Profiling capacity for coordination and systems change: the relative contribution of stakeholder relationships in interorganizational collaboratives

Unpacking Technical Assistance (TA) Strategies Within a State-Level Prevention Support System: A Mixed-Method Study in Determining Types and Amount of TA

The research-practice gap between evidence-based intervention efficacy and its uptake in real-world contexts remains a central challenge for prevention and implementation science. Providing technical assistance (TA) is considered a crucial support mechanism that can help narrow the gap. However, empirical measurement of TA strategies and their variation is often lacking. The current study unpacks the black box of TA, highlighting different TA strategies, amounts, and their relation to intervention characteristics. First, we qualitatively categorized interactions between TA providers and implementers. Second, we explored how characteristics of implementing organizations and the intervention related to variations in the amount of TA delivered. Using data spanning six years, we analyzed over 10,000 encounters between TA providers and implementers. Content analysis yielded four distinct strategies: Consultation (27.2%), Coordination Logistics (24.5%), Monitoring (16.5%), and Resource Delivery (28.2%). Organizations with prior experience required less monitoring and resource delivery. Additionally, characteristics of the intervention were significantly associated with the amount of consultation, monitoring, coordination logistics, and resource delivery provided. The specific features of the intervention showed significant variation in their relation to TA strategies. These findings provide initial insights into the implications of intervention characteristics in determining how much of which TA strategies are needed to support implementations in real-world settings.

Mapping social movements momentum: unveiling networks in the movement for the right to abortion in Mexico

In this case study, we propose a network analysis approach to map social movements through an intersectional feminist lens. We aim to gain a more in-depth understanding of movements' network structures to examine the roles and relationships of movement actors, the flow of resources between them, and potential areas of collaboration and conflict. By incorporating Social Network Analysis (SNA) techniques and visually mapping dynamics within social movements, this approach can assess the significance of small actors in creating change and stresses the need for their perspectives to be heard. Furthermore, our methodology adopts a feminist intersectional framework that recognizes the role of different identities in shaping the movement and its actors. To demonstrate the practical application of this approach, we examined the movement for the right to abortion in Mexico between September and December 2021. Our multi-step process included (1) designing a survey tool adapted to the context of the movement, (2) collecting and analyzing survey responses on movement actors' relationships and interactions, including their priorities, activities, needs, risks, and challenges, (3) visualizing the network using SNA techniques that account for the complexity and diversity of the movement, (4) interpreting the findings through insights collected in semi-structured interviews and validation meetings with key movement actors, and (5) implementing safety and security guidelines to safeguard the identity of individuals whose activities could put them at risk of suffering institutional, emotional, and physical violence. Our case study offers valuable insights that not only encourage the integration of feminist and intersectional perspectives into data collection processes but also provide a roadmap for accompanying social movements and supporting meaningful and contextually responsive activities.

Coordination and modularization: the experience of the joint prevention and control mechanism to COVID emergencies in China

Background

The integration of disparate emergency resources and the improvement of emergency response teamwork are the underlying trends and shared requirements for building resilience in an era of multiple global public health crises.

Objective

This study investigated the emergency response with emergency collaboration networks of each functional module and the overall Joint Epidemic Prevention and Control Mechanism (JPCM) network in China's COVID outbreak prevention and control.

Methods

The study employed a scholarly framework of "the integration of JPCM coordination and emergency collaborative modularization" to explore the attributes of JPCM using social network analysis. The data were obtained from administrative records from JPCM's official website, spanning January 2020 to December 2022.

Results

The study examined the JPCM coordination and found several functional working modules of JPCM, such as Interrupt Spread, Manage Supply, Medical Rescue, Restore Work and Production, and Implement Responsibility modules. The network structure indicators showed that the Manage Supply module had the most extensive network connectivity, the shortest communication distance, and the most consistent collaboration. The E-I index of the overall JPCM network and the Manage Supply network were - 0.192 and - 0.452, respectively (at p < 0.001 and p < 0.05), indicating more internal relationships than external relationships. The E-I index of the Medical Rescue and Implement Responsibility collaboration networks were 0.122 and 0.147, respectively (at p < 0.001 and p < 0.05), indicating more external relationships than internal relationships. The QAP regression analysis showed that the most vital driver on the overall JPCM network was the Interrupt Spread module, followed by the Implement Responsibility and Medical Rescue modules.

Discussion

The Interrupt Spread module initiated emergency coordination with most departments and agencies. The Manage Supply module ensured the flow of medical supplies and survival essentials, while the Medical Rescue module addressed the core aspects of the health emergency response. The Restore Work and Production module repaired the halt in production and livelihoods caused by the outbreak, strengthening and developing emergency coordination and roles across emergency organizations. The Implement Responsibility module provided more heterogeneous emergency response resources for the overall JPCM coordination, complementing the COVID cross-organizational emergency response coordination.

Conclusion

The study on the JPCM case in China improves public health emergency management and aids informed decision-making.

Alliance-building for equity and justice: An inter-organizational perspective

Cultivating alliances between specific sectors or fields with unrealized synergies is a promising strategy for systems change. Social network analysis is a useful tool for assessing whether such alliances build relationships between these previously disparate organizations. Two waves of valued network data were collected from the members (N = 25) of a justice system reform coalition composed of two types of community-based organizations: those involved in restorative justice practice and those involved in grassroots community organizing. Social network homophily analyses were employed to characterize the impact of alliance participation on relationships over time across three domains: working together, doing impactful work together, and sharing a philosophy about justice system reform. Results indicate marked increases in the prevalence of relationships between restorative justice and community organizing organizations across all domains, with the greatest increases occurring in perceptions of shared philosophy. Network structures at each time point differed by relational domain and organization type. Findings suggest that the alliance strengthened relationships between restorative justice and community organizing organizations, particularly in perceptions of shared philosophy, but that the magnitude of these changes varied depending on pre-existing interorganizational relationships and organization type. Findings challenge the idea that close working relationships between diverse members is critical to coalition effectiveness, pointing instead to the value of ambidextrous networks and alignment in members' philosophy and vision.

The Working Relationship Between Emergency Room Nurses and Medical Rape Victim Advocates: A Qualitative Examination of Nurses' Perceptions of the Influence of Nurse Training and Experience on Nurse-Advocate Interactions

Nurses and medical advocates respond to sexual assault survivors seeking hospital services. Ideally, both providers work collaboratively. However, this does not always happen. Extant research on the nurse-advocate relationship focuses on Sexual Assault Nurse Examiners (SANEs). This study examines how ER nurses perceive their training and experience influence the working relationships between emergency room (ER) nurses (not exclusively SANEs) and medical advocates. Key findings indicate nurses perceive increased training improves (a) role understanding, (b) trust, (c) respect, (d) rapport, and (e) appreciation. Less training was associated with poorer role understanding and trust.

The Evaluation of the Departmental Resources and Positions Within the Inter-Departmental Collaborative Networks: A Case Study on the Joint Prevention and Control Mechanism in China

Introduction

This study examines the inter-departmental emergency response dynamics within China's Joint Prevention and Control Mechanism (JPCM). Departments' positions in the network are fundamental to understanding the overall structure and operation of the collaborative emergency response. Moreover, understanding the influence of departmental resources on departmental positions promotes efficient inter-departmental collaboration.

Methods

The study uses regression analysis to empirically investigate the departmental resources to departments' participation in the JPCM collaboration. The independent variable adopts the departments' positions by statistically presenting the departments' centrality using social network analysis. The dependent variables employ departmental resources, including departmental duties, staffing levels, and approved annual budgets based on data from the government website.

Results

The result of social network analysis shows that in JPCM inter-departmental collaboration, the Ministry of Transport, Health Commission, Ministry of Public Security, Ministry of Emergency Management, Ministry of Culture and Tourism, Ministry of Education, and Development and Reform Commission are mainly involved. The regression analysis result indicates that the department's engagement in collaborative actions is determined and influenced by the department's statutory duties. The more statutory duties department has, the more it is in a critical position and role for JPCM.

Discussion

The study can assist emergency management practitioners and academic departments in utilizing evidence-based approaches to justify the collaboration and involvement of participating departments. The analysis of the collaborative networks considering JPCM in China by the participation and organization logic is of fundamental significance for arguing for complementing COVID emergency management and inter-departmental emergency collaboration studies.

Using social network analysis as a tool in action research

The following paper presents case examples of one research team's use of social network analysis (SNA) with three different collaboratives in South Florida: (a) a Collective Impact initiative seeking to end youth homelessness, (b) a university collaborative of campus organizations working towards Black students' concerns, and (c) a movement network of local social justice organizations. The research team used SNA to assess the level of connectivity of three different community coalitions. While research questions were slightly different for each collaborative, each project asked about the frequency of communication between organizations to determine connectivity. Results vary between case examples. Both the Youth Homeless Collaboration and the Black Student Association used Gephi to analyze results, while The Community Partnership used R to measure network centrality. The paper concludes with a general discussion of challenges related to using SNA as an action research tool, as well as the role of power in organizational networks.

Collaboration among vocational rehabilitation and mental health leaders: Supporting the vocational success of transition-age youth with serious mental health conditions

BACKGROUND: The ability of vocational rehabilitation, adult mental health and child mental health service systems to collaborate regarding the employment and career development goals of transition-age youth has not been explored nor has attention been paid to strategies that would increase this collaboration. OBJECTIVE: This qualitative study asks leaders from these three systems to describe collaborative activities that support better vocational services for transition-age youth with serious mental health conditions and discuss barriers and facilitators to collaboration. METHODS: Qualitative interviews were conducted with 39 formal and informal leaders in vocational rehabilitation (n = 16), child mental health (n = 13), and adult mental health (n = 10) systems as part of a larger study of interorganizational relationships. RESULTS: A primary barrier was lack of knowledge about the services and policies of each other’s systems. Another barrier was differences in philosophy about employment and the special needs of transition-age youth with mental health needs. CONCLUSIONS: In addition to specific activities that would encourage greater interaction across three systems, results underscore the need for the child mental health system and vocational rehabilitation system to increase their involvement with and knowledge about one another. This would include training child mental health providers about employment and career development services, vocational rehabilitation providers about the role of mental health in the youngest workers, and both being involved in transition-planning that directly addresses vocational goals and support needs.

Understanding the Development, Evaluation, and Sustainability of Community Health Networks Using Social Network Analysis: A Scoping Review

OBJECTIVE

Identify the scope of the literature which reports use of social network analysis to inform, support, or evaluate health promotion-focused community network/partnership development.

DATA SOURCE

A comprehensive search (not date-limited) of PubMed, CINAHL, Web of Science Core Collection, PsycInfo, and the Cochrane Library Database for Systematic Reviews.

INCLUSION AND EXCLUSION CRITERIA

Criteria for inclusion included published in the English language and used social network analysis to inform, support, or evaluate development of community networks/partnerships aiding health promotion efforts. Studies were excluded if they did not use social network analysis or were not focused upon health promotion.

DATA EXTRACTION

Three of the four authors extracted data using a summary chart to document information regarding study aims, target issue/population, methods, and key outcomes of the social network analysis.

DATA SYNTHESIS

The extracted data were qualitatively analyzed by 3 authors to categorize key social network analysis outcomes into categories.

RESULTS

Ninety-seven studies representing 9 geographical regions were included, with the majority (69) published after 2010. Key outcomes included the effectiveness of social network analysis to identify network characteristics, track network change over time, compare similar networks across locations, and correlate network attributes with outcomes.

CONCLUSION

Findings support the utility of social network analysis to inform, support, and evaluate development of sustainable health promotion-focused networks/partnerships.

Integration as a Tool for Interprofessional Work: A Synthesis of the Literature Regarding How to Use Integrative Strategies to Address Complex Public Health Problems

Background and Purpose

There has been limited success addressing complex public health problems using "siloed" approaches. A next important step in addressing persistent public health problems is adopting an "integrative" approach-intentional collaboration across the domains of research, clinical practice, community, and policy. This synthesis of the literature aggregates and synthesizes the diffuse and multi-disciplinary integration literature base to describe key concepts, aspects of praxis, and challenges and successes to help guide interprofessional practice.

Methods

A three-step approach was used: 1) a wide-ranging search for articles on integration theory/praxis; 2) a more focused search in the health literature bases; 3) a snowball strategy to identify additional studies.

Discussion/Conclusions

Identified themes included elements of successful integration; characteristics of an effective integrator; and dynamics between stakeholders in integration praxis. Results of this synthesis of the integration literature provide a deeper understanding of integration and points to clear and exciting next steps for integration praxis and inquiry.

Policy processes leading to the adoption of 'Jamie's Ministry of Food' programme in Victoria, Australia

This study investigated the policy processes related to the 2012 adoption of the Jamie's Ministry of Food programme by the Victorian Government in Australia. The aim was to provide insight into obesity prevention policy change processes to help strengthen future health promotion action. State-level government policy processes were examined through key informant interviews and a review of relevant documentation. Data were analysed using the Multiple Streams Theory and the Advocacy Coalition Framework in order to understand influences on relevant policy processes and strategies used by policy advocates to facilitate policy adoption. We found that policy adoption was facilitated by dedicated national funding for preventive health at that time, the relatively small number of stakeholders involved in the policy development process and the anticipated support for the programme by the general public due to the association with celebrity chef, Jamie Oliver. We identified that policy brokers aligned the policy with decision-maker ideologies and broader government objectives, and proactively managed potential criticisms. Evidence of intervention effectiveness was not a major driver of policy adoption. We conclude that, iven the complexity of policy processes for obesity prevention, multiple, reinforcing strategies are likely to be needed to facilitate policy change. Support for the adoption of obesity prevention policies is likely to increase when framing of policy options aligns with decision-maker values and has broad public appeal.

Promoting Cross-Sector Collaborations to Address Intimate Partner Violence in Health Care Delivery Systems Using a Quality Assessment Tool

Background: As part of a Domestic Violence and Health care Partnership (DVHCP) project in California, 19 leadership teams consisting of representatives from domestic violence agencies and health care delivery systems in California came together to improve care related to intimate partner violence (IPV). We evaluated the impact of a Quality Assessment/Quality Improvement (QA/QI) tool on health care delivery systems' ability to collaborate with victim service agencies to address IPV. Methods: Each leadership team completed the QA/QI tool every 6 months between 2014 and 2017. Fifteen clinics that completed the tool at least twice are included in this analysis. Results: The largest changes noted in the QA/QI tool were having written protocols for assessing for IPV, providers distributing educational safety cards about IPV to patients, scripts for providers on how to assess and support survivors of IPV, trainings led by IPV agency advocates, and support for staff to discuss difficult cases. Conclusions: Implementation of a QA/QI tool can guide health care delivery systems to make changes in provider practices and clinic protocols to improve care and support for survivors of IPV. Such clinic-level changes may support providers to more readily or consistently integrate addressing IPV in clinical encounters while facilitating and promoting cross-sector collaborations with victim service advocacy and related social service agencies.

Communication and Control: Hearing the Voices of Low-Income African American Adults to Improve Relationships with Healthcare Providers

Patient-provider relationships can either impede or encourage patient utilization of healthcare services and adherence to treatment. Given the significant health disparities found among low-income African Americans, it is imperative to understand this population's experiences with healthcare providers and how to improve their patient-provider relationships in order to increase successful treatment outcomes. Relationship management is a well-tested theory that examines factors that improve outcomes between organizations and their publics. This exploratory study uses relationship management theory to understand how African Americans who are medically underserved perceive the quality of their relationships with healthcare providers. Focus groups were held with low-income African American adults. Findings reveal that communication is key to improving trust, but other characteristics needed for a quality relationship were lacking, particularly perceived commitment, which impedes better healthcare. The low-income, medically underserved context influenced participant perceptions of factors such as commitment, but participants also expressed efficacy in feeling in control of healthcare situations, which may help them maintain quality relationships. This study offers theoretical elaboration as well as practical suggestions for how providers may wish to address an important population of patients through communication.

Justice System Reform for Health Equity: A Mixed Methods Examination of Collaborating for Equity and Justice Principles in a Grassroots Organizing Coalition

Recent critiques of collective impact have provided a conceptual alternative that emphasizes the necessity of community organizing, and more explicit emphasis on advancing equitable systems and policy changes. This article reports results from a study of a citywide coalition in Chicago, IL that espoused many of these same principles. The coalition focused on justice system reform-systems and policy change that would dismantle punitive policies disproportionately affecting people of color-but also sought to connect these efforts with broader social determinants of health. The organizations that comprised the coalition were a pairing of those traditionally involved in restorative justice practice, and those traditionally involved in grassroots organizing. An action research partnership provided an opportunity to investigate processes and outcomes of a coalition created to advance equitable systems and policy changes. This analysis of the coalition's functioning employs a mixed methods approach. We utilize two waves of interorganizational social network data and qualitative data including participant observation, in-depth interviews, and archival document review to examine the coalition's successes and challenges related to each of the six core principles of Collaborating for Equity and Justice. This analysis provides practical insights into the benefits and challenges of implementing deeply participatory processes to address policy and systemic drivers of social determinants of health. Findings show that fully integrating all six principles is challenging, especially when a coalition represents broad constituencies across race, geography, and organizational philosophy. In such diverse settings, considerable time must be spent to build relationships and a strong foundation for sustainable processes.

Tensions between Fiscal Accountability Policy and Collaborative Management Implementation in State Wildlife Agencies

Exploration of collaborative management implementation at two state wildlife agencies (SWAs) found that government fiscal accountability requirements create tensions that negatively impact collaborative plan implementation. Interview-derived insights highlight state policy misalignments between the support of collaborative governance and the application of governmental accountability controls. Tensions from this misalignment can negatively impact implementation and disrupt relationships among the SWA management staff, their partners, and their procurement staff. Rather than working as a part of a unified state interest to implement collaborative governance, procurement processes function as an internal regulatory authority that addresses different state policies. Informant comments identify dissimilar tension levels within the two SWAs, potentially due to the organizational location of procurement staffs. Confirmation of the influence of an SWA procurement staff organizational location on collaborative implementation requires further investigation. Tensions identified here likely exist in other natural resource management agencies and represent an understudied aspect of governmental collaborative management capacity often overlooked in collaborative planning and management scholarship.

Measuring coordination between women's self-help groups and local health systems in rural India: a social network analysis

OBJECTIVES

To assess how the health coordination and emergency referral networks between women's self-help groups (SHGs) and local health systems have changed over the course of a 2-year learning phase of the Uttar Pradesh Community Mobilization Project, India.

DESIGN

A pretest, post-test programme evaluation using social network survey to analyse changes in network structure and connectivity between key individuals and groups.

SETTING

The study was conducted in 18 villages located in three districts in Uttar Pradesh, India.

INTERVENTION

To improve linkages and coordination between SHGs and government health providers by building capacity in leadership, management and community mobilisation skills of the SHG federation.

PARTICIPANTS

A purposeful sampling that met inclusion criteria. 316 respondents at baseline and 280 respondents at endline, including SHG members, village-level and block-level government health workers, and other key members of the community (traditional birth attendants, drug sellers, unqualified rural medical providers, pradhans or elected village heads, and religious leaders).

MAIN OUTCOME MEASURES

Social network analysis measured degree centrality, density and centralisation to assess changes in health services coordination networks at the village and block levels.

RESULTS

The health services coordination and emergency referral networks increased in density and the number of connections between respondents as measured by average degree centrality have increased, along with more diversity of interaction between groups. The network expanded relationships at the village and block levels, reflecting the rise of bridging social capital. The accredited social health activist, a village health worker, occupied the central position in the network, and her role expanded to sharing information and coordinating services with the SHG members.

CONCLUSIONS

The creation of new partnerships between traditionally under-represented communities and local government can serve as vehicle for building social capital that can lead to a more accountable and accessible community health delivery system.

Communication and comprehensive cancer control coalitions: lessons from two decades of campaigns, outreach, and training

PURPOSE

Comprehensive cancer control (CCC) coalitions and programs have delivered effective models and approaches to reducing cancer burden across the United States over the last two decades. Communication plays an essential role in diverse coalition activities from prevention to survivorship, including organizational and community capacity-building and as cancer control intervention strategies.

METHODS

Based upon a review of published CCC research as well as public health communication best practices, this article describes lessons learned to assist CCC coalitions and programs with systematic implementation of communication efforts as key strategies in cancer control.

RESULTS

Communication-oriented lessons include (1) effective communication work requires listening and ongoing engagement with key stakeholders, (2) communication interventions should target multiple levels from interpersonal to mediated channels, (3) educational outreach can be a valuable opportunity to bolster coalition effectiveness and cancer control outcomes, and (4) dedicated support is necessary to ensure consistent communication efforts.

CONCLUSIONS

External and internal communication strategies can optimize coalition efforts and resources to ultimately help produce meaningful improvement in cancer control outcomes.

Using Social Network Analysis to Identify Successful Relationship Patterns Within Sexual Assault Response Teams (SARTs)

The current study used social network analysis (SNA) to examine relationships within three effective Sexual Assault Response Teams (SARTs) that coordinate the response of legal, medical, and advocacy organizations to sexual assault. Within each SART, organizations reported on each other member organization valuing their role, serving as a resource to their work, and communication outside of official meetings. Across the SARTs, there was high connectedness and reciprocity and low to moderate dependence on one organization to drive relationships. However, there was dependence on a subgroup of organizations to drive additional communication relationships. Implications for managing relationships in SARTs are discussed.

The Formal Systems Response to Violence Against Women in India: A Cultural Lens

Violence against women (VAW) has become an increasingly salient issue in India, with women at risk for different forms of gendered violence. While there may be universal elements in the international phenomenon of violence against women, it is a complex, multifaceted phenomenon that takes shape in a particular sociocultural context. The current study employs a narrative framework to systematically examine how culture is expressed in the formal systems response and women's help-seeking in two metropolitan cities in India. Specifically, we sought to understand, among formal system responders (a) what characterizes the dominant cultural narratives on violence against women in India; and (b) how these are reflected in community narratives of formal responders. Interviews were conducted with formal responders working in different types of local agencies (e.g., police, health centers, and non-governmental agencies). The paper illustrates the major themes that emerged from participants' narratives describing the multilevel influences that shape the formal system response to violence against women and women's help-seeking efforts. The implications of these findings for effective response and directions for future research are summarized.

Health in All local Policies: Lessons learned on intersectoral collaboration in a community-based health promotion network in Denmark

Health promotion increasingly involves collaboration with civil society organisations and the private sector rather than being implemented exclusively by public sector stakeholders. Health in All Policies (HiAP) is an approach that promotes health in policy-making across public sectors. This study explored intersectoral integration and collaboration for health promotion at a local community level through a qualitative single case study of a local community network in Denmark: the Husum Health Network. The paper describes and discusses strengths, weaknesses, and challenges of HiAP-inspired local efforts to build alliances and supportive environments for health within an inter-organisational community-based network. The data were generated from participant observations made at 11 meetings and events organised by the network partners and nine qualitative, semi-structured interviews with Husum Health Network partners conducted from August 2014 to February 2015. The data were analysed using a theoretical framework introduced by Axelsson and Axelsson (2006) to characterise aspects of integration and differentiation between organisations. With high levels of structural and functional differentiation between the partners, the network provided an opportunity to exercise inter-organisational integration at the local level. Integration was fostered by knowledge sharing, face-to-face interaction, and communal events. However, the loose structure of the network was a challenge to its sustainability and achievement. We argue that Health in All local Policies is a meaningful concept in the context of local community development only when referring to the polices and strategies of all stakeholder organisations involved in decision-making and agenda setting, and not just local government institutions.

Network Analysis in Community Psychology: Looking Back, Looking Forward

Network analysis holds promise for community psychology given the field's aim to understand the interplay between individuals and their social contexts. Indeed, because network analysis focuses explicitly on patterns of relationships between actors, its theories and methods are inherently extra-individual in nature and particularly well suited to characterizing social contexts. But, to what extent has community psychology taken advantage of this network analysis as a tool for capturing context? To answer these questions, this study provides a review of the use network analysis in articles published in American Journal of Community Psychology. Looking back, we describe and summarize the ways that network analysis has been employed in community psychology research to understand the range of ways community psychologists have found the technique helpful. Looking forward and paying particular attention to analytic issues identified in past applications, we provide some recommendations drawn from the network analysis literature to facilitate future applications of network analysis in community psychology.

Effects of Sectoral Diversity on Community Coalition Processes and Outcomes

Collaboration with diverse partners is challenging but essential for the implementation of prevention programs and policies. Increased communication with partners from diverse sectors may help community coalitions overcome the challenges that diversity presents. We examined these issues empirically in a study of 17 substance use prevention coalitions in Mexico. Building on coalition and workgroup literatures, we hypothesized that sectoral diversity would improve outcomes but undermine coalition processes. Conversely, we expected uniformly positive effects from higher levels of intersectoral communication. Data are from a 2015 survey of 211 members within the 17 community coalitions. Regression models used sectoral diversity and intersectoral communication to predict coalition processes (cohesion, leader-member communication, efficiency) and outcomes (community support, community improvement, sustainability planning). Sectoral diversity was negatively associated with coalition processes and was not associated with coalition outcomes. Intersectoral communication was positively associated with two of the three measures of coalition outcomes but not associated with coalition processes. Our findings concur with those from prior research indicating that sectoral diversity may undermine coalition processes. However, more communication between sectors may facilitate the coalition outcomes of community support and sustainability planning. Skilled team leaders and participatory decision making may also help coalitions promote intersectoral communication, thereby engaging diverse community sectors to implement preventive interventions and actualize sustained public health impact.

"Because We All Trust and Care about Each Other": Exploring Tensions Translating a Theater-based HIV Prevention Intervention into a New Context

BACKGROUND

A theater-based human immunodeficiency virus (HIV) prevention intervention developed in urban California was piloted with a new partnership in North Carolina.

OBJECTIVES

This work describes the experience of translating a complex program with an enhanced partnership approach, barriers and facilitators of implementation in the new setting, and the challenges and benefits of interdisciplinary, collaborative interventions.

METHODS

We gathered perspectives of local stakeholders involved in program implementation through process evaluation interviews and focus groups with undergraduates, a college instructor, school district administrators, and high school teachers.

RESULTS

Implementing the intervention in a new setting proved feasible and successful; however, misunderstandings arose among stakeholder groups regarding teaching priorities, philosophies, and values, and were a limiting factor in partnership functioning.

CONCLUSIONS

Implementing a cross-disciplinary intervention in a new setting is best achieved through a local community-engaged process, with active involvement of relevant stakeholders. We suggest strategies to strengthen community partnerships cooperating in implementation of complex, context-tailored interventions.

Networked Community Change: Understanding Community Systems Change through the Lens of Social Network Analysis

Addressing complex problems in communities has become a key area of focus in recent years (Kania & Kramer, 2013, Stanford Social Innovation Review). Building on existing approaches to understanding and addressing problems, such as action research, several new approaches have emerged that shift the way communities solve problems (e.g., Burns, 2007, Systemic Action Research; Foth, 2006, Action Research, 4, 205; Kania & Kramer, 2011, Stanford Social Innovation Review, 1, 36). Seeking to bring clarity to the emerging literature on community change strategies, this article identifies the common features of the most widespread community change strategies and explores the conditions under which such strategies have the potential to be effective. We identify and describe five common features among the approaches to change. Then, using an agent-based model, we simulate network-building behavior among stakeholders participating in community change efforts using these approaches. We find that the emergent stakeholder networks are efficient when the processes are implemented under ideal conditions.

Community Prevention Coalition Context and Capacity Assessment: Comparing the United States and Mexico

Effective planning for community health partnerships requires understanding how initial readiness-that is, contextual factors and capacity-influences implementation of activities and programs. This study compares the context and capacity of drug and violence prevention coalitions in Mexico to those in the United States. Measures of coalition context include community problems, community leadership style, and sense of community. Measures of coalition capacity include the existence of collaborative partnerships and coalition champions. The assessment was completed by 195 members of 9 coalitions in Mexico and 139 members of 7 coalitions in the United States. Psychometric analyses indicate the measures have moderate to strong internal consistency, along with good convergent and discriminant validity in both settings. Results indicate that members of Mexican coalitions perceive substantially more serious community problems, especially with respect to education, law enforcement, and access to alcohol and drugs. Compared to respondents in the United States, Mexican respondents perceive sense of community to be weaker and that prevention efforts are not as valued by the population where the coalitions are located. The Mexican coalitions appear to be operating in a substantially more challenging environment for the prevention of violence and substance use. Their ability to manage these challenges will likely play a large role in determining whether they are successful in their prevention efforts. The context and capacity assessment is a valuable tool that coalitions can use in order to identify and address initial barriers to success.

Preventing falls in residential construction: Effectiveness of engaging partners for a national social marketing campaign

BACKGROUND

Falls are the leading cause of fatalities in construction. The Safety Pays, Falls Cost campaign aims to prevent falls in residential construction. A critical component of our social marketing approach was to involve 70 partners in reaching target audiences.

METHODS

We assessed partner engagement April 2012-August 2013 through: (1) baseline partnership quality interviews (eight partners); (2) pre-/post-partner "market" readiness in-depth interviews (three partners); (3) a pre-/post- (29/31 partners) online partner engagement survey; and (4) standardized metrics to measure partner activity.

RESULTS

We found a high level of interest and engagement that increased with the addition of prompting to action through regular communication and new resources from organizers and formation of local partnerships that were able to tailor their activities to their own communities or regions.

CONCLUSION

It is feasible to leverage government-labor-management partnerships that enjoy trust among target audiences to widely disseminate campaign materials and messages.

Sense of community responsibility in community collaboratives: advancing a theory of community as resource and responsibility

This paper contributes to the growing body of scholarship aimed at advancing our understanding of the experience of community by empirically investigating sense of community responsibility (SOC-R) in relation to traditional measures of sense of community (SOC) and indices of satisfaction, engagement, and leadership in interorganizational collaborative settings. Findings support the proposition that, although both are related to the experience of community, SOC and SOC-R emphasize different aspects of that experience and operate under different theoretical mechanisms of influence. SOC emphasizes community as a resource which was found to be a more salient aspect in differentiating those who will be more or less satisfied with their experience. In addition, SOC was found to predict general participation in a community collaborative. SOC-R emphasizes the experience of community as a responsibility which appears to be a stronger predictor in explaining higher order engagement requiring greater investment of time and resources. Even more importantly, this study indicates that SOC-R is uniquely equipped to help us advance models of community leadership. As such, it represents an important contribution to expanding our understanding of the factors that drive members' willingness to give of themselves toward collective aims.

Interorganizational relationships among family support organizations and child mental health agencies

This study examined: (1) qualitative aspects of close working relationships between family support organizations and child mental health agencies, including effective and ineffective characteristics of the relationship and aspects that they would change, and (2) the impact of the working relationship upon the family support organization. Semi-structured interviews were conducted with 40 directors of family support organizations characterized as having a close working relationship with a child mental health agency. Three main themes emerged regarding the quality of the working relationship: (a) interactional factors, including shared trust, communication, collaboration and service coordination; (b) aspects of the inner context of the family support organization, mental health agency, or both, including alignment of goals and values and perceptions of mental health services; and (c) outer contextual factors external to the organizations, such as financial and county regulations. Responses to the perceived impact of the relationship was divided into two themes: positive impacts (e.g. gained respect, influence and visibility), and negative impacts (e.g. lack of trust). This study lays the foundation for future research to better understand the mechanisms underlying interorganizational relationships in communities among different types of providers to create a more seamless continuum of services for families of children with mental health conditions.

Linking the levels: network and relational perspectives for community psychology

In this article, we assert that relationships and networks are of paramount importance for understanding and improving settings, neighborhoods, communities, and larger social systems. Despite previous acknowledgements of their relevance, relational and social network perspectives and analyses remain underrepresented in community psychological research and action. Here, we claim that network and relational perspectives can provide conceptual and empirical 'links' between levels of analysis, more fully reflecting a transactional view. We also describe some of the sophisticated methodologies that can be employed in empirical studies drawing on these perspectives. Additionally, we contend that core concepts in community psychology such as health promotion, empowerment, coalition building, and dissemination and implementation can be better understood when employing relational and network perspectives. As an introduction to this special issue of American Journal of Community Psychology, we draw out themes and key points from the articles in the issue, and offer recommendations for future advancement of these perspectives in the field.

Miami thrives: weaving a poverty reduction coalition

In an environment where community based organizations are asked to do increasingly more to alleviate the effects of complex social problems, networks and coalitions are becoming the answer for increasing scale, efficiency, coordination, and most importantly, social impact. This paper highlights the formation of a poverty reduction coalition in south Florida. Our case study approach chronicles a developing coalition in Miami-Dade County and the role of one organization acting as lead to the initiative. Drawing on interviews with lead organization staff, participant observation field notes, network mapping and analysis of documents and artifacts from the initiative, we analyze the local organizational context and illuminate important processes associated with supporting a developing coalition. Findings offer a picture of the interorganizational relationships in the community using social network analysis and identify the organizational capacity factors that contribute to and inhibit the formation of a cohesive and effective coalition in this context. This study also highlights the utility of an action research approach to organizational learning about coalition-building in such a way that informs decision making.

A network perspective on the processes of empowered organizations

Organizational empowerment is a multi-faceted concept that involves processes occurring both within and between organizations that facilitate achievement of their goals. This paper takes a closer look at three interorganizational processes that lead to empowered organizations: building alliances, getting the word out, and capturing others' attention. These processes are located within the broader nomological network of empowerment and organizational empowerment, and are linked to particular patterns of interorganizational relationships that facilitate organizations' ability to engage in them. A new network-based measure, γ-centrality, is introduced to capture the particular network structure associated with each process to be assessed. It is demonstrated first in a hypothetical organizational network, then applied to take a closer look at organizational empowerment in the context of a coordinating council composed of human service agencies. The paper concludes with a discussion of the implications of relationships between these processes, and the potential for unintended consequences in the empowerment of organizations.

Mapping one strong 'Ohana: using network analysis and GIS to enhance the effectiveness of a statewide coalition to prevent child abuse and neglect

Network analysis and GIS enable the presentation of meaningful data about organizational relationships and community characteristics, respectively. Together, these tools can provide a concrete representation of the ecological context in which coalitions operate, and may help coalitions identify opportunities for growth and enhanced effectiveness. This study uses network analysis and GIS mapping as part of an evaluation of the One Strong 'Ohana (OSO) campaign. The OSO campaign was launched in 2012 via a partnership between the Hawai'i Children's Trust Fund (HCTF) and the Joyful Heart Foundation. The OSO campaign uses a collaborative approach aimed at increasing public awareness of child maltreatment and protective factors that can prevent maltreatment, as well as enhancing the effectiveness of the HCTF Coalition. This study focuses on three elements of the OSO campaign evaluation: (1) Network analysis exploring the relationships between 24 active Coalition member organizations, (2) GIS mapping of responses to a randomized statewide phone survey (n = 1,450) assessing awareness of factors contributing to child maltreatment, and (3) Combined GIS maps and network data, illustrating opportunities for geographically-targeted coalition building and public awareness activities.

Advancing environmental and policy change through active living collaboratives: compositional and stakeholder engagement correlates of group effectiveness

OBJECTIVE

This study aims to evaluate compositional factors, including collaborative age and size, and community, policy, and political engagement activities that may influence collaboratives' effectiveness in advancing environmental improvements and policies for active living.

DESIGN/PARTICIPANTS/SETTING

Structured interviews were conducted with collaboratives' coordinators. Survey items included organizational composition, community, policy, and political engagement activities and reported environmental improvements and policy change. Descriptive statistics and multivariate models were used to investigate these relationships.

MAIN OUTCOME MEASURE(S)

Environmental improvement and policy change scores reflecting level of collaborative effectiveness across 8 strategy areas (eg, parks and recreation, transit, streetscaping, and land redevelopment).

RESULTS

Fifty-nine collaborative groups participated in the interview, representing 22 states. Groups have made progress in identifying areas for environmental improvements and in many instances have received funding to support these changes. Results from multivariate models indicate that engagement in media communication and advocacy was statistically correlated with higher levels of environmental improvement, after adjusting for age of group and area poverty levels (P < .01). Groups that frequently solicited endorsements from community leaders and offered testimony in policy or legal hearings reported significantly more policy change, after adjusting for age of group and area poverty levels (P < .01 for both).

CONCLUSIONS

Active living collaboratives are translating the evidence on environmental and policy approaches to promote active living from research to practice. Investing in community and policy engagement activities may represent important levers for achieving structural and policy changes to the built environment.

Lições aprendidas com o trabalho em Rede em Enfermagem e Obstetrícia

A Rede Global de Centros Colaboradores da OMS para o Desenvolvimento da Enfermagem e Obstetrícia é uma organização independente, internacional, sem fins lucrativos, composta por 44 Centros Colaboradores. Dentre seus membros estão líderes de enfermagem e obstetrícia reconhecidos internacionalmente, o que ressalta o significado ímpar deste grupo. Com base em sua trajetória, este artigo descreve como o trabalho em rede pode transformar ações isoladas com resultados pontuais em ações convergentes e sinérgicas com resultados expandidos, e impacto na academia, serviços e arena política.

Rural Embedded Assistants for Community Health (REACH) network: first-person accounts in a community-university partnership

Community research and action projects undertaken by community-university partnerships can lead to contextually appropriate and sustainable community improvements in rural and urban localities. However, effective implementation is challenging and prone to failure when poorly executed. The current paper seeks to inform rural community-university partnership practice through consideration of first-person accounts from five stakeholders in the Rural Embedded Assistants for Community Health (REACH) Network. The REACH Network is a unique community-university partnership aimed at improving rural health services by identifying, implementing, and evaluating innovative health interventions delivered by local caregivers. The first-person accounts provide an insider's perspective on the nature of collaboration. The unique perspectives identify three critical challenges facing the REACH Network: trust, coordination, and sustainability. Through consideration of the challenges, we identified several strategies for success. We hope readers can learn their own lessons when considering the details of our partnership's efforts to improve the delivery infrastructure for rural healthcare.

Accomplishing structural change: identifying intermediate indicators of success

Coalitions are routinely employed across the United States as a method of mobilizing communities to improve local conditions that impact on citizens' well-being. Success in achieving specific objectives for environmental or structural community change may not quickly translate into improved population outcomes in the community, posing a dilemma for coalitions that pursue changes that focus on altering community conditions. Considerable effort by communities to plan for and pursue structural change objectives, without evidence of logical and appropriate intermediate markers of success could lead to wasted effort. Yet, the current literature provides little guidance on how coalitions might select intermediate indicators of achievement to judge their progress and the utility of their effort. The current paper explores the strengths and weaknesses of various indicators of intermediate success in creating structural changes among a sample of 13 coalitions organized to prevent exposure to HIV among high-risk adolescents in their local communities.

The role of a state-level prevention support system in promoting high-quality implementation and sustainability of evidence-based programs

Although numerous evidence-based programs (EBPs) have been proven effective in research trials and are being widely promoted through federal, state, and philanthropic dollars, few have been "scaled up" in a manner likely to have a measurable impact on today's critical social problems. The Interactive Systems Framework for Dissemination and Implementation (ISF) explicates three systems that are critical in addressing the barriers that prevent these programs from having their intended public health impact. In this article we describe the relevance of these systems in a real-world context with a specific focus on the Prevention Support System (PSS). We expand on the ISF model by presenting funders and policy-makers as active and engaged stakeholders, and demonstrate how a state-level PSS has used empirical evidence to inform general and program-specific capacity-building and support interactions among researchers, funders, and practitioners in Pennsylvania. By embracing this expanded ISF framework as a conceptual model for the wide-scale dissemination and support of EBPs, and recognizing the need for a distinct state-level PSS, Pennsylvania has created an infrastructure to effectively address the primary barriers to moving from lists of EBPs to achieving population-level public health improvement.

A state agency-university partnership for translational research and the dissemination of evidence-based prevention and intervention

This article describes a decade-long partnership between the Prevention Research Center at Penn State and the Pennsylvania Commission on Crime and Delinquency. This partnership has evolved into a multi-agency initiative supporting the implementation of nearly 200 replications of evidence-based prevention and intervention programs, and a series of studies indicating a significant and sustained impact on youth outcomes and more efficient utilization of system resources. We describe how the collaboration has developed into a sophisticated prevention support infrastructure, discuss the partnership and policy lessons learned throughout this journey, and identify remaining issues in promoting this type of research-policy partnership.

Multilevel measurement of dimensions of collaborative functioning in a network of collaboratives that promote child and family well-being

Evaluating collaboration between community partners presents a series of methodological challenges (Roussos and Fawcett in Annu Rev Public Health 21:369-402, 2000; Yin and Kaftarian 1997), one of which is selection of the appropriate level of analysis. When data are collected from multiple members of multiple settings, multilevel analysis techniques should be used. Multilevel confirmatory factor analysis (MCFA) is an analytic approach that incorporates the advantages of latent variable measurement modeling and multilevel modeling for nested data. This study utilizes MCFA on data obtained from an evaluation survey of collaborative functioning provided to members of 157 community collaboratives in Georgia. This study presents a well-fitting measurement model that includes five dimensions of collaborative functioning, and a structural component with individual- and collaborative-level covariates. Findings suggest that members' role and meeting attendance significantly predicted their assessment of collaboration at the individual level, and that tenure of collaborative leaders predicted the overall functioning of the collaborative at the collaborative level. Dimensionality of collaborative functioning and implications of potentially substantial measurement biases associated with selection of respondents are addressed.

Examining Multi-Sector Community Collaboratives as Vehicles for Building Organizational Capacity

While community collaboratives have emerged as a prominent vehicle for fostering a more coordinated community response to complex issues, research to date suggests that the success of these efforts at achieving community/population-level improvements is mixed. As a result, researchers and practitioners are increasing their focus on the intermediate outcomes accomplished by these entities. The purpose of this study is to expand upon this examination of potential intermediate outcomes by investigating the ways in which collaboratives strengthen the capacity of the organizations who participate as members. Utilizing a mixed methods design, we present an empirically-based framework of organizational outcomes associated with participation in a community collaborative. The dimensions of this framework are validated based on quantitative findings from representatives of 614 different organizations and agencies nested within 51 different community collaboratives. This article then explores how the characteristics of organizations and their representatives relate to the nature and type of impacts associated with membership. Based on study findings, we argue that community collaboratives can be effective interventions for strengthening organizational capacity across all sectors in ways that can promote greater community resiliency.

Advancing the science of community-level interventions

Community interventions are complex social processes that need to move beyond single interventions and outcomes at individual levels of short-term change. A scientific paradigm is emerging that supports collaborative, multilevel, culturally situated community interventions aimed at creating sustainable community-level impact. This paradigm is rooted in a deep history of ecological and collaborative thinking across public health, psychology, anthropology, and other fields of social science. The new paradigm makes a number of primary assertions that affect conceptualization of health issues, intervention design, and intervention evaluation. To elaborate the paradigm and advance the science of community intervention, we offer suggestions for promoting a scientific agenda, developing collaborations among professionals and communities, and examining the culture of science.

A model-driven approach to qualitatively assessing the added value of community coalitions

Community-based coalitions are commonly formed to plan and to carry out public health interventions. The literature includes evaluations of coalition structure, composition, and functioning; evaluations of community-level changes achieved through coalition activities; and the association between coalition characteristics and various indicators of success. Little information is available on the comparative advantage or "added value" of conducting public health interventions through coalitions as opposed to less structured collaborative mechanisms. This paper describes a qualitative, iterative process carried out with site representatives of the Controlling Asthma in American Cities Project (CAACP) to identify outcomes directly attributable to coalitions. The process yielded 2 complementary sets of results. The first were criteria that articulated and limited the concept of "added value of coalitions". The criteria included consensus definitions, an organizing figure, a logic model, and inclusion/exclusion criteria. The second set of results identified site-specific activities that met the definitional criteria and were, by agreement, examples of CAACP coalitions' added value. Beyond the specific findings relevant to the added value of coalitions in this project, the use of a social ecological model to identify the components of added value and the placement of those components within a logic model specific to coalitions should provide useful tools for those planning and assessing coalition-based projects.

Developing and implementing an effective framework for collaboration: the experience of the CS2day collaborative

Organizations from varied sectors have pursued collaboration to better fulfill their missions, facilitate decision making, solve more complex problems, and respond more rapidly to a changing environment. While these benefits are evident through the products and services provided, few organizations evaluate the factors that contribute to the success or failure of the collaboration itself. The CS2day Collaborative was formed by 9 separate organizations with a common goal of increasing smoking quit rates through health care professional education. To better understand the factors that influence successful collaboration, the authors applied criteria established by the Wilder Foundation to the functioning of this health care education collaborative. Factors analyzed include the influence of the environment, membership, process and structure, communication, purpose, and resources. Factors relevant to continuing medical education/continuing professional development (CME/CPD) including accreditation, conflict of interest resolution and management, guideline dissemination, continuous assessment and interprofessional education influenced the collaborative structure. Specific examples provided illustrate how diverse organizations can work together effectively to address a public health need. While the CS2day Collaborative was not formed with prior knowledge of these factors, they provide a useful framework for examining how this collaborative was developed and has operated.