Testing Practice Wisdom: Does Building Community Capacities Enable Community Practice Strategies to Achieve Community Change?

Background and Purpose:  Community health coalitions serve an important role in the provision of social services in the United States, where community wellbeing is intended to be defined and pursued democratically and locally (Fraser & Gordon, 1992).  The growth of health coalitions has been driven by the devolution of social service funding streams, but like many other mechanisms of social service delivery, coalitions have mixed evidence of efficacy (Weisner, 1983; Butterfoss, 1993; Roussos & Fawcett, 2000).  Several broad hypotheses have been proposed to explain the insufficient evidence for community health coalition effectiveness (Kreuter, Lezin, & Young, 2000).  One explanation posits that collaborative mechanisms, such as community health coalitions, cannot efficiently produce desired outcomes.  A second explanation suggests that the desired outcomes may be unrealistic to obtain.  A third explanation is that commonly used research methods are unable to detect the impact of coalition-based interventions on outcomes (Berkowitz, 2001).  Although each of these explanations is plausible, there is a growing body of evidence that some coalition-based strategies, when implemented with high fidelity to an effective model, can be rigorously tested, and show effects on meaningful outcomes.  A recent study of the Communities That Care (CTC) strategy provides clear evidence that coalition-based efforts that use a science based approach to prevention can improve the wellbeing of community youth.  As part of a larger agenda to test the theory of change underlying this effective model of community practice, this study aims to determine whether building coalition capacities facilitates the community-wide adoption of a science-based approach to prevention. 

Methods: Using data from the community-randomized trial of CTC, this paper first examines between-coalition variation in coalition member self-reported capacities (member knowledge and member acquisition of new skills), member attitudes, and organizational capacity (organizational linkages and influence on organizations) using unconditional multi-level statistical models.  This paper then explores whether these capacities are related to intervention outcomes, specifically the extent to which coalition member reported capacities moderate the relationship between the CTC prevention strategy and the community’s adoption of a science-based approach to prevention, relative to matched control communities, as reported by community leaders in 24 communities within 7 states.  A series of mixed-effect meta-regressions are used to determine if coalition capacities explain the heterogeneity in intervention effect size differences between matched pairs of communities.

Results:  Findings indicate high and favorable coalition member knowledge, attitudes, and perceptions of influence, with minimal variance between coalitions.  Coalition member self-reported acquisition of skills primarily varies at the coalition member level, but when aggregated to the coalition-level, predicts greater community-wide adoption of a science-based approach to prevention.  Findings also indicate that linkages between organizations, as reported by coalition members, explain 25% the variance in the community-wide adoption of a science-based approach to prevention (β=.50; Q_R=3.92; p=.0476).

Implications: This study provided a unique opportunity to identify malleable community capacities, such as skill acquisition and organizational linkages, which predict the success of community level interventions in making community-wide change, and thus may be used to improve the overall effectiveness of community practice.