Assessing Rural Health Coalitions Using the Public Health Logic Model: A Systematic Review

Rural communities face unique challenges including fewer healthcare providers and restricted access to nutritious foods, likely leading to poor health outcomes. Community health coalitions are groups of local organizations partnering to address local health needs. Employing such coalitions is one strategy for implementing policy-system-environment changes for improving rural health. However, their success is variable without standardized evaluation. In this review, rural community health coalitions were retrospectively assessed using the W.K. Kellogg Foundation Logic Model. Community health coalition-reported pathways through this model were explored using market basket analysis.

During Spring 2018, PubMed, Web of Science, ScienceDirect, CINAHL, and PsycINFO were searched for (coalition) AND (rural) AND (health) AND (effectiveness OR impact OR outcome OR logic model). Full-text, peer-reviewed, English articles meeting PICOS criteria (Population, rural communities; Intervention, presence of a community health coalition; Comparator, the coalition over time; Outcomes, logic model pathways) were reviewed. During Summer and Fall 2018, coalition-reported pathways were categorized according to logic model inputs and resources; internal and external activities; outputs; short-, medium-, and long-term outcomes; and impact. Market basket analysis was conducted during Winter 2018.

The 10 most frequently reported pathway items were partner diversity; organizational structures; implementing pilot studies, programs, and interventions; funding; community engagement and outreach; university partners; holding regular meetings; having working groups and subcommittees; operating under or partnering with a regional research initiative; and conducting a community health and needs assessment. Half of community health coalitions reported 4 or more of the following: funding; partner diversity; university partners; organizational structures; community engagement and outreach; and implementing pilot studies, programs, and interventions.

Many rural community health coalitions reported inputs and capacity building; few impacted health. Recommending common early phase logic model pathways may facilitate downstream success.