No abstract

Opioid overdose deaths are dramatically increasing in the United States and disproportionately affecting minority communities, with the increasing presence of fentanyl exacerbating this crisis. Developing community coalitions is a long-standing strategy used to address public health issues. However, there is a limited understanding of how coalitions operate amid a serious public health crisis. To address this gap, we leveraged data from the HEALing Communities Study (HCS)—a multisite implementation study aiming to reduce opioid overdose deaths in 67 communities. Researchers analyzed transcripts of 321 qualitative interviews conducted with members of 56 coalitions in the four states participating in the HCS. There were no a priori interests in themes, and emergent themes were identified through inductive thematic analysis and then mapped to the constructs of the Community Coalition Action Theory (CCAT). Themes emerged related to coalition development and highlighted the role of health equity in the inner workings of coalitions addressing the opioid epidemic. Coalition members reported seeing the lack of racial and ethnic diversity within their coalitions as a barrier to their work. However, when coalitions focused on health equity, they noted that their effectiveness and ability to tailor their initiatives to their communities’ needs were strengthened. Based on our findings, we suggest two additions to enhance the CCAT: (a) incorporating health equity as an overarching construct that affects all stages of development, and (b) ensuring that data about individuals served are included within the pooled resource construct to enable monitoring of health equity.

No abstract

Background The HEALing Communities Study (HCS) is a large-scale multisite study testing Community Engagement using coalition facilitation as an approach to addressing the worsening overdose crisis. Within Community Engagement, Community-Based Participatory Research (CBPR) principles guide researchers on best practices for working in partnership with communities, yet these principles have not been well researched in large complex multi-site studies. Methods This paper used ethnographic methods to explore how coalitions operationalized the CBPR principles during early coalition formation. Two coders independently analyzed 101 ethnographies from HCS coalition meetings in eight Massachusetts communities held between November 2019 and December 2020. Themes were developed through consensus between the coders followed by group discussions among the authorship team. Results We found mutual trust, shared goals, addressing power dynamics, meeting structure and attending to the sociopolitical community context could all serve as barriers or facilitators to operationalizing the CBPR principles. Conclusions These findings provide unique suggestions for future community-engaged multisite studies, and demonstrate the importance of research teams to mitigate inherent power imbalances by acknowledging and creating space for community ownership. The findings also highlight the value of a community engaged facilitator role to promote the CBPR principles. Strategies such as transparency, uniting over shared interests and bringing in a wide range of stakeholders were notable facilitators for operationalizing the principles.