A mixed methods analysis of community capacity to address health equity in the rural Southern U.S.

Background: Multisectoral community coalitions have the potential to mobilize change toward health equity. The Two Georgias Initiative supported multisectoral community coalitions with a major goal of building community capacity to address health equity in 11 rural counties in the state of Georgia.

Methods: A cross-site, mixed methods evaluation assessed changes in community capacity over the course of the five-year initiative. Coalition member surveys at two points in time, four rounds of key informant interviews, and document review informed various dimensions of community capacity, operationalized as resident participation, leadership development, skills gained, network expansion, resource mobilization, critical reflection, and redistribution of community power.

Results: Resident participation (i.e., coalition membership, community assessment, programmatic activities), leadership opportunities (i.e., coalition positions, collecting data, leading implementation, volunteering), skill gains (i.e., understanding health equity and root causes, having difficult conversations about race and class), and strengthened partnerships (i.e., for sharing information, coordinating services, and joint projects) were the most widespread capacity outcomes across the coalitions. Resource mobilization varied by coalition, with significant external funding leveraged by several. As an indicator of critical reflection on health equity, coalitions used quantitative data to identify gaps/inequities, conducted focus groups with members of priority populations, attempted to give everyone a voice, made concerted efforts to reach underserved, disadvantaged and other groups, and took services directly to those in need. Actions to address root causes of inequities within counties were less common as were shifts in community power toward health equity, although several notable examples were shared.

Conclusions: Community coalitions are an effective mechanism for strengthening selected dimensions of community capacity for health equity in rural communities. Deeper engagement of those most affected by health inequities and actions toward addressing structural and policy drivers of these inequities may require the active centering of health equity from project inception. Clarity of purpose (i.e., racial/income inequities or rural/urban inequities), technical support for community empowerment, regional networking for policy change, and longer-timeframes may also be beneficial.