18.2: Partnerships and Coalitions in Program Planning
By the end of this section, you should be able to:
- Differentiate between partnerships and coalitions.
- Identify impacted individuals or groups and mobilize community partnerships to solve health problems within programs, communities, and populations.
- Demonstrate the ability to engage with other health professionals and community partners through social networking.
- Organize team and community partners with a shared vision, values, principles, and capacity for community action.
- Discuss the ethical considerations associated with planning, implementing, and evaluating health programs.
The nurse uses a participatory approach during the development, implementation, and evaluation of effective and relevant community health promotion and disease prevention programs. A participatory approach enables and empowers community members to be actively involved in decisions throughout the program planning, implementation, and evaluation process. The nurse invites individuals or groups who are impacted by a health problem and/or are impacted by a community health program to become involved. The nurse engages community members, agencies, and organizations to enhance program planning by sharing ideas, resources, and work. The community health program is based upon mutual vision, values, principles, and capacity.
Community Partnerships and Coalitions
Community engagement is an essential component of program planning. Community engagement is the process of working collaboratively with and through groups of people to identify the health needs of community residents and strategies to address them. Any person, agency, or organization that is invested in the community’s health and in the local public health system or is impacted by the outcomes of community health programs should be considered a potential partner. The nurse develops a list of potential partners during the first stages of program planning. Table 18.2 lists potential community partners to consider when planning community health programs (U.S. Department of Housing and Urban Development [HUD], 2012; World Health Organization [WHO] & UNICEF, 2022).
| Individuals | Agencies and Organizations | Government |
|---|---|---|
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A partnership is a relationship characterized by mutual cooperation and shared responsibilities among individuals and groups with a common focus that combine resources to implement joint activities (PHAB, 2022). For example, the local public health department, WIC, the local health system, and the YMCA combine efforts to hold a mom-baby fair (Figure 18.5). The public health department provides car seat education and new car seats. WIC provides nutrition education and resources for healthy foods. The local health system provides education on immunizations and safe sleep. The YMCA offers education on mom-baby exercise classes. Each organization also contributes baby items for raffle.
Partnerships may expand into a coalition . A coalition is a group of people and organizations that work to address community needs and solve community problems (PHAB, 2022). Coalitions connect multiple sectors within the community, such as schools, worksites, government, public health, hospital systems, community-based organizations, religious organizations, and the community at large (Society for Public Health Education [SOPHE], 2016). Coalitions help gain attention for the health problem; share knowledge, strategies, risks, and responsibilities; combine resources to address the health problem; assemble diverse talents and expertise; limit duplication of programs and services; and attain sustainability for health programs (Issel & Wells, 2018; SOPHE, 2016). Coalitions are strategic, formed in response to a specific health problem. For example, the program discussed in Theory in Action: Using the Community Action Model to Improve Infrastructure and Promote Physical Activity was accomplished by a coalition (Healthy Places by Design, 2016). The KidsWalk Coalition included members from schools, businesses, government agencies, youth organizations, community and faith-based organizations , and the New Orleans Department of Public Works. The specific health focus was to improve infrastructure and safety to make walking and biking an option for community members.
Engage and Mobilize Community Partnerships
The nurse identifies and engages potential community partners and develops community partnerships before developing strategies for community health promotion and disease prevention programs. Table 18.3 describes the eight action steps and related activities the nurse uses to engage potential partners, mobilize community partnerships, and create community health coalitions.
| Action Steps | Activities |
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| 1. Identify potential partners. |
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| 2. Engage potential partners. |
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| 3. Develop a partnership agreement. |
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| 4. Determine program priorities. |
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| 5. Develop an action plan. |
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| 6. Implement strategies. |
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| 7. Evaluate the coalition and strategies. |
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| 8. Determine future as a partnership or coalition. |
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Identifying and engaging potential partners, which occurs in Steps 1 and 2, can be daunting, especially when there are few established partnerships and coalitions within the community. The nurse uses social networks to effectively engage potential partners. Social networks are linkages among individuals, groups, and organizations that arise out of geographical location, work relationships, school relationships, or recreational activities (Dozier et al., 2015). The nurse utilizes personal social networks to understand the individual, group, and organization's health priorities, recruit those with similar priorities, and solicit suggestions for other potential partners interested in the program. Social media provides an additional method to identify and engage potential partners. Social media is an effective engagement method in that it can be used to do the following (Walsh et al., 2021):
- Search for individuals and community groups who post related content, such as health information and resources, policy advocacy, and discussions related to the targeted health problem
- Disseminate information and program needs related to the targeted health problem
- Expand reach to recruit community members from diverse groups and the target population
- Provide a method to enhance communication among partners and coalitions by forming social media groups
Strategies to identify and engage potential partners more effectively include considering a potential partner's activities, accomplishments, current and potential contributions to health, individual and organizational self-interests, and possible conflicts (SOPHE, 2016). Partnerships and coalitions are more likely to succeed if specific interests and goals align and they can realistically achieve activities with minimal expense (HUD, 2012; Issel & Wells, 2018). Additionally, each partner should have a return on investment, benefiting from the partnership (HUD, 2012). The time and resources spent engaging in partnerships and relevant activities should help each partner meet their organization’s goals.
Community asset mapping and partner analysis assist the nurse in identifying potential partnerships. Community asset mapping includes all community sectors with resources that could be utilized. The nurse completes an inventory of assets and the type of activities that potential individuals, organizations, or associations are engaged in. Assets may include the following (HUD, 2012):
- Human resources, such as number, expertise, talent, and skills of staff
- Physical resources, such as location to target population, public spaces, and meeting rooms
- Information resources, such as educational materials and access to information resources
- Political resources, such as elected officials and advocacy for policy change
- Existing program resources, such as a program that has already been implemented
Partner analysis uses that information to describe an organization’s experience with program planning and implementation, knowledge and expertise, available resources, influence on other partners, and potential roles and responsibilities for the program (WHO & UNICEF, 2020). JSI (2014) created a toolkit for partnership, collaboration, and action that provides tools to evaluate organizational readiness, identify barriers and challenges for partnerships, evaluate potential partners, and evaluate collaborative practices.
During Step 3, the nurse develops partnership agreements with established partners. The partnership agreement may be a formal written agreement, such as a legal contract or Memorandum of Agreement (MOA), or an informal verbal contract. The best approach is a written agreement, reviewed annually, that contains enough detail to evaluate whether each partner fulfilled their partnership commitment (JSI, 2014). This legally protects all partners’ best interests. JSI (2014) developed the Partnership Agreement Development Tool (PAD) to assist in developing a partnership agreement. The tool directs partners to address roles and responsibilities of each party in the relationship.
Strategies to assist the nurse during Step 4, determine program priorities, and Step 5, develop an action plan, are described in sections below.
Organize Teams with Shared Vision, Values, Principles, and Capacity for Community Action
The nurse is aware that team dynamics influence effective collaboration of partners during community program planning. Team dynamics refers to the relationships, interactions, attitudes, and behaviors that arise when a group of individuals work together. Positive team dynamics, such as open communication, conflict resolution, alignment of roles, commitment to the project, and optimism, improve both team and individual performance and enhance effectiveness to reach team goals (Sharma, 2023).
Healthy team dynamics enhance a teams’ ability to communicate effectively, make decisions, and accomplish shared goals.
Watch the video, and then respond to the following questions.
- What are characteristics of a healthy team?
- Why is setting team expectations important when working with a group?
- What are factors that make a team successful?
The nurse, partners, and other interested parties meet to develop a shared vision, values, principles, and capacity to clarify the team’s common interests and provide purpose, focus, and direction for program planning. A program vision is a statement that articulates the desired goals that the planning team aspires to achieve (HUD, 2012; PHAB, 2022). The vision should include diverse perspectives and be broad, inspiring, and easy to communicate (HUD, 2012). For example, the North Carolina Farmworker Health Program (NCFHP, 2023) vision statement directs collaboration with local agencies to meet farmworkers’ health needs:
- We envision a comprehensive network of health care professionals that provides culturally appropriate and accessible health services, empowering farmworkers and their families to live healthy lives as valued members of informed and inclusive communities.
When writing the program vision, the team answers the following questions:
- What is the problem we are attempting to solve?
- What are we hoping to achieve?
- If we achieved all the goals, what would the community look like in the future?
A program’s values flow from the vision. Values are the core principles and beliefs that direct the team (PHAB, 2022). When writing the program values, the team answers the following questions:
- What shared values are unique to our team?
- What behaviors do we value that are related to the problem, health promotion, and disease prevention?
- How will we implement our program activities to achieve our vision?
Although program documents may not explicitly note values, they are interwoven throughout activities and demonstrated in the program’s practices. For example, values evident in the NCFHP are health equity, cultural and linguistic competency, collaboration, access, and empowerment.
Finally, the nurse, partners, and other interested parties define the program’s capacity. When determining program capacity, the team answers the following questions:
- What resources can each partner and interested party contribute to the program?
- Are there other resources in the community that could be utilized?
- Is additional funding available, such as state or federal grant opportunities or community donors?
- Are there other community relationships that could be established to increase capacity?
- Are there barriers related to resources and relationships?
A community health program is developed according to the vision, values, and capacity of partners and other interested parties planning and implementing the program. The NCFHP demonstrates the incorporation of vision, values, and capacity by assisting local agencies in increasing access to health and dental care for farmworkers and their families.
Watch the video, and then respond to the following questions.
- What barriers to accessing health care did the migrant workers face? How did the NCFHP address them?
- How has the NCFHP vision impacted program activities?
- How are values incorporated into NCFHP activities?
- How does the NCFHP build capacity?
Ethical Considerations Associated with Planning, Implementing, and Evaluating Community Programs
The program team must consider community health ethical principles and issues associated with program planning, implementation, and evaluation. Ethical and moral norms related to health care and community health are considered when planning program activities. The American Public Health Association (APHA, 2019) Public Health Code of Ethics provides an overview of ethical norms to consider. Accountability, participant protection, and incentive use are specific ethical topics that influence program planning decisions. Program planning, implementation, and evaluation teams are responsible for ensuring ethical and moral norms are upheld. Ethical analysis should occur in the beginning stages of program planning.
Ethical and Moral Norms
The nurse and program team follow the Public Health Code of Ethics during program planning, implementation, and evaluation. Table 18.4 provides a description and application of ethical and moral standards that should be incorporated into program development and implementation.
| Ethical Standard | Examples of Application |
|---|---|
| Professionalism and trust |
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| Health and safety |
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| Health justice and equity |
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| Interdependence and solidarity |
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| Human rights and civil liberties |
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| Inclusivity and engagement |
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Unequal access to resources leads to health disparities. Health disparities are health differences that negatively affect socially disadvantaged populations. Public health programs focus on eliminating health disparities by promoting health equity and health justice. Health equity gives individuals what they need to achieve equal health outcomes. Health justice is one method to achieve health equity and involves eliminating personal, community, political, and systematic barriers to equitable health outcomes. This video discusses causes of health inequity and provides recommendations to achieve health equity.
Watch the video, and then respond to the following questions.
- What causes health inequity?
- What does the American Public Health Association recommend to reduce disparities and promote health justice and equity?
Accountability
The nurse and program team consider professional and program accountability during partnership establishment, program planning, program intervention, and program evaluation. Professional accountability ensures that team members act within the scope of their professional license. Additionally, individuals within the team should have the appropriate training, skill, and supervision to ensure that the services and activities offered are the best available. For example, Jamie (the nurse) and the KHCFBP team asked a local bike expert and licensed educator to assist with activity planning and content delivery. This ensured that the right individual, with the needed knowledge, skill, and experience, was involved.
The nurse and program team consider program accountability when developing the program’s vision, values, and activities. The program is accountable for upholding community health program standards, such as implementing activities that originate from health needs of the community, are delivered with efficient use of resources, reach the intended population, have been delivered as planned, are managed according to the planned budget, make the most impact, and follow local, state, and federal law (Issel & Wells, 2018). The program must be fiscally responsible, including efficient and appropriate use of funds. For example, funds that were donated to purchase bikes and bike helmets for a community health biking program must be used for that purpose. It would be unethical to use those funds in any other way. Finally, program accountability includes transparency, commitment, and sustainability of services (Akrami et al., 2018). The program should be implemented as promised and continue for as long as promised. For example, if a program offers free screening to community members, the program should have the resources to provide screening to all who qualify.
Participant Protection
Participants’ privacy and autonomy should be protected throughout program implementation and evaluation. Community program participant information is only confidential by law under certain circumstances, such as the Health Insurance Portability and Accountability Act (HIPAA) for health care systems and the Family Educational Rights and Privacy Act (FERPA) for educational systems (Issel & Wells, 2018). Even if the community program does not fall within those categories, best practice is to only allow access to participants’ personal information for those working directly with participants or within reports required for funding purposes. At the beginning of the program, the nurse communicates circumstances where the team may share personal information and may attain informed consent for sharing of information.
Participant autonomy is protected through disclosure and informed consent . The nurse discloses program conditions and activities, conflict of interest, policies regarding confidentiality, and if the program is a part of a research study. The participant also has the choice to participate in and withdraw from the program at any time. If the program is part of a research study, Institutional Review Board (IRB) approval must be gained, and participants must consent to participate in the study. The IRB reviews evaluation and research plans to ensure ethical standards are followed and participant rights are protected. Consent includes ensuring participant understanding of the purpose of the study. Autonomy and informed consent issues arise in community health programs because many programs target vulnerable populations and children (Issel & Wells, 2018). Care must be taken in these situations to ensure that ethical standards are followed.
Incentive Use
Using incentives in community health programs has been a highly debated topic. Incentives are used to motivate program participants to do something. Community health programs may use incentives to increase program enrollment and retention or adoption of health promotion and disease prevention behaviors. Four types of incentives have been used in community health programs (CDC, 2021):
- Cash incentives: providing cash to a person or direct depositing funds into a bank account
- Noncash financial incentives: providing items that have cash value, such as gift cards, vouchers, or insurance premium discounts
- Nonfinancial incentives: providing items that have value, but not cash value, such as prizes, products, or memberships
- Mixed incentives: providing a combination of above
Incentives reward behavior in the short-term, which people most often prefer, and so increase the likelihood of behavior in the short-term (CDC, 2021). Incentives may also provide motivation to adopt a healthy behavior, but this depends upon the complexity of the behavior change (CDC, 2021). For example, an incentive for simple behaviors, such as attending a meeting for weight loss, may be more successful than an incentive for complex behaviors, such as losing 20 pounds. Complex behaviors take more time, effort, and consistent change than simple ones, so the incentive may not align with the complexity. Programs that use incentives have been found to have higher levels of attendance and increased adoption of health behaviors compared to those that do not, but these results have varied according to race (CDC, 2021). Because of this, it is important to include members of the target population in decision-making regarding incentive use.
Factors to consider before adoption of the use of incentives include the following (CDC, 2021):
- Program setting and participants—Types of incentives may work in some settings and populations but not in others.
- Maintenance of change—Behaviors may not continue when incentives have stopped, so strategies to maintain behavior change should be incorporated into the program.
- Incentive type, amount, and frequency—Determine whether to use financial or nonfinancial incentives and how much incentive is needed to motivate participants as well as how often incentives will be given.
- Measurement method—Decide whether to provide incentives only for behaviors that can be measured rather than those that require self-reporting.
Ethical Analysis of Community Programs
The nurse appraises community programs to ensure ethical norms are maintained. The APHA (2019) offers a list of questions that can be used to analyze the ethics of a community program. Table 18.5 lists ethical standards and associated questions.
| Ethical Standard & Description | Example of Question for Assessment |
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Permissibility
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Respect
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Reciprocity
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Effectiveness
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Responsible use of resources
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Proportionality
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Accountability and Transparency
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Public participation
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