Perspectives of community partners and researchers about factors impacting coalition functioning over time

Differences in perceptions of community stigma towards opioid use disorder between community substance use coalition members and the general public

INTRODUCTION

To examine differences in perceptions about community stigma towards individuals with opioid use disorder (OUD) between community members involved in the opioid response (i.e., coalition members) and the general public, and how community geography may moderate this relationship.

METHODS

This study administered identical cross-sectional surveys about perceived community opioid-related stigma to two distinct populations in 66 communities participating in the HEALing Communities Study prior to the intervention period (i.e., coalition members, November 2019-January 2020; residents, March-April 2020). Linear-mixed models compared survey responses of populations, including the moderating effect of community rural/urban location.

RESULTS

A total of 826 coalition members and 1131 residents completed the surveys. The study found no differences between the coalition members and residents for general perceived community opioid-related stigma. In both urban and rural communities, coalition members reported greater perceived community stigma than residents reported towards medication for opioid use disorder (MOUD), naloxone, and drug treatment as an alternative to incarceration.

CONCLUSION

Our findings suggest similar perceived community opioid-related stigma between coalition members and residents, yet differences emerge related to evidence-based practices (i.e., MOUD, naloxone, and drug treatment as an alternative to incarceration) to reduce opioid overdose deaths.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04111939.

Initial conditions and functioning over time among community coalitions

Developing operationally strong community coalitions is critical to actualizing their potential for public health improvement. The purpose of this study was to measure how substance use prevention coalitions in Mexico functioned across their first 1.5 years, and to test associations between initial community contextual factors and subsequent coalition functioning and outcomes. Members of 19 coalitions participated in three waves of surveys about coalition context and functioning. We used paired t-tests to assess changes in coalition functioning and outcomes. Regression models estimated associations between coalition functioning and outcomes and initial community context. Among coalition functioning factors, over coalitions' first 1.5 years, member engagement increased, as did coordinator skill and participatory leadership style. Two initial community context factors - community support for prevention and community champions - predicted several measures of process competence, but only community champions predicted perceived community improvement. Thus, community champions may play a pivotal role in later coalition success. The observed increases in member engagement and process competence may support subsequent coalition sustainability, a crucial component to realizing their potential impact on public health.

Retrospective evaluation of Project Envision: A community mobilization pilot program to prevent sexual violence in New York City

Sexual violence is a public health problem associated with short- and long-term physical and mental health consequences. Most interventions that aim to prevent sexual violence before it occurs target individual-level change or promote bystander training. Community-level interventions, while increasingly recommended in the sexual violence prevention field, are rarely documented in peer-reviewed literature. This paper is a targeted process evaluation of Project Envision, a 6-year pilot initiative to address social norms at the root of sexual violence through coalition building and community mobilization in three New York City neighborhoods, and reflects the perspectives of those charged with designing and implementing the program. Evaluation methods included a systematic literature review, archival source document review, and key informant interviews. Three themes emerged from the results: community identity and implications for engagement; capacity and readiness for community mobilization and consequences for implementation; and impacts on participants. Lessons learned include the limitations of using geographic boundaries to structure community interventions in urban settings; carefully considering whether communities should be mobilized around an externally-identified issue; translating theoretical frameworks into concrete tasks; assessing all coalition partners and organizations for readiness; critically evaluating available resources; and recognizing that community organizing is a skill that requires investment from funders. We conclude that Project Envision showed promise for shifting institutional norms towards addressing root causes of sexual violence in addition to providing victim services.

Evaluation of the Southern Harm Reduction Coalition for HIV Prevention: Advocacy Accomplishments

BACKGROUND

HIV/AIDS rates are higher in the Southern United States compared to other regions of the country. Reasons for disparities include poverty, health care access, and racism. People who inject drugs (PWID) account for 8% of HIV/AIDS incidence rates. Harm reduction can connect PWID to needed resources. AIDS United Southern REACH grantees developed the Southern Harm Reduction Coalition (SHRC) as a means to decrease HIV/AIDS and viral hepatitis rates, criminalization of drug users and sex workers, and drug overdose.

METHOD

Investigators used an intrinsic case study design to examine the context of harm reduction in the Southern United States, successful strategies, and outcomes. Data collection included key informant interviews and coalition documents. The community coalition action theory was used to examine the data.

RESULTS

The SHRC initiated regional conferences and customized trainings. Strengths-based language and utilization of diverse strengths among coalition members were used to effect change. Coalition outcomes included syringe decriminalization legislation, syringe exchange, naloxone access, naloxone funding legislation, and 911 Good Samaritan laws, along with expanded support for PWID.

CONCLUSIONS

Advocacy successes can be applied to similar organizations in the Southern United States to promote harm reduction and potentially decrease HIV/AIDS burden, viral hepatitis, criminalization, and overdose.

Ensuring Community Participation During Program Planning: Lessons Learned During the Development of a HIV/STI Program for Young Sexual and Gender Minorities

HIV/STI incidence has shifted to a younger demographic, comprised disproportionately of gay and bisexual men, transgender women, and people of color. Recognizing the importance of community organizing and participatory engagement during the intervention planning process, we describe the steps taken to engage diverse constituents (e.g., youth and practitioners) during the development of a structural-level HIV/STI prevention and care initiative for young sexual and gender minorities in Southeast Michigan. Our multi-sector coalition (MFierce; Michigan Forward in Enhancing Research and Community Equity) utilized a series of community dialogues to identify, refine, and select programmatic strategies with the greatest potential. Evaluation data (N = 173) from the community dialogues highlighted constituents' overall satisfaction with our elicitation process. Using a case study format, we describe our community dialogue approach, illustrate how these dialogues strengthened our program development, and provide recommendations that may be used in future community-based program planning efforts.

Coincidence of role expectations between staff and volunteer members of drug free community coalitions

Community coalitions have proliferated as a means of addressing a range of complex community problems. Such coalitions often consist of a small paid staff and volunteer members. The present study examines one likely contributor to coalition effectiveness: the degree of agreement on role expectations between paid staff and volunteer members. Role confusion occurs when paid staff and volunteers differ in their expectations of who is responsible for accomplishing specific tasks. Staff and volunteer members from 69 randomly selected Drug Free Coalitions in the United States as well as 21 Drug Free Coalitions in Connecticut were asked to respond to an online survey asking about 37 specific coalition tasks critical for effective coalition functioning and the degree to which paid staff and/or voluntary members should be responsible for accomplishing each. Our final sample consisted of 476 individuals from 35 coalitions. Using coalitions as the unit of analysis, we found significant differences between paid staff and volunteer coalition members on nine tasks reflecting four domains: meeting leadership and participation, (2) planning and implementation leadership, (3) publicity/media relations, and (4) logistical functions. Implications of these differences and ways that evaluators could help coalitions deal with differing role expectations were discussed.

"There's Gotta be Some Give and Take": Community Partner Perspectives on Benefits and Contributions associated with Community Partnerships for Youth

Successful community partnerships for youth are based on the premise that reciprocity exists between all parties, but to what extent is equal power actually present? The current investigation examines the benefits and contributions associated with partnerships from community partners' perspectives. Respondents from 15 different Connect to Protect® coalitions initiated by the Adolescent Medicine Trials Network for HIV/AIDS Interventions were interviewed at the onset of their partnerships. Community partners asserted that their contributions to partnerships are more varied than researchers', yet they perceived that researchers acquire more kinds of benefits. Findings indicate nuances regarding reciprocity and power inequities between partners. Community partners' insights have implications for defining best practices within partnerships that benefit youth.