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Prioritizing Equity: Exploring Conditions Impacting Community Coalition Efforts.

Ariel M Domlyn1, Shemekka Coleman2

  • 1Department of Psychology, University of South Carolina, Columbia, South Carolina.

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Summary

Community coalitions in states with low support, like those not expanding Medicaid, are more likely to prioritize health equity. Contextual factors significantly influence their focus on addressing local health disparities.

Keywords:
community coalitionshealth inequityprogram evaluationqualitative comparative analysis

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Area of Science:

  • Public Health
  • Health Equity Research
  • Community Health Initiatives

Background:

  • Addressing health care equity is a critical public health imperative.
  • Community coalitions are vital for tackling local health disparities and promoting well-being.
  • Understanding factors influencing coalition prioritization of equity is essential for effective interventions.

Purpose of the Study:

  • To analyze internal and external contextual factors affecting community coalitions' prioritization of health equity.
  • To identify conditions under which coalitions are more likely to focus on equity issues.

Main Methods:

  • Utilized qualitative comparative analysis (QCA), a hybrid method, with data from 18 U.S. community coalitions.
  • Employed fuzzy set QCA and direct method of calibration to determine causal sufficiency for prioritizing equity.

Main Results:

  • Coalitions in states that did not expand Medicaid were more likely to prioritize equity.
  • Coalitions working with marginalized populations and having low organizational readiness also showed a tendency to prioritize equity.
  • The lack of Medicaid expansion in a state emerged as a stronger predictor for prioritizing equity.

Conclusions:

  • QCA is a valuable method for evaluating community-based initiatives and understanding contextual influences.
  • External factors, such as state-level support (e.g., Medicaid expansion), play a crucial role in shaping coalition priorities.
  • Community coalitions demonstrate a capacity to address health inequities, particularly when facing lower state-level support.