Prioritizing Equity: Exploring Conditions Impacting Community Coalition Efforts

Abstract

Purpose: There is a critical push toward addressing equity in health care. Community coalitions are uniquely situated to heed this call by tackling issues of equity and well-being that are the most relevant for their local context. This article analyzes internal and external contextual factors that may affect coalitions' prioritization of equity. Methods: Data were collected from 18 coalitions participating in a national, U.S.-based initiative aimed at strengthening community coalition work through the principles of equity and inclusion. A hybrid qualitative–quantitative method (qualitative comparative analysis [QCA]) was conducted using the direct method of calibration and fuzzy set QCA and to obtain casual sufficiency results. Results: Coalitions located in states that did not expand Medicaid after the Affordable Care Act were most likely to prioritize equity, as were coalitions who were both working with marginalized populations and had low organizational readiness for the initiative. However, only one case demonstrated the latter causal solution; the former accounts for greater coverage of the outcome. Conclusion: This study illustrates the use of QCA for evaluation and underscores the critical role of contextual factors for affecting meaningful community-level change. Coalitions are willing and able to prioritize tackling health inequities across settings, but those in settings with low state-level support may be more likely to emphasize inequities in their work.

The Evaluation of Equity-Focused Community Coalitions: A Review of the Empirical Literature

“…A number of researchers have noted the lack of progress and measurable improvements being made in addressing health disparities (Domlyn & Coleman, 2019), a finding attributable, at least in part, to a siloed conception of community health that neglects opportunities to marshal community participation and better align resources (Horowitz & Lawlor, 2008). The Centers for Disease Control and Prevention (2007) have highlighted that many community initiatives lack community voice, support, and participation, all of which are considered essential for sustainable, long-term change.…”

“…While there did not seem to be a singular definition or conception of equity, all did identify specific aspects or qualities of equity. For some, equity meant integrating partners with lived experience (e.g., Hilgendorf et al, 2020;Minkler et al, 2019), sharing power (e.g., Reid et al, 2019;Sirdenis et al, 2019), identifying the systemic and structural nature of the change required (e.g., Domlyn & Coleman, 2019;Sirdenis et al, 2019), building issues of race into the process (e.g., Minkler et al, 2019;Reid et al, 2019), focusing on the academic language of evaluation (Hilgendorf et al, 2020), and developing relationships in the community (e.g., Bryan, 2014;Sirdenis et al, 2019).…”

“…Cultural and contextual clarity and responsiveness enable evaluators and researchers to better understand what is salient within a specific context and which cultural aspects are relevant, all of which vary by context, community, and program. Several of these studies noted the need to understand the broad social and political history of the communities in which they work, as it shapes their cultural context and relationships (e.g., Bryan et al, 2014;Domlyn & Coleman, 2019;Minkler et al, 2019). This macro-level contextual knowledge helps evaluators understand how best to approach their work (Cacari-Stone et al, 2014).…”

Challenges Evaluating an Equity-Focused Community Coalition Initiative

“…Greater eff ort should be put on developing the skills of prevention in collecting, analyzing, and communicating behavioural health data. Th is training and technical assistance should intentionally include skill development in culturally responsive approaches (Domlyn & Coleman, 2019). 3.…”

R = MC2 readiness building process: A practical approach to support implementation in local, state, and national settings

“…The readiness building process is designed to bridge the activities of the ISF support system with the ISF delivery system. (Adapted from Wandersman et al, 2008) (Domlyn & Coleman, 2019). Only one study reported on systematic use of R = MC 2 to measure and build readiness, which exclusively pertained to implementation in healthcare settings (Livet et al, 2020).…”