The Role of Coalition Functioning, Community Involvement, and Technical Assistance in Promoting Effective Coalition Implementation across Developmental Stages: A Mixed Method Study

Introduction: Coalitions have gained prominence as an avenue towards community change. These interorganizational relationships mobilize stakeholders in a collaborative effort to improve community health outcomes. Theory suggests coalitions progress through developmental stages, and that activities which support coalitions vary between stages. This study explored factors associated with coalition implementation and functioning across development. Data was collected from coalitions participating in the WA State Community Prevention and Wellness Initiative (CPWI). CPWI integrates best practices from the Strategic Prevention Framework and Communities That Care models. Outcome analyses have provided preliminary evidence of effectiveness, but mechanisms underlying this effect have not yet been explored. This process evaluation addresses that gap.

Methods: A total of 59 (51%) respondents across four cohorts completed a web-based survey assessing coalition development, functioning, and implementation. Twenty (34%) of the respondents also participated in semi-structured key informant interviews (average length: 50 minutes) to illuminate the collaborative experience with a state agency in implementing prevention strategies in WA State. Thematic analysis was used to identify patterns in responses across interviews.

Results: Survey and interview data provided convergent evidence that coalition leadership and functioning, community involvement, and technical assistance enhance CPWI implementation. More developed coalitions reported higher levels of functioning, implementation progress, satisfaction with their CPWI work, and community change as a result of CPWI. These coalitions also reported more community involvement and effective community champions. For coalitions in earlier stages of development, school involvement was a more significant challenge. These less developed coalitions reported greater technical assistance needs in: leadership development, coalition building, program implementation, risk factor analysis, and leveraging local data.

Conclusions: Successful implementation practices are critical for achieving positive community health outcomes. To date, few studies have examined the interplay of coalition developmental stage with functioning and implementation barriers. The current mixed methods study captures this information, enabling community coalitions and supporting agencies to provide developmentally-targeted technical assistance at critical junctures.