Coalitions have been developing rapidly over the past quarter century in various sectors including health with the intention of creating opportunities that will benefit all members of the coalition. More specifically, community coalitions have developed with the intention of achieving a common goal among the members of the community and have become common practice within the realm of health promotion. While coalitions have become a popular means for soliciting health initiatives, it is difficult to measure their effectiveness due to the inherent complexity of coalitions. The community coalition action theory (CCAT) identifies internal factors within the coalition that lead to the implementation of community change, and thereby provides an approach for assessing the efforts of coalitions (Kegler, Rigler & Honeycutt, 2010).
CCAT is comprised of fifteen constructs and twenty-one practice-proven propositions that have developed based on the constructs. The fifteen constructs identified by Butterfoss & Kegler (2009) include stages of development, community context, lead agency or convening group, coalition membership, processes, leadership and staffing, structures, pooled membership and external resources, member engagement, collaborative synergy, assessment and planning, implementation of strategies, community change outcomes, health/social outcomes, and community capacity. The related propositions fall within the constructs and propose such things as the notion that "coalitions are heavily influenced by contextual factors in the community throughout all stages of development" (Proposition 3) and "participation in successful coalitions allows community members and organizations to develop capacity and build social capital" (Proposition 21) (Butterfoss & Kegler, 2009). These propositions summarize what is already commonly and empirically known about how community coalitions can improve health outcomes (Kegler, Rigler & Honeycutt, 2010).
CCAT posits that coalitions develop in stages, with the identified stages being formation, maintenance and institutionalization. During the formation stage, the leading group or agency recruits an initial group of community partners who identify an issue of concern and then develop operating procedures. The maintenance stage involves preserving member involvement, generating group synergy, acquiring resources, and implementation, eventually leading to changes in practice and policy. Within the institutionalization stage, outcomes are produced as a direct result of effective strategies. These strategies can then be adopted by organizations or become part of a long-term coalition. It is important to note that these stages are not linear, but cyclical, which permits revolving back to earlier stages when new issues arise within the coalition (Butterfoss & Kegler, 2009).
While the use of community coalitions has become more prevalent in health promotion settings, and a search of the literature demonstrated a plethora of studies using community coalitions to address obesity, physical activity, cancer and diabetes prevention, the specific utilization of the community coalition action theory is limited. Due to the complex nature of the theory, applications of the CCAT tend to focus on major constructs rather than causal pathways. In 1992, the Centers for Disease Control and Prevention (CDC) demonstrated how community coalition could improve immunization rates for children under the age of two through the Consortium for the Immunization of Norfolk's Children (CINCH) in Norfolk, Virginia. In following the community coalition model, CINCH enabled this diverse community to develop and implement effective strategies and thereby increased childhood immunization rates by 17 percent (Butterfoss, & Kegler, 2009). Kegler and Swan (2011) used data from the California Healthy Cities and Communities (CHCC) program, a coalition comprised of 20 communities, to test selected relationships in both the formation and maintenance stages of coalition development. …