Contributions to the literature
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This systematic review is the first known to focus exclusively on international research quantitatively analyzing the associations between coalition characteristics and outcomes
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In a field with many competing theoretical frameworks, the review outlines which relationships between coalition characteristics and outcomes have empirical evidence behind them, and which do not
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The review provides a basis for health promotion coalitions to structure their development and work upon, globally
Introduction
Methods
Inclusion criteria
Search strategy
Data extraction and analysis
Results
Study characteristics
Summary characteristics | na | %b |
---|---|---|
Location | ||
USA | 20 | 77 |
Israel | 2 | 8 |
Mexico | 1 | 4 |
United Kingdom | 1 | 4 |
Italy | 1 | 4 |
Malaysia | 1 | 4 |
Participants | ||
People (range) | 18 - >19,633 | |
Coalitions (range) | 2 - 551 | |
Study design | ||
Cross sectional | 12 | 46 |
Quasi-experimental | 2 | 8 |
Mixed methods | 2 | 8 |
Randomised controlled trial | 2 | 8 |
Case study | 1 | 4 |
Not specified | 7 | 27 |
Theoretical framework | ||
Collaborative capacity (various) | 9 | 35 |
Community Based Participatory Research | 3 | 12 |
Organisational development | 3 | 12 |
Community readiness to change | 3 | 12 |
Health promotion framework | 3 | 12 |
Empowerment theory | 2 | 8 |
Social network theory | 2 | 8 |
Other | 3 | 12 |
Condition (SDOH) data collection tool | ||
Survey with self-reported ratings | 2 | 8 |
Community survey | 2 | 8 |
Case studies | 1 | 4 |
No data collected | 21 | 81 |
Exposure (coalition characteristics) data collection tool | ||
Survey with self-reported ratings | 20 | 77 |
Survey with researcher ratings | 1 | 4 |
Interview | 3 | 12 |
Survey/interview and document scan | 2 | 8 |
Outcome (community change) data collection tool(s) | ||
Coalition survey | 22 | 85 |
Interview | 6 | 23 |
Document scan | 4 | 15 |
Observational data collection | 2 | 8 |
Outcome (community change) indicators | ||
Perceived effectiveness | 10 | 38 |
Policy, systems, environment change | 9 | 35 |
Community readiness / capacity | 7 | 27 |
Social capital | 6 | 23 |
Partner capacity | 4 | 15 |
Interagency coordination | 4 | 15 |
Empowerment | 4 | 15 |
Health condition / risk factor prevalence | 3 | 12 |
Analysis type | ||
Correlation / regression | 16 | 62 |
Statistical or pathway modelling | 10 | 38 |
Other | 3 | 12 |
Total |
26
|
100
|
Coalitions
Author | Year | Location | Study design | Coalition name | Formation | Theoretical framework | Participants | Exposure (coalition characteristics) measurement tool | Outcome indicators |
---|---|---|---|---|---|---|---|---|---|
Allen et al. [39] | 2012 | USA: Mid-west | Analytical cross-sectional | Family Violence Coordinating Councils (FVCC) | Unclear | Own, including collaborative capacity, social capital, and empowerment concepts | 671 participants 21 coalitions | Self-rated survey | Social capital, member empowerment, community readiness/capacity, institutionalised change |
Anderson-Carpenter et al. [46] | 2017 | USA: Kansas | Pre-test, post-test | Kansas Strategic Prevention Framework State Incentive Grant (SPF-SIG) | Policy/funding response | Tri-Ethnic Center for Prevention Research Communtiy Readiness Model | 7 coalitions | Self-rated survey Document scan | Community readiness/capacity |
Brown et al. [28] | 2017 | Mexico | Analytical cross-sectional | Red de Coaliciones Comunitarias de Mexico | Unclear | Collaborative capacity (Foster-Fishman 2001) Work group (Hackman 1987) | 211 participants 17 coalitions | Self-rated survey | Community readiness/capacity, community improvement attributable to the coalition, sustainability planning |
Calancie et al. [44] | 2018 | USA, Canada, Native American Tribes and First Nations | Not specified (analytical cross sectional)
| Food Policy Councils (FPCs) | Various | FPC Framework (Allen et al. 2012) | 354 participants 95 coalitions | Self-rated survey | Social capital, perceived effectiveness |
Cicognani et al. [29] | 2019 | Italy: Emilia-Romagna region | Retrospective, cross-sectional | Guadagnare Salute in contesti di Comunita [Gaining health in community contexts] | Unclear | Sense of community (Nowell & Boyd 2010, 2014) Empowerment (Perkins & Zimmerman 1995; Powell & Peterson 2014) | 238 participants 6 coalitions | Self-rated survey | Empowerment, perceived efficacy, community readiness/capacity |
Crowley et al. [45] | 2000 | USA | Not specified (retrospective cohort)
| Community Coalition Program | Policy/funding response | Community-based prevention | Participants not specified >123 coalitions | Self-rated survey | Community readiness/capacity, risk and protective factor prevalence (knowledge, behaviour, attitudes, environment/systems) |
Donchin et al. [30] | 2006 | Israel | Analytical cross-sectional | Healthy Cities Israel | Policy/funding response | Health for All & Agenda 21 | 18 participants 18 coalitions | Survey with researcher ratings | Policy and political support, policy change, best practice health promotion activities, environmental protection actions |
Drach-Zahavy et al. [31] | 2006 | Israel | Analytical cross-sectional | Healthy Community Centers | Policy/funding response | Ottawa Charter for Health Promotion | 37 participants 37 coalitions | Interview | Perceived effectiveness |
Duran et al. [32] | 2019 | USA | Analytical cross-sectional | not specified & various | Unclear | Community-Based Participatory Research | 450 participants 164 coalitions | Interview | Partnership synergy, partner and agency capacity, equal power, partnership sustainability, community health and transformation |
Emshoff et al. [47] | 2007 | USA: Georgia | Not specified (cohort)
| Family Connection | Unclear | Not specified | participants not specified 157 coalitions | Self-rated survey | Shared and inclusive decision making, financial resources, accessible services |
Feinberg et al. [33] | 2004 | USA: Pennsylvania | Analytical cross-sectional | Communities That Care | Research project | Own model based on community readiness and organisational development frameworks | 203 participants 21 coalitions | Interview | Perceived effectiveness |
Flewelling et al. [12] | 2016 | USA: 26 states | Not specified (cohort)
| SPF SIG | Policy/funding response | CSAP Strategic Prevention Framework | 318 coalitions (process) 129 coalitions (outcome) | Self-rated survey | Alcohol consumption |
Kegler et al. [34] | 2012 | USA: California | Analytical cross-sectional | California Healthy Cities and Communities | Policy/funding response | Community Coalition Action Theory | 231 participants 19 coalitions | Self-rated survey | Community capacity, social capital, sense of community |
Lawless et al. [41] | 2010 | UK: England | Not specified (cohort)
| New Deal Communities | Policy/funding response | Government policy focusing on evidence, strategy, and locality | 19,574 (wave 1) 19,633 (wave 2) 15,792 (wave 3) participants (outcome data) 39 participants (coalition data) 39 coalitions | Self-rated survey | Spend, outputs, project-level reviews, improved schools, police and health facilities |
Mansergh et al. [50] | 1996 | USA: Indianapolis & Pasadena | Case study | Day One Coordinating Council, I-STAR Community Action Council | Research project Grassroots | Butterfoss et al. (1993) collaboration model | 100 participants 2 coalitions | Self-rated survey | Coalition efficiency, outcome efficiency (AOD use), interagency coordination |
Nowell et al. [47] | 2011 | USA: Mid-west | Mixed methods | Not specified | Grassroots | Authors’ own | 614 organisations 51 coalitions | Self-rated survey | Partner organisation capacity |
Oetzel et al. [35] | 2018 | USA | Analytical cross-sectional & case study | Research for Improved Health study | Unclear | Community-Based Participatory Research | 650 participants 200 coalitions | Interview Self-rated survey Document scan | Agency capacity building, personal capacity building, sustainability of the work |
Powell et al. [36] | 2014 | USA | Cross sectional | SPF SIG | Policy/funding response | Psychological Empowerment and Organisational Efforts | 138 participants 11 coalitions | Self-rated survey | Psychological empowerment, sense of community, perceived effectiveness |
Ramanadhan et al. [37] | 2012 | USA | Analytical cross-sectional | Massachusetts Community Network for Cancer Education, Research, and Training (MassCONECT) | Policy/funding response | Community-Based Participatory Research | 38 participants 3 coalitions | Self-rated survey | Community activities, grants and publications, policy engagement |
Valente et al. [49] | 2007 | USA: Massachusetts, Colorado, Adkansas, Iowa & MIssouri | Randomised controlled trial | STEP (Steps Toward Effective Prevention) | Research project | Social network theory | 415 (baseline) 406 (follow up) participants 24 coalitions | Self-rated survey | Benchmark achievement, prevention activity progress |
Wagner et al. [42] | 2009 | USA: Colorado | Not specified (pre-test, post-test)
| Not specified | Unclear | Social capital theory | 181 participants 10 coalitions | Self-rated survey | Social capital |
Watson-Thompson et al. [51] | 2008 | USA: Kansas City | Quasi-experimental, interrupted time-series design | Ivanhoe Neighbourhood Council & Northeast Coalition | Grassroots | Institute of Medicine’s Framework for Collaborative Public Health Action in Communities | 40 participants 2 coalitions | Self-rated survey | Instances of community and systems change |
Watson-Thompson et al. [52] | 2014 | USA: Mid-west | Between-group randomised controlled trial | Community Anti-Drug Coalitions of America (CADCA) | Unclear | Institute of Medicine’s Framework for Collaborative Public Health Action in Communities | 27 participants 10 coalitions | Self-rated survey | Community change (e.g. policy, practice) |
Wells et al. [48] | 2009 | USA: Pennsylvania | Mixed methods | Communities That Care | Unclear | Organisational theory (Hackman) | 1,081 (exposure) 1,502 (outcome) participants 45 coalitions | Self-rated survey | Perceived coalition impact |
Yang et al. [38] | 2012 | USA | Analytical cross-sectional | CADCA | Unclear | Socio-ecological Framework & Community Problem Solving and Change Framework | 551 participants 551 coalitions | Self-rated survey | Comprehensiveness of strategies, engagement with systems change, facilitating community change |
Zeldin et al. [43] | 2016 | Malaysia | Not specified (quasi/ pre-test post-test)
| Not applicable | Policy/funding response | Youth-adult partnership | 357 (wave 1) 207 (wave 2) participants 3 coalitions | Self-rated survey | Youth empowerment |
Author | Outcome measurement tool | SDOH Initiative focus | SDOH measurement tool | Analysis | Analysis type | Analysis level | Mediating effects observed | Quality score (0-8) |
---|---|---|---|---|---|---|---|---|
Allen et al. [39] | Survey (coalition members) | Family violence | Not evaluated | Hierarchical linear modelling | Reg/Cor Modelling | Individual, coalition | Yes | 3 |
Anderson-Carpenter et al. [46] | Interview (coalition members) | Underage drinking | Not evaluated | Paired-sample t-tests and Two-tailed Person correlations | Sig diff Reg/Cor | Geographical region | Not analysed | 6 |
Brown et al. [28] | Survey (coalition members) | Drug use, violence, crime | Not evaluated | Multiple regression | Reg/Cor | Coalition | Not analysed | 6 |
Calancie et al. [44] | Survey (coalition members) | Food environments | Not evaluated | Structural equation modelling | Modelling | Individual, coalition | Yes | 6 |
Cicognani et al. [29] | Survey (coalition members) | Healthy eating, physical activity, smoking, alcohol consumption, health inequalities | Not evaluated | Regression & SEM | Reg/Cor Modelling | Coalition | Yes | 3 |
Crowley et al. [45] | Survey (coalition members) | Substance abuse | Self report survey (coalition) | Structural equation modelling | Modelling | Not specified | Not analysed | 4 |
Donchin et al. [30] | Survey (coalition members) | Health equity | Not evaluated | Spearman’s correlation & ANOVA | Reg/Cor | Coalition | Not analysed | 3 |
Drach-Zahavy et al. [31] | Interview (coalition members) | Smoking, nutrition, physical activity, health conditions | Not evaluated | Pearson intercorrelations & hierarchical regression analysis | Reg/Cor | Coalition | Not analysed | 4 |
Duran et al. [32] | Survey (coalition members) | Not specified | Not evaluated | Univariate regression | Reg/Cor | Individual | Not analysed | 3 |
Emshoff et al. [47] | Survey (coalition members) | Early years | Self report survey (coalition) | Multi-level modelling | Reg/Cor Modelling | Not specified | Yes | 4 |
Feinberg et al. [33] | Interview (coalition members) | Teen substance use, violence, educational attainment, pregnancy | Not evaluated | Intercorrelations, scatterplots & mediational analysis | Reg/Cor | Coalition | Yes | 5 |
Flewelling et al. [12] | Survey (community) | Underage drinking | Community survey | Mixed model regression | Reg/Cor | Coalition | Not analysed | 6 |
Kegler et al. [34] | Survey (coalition members) | Youth development, civic capacity building, neighbourhood improvement, education (et al.) | Not evaluated | Multi-level mediation analysis | Reg/Cor Modelling | Individual, coalition | Yes | 4 |
Lawless et al. [41] | Survey (coalition members) | Crime, the community, housing and the physical environment, health, education, employment | Community survey | z-scores of a composite index of relative change | Sig diff | Geographic region | Not analysed | 2 |
Mansergh et al. [50] | Survey (coalition members) Document scan | Alcohol and other drug use | Not evaluated | ANCOVA & MANCOVA | Reg/Cor | Individual, coalition | Not analysed | 5 |
Nowell et al. [47] | Survey (coalition members) | Domestic violence | Not evaluated | SEM, ANOVA & OLS multiple linear regression | Reg/Cor Modelling | Individual | Not analysed | 5 |
Oetzel et al. [35] | Survey (coalition members) Interview (coalition members) Document scan Observational data collection | Not specified | Case study & survey | SEM | Modelling | Coalition | Not analysed | 5 |
Powell et al. [36] | Survey (coalition members) | Alcohol, tobacco, and other drug use | Not evaluated | SEM | Modelling | Individual | Yes | 5 |
Ramanadhan et al. [37] | Survey (coalition members) | Health inequities | Not evaluated | Multiple linear regression models | Reg/Cor | Not specified | Not analysed | 4 |
Valente et al. [49] | Survey (coalition members) | Drug prevention | Not evaluated | Confirmatory factor analysis & regression analysis | Reg/Cor | Coalition | Yes | 2 |
Wagner et al. [42] | Survey (coalition members) Interview (coalition members) | Natural resources management | Not evaluated | Multiple regression analysis, general linear model, mediation analysis | Reg/Cor | Individual, coalition, all coalitions | Yes | 6 |
Watson-Thompson et al. [51] | Interview (coalition members) Document scan | Neighbourhood improvement | Not evaluated | Between-group comparison | Sig diff | Coalition | Not analysed | 4 |
Watson-Thompson et al. [52] | Survey (coalition members) Document scan Observational data collection | Substance abuse | Not evaluated | Paired sample t-test | Sig diff | Coalition | Not analysed | 4 |
Wells et al. [48] | Survey (coalition members) | Adolescent risk factors | Not evaluated | Bivariate correlations & regression model | Reg/Cor | Coalition | Not analysed | 5 |
Yang et al. [38] | Survey (coalition members) | Substance abuse | Not evaluated | SEM | Modelling | Not specified | Not analysed | 5 |
Zeldin et al. [43] | Survey (youth) | Youth empowerment, civic engagement | Not evaluated | Other modelling / pathway analysis | Modelling | Not specified | Yes | 7 |
Conceptual framework
Intervention target (SDOH)
Exposure (collaboration characteristics)
Community outcomes
Short-term | Medium-term | Long-term |
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- Service diversity - Targeting of multiple program and policy sectors - Sustaining the work - Collaborative service delivery - Resource acquisition - Enhanced opportunity for impact - Self-efficacy - Coalition efficacy - Make outcomes matter - Partnership capacity / capability - Synergy - Member capacity | - Community capacity - Social capital - Community empowerment - Awareness (of issue) - Perceived effectiveness | - Community change (not specified) - Health promoting environments - Program, policy and procedure change - Equitable policy change - Health issue specific indicators e.g. prevalence |
Quality appraisal findings
Data analysis
Coalition characteristics
Domain | Coalition characteristic | Associated outcomes – direct pathways (significance) | Associated outcomes – indirect pathways (intermediary) | |
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Community context | Community resources | Socio-economic position (income, income support, food relief, educational attainment, employment) | Positive: Systems change (shared decision making, p<0.05) [47] | |
Community vibrancy (building, youth, housing growth) | ||||
Social capital |
Mediation: Social capital (mediated by success) [42] | |||
Capacity | Partnership capacity |
Pathway: Perceived effectiveness (via social capital) [44] | ||
Community psychological, political and financial empowerment | Positive: Number of health promotion changes (p<0.05) [31] Negative: Health promoting environments (p<0.05) [31] | |||
Community readiness to change / capacity |
Mediation: Perceived effectiveness of coalition’s work (mediated by coalition functioning) [33]
Pathway: Health outcome and behaviour change (via intermediate outcomes) [45] | |||
Coalition resources | Resource levels | Adequacy of staffing | Positive: Member satisfaction (p<0.001) [34] |
Mediation: Community capacity (new skills, social capital and sense of community, mediated by member satisfaction) [34] |
Resource levels |
Barrier: Barrier to success [33] | |||
Training and technical assistance | ||||
Resource management | Community power over resources | |||
Joint resource management between partners | ||||
Effective management of financial, in-kind and time resources | ||||
Shared resource generation and use | ||||
Coalition structure | Coordination | Chair tenure | Positive: Collaborative service delivery (p<0.05) [47] | |
Age | Coalition age/maturity | |||
Structure | Formal organisation/structure/agreement | Positive: Health outcome (reduced alcohol use, p=0.039, binge reduced drinking, p=0.031) [12], program array (p<0.05) [47], perceived effectiveness (p<0.05) [43], social capital (p<0.05) [39], equal power between coalition and community (p<0.01) [32], community transformation and health equity (p<0.05) [32] |
Pathway: Institutional change (via social capital) [39] | |
Size | Coalition size | Positive: Rate of implementation (p value not supplied) [51] | ||
Member characteristics | Expertise | Health promotion experience of coordinator | Positive: Community participation and intersectoral diversity (p<0.05) [30] | |
Experience collaborating | Negative: Trust (p<0.05) [42] | |||
Diversity | Sectoral diversity (members) |
Mediation: Community capacity (new skills, mediated by member participation) [34]
Pathway: Institutional change (via social capital) [39] | ||
Empowerment | Psychological and political empowerment | Positive: Perceived effectiveness (p<0.01) [36] | ||
Member engagement and satisfaction | Meetings | Meeting attendance | ||
Proportion of members who spoke in meetings | Positive: Perceived coalition impact (p<0.10) [48] | |||
Activity | Participation in coalition activities |
Pathway: Intermediate and health/behavioural outcomes (via community capacity) [45] | ||
Activity level (meeting frequency and engaging in shared activity) | ||||
Duration | Duration of membership | |||
Coalition configuration (extent, duration and focus of member involvement) | Positive: Coalition effectiveness (p<0.05) [31] Negative: Number of health plans (p<0.05) [31] | |||
Satisfaction | Satisfaction with coalition | |||
Group facilitation | Decision making | Shared decision making | ||
Functioning | Internal functioning (resourcing, activity, personal benefits, clear plan, sense of direction) | |||
Relationships (leadership, resource management, trust, participatory decision making) | ||||
Task focus | Positive: Community capacity (new skills, p≤0.01) [34] | |||
Organisation and resources | ||||
Coalition capacity (development and use of plans, expanded membership) | Positive: Comprehensiveness of strategies (p<0.01) [38] |
Mediation: Community change (mediated by comprehensive strategies) [38] | ||
Collaboration quality (culture of reflection, interdependence, flexibility, new professional activities) |
Pathway: Perceived efficacy (via member empowerment, sense of community responsibility, and sense of the community contributing to health promotion) [29] | |||
Values | Shared values | Positive: Intermediate (p<0.01) and distal (p<0.01) coalition outcomes [35], member agency capacity building (p<0.05) [32], community transformation and health equity (p<0.05) [32] partnership synergy (development of goals and strategies, problem solving, responsive to community needs, teamwork, p=0.05) [32] |
Pathway: Intermediate and distal community outcomes (via relationship and leadership quality, and synergy) [35] | |
Leadership | Leadership quality | Positive: Member satisfaction (p≤0.001) [34], community capacity (new skills, p≤0.001) [34], perceived effectiveness (p<0.01) [36], knowledge and awareness (p<0.001) [47], social capital (p<0.001 [47], p<0.01 [39]) opportunity and impact (p<0.001) [47], resource acquisition (p<0.001) [47], partnership synergy (development of goals and strategies, problem solving, responsive to community needs, teamwork, p=0.001) [32], community transformation and health equity change (p=0.05) [32], | ||
Empowerment | Member empowerment | Positive: Institutional change (p<0.01) [39] | ||
Members encouraged into leadership roles | Positive: Coalition effectiveness (p<0.01) [36] | |||
Communication | Communication quality | Positive: Perceived success (p<0.05) [42] | ||
Group dynamics | Conflict | Group cohesion |
Mediation: sense of community (via member satisfaction) [34] | |
Conflict | Negative: level of implementation (p value not supplied) [33], |
Barrier: Barrier to implementation [47] | ||
Support | Supportive relationships |
Pathway: Health outcome (school attachment, via program safety) [43] | ||
Dialogue and listening (positive attitude, participation and learning from each other) | Positive: Equal power between coalition and community (p=0.05) [32] | |||
Trust | Perceived safety, inclusion |
Pathway: institutional change (via social capital) [39] | ||
Trust | ||||
Relationship and network structure | Number | Number of intersectoral partnerships | ||
Increase in number of social connections | ||||
Structure | Network density (social network analysis) | Positive: Planning in early stages of coalition (p<0.05) [49], Negative: Coalition functioning and progress in later stages of coalition (p<0.05) [49] | ||
Loosely bound network (part-time and moderate turnover of positions) | Negative: Number of health plans implemented (p<0.05) [31] | |||
Reciprocity of partnerships | ||||
Community partnership | Community partnerships | Resident involvement | Positive: Community neighbourhood satisfaction (p<0.01) [41], perceived neighbourhood improvement (p<0.01) [41], feel a part of the community (p<0.05) [41], trust the coalition (p<0.05) [41], feel they can influence local decisions (p value not specified) [41], individual member capacity building (p=0.03) [32], community transformation and health equity change (p=0.01) [32], equal power between coalition and community (p<0.001) [32], intermediate (p<0.01) and distal (p<0.01) coalition outcomes [35] Negative: Worklessness improvements (p value not specified) [41], | |
Political support | Positive: Equitable policy change (p<0.01) [30] | |||
Professional partnerships | Links with external entities | Positive: Health outcome improvement (p=0.011) [12] | ||
Engagement with health professionals and subject matter experts | Positive: Coalition effectiveness (p<0.05) [31], number of health promotion actions implemented (p<0.05) [31], healthy physical and social environments (p<0.01) [31] Negative: empowerment (p<0.05) [31] | |||
Participation in community of practice | ||||
Planning and implementation | Implementation | Number of actions implemented | ||
Level of policy implementation | Positive: Increased community capacity (p≤0.05) [45] |
Pathway: Intermediate and health/behavioural outcomes (via community capacity) [45] | ||
Collaborative service delivery | Positive: Service diversity (p value not specified) [47] | |||
Intervention fidelity | Positive: Perceived coalition impact (p<0.05) [48] | |||
Partnership synergy (strategic planning, problem solving, teamwork, responsiveness) | ||||
Governance of the work | Positive: Perceived coalition impact (p<0.001) [48] | |||
Planning | Have a strategic plan | Positive: Rate of implementation (p value not supplied) [51] | ||
Diverse/comprehensive strategies | ||||
Number of health plans | ||||
Number of data sources used to inform strategies | Negative: Health outcome (alcohol use, p=0.029) [12] |