A multiple case study of implementation in 10 local Project ASSIST coalitions in North Carolina

Community health promotion relies heavily on coalitions to address a multitude of public health issues. In spite of their widespread use, there have been very few studies of coalitions at various stages of coalition development. The purpose of this study was to identify factors that facilitated or impeded coalition effectiveness in the implementation stage of coalition development. The research design was a multiple case study with cross-case comparisons. Each of the 10 local North Carolina Project ASSIST coalitions constituted a case. Data collection included: semi-structured interviews, observation, document review, and surveys of members and staff. Some of the major factors that facilitated implementation included: the ability of the coalition to provide its own vision, staff with the skills and time to work with the coalition, frequent and productive communication, cohesion or a sense of belonging on the coalition, and complexity of the coalition structure during the intervention phase. Barriers to effective implementation included: staff turnover and staff lacking community organization skills, dependence on the state-level staff during the planning phase and lack of member input into the action plan. Conflict contributed to staff turnover, reluctance to conduct certain activities and difficulty in recruiting members, all of which had implications for implementation.     

Defining elements of success: a critical pathway of coalition development

In recent decades, coalitions have been established to address many public health problems, including injury prevention. A partnership among the Kentucky Injury Prevention and Research Center and four injury prevention coalitions has documented the developmental stages of successful coalitions. This developmental process was constructed through the analysis of participating coalition documents, such as each coalition's mission statement, bylaws or rules of operation, the use of committees within the organization, frequency of meetings, and additional historical documents. Themes from this analysis guided researchers in designing a critical pathway model that describes milestones in coalition formation. Critical components in coalition formation include a clear definition of the coalition structure, coalition enhancement, funding, community support, leadership, education and outreach to the community, membership, partnerships, data and evaluation, and publicity. These findings are applicable to public health professionals who work with community-based coalitions and citizens who participate in local coalitions.     

Characteristics and participant perceptions of tobacco control coalitions in California

The 61 local health departments in California have been mandatedto form tobacco control coalitions as part of Proposition 99,the 1988 Tobacco Tax Initiative. A self-administered surveyof 361 coalition members and staff was conducted approximately1.5 years after coalitions were formed to identify key characteristics,functions, problems and successes of the coalitions. This reportsummarizes some of the views of member and staff respondentsto the survey. Significant differences exist between memberand staff views of coalition roles and responsibilities andjudgments of each others' expertise. While both members andstaff place value on well-functioning tobacco control coalitions,the differences revealed between member and staff predictorsof coalition functioning and outcome appear to be mediated byvarying perceptions of the role of the coalition. These andother related findings support several key assumptions underlyingcoalition development, and have implications for both practiceand research.     

Evaluating community partnerships and coalitions with practitioners in mind

Evaluation plays a key role in developing and sustaining community partnerships and coalitions. We recommend focusing on three levels of coalition evaluation that measure (a) processes that sustain and renew coalition infrastructure and function; (b) programs intended to meet target activities, or those that work directly toward the partnership's goals; and (c) changes in health status or the community. A tendency to focus on quick wins and short-term effects of programs may explain why some coalitions are not able to achieve systems and/or health outcomes change. Although measuring community-level or system changes (e.g., improving environmental quality or changing insurance coverage policies) is much more difficult than evaluating program outcomes, it is essential. This article presents challenges that coalition practitioners and evaluators face and concludes with practical resources for evaluation.     

Management and governance processes in community health coalitions: a procedural justice perspective.

Community-based coalitions are a popular strategy for promoting community health despite the fact that coalitions often fail to achieve measurable results. Using a procedural justice framework, this study seeks to advance knowledge about the relationship between coalition governance and management processes and indicators of coalition functioning. Member survey data from 25 coalitions participating in the Community Care Network Demonstration Program were analyzed using two-stage least squares regression. Results show that personal influence in decision making. decision process clarity, and collaborative conflict resolution were significantly associated with procedural fairness perceptions. Procedural fairness perceptions, in turn, were positively associated with member satisfaction with coalition decisions, but not personal engagement in the coalition or organizational integration of coalition goals and activities. Personal influence in decision making and collaborative conflict resolution also exhibited direct relationships with all three indicators of coalition functioning examined in the study.     

Evaluating community coalition characteristics and functioning: a summary of measurement tools

Community coalitions and partnerships are frequently used to promote community health; however, little research to evaluate measurement tools for assessing their effectiveness has been reported. This summary identified measurement tools for coalition or partnership characteristics and functioning. The largest numbers of measures were identified for assessing individual and group characteristics, with impact and outcome measures being the least numerous. Published measures often lacked information regarding validity and reliability, with internal consistency reliability being the most commonly reported statistic. Some measures were well defined, but others lacked conceptual clarity. Valid and reliable tools that can be applied across multiple coalitions are necessary in order to achieve a better understanding of the associations among factors influencing optimal coalition functioning and community health impacts and outcomes.     

Process evaluation of a monitoring log system for community coalition activities: five-year results and lessons learned

PURPOSE: Coalitions can be a successful way to promote healthy initiatives throughout a community. To properly measure the success of coalition-based interventions, it is important to conduct a process evaluation of coalition activities and establish a system for evaluating outcomes. This article describes a process evaluation of a monitoring and feedback system for community coalitions targeting chronic disease risk reduction. METHODS: Community coalitions in six rural, southeast Missouri counties collaborated with the Missouri Department of Health and Saint Louis University to track coalition events using the process described in the Centers for Disease Control and Prevention manual Evaluating Community Efforts to Prevent Cardiovascular Diseases. SUMMARY: First, we describe the methodology used to monitor monthly activities and to evaluate satisfaction with the process. Next, we discuss the data that resulted from the monitoring system and interviews with recorders. Third, we discuss changes made to the monitoring system and lessons learned along the way. Finally, we end with recommendations for incorporating this monitoring system in community practice. CONCLUSIONS: When used properly, this system is an effective way of evaluating and promoting sustainability of community interventions.     

The REACH 2010 logic model: an illustration of expected performance

The Centers for Disease Control and Prevention (CDC) supports 40 Racial and Ethnic Approaches to Community Health (REACH 2010) community coalitions in designing, implementing, and evaluating community-driven strategies to eliminate health disparities in racial and ethnic groups. The REACH 2010 logic model was developed to assist grantees in identifying, documenting, and evaluating local attributes of the coalition and its partners to reduce and eliminate local health disparities. The model emphasizes the program's theory of change for addressing health disparities; it displays five distinct stages of evaluation for which qualitative and quantitative measurement data are collected. The CDC is relying on REACH 2010 grantees to provide credible evidence that explains how community contributions have changed conditions and behaviors, thus leading to the reduction and elimination of health disparities.     

Health promotion teams' effectiveness: a structural perspective from Israel

This study addressed the question of how to structure coalitions in order to increase their engagement in multiple strategies for health promotion and consequently to improve their effectiveness. Three structural variables were chosen: (i) coalition's heterogeneity, captured by the professional diversity of its members; (ii) coalition's configuration, defined as the way members were involved in the coalition: full- or part-cycle membership, full- or part-time assignment, and core or peripheral membership; and (iii) coalition's contractual collaborations with external professionals. A large non-profit network of community centers served as the setting for this study. The sample consisted of 37 coordinators of local coalitions for health promotion in Israel. The study's design was a cross-sectional survey. Data were collected by a multimethod (semistructured interviews, self reported questionnaires and administrative data) approach. Effectiveness was assessed by a self-report questionnaire administrated to coalition coordinators. Engagements in multistrategies as well as structural variables were measured by semistructured interviews with coalition coordinators. Results demonstrated that while a homogeneous, bounded structure seemed to promote the implementation of health education programs, a more flexible coalition configuration with frequent use of professionals contributed more to working by multiple strategies and improved coalition's effectiveness. In addition, the use of external professionals promoted action for a healthier environment, but did not add to empowering the community. The results contribute to shifting the conception of a coalition as a tightly bounded, well-defined, stable entity to that of a more fluid and permeable structure interacting with an external environment. These findings highlight the importance of incorporating structural considerations into the management of coalitions and are discussed in light of the potential costs and benefits of alternative modes of structuring such coalitions.     

Community-based coalitions' capacity for sustainable action: the role of relationships.

Given both the importance and difficulty of promoting community-based public health coalitions, their capacity for sustainable action merits systematic examination. The current study addresses this need, focusing specifically on the relational dimension of capacity, that is, how relationships both among members and with external actors affect coalition-level activity. The context is a multimethod comparative case study of two rural cancer control coalitions. The authors began by using quantitative and qualitative data to characterize relational capacity in each coalition and then assessed the association between coalition-level relational capacity and level of subsequent interventions. The more active coalition had a more inclusive relational structure than did its less active counterpart but also placed less emphasis on personal friendships. The authors conclude that coalitions' relational structures are measurable and that this dimension of capacity may affect sustainable capacity for health promotion.     

The evolution, operation and future of Minnesota SAFPLAN: a coalition for family planning

Health coalitions are a key means by which health educators can pursue policy objectives. However, little research to date has focused on the formation, operation and maintenance of health coalitions. This paper examines the development and operation of Minnesota SAFPLAN (Statewide Association for Family Planning), a coalition of organizations and individuals that came together in 1990 to address the problem of inadequate state-subsidized family planning funds. Data were collected through 31 structured interviews with coalition member representatives and lobbyists, review of documentary data, and participant observation in coalition activities and meetings. The paper focuses on SAFPLAN's recruitment of members and division of labor. Recruitment of member organizations of SAFPLAN relied heavily on existing interpersonal and interorganizational networks. While this allowed rapid mobilization of a coalition that was an effective force in the state legislature, it left important gaps in SAFPLAN's membership and lingering questions about whom the coalition was designed to represent. A division of labor that reflected variation in members' commitment, skill, knowledge and discretionary time was developed. The SAFPLAN model merits careful consideration by health educators and others interested in affecting public policy through health coalitions.     

Toward a social ecology of community coalitions

This article is guided by several premises. First, community coalitions fit with a social ecology perspective of health promotion because they work with multiple domains and promote community change. Second, the community context affects the functioning of coalitions. Third, key leaders are an important part of the social fabric of a community and influence the social ecology of a community; therefore a coalition should include key leaders and influence them and their organizations. The purpose of this article is to advance an understanding of the social ecology of coalitions by describing concepts, variables and results from two national studies and by providing anecdotal evidence and a measure of key leaders from our own work. After briefly defining and describing community coalitions, we: (1) review literature on contextual variables and community coalitions, (2) provide examples of contextual variables influencing community coalition development, and (3) discuss the relationship of key leaders in multiple domains and community coalitions. The article concludes with a discussion of the need for a framework of contextual variables and a promising next step.     

The effects of leadership and governance processes on member participation in community health coalitions.

This study examines the effects of coalition leadership and governance on member participation in voluntary community health coalitions. Path modeling was used to explore how leadership and governance processes in coalitions affect existing member costs, benefits, and levels of participation. It was hypothesized that the effects of coalition decision making and leadership variables would be indirect by working through their effects on participants' perceived influence over coalition decision making and on overall consensus around the coalition vision. Results of the analysis indicate that open and collaborative decision making and empowering leadership do have indirect, positive effects on the level of participation by way of vision consensus and participation benefits. Participation costs, however, show no significant direct effect on the level of participation. Perceived personal influence appears to be primarily an outcome of participation rather than an antecedent.     

Assessing Community Coalition Capacity and its Association with Underage Drinking Prevention Effectiveness in the Context of the SPF SIG

Community coalitions are a prominent organizational structure through which community-based substance abuse prevention efforts are implemented. There is little empirical evidence, however, regarding the association between coalition attributes and success in achieving community-level reductions in substance abuse behaviors. In this study, we assessed the relationship between coalition capacity, based on coalition coordinator responses to 16 survey items, and reductions in underage drinking prevalence rates. The coalitions were funded through the federally sponsored Strategic Prevention Framework State Incentive Grant (SPF SIG). We first examined whether coalition capacity increased over the life of the projects. Mean capacity scores increased for all 16 capacity items examined (N?=?318 coalitions), the majority of which were statistically significant. Analysis of the associations between capacity and reductions in underage drinking was limited to coalitions that targeted underage drinking and provided usable outcome measures based on student survey data for either past 30-day alcohol use (N?=?129) or binge drinking (N?=?100). Bivariate associations between the capacity items and prevalence reductions for each outcome were consistently positive, although many were not statistically significant. Composite measures of correlated items were then created to represent six different capacity constructs, and included in multivariate models to predict reductions in the targeted outcomes. Constructs that significantly predicted reductions in one or both outcome measures included internal organization and structure, community connections and outreach, and funding from multiple sources. The findings provide support for the expectation that high functioning community coalitions can be effective agents for producing desirable community-level changes in targeted substance abuse behaviors.     

Advancing coalition theory: the effect of coalition factors on community capacity mediated by member engagement

Community coalitions have the potential to enhance a community's capacity to engage in effective problem solving for a range of community concerns. Although numerous studies have documented correlations between member engagement and coalition processes and structural characteristics, fewer have examined associations between coalition factors and community capacity outcomes. The current study uses data from an evaluation of the California Healthy Cities and Communities program to examine pathways between coalition factors (i.e. membership, processes), member engagement (i.e. participation, satisfaction) and community capacity as hypothesized by the Community Coalition Action Theory (CCAT). Surveys were completed by 231 members of 19 healthy cities and communities coalitions. Multilevel mediation analyses were used to examine possible mediating effects of member engagement on three community capacity indicators: new skills, sense of community and social capital. Results generally supported CCAT. Member engagement mediated the effects of leadership and staffing on community capacity outcomes. Results also showed that member engagement mediated several relationships between process variables (i.e. task focus, cohesion) and community capacity, but several unmediated direct effects were also observed. This suggests that although member engagement does explain some relationships, it alone is not sufficient to explain how coalition processes influence indicators of community capacity.     

MAPP in Chicago: a model for public health systems development and community building.

The Chicago Department of Public Health's (CDPH's) community planning efforts came from a city-wide strategic plan that called for the establishment of a city-wide network of community partnerships that focus on community needs and resource assessment and program development. Using Mobilizing for Action through Planning and Partnerships as a framework for planning at the community level, the CDPH supports five community coalitions through the Chicago Center for Community Partnerships. The overall goal of the Center is to increase community capacity, build new partnerships, provide coalitions with access to decision makers, and inform the role of local public health agencies in supporting this type of work. Bringing together a wide spectrum of stakeholders, coalition members work to conduct assessments and develop and implement strategies. While coalitions demonstrate outcomes related to specific strategies, they also exhibit infrastructure-level results, with increased levels of community organizing, leveraging of existing resources, and new systems for information dissemination. Simultaneously, the CDPH has gained new partners in public health, increased collaboration, and more information about communities. These outcomes are contingent on certain elements of success: (1) committed leadership; (2) commitment to a new way of doing business; (3) prepared public health workforces; and (4) community readiness.     

Leadership and team effectiveness in community coalitions for the prevention of alcohol and other drug abuse

Comprehensive community coalitions or partnerships are increasinglybeing developed in this country to coordinate and expand alcoholand other drug (AOD) abuse prevention services. While case studyevidence suggests that some coalitions are effective, thereis very little theory development or empirical research on factorscontributing to successful coalitions. This paper presents atheoretical model of coalition team effectiveness hypothesizingthat an empowering style of leadership increases member satisfactionand perceptions of team efficacy which ultimately increasesteam effectiveness. This theoretical model was pilot testedin an exploratory study using preliminary, small sample data(N = 65) from the first year evaluation of an AOD preventioncoalition. The exploratory research strategy employed factoranalysis and multiple regression analysis to test the relationshipof coalition members' process data (i.e. perceptions of teamleader's style, team efficacy and member satisfaction) to outcomedata (i.e. team members' AOD knowledge and use and team effectivenessin developing fundable plans). The results supported the proposedmodel and suggest that further model testing employing largersamples, more diverse community teams, and more sophisticateddata analyses (structural equation modeling or path analysis)could lead to information useful in training team leaders anddeveloping more effective coalitions.     

How does community context influence coalitions in the formation stage? a multiple case study based on the Community Coalition Action Theory

Background  

Community coalitions are rooted in complex and dynamic community systems. Despite recognition that environmental factors affect coalition behavior, few studies have examined how community context impacts coalition formation. Using the Community Coalition Action theory as an organizing framework, the current study employs multiple case study methodology to examine how five domains of community context affect coalitions in the formation stage of coalition development. Domains are history of collaboration, geography, community demographics and economic conditions, community politics and history, and community norms and values.     

Mobilizing for Change: A Case Study of a Campus and Community Coalition to Reduce High-Risk Drinking

Campus and community coalitions include a partnership between campus leaders and community stakeholders and can effectively address the environment that may promote high-risk drinking. Despite evidence suggesting that coalitions may be effective vehicles for producing sustainable changes in college drinking, few campuses work within such a structure. The purpose of this study was to examine the effectiveness of a campus and community coalition to implement environmental changes and thereby reduce high-risk drinking and associated consequences. This study utilized a case study method to tell the story of a campus and community coalition (CCC) implemented on a large university campus in the Northeast. The study employed multiple methods including archival document review, review of campus and community level data (i.e. alcohol-related arrests and sanctions) and analysis of student level data. The case study discusses the strategies employed, the environmental changes that occurred and the impact these changes have had on student drinking and consequences. Since implementing the campus and community coalition, the campus has seen an increase in enforcement by campus and local police, changes in community by-laws, and significant reductions in student drinking and consequences. The data provide evidence that a comprehensive approach to reducing high-risk drinking can have an impact on the campus and community environment, which in turn impacts student drinking and associated consequences. The CCC utilized a strategic and comprehensive approach to substance abuse prevention, allowing all participants to have a shared understanding of the challenges and best practices. Implications for research and practice are also discussed.     

Ecological contexts in the development of coalitions for youth violence prevention: an organizational network analysis

Community coalitions are a recognized strategy for addressing pressing public health problems. Despite the promise of coalitions as an effective prevention strategy, results linking coalition efforts to positive community outcomes are mixed. To date, research has primarily focused on determining organizational attributes related to successful internal coalition functioning. The authors' research complements and adds to this literature by offering a network conceptualization of coalition formation in which coalition participation is studied within the broader context of local organizational networks both within and beyond a coalition. The authors examine participation in the first year of a youth violence prevention coalition exploring both differences between participating and nonparticipating organizations and levels of participation. Each network variable, reflecting prior collaboration and being viewed by other organizations as a local leader, approximately doubled the explained variance in coalition participation beyond the predictive power of all available organizational attributes combined. Results suggest that initial coalition participation emerged out of a preexisting network of interorganizational relations and provide an alternative perspective on coalition formation that goes beyond conceptual orientations that treat coalitions as bounded organizational entities that exist apart from the communities in which they are embedded.