Improving Community Readiness for Change through Coalition Capacity Building: Evidence from a Multi-Site Intervention

Kailo: a systemic approach to addressing the social determinants of young people's mental health and wellbeing at the local level

The mental health and wellbeing of children and young people is deteriorating. It is increasingly recognised that mental health is a systemic issue, with a wide range of contributing and interacting factors. However, the vast majority of attention and resources are focused on the identification and treatment of mental health disorders, with relatively scant attention on the social determinants of mental health and wellbeing and investment in preventative approaches. Furthermore, there is little attention on how the social determinants manifest or may be influenced at the local level, impeding the design of contextually nuanced preventative approaches. This paper describes a major research and design initiative called Kailo that aims to support the design and implementation of local and contextually nuanced preventative strategies to improve children's and young people's mental health and wellbeing. The Kailo Framework involves structured engagement with a wide range of local partners and stakeholders - including young people, community partners, practitioners and local system leaders - to better understand local systemic influences and support programmes of youth-centred and evidence-informed co-design, prototyping and testing. It is hypothesised that integrating different sources of knowledge, experience, insight and evidence will result in better embedded, more sustainable and more impactful strategies that address the social determinants of young people's mental health and wellbeing at the local level.

Addressing the marketing and availability of unhealthy food and beverages in and around selected schools in Ghana: a community readiness appraisal

OBJECTIVE

This study assessed stakeholder readiness to address unhealthy food and beverage marketing and availability in/around Public Basic Schools (for children 4-15 years) in Greater Accra Region, the highly urbanised administrative capital of Ghana.

DESIGN

The community readiness model was used to conduct in-depth mixed methods interviews with stakeholders. Using predefined anchored rating statements, quantitative readiness scores ranging from 1 to 9 were generated. Thematic qualitative analysis was undertaken to understand barriers and facilitators that could influence the implementation of interventions.

SETTING

Greater Accra Region, Ghana.

PARTICIPANTS

18 key informants from various school/education/citizen sectors, which together represented the 'school community' of Greater Accra Region.

RESULTS

The mean readiness scores indicated that the 'school community' was at the 'preplanning' stage of readiness (4.44±0.98) to address the marketing and availability of unhealthy food and beverages in and around schools. The mean readiness score for 'leadership' was the highest of all dimensions (5.36±1.60), corresponding to the 'preparation' stage. The lowest scores were found for 'community knowledge of efforts' (3.19±2.45) and 'resources for efforts' (3.64±0.87), both of which were at a 'vague awareness' stage.

CONCLUSIONS

The 'school community' recognised that the marketing and availability of unhealthy food and beverages was a problem. Additionally, current leadership was actively supportive of continuing/improving efforts that create healthier children's food environments. However, actions that aim to increase the 'school community's' knowledge of existing interventions and securing resources to sustain those interventions are needed before introducing readiness appropriate strategies.

Understanding community- and system-capacity change over time: A close look at changing social capital in Evidence2Success communities

Evidence in majority White and low-population areas suggest that community prevention systems can create social capital that is needed to support high-quality implementation and sustainability of evidence-based programs. This study expands prior work by asking the question: How does community social capital change during the implementation of a community prevention system in low-income, highly populated communities of color? Data were collected from Community Board members and Key Leaders in five communities. Linear mixed effect models analyzed data on reports of social capital over time, first as reported by Community Board members then by Key Leaders. Community Board members reported social capital improved significantly over time during the implementation of the Evidence2Success framework. Key Leader reports did not change significantly over time. These findings suggest that community prevention systems implemented in historically marginalized communities may help communities build social capital that is likely to support the dissemination and sustainability of evidence-based programs.

Intersectoral collaboration in a Dutch community health promotion programme: building a coalition and networks

In health promotion programmes (HPP), it is crucial to have intersectoral collaboration within coalitions and to build networks between health and other societal sectors. A health broker role is recognized as being helpful in connecting the coalition with the broader network, and participatory action research (PAR) is deemed supportive because it facilitates evaluation, reflection, learning and action. However, there is a lack of insight into how processes that affect collaboration develop over time. Therefore, this study aimed to provide insights into the coalition's processes that facilitate building and maintaining intersectoral collaboration within a HPP coalition and network and how these processes contribute to the coalition's ambitions. As part of PAR, the coalition members used the coordinated action checklist (CAC) and composed network analysis (CNA) in 2018 and 2019. The CAC and CNA results were linked back into the coalition in five group sessions and used for reflection on pro-gress and future planning. Coalition governance, interaction with the context, network building and brokerage, and generating visibility emerged as the most prominent processes. Important insights concerned the health broker's role and positioning, the programme coordinator's leadership and the importance of visibility and trust leading to investment in continuation. The combined research instruments and group sessions supported discussion and reflection, sharing visions and adjusting working strategies, thereby strengthening the coalition's capacity. Thus, PAR was useful for evaluating and simultaneously facilitating the processes that affect collaboration.

Assessing Community-Based Public Health Plans: An Example From US Army Injury Prevention

CONTEXT

The US Army requires community health coalitions to develop action plans for their top public health priorities.

OBJECTIVE

To date, the US Army has not implemented a standardized review process for community action plans.

DESIGN

This project used the Plan Quality Index (PQI), an evidence-based, standardized tool, to evaluate injury prevention action plans created by injury prevention teams (IPTs).

SETTING

17 Army installations.

PARTICIPANTS

17 IPT leads; 5 Health Promotion Program Officers.

INTERVENTION

Implementation of the PQI to evaluate the strength of injury prevention action plans and make recommendations for quality improvement to drive reductions in injuries at 17 Army installations.

MAIN OUTCOME MEASURE

PQI total scores for high- (≥50 points on the PQI) and low-ranking plans (<50 points on the PQI) were assessed for differences using t tests of the mean PQI score. Chi-square tests were employed to identify differences in meeting criteria between high- and low-scoring plans.

RESULTS

PQI total scores ranged from 9 to 78 points out of 80. The weakest planning elements among all plans were lack of use of SMART objectives (18%), lack of identification of responsible parties (18%), absent evaluation plan (24%), and lack of timelines (35%). The mean score for the high-ranking plans (64.6 ± 9.5) was significantly higher than the mean score for the low-ranking plans (26.2 ± 12.7) ( P < .001). Mean scores for clarity, effectiveness, and quality were all significantly higher for the high-ranking plans than for the low-ranking plans ( P = .014, P = .002, and P < .001, respectively).

CONCLUSIONS

The PQI tool provides a framework for objective, standardized, and evidence-based feedback and recommendations for improving community health plans. The project identified examples of high-quality action plans and provided actionable recommendations for plan improvement to facilitate sustainability of initiatives addressing injuries, which have long posed a threat to military health and readiness.

The impact of coalition characteristics on outcomes in community-based initiatives targeting the social determinants of health: a systematic review

Background

Coalitions are a popular mechanism for delivering community-based health promotion. The aim of this systematic review was to synthesize research that has quantitatively analyzed the association between coalition characteristics and outcomes in community-based initiatives targeting the social determinants of health. Coalition characteristics described elements of their structure or functioning, and outcomes referred to both proximal and distal community changes.

Methods

Authors searched six electronic databases to identify peer reviewed, published studies that analyzed the relationship between coalition characteristics and outcomes in community-based initiatives between 1980 and 2021. Studies were included if they were published in English and quantitatively analyzed the link between coalition characteristics and outcomes. Included studies were assessed for quality using the Joanna Briggs Institute analytical cross-sectional studies assessment tool.

Results

The search returned 10,030 unique records. After screening, 26 studies were included from six countries. Initiatives targeted drug use, health equity, nutrition, physical activity, child and youth development, crime, domestic violence, and neighbourhood improvement. Community outcomes measured included perceived effectiveness (n=10), policy, systems or environment change (n=9), and community readiness or capacity (n=7). Analyses included regression or correlation analysis (n=16) and structural equation or pathway modelling (n=10). Studies varied in quality, with a lack of data collection tool validation presenting the most prominent limitation to study quality. Statistically significant associations were noted between community outcomes and wide range of coalition characteristics, including community context, resourcing, coalition structure, member characteristics, engagement, satisfaction, group facilitation, communication, group dynamics, relationships, community partnership, and health promotion planning and implementation.

Conclusion

Existing literature demonstrates that coalition characteristics, including best practice health promotion planning and evaluation, influence community outcomes. The field of coalition research would benefit from more consistent description and measurement of coalition characteristics and outcomes, and efforts to evaluate coalitions in a wider range of countries around the world. Further research using empirical community outcome indicators, and methods that consider the interrelationship of variables, is warranted.

Trial registration

A protocol for this review was registered with PROSPERO (CRD42020205988).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13678-9.

Which factors explain information exchange and user referral among program implementers?

The Program for Psychosocial Care and Comprehensive Health for Victims serves, on a yearly basis, an average of 25,000 users in northern Colombia alone. The program is implemented by multidisciplinary teams comprised of psychologists, social workers, and community facilitators, who step in at the individual, family, and community levels. An attempt has been made to determine the effect generated by the timeframe through which professionals have been engaged with the program-filling positions of centrality and betweenness within the networks of information exchange and user referral, including the potential mediating effect from the structure of the egocentric network of implementers in the two aforementioned networks and the moderating effect of the sense of belonging to a team of professionals. Both centrality and betweenness are positional measures describing the location actors occupied within the network structure. Centrality reflects the nominations made and receipt by an actor in a network and is considered an individual indicator of prominence and power. Betweenness shows the times that an actor act as a bridge among two actors in a network and it is considered an indicator of strategic positioning in social networks. An egocentric network is the local structure of relationships that each implementer maintains with his or her direct contacts. In this study, 112 active implementers were included, mostly women (n = 97, 88.2%), who had been working on the program for 16.9 months on average (SD = 14.7). Through conditional process analysis, it has been shown that the time that the implementers have been working on the program and the sense of belonging to the task team are relevant factors that interact with each other toward explaining the level of centrality and betweenness of professionals in the information exchange and user referral networks.

Low level of community readiness prevails in rural northwest Ethiopia for the promotion of institutional delivery

Introduction

the health benefits of institutional delivery with the support of skilled professional are one of the indicators of maternal health status which have an impact on the health of women and new coming generation. Despite these benefits, many pregnant women in Ethiopia are not actively bringing delivery at health facility. This study was aimed at determining the readiness level of community for promoting child birth at health facility.

Methods

a population-based cross-sectional study was conducted. We interviewed 96 key informants using a semi-structured questionnaire adapted from the community readiness assessment model and translated to Amharic language. The key informants were purposively selected in consultation with the district health office to represent the community. The interviews were transcribed verbatim and survey scores were matched with the readiness stage of 1 of the 9 for the five dimensions using the assessment guidelines.

Results

this study placed nine kebeles at stage 3 (vague awareness), which indicates the need for more institutional delivery service strategy programming; efforts of the community were not focused and low leadership concern and one kebele was in stage 2 (denial/resistance). Six kebeles were placed at high level of readiness i.e. in stage 7 (stabilization), indicating actions are sustained by the local managers or opinion leaders.

Conclusion

evidence derived from the present study can be used to match intervention tactics for promoting health facility child birth service utilization to communities based on their level of readiness.

How many key informants are enough? Analysing the validity of the community readiness assessment

Objective

Communities are important settings for health promotion and prevention. The community readiness assessment offers a structured approach to assess resources and opportunities to tackle a health problem within a community. The assessment relies on semi-structured interviews with key informants from the communities. A number of 4–6 key informant interviews are recommended in the literature. However, it is unclear whether this is sufficient to obtain a valid representation of the respective community. This study analysed whether increasing the number of key informants from 4–6 to 12–15 alters the results of the community readiness assessment.

Results

A total of 55 community readiness interviews were carried out in 4 communities. Overall, the community readiness scores showed little variation after having interviewed 10 key informants in a community. However, even after completing 10 interviews in a community, key informants were still able to identify up to 6 new information items regarding community efforts for physical activity promotion among the elderly, contact and communication channel for informing or approaching the target group, or barriers to participation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05497-9.

The Usability of the Plan Quality Index to Support Evaluation of Community Health Action Plans

INTRODUCTION

The U.S. Army requires community health coalitions to develop targeted action plans in order to more effectively address top public health priorities. Reviews of community action plans indicate that they are often poorly developed and not fully implemented. To date, the U.S. Army has not implemented a standardized tool or process to evaluate action plans and provide recommendations for improvement to local installations. The Plan Quality Index (PQI) is an evidence-based, standardized tool that has been used successfully by technical experts to review and improve community action plans related to the prevention of obesity, injury and violence, and cancer.

MATERIALS AND METHODS

The objective of this project was to determine the usability of the PQI and to provide recommendations for improving community health action plans focused on injury prevention for the U.S. Army. Five Health Promotion Project Officers and one Health Promotion Project Assistant at Army Public Health Center were trained on the PQI and reviewed injury prevention action plans for 17 installations. After using the PQI to assess injury prevention action plans, the individuals were given a System Usability Scale (SUS) survey to assess the usability of the PQI.

RESULTS

Results of the SUS survey can range from 0 to 100, but do not represent percentages. A score of 65 indicates "greater than average" usability. Participant scores on the SUS demonstrated that the PQI has a high degree of usability. Mean usability was calculated at 83.3 (range 72.5-97.5, median 85, sd +/- 9.3).

CONCLUSION

The PQI demonstrated a high level of usability by technical experts for providing feedback and recommendations regarding community health action plans for injury prevention in the U.S. Army. As a result, the PQI may be beneficial as a standard tool for community health improvement planning and consultation throughout the Army Public Health Center.

Introduction to the Special Issue on "Promoting a Culture of Prevention: an International Perspective"

The primary goal of this special issue is to showcase novel, theory-driven, creative, and rigorous contributions to our understanding of the existence and development of a culture of prevention and readiness to prevent. The term “culture of prevention” is neither a set of practical guidelines nor a leading theory. Instead, it is a multidimensional term representing the general orientation and readiness of a group of people (be it a family, community, school, organization, nation, etc.) to deal with problems using a preventive, rather than a reactive, approach. The COVID-19 pandemic creates an opportunity for taking stock of the worldwide progress in creating a “culture of prevention.” This special issue aims to stimulate this discourse by presenting six studies and three commentaries from international scholars focused on themes and approaches for creating a culture of prevention.

Transformative school-community collaboration as a positive school climate to prevent school absenteeism

School absenteeism has become a prevalent problem that affects student development and future societies across the world. We examined whether and how the framework for transformative school-community collaboration (TSCC) can be utilized to effectively reduce school absenteeism. To achieve this goal, we analyzed clustered data involving 3428 students within 14 schools that collaborated with communities in providing out-of-school time programs. A generalized ordered logit analysis with clustered standard errors showed that overall TSCC significantly decreased the likelihood of students' school absenteeism. Democratic and empowering structures in the collaboration were particularly significant for reducing the higher level of school absenteeism. We conclude our article with practice implications to translate the core dimensions of TSCC into effective practice.