Examining Explanatory Inputs and Community System Change Intensity

Abstract

This investigation into behavioral science of community health systems improvement is the result of a concern about the observed discrepancy between what is planned and what is actually accomplished in community. Differences in methods of development and implementation for population-level health improvement programs are affected by collaborative efforts to modify and improve systems. The variability in outcomes may be attributed to the unfolding development of structure of a community coalition or partnership and community system changes completed during project implementation efforts over time. Comparing community system change intensity to implementation efforts across sites can demonstrate effectiveness through replication and predicting the influence of interventions. Supported by Bristol-Myers Squibb Foundation’s Together on Diabetes Initiative, three community-based projects were selected for analyses. Development activities, services provided, and resources generated (i.e., the actions which prepare or enable a collaborative to address goals and objectives, the delivery of information, training, or other valued goods and activities, and the acquisition of funding or resources through grants, donations or gifts in-kind, respectively) served as independent variables. The community system changes – new or modified programs, policies or practices in the community, organization, or system – partnerships completed served as the dependent variable. A multiple case study was applied to show replications across various contexts. Linear regression analyses found significant associations between inputs and system changes for two sites. Projected impact of system changes was determined using established intensity scoring procedures. Data suggests linkages between inputs influenced implemented system changes and intensity values.​