Community Coalitions within Complex Systems: A Study of Contextual Factors Impacting Perceived Effectiveness

Background: Increasingly, public health funding supports initiatives implemented by community-level coalitions, which are focused on creating environmental changes that contribute to reversing societal health problems. Recent public health models, such as the Strategic Prevention Framework (SPF), provide guidance for coalitions to implement community-level interventions to decrease the consequences of substance abuse or other health issues. These frameworks do not account for the complex systems within which coalitions operate. The present study contributes to the literature through an examination of contextual factors that might impact coalitions’ efforts in pursuing their goals. Specifically, the purpose of this study was to determine which domains of contextual factors impact coalition members’ perceived effectiveness of their prevention efforts to decrease community consequences of substance abuse.

Methods: This study utilized a mixed methods approach, using qualitative interview and cross-sectional survey designs. A total of 34 interviews were conducted. The self-administered survey was conducted with a purposeful, non-random sample of staff and members associated with 17 regionally-based coalitions (n = 461). Data were collected in 2015 as part of a parent study to evaluate these coalitions implementing the SPF within a northeastern state. Most of the survey participants were female (77%); half identified as white (54%); and 5% Latino or Hispanic. The data were collected through a web-based, self-administered survey containing subscales from existing, validated instruments or conceptual models. The current study used a series of questions assessing what types of contextual factors impacted the coalitions’ work and a perceived effectiveness scale. Qualitative interview data were used to triangulate findings.

Using previous study as a guide, a priori coding processes were conducted with interview data to assess whether contextual factors (i.e., politics, history, norms, and demographics) were predictors of perceived effectiveness. Additionally, resources (i.e., available data, funding, expertise) emerged as another significant factor in implementing the SPF. Confirmatory factor analysis was conducted to verify the factor structure of the five contextual domains. Subsequently, the hypothesized path model was tested to examine goodness of fit.

Results: Results of the full structural equation model indicated a marginal fit to the data ( X² = 193.547;  df = 90, p < .01, CFI = .949, NFI .911, RMSEA = .05) and explained 34% variation of the perceived effectiveness. Resources had a mediational effect on all contextual factors (history, politics, and norms) with their impact on perceived effectiveness. Conversely, resources fully mediated for the effect of demography on perceived effectiveness. Qualitative finding indicated that funding and data to support coalitions’ missions was a strong predictor of perceived effectiveness.

Implications: Resources are valued by coalition members in promoting effective efforts. This is congruent with the SPF, which requires data-driven efforts in prevention and sustainability. The results of our study extend previous research demonstrating that resources are vital to dealing with other contextual factors in the success of coalitions. Social work researchers and prevention experts might focus on capacity building to increase coalitions’ ability to gain expertise and sustain funding while also working to improve data information systems at a broader level.