A Conceptual Model for Understanding Effective Coalitions Involved in Health Promotion Programing

Evaluating governance in a clinical and translational research organization

Institutional Development Awards for Clinical and Translational Research (IDeA-CTR) networks, funded by NIH/NIGMS, aim to advance CTR infrastructure to address historically unmet state and regional health needs. Success depends on the response to actionable feedback to IDeA-CTR leadership from network partners and governance groups through annual surveys, interviews, and governance body recommendations. The Great Plains IDeA-CTR applied internal formative meta-evaluation to evaluate dispositions of 172 governance recommendations from 2017 to 2021. Results provided insights to improve the classification and quality of recommendations, credibility of evaluation processes, responsiveness to recommendations, and communications and governance in a complex CTR network comprising multiple coalitions.

Intersectoral collaboration in a Dutch community health promotion programme: building a coalition and networks

In health promotion programmes (HPP), it is crucial to have intersectoral collaboration within coalitions and to build networks between health and other societal sectors. A health broker role is recognized as being helpful in connecting the coalition with the broader network, and participatory action research (PAR) is deemed supportive because it facilitates evaluation, reflection, learning and action. However, there is a lack of insight into how processes that affect collaboration develop over time. Therefore, this study aimed to provide insights into the coalition's processes that facilitate building and maintaining intersectoral collaboration within a HPP coalition and network and how these processes contribute to the coalition's ambitions. As part of PAR, the coalition members used the coordinated action checklist (CAC) and composed network analysis (CNA) in 2018 and 2019. The CAC and CNA results were linked back into the coalition in five group sessions and used for reflection on pro-gress and future planning. Coalition governance, interaction with the context, network building and brokerage, and generating visibility emerged as the most prominent processes. Important insights concerned the health broker's role and positioning, the programme coordinator's leadership and the importance of visibility and trust leading to investment in continuation. The combined research instruments and group sessions supported discussion and reflection, sharing visions and adjusting working strategies, thereby strengthening the coalition's capacity. Thus, PAR was useful for evaluating and simultaneously facilitating the processes that affect collaboration.

Consolidated Framework for Collaboration Research derived from a systematic review of theories, models, frameworks and principles for cross-sector collaboration

Cross-sector collaboration is needed to address root causes of persistent public health challenges. We conducted a systematic literature review to identify studies describing theories, models, frameworks and principles for cross-sector collaboration and synthesized collaboration constructs into the Consolidated Framework for Collaboration Research (CFCR). Ninety-five articles were included in the review. Constructs were abstracted from articles and grouped into seven domains within the framework: community context; group composition; structure and internal processes; group dynamics; social capital; activities that influence or take place within the collaboration; activities that influence or take place within the broader community; and activities that influence or take place both in the collaboration and in the community. Community engagement strategies employed by collaborations are discussed, as well as recommendations for using systems science methods for testing specific mechanisms of how constructs identified in the review influence one another. Researchers, funders, and collaboration members can use the consolidated framework to articulate components of collaboration and test mechanisms explaining how collaborations function. By working from a consolidated framework of collaboration terms and using systems science methods, researchers can advance evidence for the efficacy of cross-sector collaborations.

Evaluating Effective Leadership and Governance in a Midwestern Agricultural Safety and Health Coalition

Agricultural Centers are a coalition of organizations and individual members with a common purpose: to improve the health and safety of the agricultural community. Successful leadership and governance are essential in accomplishing these goals. This article examined the effectiveness of a midwestern Agricultural Health and Safety Center (Ag Center) leadership and governance structure. The Internal Coalition Outcomes Hierarchy (ICOH) framework and the Internal Coalition Effectiveness (ICE©) instrument were used, with field visit interviews conducted to gain further insight. Combined comparative findings from both research methods showed that scores in each of the categories increased. Adjustments led to stronger collaborative leadership, vital to successful population health improvement programs. This study showcases coalition qualities in a broader environment, capturing a clearer depiction of leadership and member interaction. Field visit interviews confirmed that this midwestern Ag Center continued to have strong levels of effectiveness in each of the conceptual constructs of a coalition.

Community Advisory Board Members’ Perspectives Regarding Opportunities and Challenges of Research Collaboration

This case study examines the perspectives of rural community advisory board (CAB) members regarding the opportunities and challenges of partnering with academic investigators on funded research. We used a sequential exploratory design to evaluate the phenomena. Qualitative and quantitative data from CAB members were integrated to gain better understanding. Results showed that CAB members valued professional networking and gaining new evidence-based knowledge to enhance their professional practices. They identified rurality, the academic research process, and fulfilling research roles as the most significant challenges. CAB members also believed that strong community-based leaders had been essential in promoting and sustaining a shared vision for evidence-based research solutions to their community problem. Self-evaluation is essential for effective CAB research partnerships, and nurse researchers can strengthen these collaborations by (a) providing continuing education on research and evidence-based practices, (b) assuring that perceived benefits of CAB participation outweigh perceived challenges, and (c) supporting community-based leadership.

Building capacity in disadvantaged communities: development of the community advocacy and leadership program

BACKGROUND

Successful community groups have the capacity to mobilize community assets to address needs. Capacity-building education is integral to building competent communities.

OBJECTIVES

A community-university team developed and pilot tested an education program for community advocates from disadvantaged neighborhoods with high chronic disease burden.

METHODS

The Community Advocacy and Leadership Program (CALP) included eight monthly workshops, a mini-grant opportunity, and technical assistance. A nominal group with community health practitioners, focus group with community advocates, and a literature search comprised a triangulated educational needs assessment. A participating pretest with 35 community health practitioners guided curriculum refinement. Seven representatives from three community groups in a medically underserved South Carolina county participated in pilot implementation and evaluation. Qualitative and quantitative data informed the process and impact evaluation.

RESULTS

The mean knowledge score at 1 month after the program was 77% (range, 52%-96%). The mean score on post-program self-assessment of skills improvement was 3.8 out of a possible 4.0 (range, 3.6-4.0). Two groups submitted successful community mini-grant applications for playground improvements, and the third group successfully advocated for public funding of neighborhood park improvements. Participants reported favorable impressions and both personal and community benefits from participation.

CONCLUSIONS

A community-university partnership successfully conducted a local educational needs assessment and developed and pilot tested a capacity development program within a CBPR partnership. Successes, challenges, and lessons learned will guide program refinement, replication, and dissemination.

Children's Agricultural Safety Network: Evaluating Organizational Effectiveness and Impacts

Coalitions that are effectively organized and led are more likely to achieve their intended program outcomes and impacts, as well as achieve sustainability. External evaluation of the coalition's governance and leadership can help identify strengths and areas for improvement. This article describes the evaluation of the Children's Agricultural Safety Network (CASN)-a national coalition, or network of 45 organizational members. The conceptual framework, Internal Coalition Outcomes Hierarchy, guided the evaluation. We used a mixed-methods approach to answer study's primary objectives from the perspective of CASN members and leaders for (a) organizational effectiveness, (b) network impact, and (c) member benefits. We collected quantitative data using a survey and the Internal Coalition Effectiveness (ICE) instrument. Focused interviews were conducted by phone to gather rich data on examples. Combined findings showed that both members and leaders rated the CASN effective in all construct areas that define successful coalitions. Members feel as invested in CASN success as do leaders. The major impact of CASN has been as a national leader and clearinghouse for childhood safety issues, and the most frequently cited example of impact was the national tractor safety campaign. Members identified the benefits of CASN membership as networking, resource sharing, and opportunities to enhance their knowledge, skills, and practices in the area. Members also valued the national attention that CASN was able to bring to the important issues in childhood agricultural safety. Suggestions for improvement were to focus on more research to improve best practices and strengthen dissemination and implementation science.

Smoke-free coalition cohesiveness in rural tobacco-growing communities

Promoting tobacco control policies in rural tobacco-growing communities presents unique challenges. The purpose of this study was to assess smoke-free coalition cohesiveness in rural communities and identify coalition members' perceived barriers or divisive issues that impede the development of smoke-free policies. A secondary aim was to evaluate differences in coalition cohesiveness between advocates in communities receiving stage-based, tailored policy advocacy assistance versus those without assistance. Tobacco control advocates from 40 rural Kentucky communities were interviewed by telephone during the final wave of a 5-year longitudinal study of community readiness for smoke-free policy. On average, five health advocates per county participated in the 45-min interview. Participants rated coalition cohesiveness as not at all cohesive, somewhat cohesive, or very cohesive, and answered one open-ended question about potentially divisive issues within their coalitions. The mean age of the 186 participants was 48.1 years (SD = 13.3). The sample was predominantly female (83.6%) and Caucasian (99.5%). Divisive concerns ranged from rights issues, member characteristics, type of law, and whether or not to allow certain exemptions. Three of the divisive concerns were significantly associated with their rankings of coalition cohesiveness: raising tobacco in the community, the belief that smoke-free would adversely affect the economy, and government control. Educating coalition members on the economics of smoke-free laws and the actual economic impact on tobacco-growing may promote smoke-free coalition cohesiveness. More resources are needed to support policy advocacy in rural tobacco-growing communities as well as efforts to reduce the divisive concerns reported in this study.

Internal Structure Analysis of a Tobacco Control Network on the U.S.-México Border

Tobacco control (TC) networks (in which multiple agencies collaborate) are essential components within comprehensive TC efforts. The aim of this study was to assess the internal coalition outcomes hierarchy model (via the Internal Coalition Effectiveness [ICE] scale) in the present sample. Participants (members of a TC Network on the U.S.-México border; independent Waves 1 [N = 30] and 2 [N = 33; at a 1-year subsequent assessment]) completed a background questionnaire and an adapted version of the ICE scale. Mean values for ICE subscales suggested a strong enthusiasm of Network members and recognition of the importance of a cohesive social vision, employment of efficient practices, a need for improved and maintained knowledge/training, and stable social relationships among members. However, no significant differences were observed between data waves in the ICE subscales, multivariate analysis of variance: λ = .97, F(4, 43) = 0.31, p > .86. Considering a multifaceted assessment may enhance the understanding of the dynamics and strengths of the Network. Finally, including an assessment of the leadership's perspective regarding internal coalition outcome hierarchy model constructs to compare them with members' perspective is warranted.

Factors influencing partnerships between higher education and healthcare

OBJECTIVE

The aim of this study was to describe the factors influencing partnerships between higher education and healthcare.

BACKGROUND

Partnerships have often been studied as organisations' internal processes or multi-professional team activities. However, there has been less research on the partnership as a phenomenon between organisations and, until now, the research has mainly focused on experiences in the US and the UK.

SETTING, PARTICIPANTS AND METHODS

The study was carried out in Finland. Staff from a university of applied sciences and a service unit for the elderly took part in nine focus group interviews (n=39) and produced self-evaluations based on diaries (n=13) and essays (n=24). The data were analysed by qualitative content analysis.

RESULTS

The factors influencing partnerships were: a joint development target, agreeing on collaboration, providing resources for partnership, enhancing mutual understanding, sharing operational culture, commitment and participatory change management and communication.

CONCLUSIONS

This study updates, and complements, previous reviews on factors influencing partnerships, by providing some new concepts and a new cultural perspective from Finland on a partnership between higher education and healthcare. The results provide information on factors that influence partnerships and develop and manage their sustainability.

A controlled community-based trial to promote smoke-free policy in rural communities

PURPOSE

Rural, tobacco-growing areas are disproportionately affected by tobacco use, secondhand smoke, and weak tobacco control policies. The purpose was to test the effects of a stage-specific, tailored policy-focused intervention on readiness for smoke-free policy, and policy outcomes in rural underserved communities.

METHODS

A controlled community-based trial including 37 rural counties. Data were collected annually with community advocates (n = 330) and elected officials (n = 158) in 19 intervention counties and 18 comparison counties over 5 years (average response rate = 68%). Intervention communities received policy development strategies from community advisors tailored to their stage of readiness and designed to build capacity, build demand, and translate and disseminate science. Policy outcomes were tracked over 5 years.

FINDINGS

Communities receiving the stage-specific, tailored intervention had higher overall community readiness scores and better policy outcomes than the comparison counties, controlling for county-level smoking rate, population size, and education. Nearly one-third of the intervention counties adopted smoke-free laws covering restaurants, bars, and all workplaces compared to none of the comparison counties.

CONCLUSIONS

The stage-specific, tailored policy-focused intervention acted as a value-added resource to local smoke-free campaigns by promoting readiness for policy, as well as actual policy change in rural communities. Although actual policy change and percent covered by the policies were modest, these areas need additional resources and efforts to build capacity, build demand, and translate and disseminate science in order to accelerate smoke-free policy change and reduce the enormous toll from tobacco in these high-risk communities.

Appalachian regional model for organizing and sustaining county-level diabetes coalitions

This article describes a model for developing diabetes coalitions in rural Appalachian counties and presents evidence of their sustainability. The rural Appalachian coalition model was developed through a partnership between two federal agencies and a regional university. Coalitions go through a competitive application process to apply for one-time $10,000 grants. The project has funded 7 to 9 coalitions annually since 2001, reaching 66 total coalitions in 2008. Sustainability of the coalitions is defined by the number of coalitions that voluntarily report on their programs and services. In 2008, 58 of 66 (87%) coalitions in the Appalachian region continue to function and voluntarily submit reports even after their grant funds have been depleted. The factors that may contribute to sustainability are discussed in the article. This model for organizing coalitions has demonstrated that it is possible for coalitions to be maintained over time in rural underserved areas in Appalachia.

Proximal outcomes matter: a multilevel examination of the processes by which coordinating councils produce change

Communities are engaged in efforts to create a coordinated response to intimate partner violence. Though coordinating councils are commonly employed vehicles for such efforts, research provides only equivocal support regarding their effectiveness. These mixed findings may reflect methodological and conceptual challenges. Specifically, there is an over-reliance on conceptualizing council effectiveness in terms of distal outcomes (e.g., behavior change), rather than the intermediary processes by which councils affect change. A direct assessment of councils' proximal outcomes may highlight change mechanisms. To that end, this study investigates the extent to which councils impact proximal outcomes and examines the processes through which proximal outcomes are interrelated and linked to distal community change. Study findings suggest that perceived proximal outcomes do significantly predict variability in perceived distal community change across councils. Specifically, promotion of social capital and institutionalized change predict achievement of distal community change, and promotion of social capital also predicts achievement of institutionalized change.

Evaluation of a successful fetal alcohol spectrum disorder coalition in Ontario, Canada

Leading a successful coalition that benefits both the members and the community is a difficult task. Coalitions are complex and require a great deal of skill to initiate, lead, and evaluate. This article examines a successful coalition, developed to build community capacity to address fetal alcohol spectrum disorder (FASD). FASD is a complex, multidimensional health issue common in many communities. Coalitions can be effective in tackling these types of issues and fit with community capacity-building approaches to health promotion. The Internal Coalition Outcome Hierarchy (ICOH) model (Cramer, Atwood, & Stoner, 2006a, 2006b) is used to retrospectively examine the internal constructs of the FASD Action Network and provide useful lessons learned for other coalition leaders and public health nurses. This hierarchical model demonstrates that sound internal processes lead to more successful outcomes and ultimately an increased impact on community issues. The usefulness of ICOH as a tool in evaluating the FASD Action Network and its application to other health-promotion situations with community capacity goals is described in this article.

Community health promotion: a framework to facilitate and evaluate supportive social environments for health

The evaluation of community health promotion designed to create supportive social environments for health is still in its infancy. There is a lack of consensus on concepts, a lack of information on interventions that bring about social change, and a lack of feasible methods and tools. Consequently, the effectiveness of community health promotion may not be evaluated under all relevant headings. Therefore, this study aims to contribute to the evaluation of change in the social environment by presenting a framework. On the basis of the relevant literature we describe the relation between social environment and health predicting mediators. We selected participation and collaboration as core concepts in moderating the social environment of health because these terms give insight into the actual dynamics of health promotion practice. We synthesize the results into a framework with operational variables and offer four guidelines on how to apply the framework: use the variables as a menu, set specific aims for social change processes, use an action research approach, and triangulate data. The framework and guidelines enable the start-up, facilitation and evaluation of social change and learning processes and provide common ground for researchers and practitioners to improve the practice of their professions.

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.

METHODS

Data were from 8 sites that participated in an evaluation of a healthy cities and communities initiative in California. Twenty-three focus groups were conducted with coalition members, and 76 semi-structured interviews were conducted with local coordinators and coalition leaders. Cross-site analyses were conducted to identify the ways contextual domains influenced selection of the lead agency, coalition membership, staffing and leadership, and coalition processes and structures.

RESULTS

History of collaboration influenced all four coalition factors examined, from lead agency selection to coalition structure. Geography influenced coalition formation largely through membership and staffing, whereas the demographic and economic makeup of the community had an impact on coalition membership, staffing, and infrastructure for coalition processes. The influence of community politics, history, norms and values was most noticeable on coalition membership.

CONCLUSIONS

Findings contribute to an ecologic and theory-based understanding of the range of ways community context influences coalitions in their formative stage.

Lessons learned and challenges in building a Filipino health coalition

In recent years, community-based coalitions have become an effective channel to addressing various health problems within specific ethnic communities. The purpose of this article is twofold: (a) to describe the process involved in building the Kalusugan Coalition (KC), a Filipino American health coalition based in New York City, and (b) to highlight the lessons learned and the challenges from this collaborative venture. The challenges described also offer insights on how the coalition development process can be greatly affected by the partnership with an academic institution on a community-based research project. Because each cultural group has unique issues and concerns, the theoretical framework used by KC offers creative alternatives to address some of the challenges regarding coalition infrastructures, leadership development, unexpected change of coalition dynamics, and cultural nuances.

Health promotion health center project

OBJECTIVES

As part of a major government support for health promotion, a health promotion health center (HPHC) project was launched at the national level in Korea. The purpose of the study was to describe this 2-year HPHC project within the framework of the Ottawa Charter for Health Promotion and to evaluate the preliminary outcomes of the community residents.

DESIGN

A cross-sectional design was used.

SAMPLE

A total of 2,261 community residents participated in the survey, with 792 in HPHC sites and 1,469 in non-HPHC sites.

MEASUREMENT

The instrument included questions on participants' demographic characteristics, awareness, participation, health behavior (smoking, exercise, meat consumption, and blood pressure checkup), and satisfaction with the health promotion programs.

RESULTS

The 5 main health promotion strategies of the Ottawa Charter were evident in the HPHCs. HPHCs were successful in enhancing awareness, participation, and satisfaction through their health promotion programs, although health behaviors were not significantly different between the 2 groups, except exercise.

CONCLUSION

Ottawa Charter strategies embedded within the practice of the community health promotion activities were effective in increasing the short-term outcomes (awareness, participation, and satisfaction with health promotion programs), which is a promising finding for the development of health promotion behaviors in the future.

Measuring community coalition effectiveness using the ICE instrument

This article presents the development and psychometric testing of the Internal Coalition Effectiveness (ICE) instrument, which was based on the conceptual model Internal Coalition Outcome Hierarchy. Sixty-one items were derived from literature about successful coalitions, and the ICE instrument was tested for reliability and validity. A national panel of eight experts conducted content validity. Remaining tests involved a sample of 61 members and leaders of a large midwestern coalition (77% response rate, n=47). Content validity involved a two-stage process for rigorous item development and quantification (0.88, p<0.05). Internal consistency was based on bivariate Pearson's correlation of 0.30-0.70 for two-item scales and Cronbach's alpha(alpha=0.70). Construct validity was assessed by correlation analysis, independent Student's t tests, and informal coalition feedback. The final 30-item version of ICE is psychometrically sound. Findings were shared with the local coalition, and, in support of the instrument's validity, members and leaders found this information useful for promoting coalition sustainability by identifying internal strengths and areas for improvement. The ICE instrument adds to the body of literature by measuring critical constructs of coalition effectiveness and has significant application for public health nurses working as evaluators for coalitions engaged in community health programming.