discussed at HEDA Team meetings. The input gathered from participants in the three focus groups was wide-ranging. They provided many insights into issues related to mental health, low income, and connections between the two. The most frequently voiced comments were categorized in four overarching themes; 1) The Mental Health System; 2) Social Determinants of Health; 3) Family and Social Supports, and 4) Knowledge and Awareness. Within the Mental Health System, themes that emerged included navigating the system, insurance, and services. One participant stated, If you make too much money, you can't get insurance… what I'm trying to say is, if you're rich, you're fine because you can afford to take yourself to therapy. If you are poor, you can get insurance help through the county. If you're right in that middle, you eat, or you go to therapy.” Within the Social Determinates of Health, themes that emerged included transportation and employment. One participant stated, There are people who can't get to court; people can't get to their—if they live out here [rural areas], they can't get to their county meetings with their reps. They can't get to the food shelf. They can't go to job interviews. They're going to make you feel more hopeless.” Within the Family and Social Supports, themes that emerged included social connections/isolation and life events. One participant stated, They [Hennepin County] would have the AA and the NA group and the Overeaters Anonymous, sexual abuse [support groups]. Like you were talking, the gay, lesbians, transgender [support groups]. Every night there would be different groups that you could go to. Out here [in Carver County], besides the CSP and the Cedar House, I haven't seen support groups.” Lastly, within Knowledge and Awareness, themes that emerged included stigma, training, and education. One participant stated, I think part of the stigma, is, Oh you're depressed? You're just not taking care of yourself; like you just aren't eating right.” Yeah, Suck it up”. Get tough.”