Connecting Boston's Public Housing Developments to Community Health Centers: Who's Ready for Change?

Background: Despite close proximity to community health centers, public housing residents are at increased risk of uncontrolled chronic disease, in part because of under-utilization of routine health care. Objectives: To assist in program planning, the Partners in Health and Housing Prevention Research Center (PHHPRC) used the Community Readiness Model to compare readiness of public housing developments and community health centers to address community-identified health priorities. The model assumes that program success to affect change depends on matching the community's level of readiness to address the issue. Methods: Key respondent interviews were conducted across 15 communities: Eight housing developments and seven health centers. Interviews were scored across six dimensions on an anchored, 9-point scale and averaged to provide a composite readiness score. Higher scores indicate increasing levels of readiness. Interview transcripts were reviewed for consistent themes. Results: Health centers scored significantly higher (mean, 5.88) than housing developments (mean, 3.33), corresponding with the Preparation stage of readiness compared with the Vague Awareness stage, respectively. Both scored highest in Existing Programs and Resources and lowest in Knowledge of Efforts. Qualitative analysis revealed a lack of existing partnerships between housing developments and health centers as well as significant social barriers preventing housing residents from engaging in care. Conclusion: We found a mismatch in readiness to address community health priorities. Although health centers have programs to address health issues, community awareness of programs is limited and barriers to engaging in care persist. The model provided a useful tool for engaging communities into shared program planning.