18.2 Partnerships and Coalitions in Program Planning

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).

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.

Figure 18.5 A community health nurse partners with local organizations, such as WIC, to provide education to expecting and new parents during a health fair. (credit: FNS Midwest/Flickr, Public Domain)

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.

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).

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?

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.