Advancing positive social determinants of health through collective impact

Abstract

Background Communities across the U.S. and globally confront the challenge of transforming negative social determinants of health (SDOH) into positive ones. To address this complex social problem, collective impact (CI) has promise but has been critiqued for insufficiently challenging structural inequities. Research applying CI to SDOH is limited. This mixed-methods study examined early adoption of CI in the 100% New Mexico initiative that aims to address SDOH population-wide in a state with strong cultural identity and assets but also persistent socio-economic inequality. | Methods. A web-based survey, interviews and focus groups were conducted with initiative participants in June and July 2021. Survey participants rated agreement with six items assessing CI foundation from the Collective Impact Community Assessment Scale. Interviews and focus groups centered on motivation to engage, progress in model components, CI core conditions, and contextual factors influencing experiences. Surveys were analyzed using descriptive means. Qualitative data were analyzed using thematic analysis, an inductive approach, stratified analyses, and co-interpretation. Results. Fifty-eight participants completed the survey, and 21 participated in interviews (n = 12) and focus groups (n = 9). Survey means were highest related to initiative commitment, and lower regarding shared ownership, having multiple perspectives and voices, and adequate resources. Qualitative results indicated the framework’s cross-sector emphasis helped motivate participation. Participants embraced the focus on leveraging community assets that characterizes CI and the current framework. Counties used unique engagement and visibility strategies including mural projects and book clubs. Participants reported communication challenges across sector teams which influenced feelings of accountability and ownership. Participants did not report challenges lacking relevant, available, and timely data or tension between funder-driven and community-driven desired outcomes, contrasting previous CI research. Conclusion. Multiple foundational conditions of CI were supported in 100% New Mexico, including evidence for support of the common agenda addressing SDOH, shared measurement framework, and mutually reinforcing activities. Results suggest that efforts to launch CI to address SDOH, which are by nature multi-sector, should include robust communication support for local teams. The use of community-administered surveys to identify gaps in SDOH resource access contributed to ownership and collective efficacy that may portend sustainability; however, relying on volunteers threatens sustainability.

Brother, We Got You: A collective impact approach to addressing Black college men's mental health

“…Practitioners have applied the collective impact framework to advancing student success in educational settings and positive social determinants of health among various populations (McCrae & Spain, 2022, 2023Soto, 2017). To support the success of these efforts, having a solid backbone organization to facilitate the work by planning and managing the coordinated plan of action was critical (Kania & Kramer, 2011).…”