Community coalition action theory and its role in drug and alcohol abuse interventions.
|Publication:||Name: Journal of Alcohol & Drug Education Publisher: American Alcohol & Drug Information Foundation Audience: Academic; Professional Format: Magazine/Journal Subject: Health; Psychology and mental health; Social sciences Copyright: COPYRIGHT 2011 American Alcohol & Drug Information Foundation ISSN: 0090-1482|
|Issue:||Date: Dec, 2011 Source Volume: 55 Source Issue: 3|
Coalitions have been developing rapidly over the past quarter
century in various sectors including health with the intention of
creating opportunities that will benefit all members of the coalition.
More specifically, community coalitions have developed with the
intention of achieving a common goal among the members of the community
and have become common practice within the realm of health promotion.
While coalitions have become a popular means for soliciting health
initiatives, it is difficult to measure their effectiveness due to the
inherent complexity of coalitions. The community coalition action theory
(CCAT) identifies internal factors within the coalition that lead to the
implementation of community change, and thereby provides an approach for
assessing the efforts of coalitions (Kegler, Rigler & Honeycutt,
CCAT is comprised of fifteen constructs and twenty-one practice-proven propositions that have developed based on the constructs. The fifteen constructs identified by Butterfoss & Kegler (2009) include stages of development, community context, lead agency or convening group, coalition membership, processes, leadership and staffing, structures, pooled membership and external resources, member engagement, collaborative synergy, assessment and planning, implementation of strategies, community change outcomes, health/social outcomes, and community capacity. The related propositions fall within the constructs and propose such things as the notion that "coalitions are heavily influenced by contextual factors in the community throughout all stages of development" (Proposition 3) and "participation in successful coalitions allows community members and organizations to develop capacity and build social capital" (Proposition 21) (Butterfoss & Kegler, 2009). These propositions summarize what is already commonly and empirically known about how community coalitions can improve health outcomes (Kegler, Rigler & Honeycutt, 2010).
CCAT posits that coalitions develop in stages, with the identified stages being formation, maintenance and institutionalization. During the formation stage, the leading group or agency recruits an initial group of community partners who identify an issue of concern and then develop operating procedures. The maintenance stage involves preserving member involvement, generating group synergy, acquiring resources, and implementation, eventually leading to changes in practice and policy. Within the institutionalization stage, outcomes are produced as a direct result of effective strategies. These strategies can then be adopted by organizations or become part of a long-term coalition. It is important to note that these stages are not linear, but cyclical, which permits revolving back to earlier stages when new issues arise within the coalition (Butterfoss & Kegler, 2009).
While the use of community coalitions has become more prevalent in health promotion settings, and a search of the literature demonstrated a plethora of studies using community coalitions to address obesity, physical activity, cancer and diabetes prevention, the specific utilization of the community coalition action theory is limited. Due to the complex nature of the theory, applications of the CCAT tend to focus on major constructs rather than causal pathways. In 1992, the Centers for Disease Control and Prevention (CDC) demonstrated how community coalition could improve immunization rates for children under the age of two through the Consortium for the Immunization of Norfolk's Children (CINCH) in Norfolk, Virginia. In following the community coalition model, CINCH enabled this diverse community to develop and implement effective strategies and thereby increased childhood immunization rates by 17 percent (Butterfoss, & Kegler, 2009). Kegler and Swan (2011) used data from the California Healthy Cities and Communities (CHCC) program, a coalition comprised of 20 communities, to test selected relationships in both the formation and maintenance stages of coalition development. They found that member characteristics, namely the number of community sectors engaged in the coalition, influence coalition outcomes, possibly due to collaborative synergy. Additionally, they found that coalition size in the formation stage was correlated with participation and dollars leveraged in the maintenance stage. Their findings supported the CCAT proposition that collaborative synergy leads to community change, thereby strengthening community capacity. Kegler, Rugler and Honeycutt (2010), however, chose to focus on the construct of community context and its related propositions and how they influenced the formation of coalition for the same healthy community initiative previously discussed, (CHCC). They found common themes among the related propositions that ultimately confirmed the impact community context can have on community coalition formation. In a very different application of the CCAT, Kluhsman, Bencivenga, Ward, Lehman & Lengerich (2006) describe a coalition data collection system designed to monitor the impact of rural cancer coalitions in Pennsylvania and New York, where the 11 coalitions involved were conceptualized by the CCAT. These authors observed that, over the 3-year study period, there were increasing trends in interventions, completed screenings, and documented community changes, which speaks to the effectiveness of coalitions, ultimately supporting the use of the CCAT. Kluhsman et al (2006) reported that the 11 coalitions achieved more through their collective partnerships than any of the coalitions could have done alone, which supports the CCAT construct of pooling resources in an effort to improve the implementation strategies and, eventually, health outcomes.
As previously stated, the breadth of literature on the use of community coalition action theory and health promotion initiatives is quite limited, and additional searches revealed that to date, CCAT has yet to be applied to drug and alcohol abuse interventions. While community coalition action theory has yet to be used with this specific health issue, there are studies in the literature that consider coalitions in general and alcohol and substance abuse interventions. Collins, Johnson and Becker (2007) conducted a meta-analysis of a science based prevention intervention for substance abuse among adolescents that was part of a community coalition effort. In an effort to understand approaches that measure community coalitions, Goodman and colleagues (1996) conducted an ecological assessment of a community based intervention for preventing alcohol, tobacco and other drug abuse. Redmond and partners (2009) examined the long-term protective outcomes of an evidenced based intervention for improving parent and youth skills with the intent of reducing problem behaviors in adolescents such as substance abuse.
This gap in the literature in regard to CCAT and drug and alcohol interventions could be filled with future studies that expand what has already been established with coalitions and health promotion initiatives. Future studies that want to examine CCAT and drug and alcohol interventions should consider addressing the theory in its entirety, as opposed to just single constructs. Furthermore, practitioners should consider examining more than the coalition functioning and also consider the desired health outcomes and long-term sustainability.
While CCAT is a relatively new theory, grounded in nearly two decades of practice and research (Butterfoss & Kegler, 2009), it does have some limitations. Community coalitions are complex, and attributing changes in health outcomes to community efforts is difficult to do, further complicated by numerous constructs that are complex on their own. Additionally, evidence to support the constructs and propositions is rare, and further research should aim to clarify the constructs and how they are linked.
Butterfoss, F. D., & Kegler, M. C. (2009). The community coalition action theory. In R. J. DiClemente, R. A. Crosby, & M. C.
Kegler (Eds.), Emerging theories in health promotion practice and research (2nd ed.). San Francisco, CA: Jossey-Bass.
Collins, D., Johnson, K., & Becker, B. J. (2007). A meta-analysis of direct and mediating effects of community coalitions that implemented science-based substance abuse prevention interventions. Substance Use & Misuse, 42(6), 985-1007. DOI: 10.1080/10826080701373238.
Goodman, R.M., Wandersman, A., Chinman, M., Imm, P. & Morrissey, E. (1996). An ecological assessment of community-based interventions for prevention and health promotion: Approaches to measuring community coalitions. American Journal of Community Psychology, 24(1), 33-61.
Kegler, M. C., Rigler, J. & Honeycutt, S. (2010). How does community context influence coalitions in the formation stage? A multiple case study based on the community coalition action theory. BMC Public Health, 10(90), 1-11.
Kegler, M. C. & Swan, D. W. (2011). An initial attempt at operationalizing and testing the community coalition action theory. Health Education & Behavior, 38(3), 261-270. Doi: 10.11777/1090198110372875.
Kluhsman, B. C., Bencivenga, M., Ward, A. J., Lehman, E.& Lengerich, E. J. (2006). Initiative of 11 rural Appalachian cancer coalitions in Pennsylvania and New York. Preventing Chronic Disease, 3(4), 1-10.
Redmond, C., Spoth, R. L., Shin, C., Schainker, L. M., Greenberg, M. T. & Feinberg, M. (2009).Long-term protective factor outcomes of evidence based interventions implemented by community teams through a community-university partnership. Journal of Primary Prevention, 30(6), 513-530. DOI 10.1007/s10935-009-0189-5.
Manoj Sharma, MBBS, MCHES, Ph.D.
Editor, Journal of Alcohol & Drug Education & Laura Smith, MPH(c)
University of Cincinnati
527 C Teachers College
PO Box 210068
Cincinnati, OH 45221-0068
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