Addressing Health Disparities through Collaboratives: The Role of Community Voice in Developing Collaborative Structures

Background:

Addressing health disparities is a hot topic of conversation for many sectors in the United States involved in population health work. Health care, public health, and social service organizations are invested in addressing disparities and are more closely collaborating. While there is no overarching strategy for how to collaborate, the Robert Wood Johnson Foundation recently developed the Alignment Theory of Change (AToC) to help health-oriented collaboratives increase their effectiveness and sustainability. A central idea in the AToC is that collaboratives are more effective at reducing health disparities where they have developed aligned structures in four core areas: shared purpose, data, finance, and governance. For each core area, the theory of change suggests that community engagement plays an important role in the development of sustainable structures. However, the actual roles that communities play in developing sustainable structures in each core area are not well understood.

Objective:

The objective of this paper is to improve our understanding of the roles played by communities in the development of collaborative structures in the areas of shared purpose, governance, finance, and data. This will provide a basis for understanding how community engagement can be conceptualized, implemented, and researched in relation to collaborative practices. We ask the following questions: What roles do communities play in the development of structures in the four core areas? Why and how are these roles enacted? What are the apparent consequences?

Method:

This paper reviewed thirty-seven articles on community engagement that were identified through a systematic review of the cross-sector, health-oriented collaboration literature. These articles were analyzed using the method of rapid realist review. Each article was coded for context, mechanism, and outcome and the codes were analyzed.

Results:

Results from the review support the idea that community engagement is an integral part of collaboration and can be built into the four core areas of the AToC. Communities were often engaged in collaboratives by helping develop shared purpose and by participating in governance structures (e.g. having a seat on an advisory board). However, few articles examined specific mechanisms for including community members in collaborative work. Of those mechanisms that were discussed, Health Impact Assessments/Community Health Needs Assessments were considered common and effective means of community engagement. Research on these mechanisms indicates a need for including community members early in intervention processes.

Conclusion:

As more avenues open up for health care, public health, and social service organizations to collaborate, more research is needed on how communities are engaged in or help drive these collaboratives. While there is little outcomes-focused research in this area, evidence suggests that involving community members in the development of collaborative structures in the four core areas can strengthen collaborative sustainability and, eventually, health outcomes. Empowering community members can have an important impact on what health disparities are addressed and how health disparities are addressed. This is especially important for social service organizations and social workers because of their increasing importance in collaborative work and because of the large role they already play as conduits for community engagement.