From Stories to Narratives: Capturing System-Level Work in a Community Grant Program

Abstract Information: The Eliminating Health Disparities Initiative (EHDI) is a grant program within the Minnesota Department of Health Center for Health Equity. EHDI invests in community initiatives that address health inequities for populations of color and American Indians across eight priority health areas. EHDI evaluation is quantitative (shared and individual measures) and qualitative (narratives). The method of collecting narratives in the grantees’ own words has evolved over EHDI’s 20 years. Starting with structured questions, it became guided storytelling, and in the last three years became change narratives. Two factors led to the change: broadening the scope of EHDI to allow grantees to address the social and economic conditions for health, and COVID-19 which upended grantees’ planned activities. This session will discuss how the switch from stories to narratives allowed grantees to relate a series of events in the order they occurred, and to be more reflective of their cultural values and history.

Relevance Statement: The Eliminating Health Disparities Initiative (EHDI) is a grant program within the Minnesota Department of Health Center for Health Equity. EHDI invests about $5 million dollars annually in community initiatives that address health inequities for populations of color and American Indians across eight different priority health areas: Breast and Cervical Cancer, Diabetes, Heart Disease and Stroke, HIV/AIDS and Sexually Transmitted Infections, Immunizations, Infant Mortality, Teen Pregnancy, and Unintentional Injury and Violence. EHDI was established by the Minnesota State Legislature in 2001 to address the growing health disparities in the state. Over the years, the EHDI approach has been to support organizations and projects run by and for communities of color and American Indians to develop and implement strategies that are effective in reaching their communities. By investing in community-based organizations and tribes to develop health improvement strategies built on cultural knowledge and wisdom and community strengths, community members are more likely to be reached, engaged and impacted. There are 25 organizations funded in the current 2019-2023 grant cycle. A key recommendation that emerged from a 2015 EHDI community input process was to encourage grantees to broaden program activities to address the social and economic conditions for health, which meant expanding the scope of their work beyond targeting individual-level changes to changing policies, systems or environments to address the root causes of inequities. The evaluation of EHDI is both quantitative (shared and individual measures) and qualitative (change narratives). The narratives are meant to add meaning to quantitative data and better capture the many ways grantees are trying to effect change on several levels. The method of collecting the narratives has evolved over EHDI’s 20 years. Starting with structured questions, it became guided storytelling, and in the last three years became change narratives. Two factors led to the change: broadening the scope of EHDI to allow grantees to address the social and economic conditions for health, and COVID-19 which upended grantees’ planned activities and caused them to quickly adapt to the new normal brought about by the pandemic. Plain stories were not enough to capture these changes; grantees had to have the freedom to relate not just one event but other interweaving events, in the order in which they occurred, and for their stories to reflect their cultural values and history. This has increased in significance because an important public health lesson during the pandemic was the need to provide culturally appropriate messaging and services. This session contributes to the field of evaluation by showing how paying attention to context, honoring people’s culture, and addressing inequities are reflective of AEA's evaluation principles.