Effect of Community Coalition Structure and Preparation on the Subsequent Implementation of Cancer Control Activities

Abstract

Purpose. The purpose of this paper is to identify factors within a three-phase community coalition development model that influence short-term success in cancer control coalitions based on the cumulative number of educational and screening activities conducted by the coalitions. Design. This study was a nonrandomized community intervention trial involving four autonomous, independently funded multistate projects aimed at using coalitions to increase cancer screening and early detection. Setting. The study was conducted in medically underserved, rural counties of Appalachia. Subjects. Sixty-three coalitions involved 1725 members representing 71 counties within 10 states. Intervention. A network of local and regional community cancer control coalitions throughout rural Appalachia delivered culturally sensitive cancer control messages to women, with the long-term goal of increasing the early detection of breast cancer. Analysis. County-level coalitions were the unit of analysis for this study. Multiple linear regression was used to determine if three classes of variables corresponding to the developmental history of coalitions—formation, preparation for implementation, and implementation—were associated with the number of educational and screening activities conducted by the coalitions. Results. The presence of a paid coordinator and formal organizational structure were both strongly associated with the number of activities conducted, accounting for 71% of the variability in coalition activities. Other variables positively associated with number of activities were the preparation of written community assessments and the modification of implementation plans. The same factors (structure, written plans) were associated with activities in coalitions without paid organizers (r2 = .57), as was the number of meetings. However, such coalitions produced an average of only 2.2 activities vs. 21.7 activities in coalitions with paid coordinators. Conclusion. The ALIC study would seem to indicate that community-based coalitions with paid coordinators and formal structures are capable of generating significantly higher levels of activity than those without either a paid coordinator or formal structure.