Which aspects of coalition functioning are key at different stages of coalition development? A qualitative comparative analysis

Abstract

Background Coalitions are increasingly utilized to promote positive community health outcomes. Typically, coalitions producemore desirable outcomes when coalition functioning is strong and the coalition model is implemented withfidelity.Although theory indicates that coalitions proceed through predictable stages of development, minimal researchexplicitly examines functioning andfidelity at these different stages. Method Within a larger evaluation of Washington State Community Prevention and Wellness Initiative, this cross-sectionalstudy employs qualitative comparative analysis to illuminate the coalition functioning conditions necessary and suf-ficient to produce high modelfidelity at different stages of development in 43 substance misuse prevention coali-tions in one state. Results In the formation stage, only the presence of high levels of coalition leadership was sufficient to produce high modelfidelity. In the maintenance stage, three combinations of conditions were sufficient: (1) sustainability planning if, andonly if, accompanied by the absence of coalition participation costs, (2) coordinator leadership, and (3) a combin-ation of coalition leadership and team cohesion. In the institutionalization stage, two solutions were sufficient: (1)coalition leadership if, and only if, accompanied by the absence of sustainability planning, and (2) sustainability plan-ning if, and only if, accompanied by the absence of coordinator leadership. Conclusions This study illustrates several tangible steps technical assistance providers may take to increase the likelihood ofachieving modelfidelity. In the formation stage, skillful and inclusive coalition leadership is important. In the main-tenance stage, technical assistance should focus on reducing participant-perceived costs;increasing sustainabilityplanning; enhancing coordinator-specific leadership; and developing team cohesion and coalition leadership. Forcoalitions in the institutionalization stage, coalition leadership and sustainability planning may be prime targets fortechnical assistance