Health Education Research Advance Access originally published online on May 17, 2004
Health Education Research 2004 19(5):514-532; doi:10.1093/her/cyg056
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Health Education Research Vol.19 no.5, © Oxford University Press 2004; All rights reserved
Evaluating community coalition characteristics and functioning: a summary of measurement tools
1 Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
2 Correspondence to: M. L. Granner; E-mail: mgranner{at}sc.edu
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Abstract |
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Community coalitions and partnerships are frequently used to promote community health; however, little research to evaluate measurement tools for assessing their effectiveness has been reported. This summary identified measurement tools for coalition or partnership characteristics and functioning. The largest numbers of measures were identified for assessing individual and group characteristics, with impact and outcome measures being the least numerous. Published measures often lacked information regarding validity and reliability, with internal consistency reliability being the most commonly reported statistic. Some measures were well defined, but others lacked conceptual clarity. Valid and reliable tools that can be applied across multiple coalitions are necessary in order to achieve a better understanding of the associations among factors influencing optimal coalition functioning and community health impacts and outcomes.
Community coalitions and partnerships are frequently used to promote community health; however, little research to evaluate measurement tools for assessing their effectiveness has been reported. This summary identified measurement tools for coalition or partnership characteristics and functioning. The largest numbers of measures were identified for assessing individual and group characteristics, with impact and outcome measures being the least numerous. Published measures often lacked information regarding validity and reliability, with internal consistency reliability being the most commonly reported statistic. Some measures were well defined, but others lacked conceptual clarity. Valid and reliable tools that can be applied across multiple coalitions are necessary in order to achieve a better understanding of the associations among factors influencing optimal coalition functioning and community health impacts and outcomes.
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Introduction |
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Coalitions and community partnerships provide a means of pooling the abilities, expertise and resources of numerous stakeholders to positively affect community health. Because of this rich potential, coalitions are frequently chosen for participatory, community-based research and grassroots initiatives to promote health (Goodman et al., 1996
; Goodman, 1998; Israel et al., 1998; Roussos and Fawcett, 2000; Green et al., 2001). There is, however, a lack of systematic empirical research evaluating the functioning and effectiveness of coalitions and partnerships—information that is necessary for ensuring success and justifying long-term funding (Florin and Wandersman, 1990; Butterfoss et al., 1993; Florin et al., 1993; Roussos and Fawcett, 2000; Berkowitz, 2001).
Stages of coalition development
There is a dearth of empirical information regarding the formation and development of coalitions (Francisco et al., 1993). There are several frameworks for conceptualizing coalition functioning, including collaboration, empowerment, community capacity/competence, citizen participation and community development (Francisco et al., 1996; Kegler et al., 2000). Conceptualizing coalition functioning in terms of stages of development may be particularly useful for evaluation in that a coalition's functioning and factors important to its functioning may evolve through stages of development or readiness (Butterfoss et al., 1993; Florin et al., 1993; Nezlek and Galano, 1993; Goodman et al., 1996). The stages of development have been described by Florin et al. (Florin et al., 1993) as initial mobilization, establishing organizational structure, building capacity for action, planning for action, implementation, refinement and institutionalization.
Advancement in the creation of a specific theory of coalition functioning is evident in the recent work of Butterfoss and Kegler (Butterfoss and Kegler, 2002) who developed the Community Coalition Action Theory, which incorporates stages of development with several key processes and concepts, including community development, citizen participation, interorganizational relationships and group processes. With community developmental processes and concepts formally integrated with the stages of coalition development, this theory has the potential to describe a wide range of coalition structures and processes. While the Community Coalition Action Theory introduces a comprehensive framework of coalition development and functioning along the stages of development (formation, maintenance and institutionalization), Florin et al.'s (Florin et al., 1993) stages represent a more detailed conceptualization, which is more instructive for evaluation, particularly for iterative processes of partnership functioning and evaluation. Evaluation research is necessary to determine how processes and outcomes may differ across various coalition functions, structures and developmental sequences. For example, a small, grassroots coalition formed to be a catalyst for change or to address a crisis may progress through the stages of development differently than might be expected of a larger community-based coalition formed to address community health and resources on an ongoing basis (Butterfoss and Kegler, 2002).
Evaluation of coalition or partnership process, functioning and impact
The difficulty in evaluating coalitions for health outcomes lies in the complexity and scope of participatory and social ecological approaches, which often characterize community partnerships for health promotion. Some evaluation tasks might be relatively straightforward, such as the use of formative and process evaluation; longer-term impact and outcome evaluation; context and secular trend analysis; adequate evaluation design (maintaining a comparison group); and systematic measurement of policy, organizational, and physical and social environmental indicators. However, other evaluation tasks pose more complex problems, such as tracking the evolution of the coalition or partnership, comparing results across coalitions or communities and assessing multiple interventions with multiple levels of influence (Goodman et al., 1996; Goodman, 1998; Gabriel, 2000; Kegler et al., 2000; Roussos and Fawcett, 2000; Butterfoss et al., 2001; Green et al., 2001). Furthermore, measures are needed to assess stages of development, and the wide range of process, impacts and outcomes related to coalition functioning (Francisco et al., 1993). Because of the complexity of community development and coalition building, triangulation of data collection has been suggested to help avoid bias inherent in any one type of methodology and to enhance validity (Goodman et al., 1996). Use and integration of both qualitative and quantitative data is recommended to provide a comprehensive assessment and understanding of coalition development, function and impact (Francisco et al., 1996; Goodman et al., 1996; Goodman, 1998; Israel et al., 1998).
The purpose of this summary was to identify published measurement tools for assessing coalition or partnership functioning, and to report the available evidence for validity and reliability of each. Work in progress but not yet published on either a website or in a journal was not included. This summary provides an inventory for researchers and practitioners in search of measurement tools. Discussion of the complexity and breadth of the evaluation of community partnerships is beyond the scope of this paper. In-depth discussions of evaluation methods, and other issues relevant to coalitions and partnerships, are available elsewhere (Windsor et al., 1994; Fetterman et al., 1996; Baker and Teaser-Polk, 1998; Goodman, 1998; Goodman et al., 1998; Israel et al., 1998; Green and Kreuter, 1999; Gabriel et al., 2000; Kreuter et al., 2000; Roussos and Fawcett et al., 2000).
Numerous definitions have been suggested for coalitions, partnerships and collaboratives [see (Butterfoss et al., 1993; Green et al., 2001; Himmelman et al., 2001) for examples of definitions and discussion of differences in these types of groups]. The measurement tools in this summary may apply to each of these groups with varying degrees of fit and, therefore, no distinction among these groups was made for inclusion of the tools in this summary.
Some factors suggested to be important to coalition and partnership effectiveness are listed in Table I. Many of these factors have been derived from experience in working with coalitions, but have not been empirically tested (Butterfoss et al., 1993). [For detailed discussions of these constructs, see (Butterfoss et al., 1993; Florin et al., 1993; Israel et al., 1998; Kegler et al., 2000; Roussos and Fawcett, 2000; Wolff, 2001).] While many of these constructs have been defined, there remains a lack of conceptual precision or consensus in the literature.
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Methods |
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A review of the research literature was conducted through Medline, PsychInfo and Sociological Abstracts with the following terms: community, coalition, partnership, collaboration, measurement, scale, evaluation, reliability and validity. The Internet was also searched, through the Google search engine, to identify tools and reports using the same search terms as the literature search. Measures were included in this summary if they provided at least a conceptual definition of the construct measured. Twenty-six articles or reports were identified, representing 146 measurement scales/indexes. Information on validity and reliability that was reported in the original article/report is provided in this summary where available.
Although frameworks for stages of coalition development have been proposed for assessing coalitions, few evaluation studies have explicitly used this type of framework; therefore, for the purpose of organizing the summary tables, five general categories (which are not necessarily mutually exclusive) were used to group measurement tools: (1) Member Characteristics and Perceptions, (2) Organizational or Group Characteristics, (3) Organizational or Group Processes and Climate, (4) General Coalition Function or Scales Bridging Multiple Constructs, and (5) Impacts and Outcomes. Within each of these broad categories, subheadings group together sets of similar constructs. For each of these groupings, measures are ordered by increasing number of total items.
The five general categories used above for organizational purposes in this paper roughly correspond to the stages of coalition development that Florin et al. (Florin et al., 1993) described as being initial mobilization, establishing an organizational structure, building capacity for action, planning for action, implementation, refinement and institutionalization. Initial mobilization involves recruitment of participants whose Member Characteristics and Perceptions provide the coalition with skills, experience and community representation that guide and enable the partnership's activities. Establishing an organizational structure, building capacity for action and planning for action are supported by Organizational or Group Characteristics of leadership, staff, and formalized structures and procedures. Implementation, refinement and institutionalization are supported by Organizational or Group Processes and Climate, which enable members to work together to accomplish goals, Impacts and Outcomes.
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Results |
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Tables II–VI
provide a summary of measures in each category including the conceptual definition, number of items, available information on validity and reliability, and the reference. Coalition members and/or staff were the respondents unless otherwise noted. Few papers explicitly stated that validation measures were included in their study. Because of the general lack of a guiding theoretical framework in much of the literature, it was not always possible to determine whether the authors' intent was validation, a report of ‘causal’ associations between coalition functioning and various outcomes or an exploration of cross-sectional correlates. Because of this uncertainty, Tables II–VI report only explicitly stated validation information. Further information about correlations with other variables is provided in a more extensive set of tables, which have been posted on the Internet (http://prevention.sph.sc.edu/; under Reports and Tools).
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Individual and group characteristics had the largest numbers of measures, with impact and outcome measures being the least numerous. Generally, there were gaps in the reporting of validity and reliability, with most measures reporting only internal consistency reliability. Table II presents measures of Member Characteristics and Perceptions. There were a total of 59 measures, with the most measures for member participation (15 measures), member satisfaction (seven measures) and member benefits to participation (seven measures). Thirty-three of these measures (56%) reported at least one type of validity or reliability. Twenty-seven measures of Organizational or Group Characteristics were identified (Table III). Most of the measures were related to leadership (nine measures) and staff performance (eight measures). Fifty-nine percent (n = 16) of these measures reported some type of validity or reliability. Table IV includes 32 measures of Organizational or Group Processes and Climate, with the most measures for action plan quality (seven measures), and group relationships, communication and resources (four measures each). Forty-four percent (n = 14) of these measures had some type of validity or reliability data available. In Table V, there are 10 general measures of coalition functioning, with the most measures of collaboration (four measures) and of general functioning (four measures). Three of these measures (30%) reported some validity or reliability. Measures of Impacts and Outcomes are presented in Table VI. There were 20 measures, with the most measures for community linkages (eight measures) and capacity/empowerment (six measures). Fifty-five percent (n = 11) of these measures had some type of validity or reliability.
Some authors reported varying conceptual definitions of similarly named variables and a few measures included several different constructs in one measure (e.g. a measure of ‘member participation’ including single items assessing commitment and/or diversity of membership). While some constructs have been well defined, others lack clarity.
In terms of inter-relationships among variables (reported in the extended tables on the Internet at http://prevention.sph.sc.edu/; under Reports and Tools), some authors have reported associations between coalition characteristics and functioning variables (e.g. between member participation and member communication). Far less research reports the association of coalition characteristics and functioning to impacts and outcomes; and there is little or no information describing variables by stages of coalition development.
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Discussion |
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The literature on measurement of coalition characteristics and functioning reveals a diverse array of concepts and measures. While some published measures were clearly derived from theoretical frameworks, the literature overall is a fragmented collection of tools. There remains a need for matching theory to conceptual and operational definitions (Butterfoss et al., 1993
; Francisco et al., 1996; Kegler et al., 2000). Rigorous evaluation assumes valid and reliable measurement tools, yet relatively few published tools to measure coalition characteristics and functioning report validity and reliability. In addition, there is a tension between standardized tools that facilitate comparison across programs and specialized tools that fit specific program and community contexts (Goodman, 1998). While this summary does not solve these problems, it represents a starting point for advancing coalition evaluation by providing an inventory of existing tools, including any published reliability and validity information. Selection of specific tools for any given project must be guided by the researchers' conceptual or theoretical framework, the goals and expectations within the specific community context, and the quality of the measure. An array of concepts that have been empirically associated, or are expected to be associated, with coalition functioning and/or success, appear in Table I as a rough guide. Selection of several measures within each of the broad categories in Table I will help address the range of factors that may influence effectiveness and provide evaluation data to be used to guide the process and refinement of coalition building.
In selecting measures to match the community context, consideration of the expectations, needs and goals of stakeholders, as well as the project's evaluation plan should be considered. In some instances, measures that are not related to the evaluation plan per se may hold local interest for stakeholders and are therefore worth including.
In choosing measures, a rule of thumb for minimally acceptable internal consistency reliability is 0.70 for relatively new areas of investigation (Nunnally and Bernstein, 1994). For scales that have been factor analyzed to establish construct validity, retaining items with factor loadings 
0.40 is the norm (Hatcher, 1994). Validation of individual items and scales is more difficult to assess, and is less commonly reported in the research literature, but the quality of a measure increases with evidence of validity. If a measure is not valid, reliability does not matter (Nunnally and Bernstein, 1994).
Another consideration regarding measurement properties is the population with which the measure has been used. Measures that have performed well in terms of validity or reliability in one population may not perform the same way when used with a different population or subgroup of different age, ethnicity or income. Measures should, therefore, be tested with the intended population.
The tools have been reported in the tables as individual measures under a conceptual heading. Some of these tools are part of a collection of measures that were developed within a conceptual framework and therefore may have added value when administered as a set. Readers are urged to review the original sources.
In addition to development or selection of measurement tools, there are additional conceptual issues concerning measurement of constructs related to coalition functioning. In particular, there remains a need for a better understanding of the inter-relationships among stages of development, factors influencing optimal functioning and attainment of outcomes (Butterfoss et al., 1993; Kegler et al., 2000), as well as how these factors may interact with different types and sizes of coalitions, partnerships or other collaboratives (Florin et al., 1993). Understanding of how concepts within a framework may evolve with a coalition over time may provide information for strategies to enhance the development and sustainability of coalitions, and to help improve the ability of coalitions to influence both proximal and distal outcomes.
Before these associations can be evaluated, standardized measurement tools with documented validity and reliability are required. Typically, coalitions have a relatively small number of members compared to the sample sizes required for validity and reliability analyses. Further, evaluation of multiple programs or coalitions is hindered by the fact that certain types of coalitions may be difficult to locate for research and are widely dispersed (Berkowitz, 2001). Exploration of key coalition characteristics and aspects of coalition functioning predictive of success is possible only when adequate sample sizes are available; thus, in addition to large-scale psychometric studies, the widespread use of select measures across many evaluation projects would facilitate generalization of results.
Given the broad array of available measurement tools and lack of conceptual consensus thus far in the research literature, users of this summary are advised to take the following approach to their evaluation of coalition functioning. (1) Identify an overarching framework, theory or combination of theories. Although there are several theories that may be relevant, one promising theory that provides a comprehensive framework for evaluation and understanding coalition functioning is Butterfoss and Kegler's (Butterfoss and Kegler, 2002) Community Coalition Action Theory, which may be enhanced with consideration of a more detailed conceptualization of stages of coalition development [e.g. (Florin et al. (1993)]. Measurement tools in the tables could be matched to the theoretical constructs of the Community Coalition Action Theory to address, or at least partially address, evaluation of each construct. For example, the construct of coalition membership could be addressed by measures of commitment and representation in Table II. The construct of leadership and staffing could be addressed by measures of leadership and staff performance in Table III. Coalition operations and processes could be addressed by measures of skills and experience and participation benefits and costs from Table II, and measures of communication, conflict management, decision making and group relationships from Table IV. [See (Butterfoss and Kegler, 2002) for definitions of the theory's constructs.] (2) Identify specific evaluation objectives based on project needs, community context and various stakeholders' expectations for evaluation. Consider the following: scope of the project, the available resources, delimiting the pool of concepts to be measured, use of qualitative and quantitative methods, and stages of coalition development. (3) Identify measurement tools with adequate validity and reliability, and/or create and validate new tools if time and resources allow.
In clinical research, consensus panels have been formed to review the literature, summarize the current state of knowledge, make recommendations for future research and practice [e.g. (National Institutes of Health and National Heart, Lung and Blood Institute, 1998)], and suggest or develop core measures for use across clinical trials [e.g. (Peeples et al., 2001; Siegal et al., 2001)]. Such a consensus panel that includes discussion of measurement tools within the broader context of coalition building, maintenance and institutionalization would be useful in the development of a definitive consensus document that communities and researchers could use as a platform for developing effective local partnerships. These efforts may result in the development of a foundation of data upon which comparisons between partnerships could be made, provide guidance for increasing effectiveness and sustainability, and provide impetus for increased funding of successful coalitions or partnerships. In the meanwhile, this guide will provide researchers and practitioners a starting point to locate existing measurement tools.
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Acknowledgments |
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The authors thank Delores Pluto for website technical assistance. This article was supported in part by Cooperative Agreement Number U48/CCU409664 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.
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Received on January 2, 2003; accepted on September 2, 2003
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