Necessary and Sufficient Coalition Functioning Conditions for Model Fidelity across Developmental Stages: A Qualitative Comparative Analysis

Introduction: Coalitions have gained prominence as an avenue towards community change. These interorganizational relationships mobilize stakeholders in a collaborative effort to improve health outcomes. Theory suggests coalitions progress through developmental stages and that activities which support coalitions vary between stages. This study will explore aspects of coalition functioning which were necessary and sufficient for coalitions to achieve model fidelity at each developmental stage. Model fidelity is a well-evidenced predictor of positive coalition outcomes.

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. Theory and preliminary analyses suggest that there are different coalition needs at each developmental stage, but the combinations of conditions which are necessary and/or sufficient to achieve model fidelity have not yet been explored. This study addresses that gap.

Methods: Coalition coordinators (n=43) across four cohorts of CPWI coalitions completed a web-based survey assessing coalition development, functioning, and model fidelity. Each respondent indicated agreement with an item describing their coalition’s development as consistent with one of three stages explicated in the Community Coalition Action Theory: formation, maintenance, or institutionalization. At each stage, we will use Qualitative Comparative Analysis (QCA) to evaluate the necessity and sufficiency of configurations of coalition functioning factors (e.g. sustainability planning, program evaluation, etc.) for achievement of model fidelity.

Results:

Membership in these developmental stages was approximately representative: 40% identified as in the institutionalization stage, 35% as in the maintenance stage, and 26% as in the formation stage. Initial analyses demonstrate differences across stages in the combinations of coalition functioning factors that are necessary and sufficient to achieve model fidelity. For example, coalitions in the maintenance stage achieved model fidelity only when strong coalition leadership was present; at both later stages, various pathways led to model fidelity.

Conclusions: To our knowledge, this is the first study to employ QCA to investigate developmentally-specific coalition needs. Such sub-group scrutiny will allow for more specific inferences about the technical assistance needed to ensure achievement of model fidelity, a significant predictor of positive outcomes, by coalitions at various developmental stages.