How to Create Change in Community Health, According to Science

A Tufts expert and coalition leader share how community coalitions can more effectively reach their goals and improve child health equity

Community coalitions across the Boston area and the U.S. are working hard to create change, whether that’s by educating communities, providing financial safety nets, or improving public health. And the most effective coalitions may share similar structures and strategies, according to a new study by researchers at the Friedman School of Nutrition Science and Policy at Tufts University published in PLOS Complex Systems

The study is part of a larger project called Catalyzing Communities, initiated by Christina Economos, dean of the Friedman School of Nutrition Science and Policy and a co-author on the new study. Researchers involved in the project work with changemakers and community leaders across Massachusetts with the goal of promoting child health equity. 

Travis Moore, first author of the new study and a postdoctoral researcher at the Friedman School, recently shared some findings of the study as well as additional advice for how coalition leaders can ensure their groups remain effective. Maydee Morales, director of the Resiliency Center at the Worcester Community Action Council, which is involved in the Catalyzing Communities project, also shared her experience building a strong coalition.

Bring Diverse Voices to the Table

One result of the new study was the strongest, most effective coalitions are also the most diverse, Moore said. And while racial and gender diversity are a part of that metric, other types of diversity—like including people working in diverse sectors of society—are also very important. “If you’re working with, for example, people from schools, the nonprofit sector, hospitals, and community-based organizations, that’s more likely to lead to better coalition outcomes than if your coalition was just made up of one of those sectors,” Moore said. Geographic diversity and diversity of lived experience are also important to consider.

Morales agreed and emphasized that supporting engagement from a diverse and representative group of members is key: “Everybody has a voice here,” she said. “We ensure that everybody has a safe space to work together and has what they need in order to participate.”

“Focusing on having all parties at the table from the get-go is best for coalition building,” she said.

Moore recommends increasing diversity by intentionally looking outside of one’s own professional network or seeking participation from people who have lived experience with the issue you’re trying to impact. For example, a coalition that wants to make an impact on a certain disease might involve non-profit organizations that work with that disease, hospitals that serve those suffering from the disease, and people with the disease.

Coalitions should also consider another key finding from the study: that individuals with strong professional networks in their respective fields are often more effective at driving change. By actively seeking and including these well-connected individuals, coalitions can enhance their overall impact.

Decrease Barriers, Especially for Young Women

Moore and his colleagues also found that younger women who are newer to their discipline may face barriers in engaging with coalitions. Addressing that disparity and removing those barriers are key to fostering an effective coalition, Moore said, though more research is needed to identify exactly why this trend exists.

Moore recommends improving incentives for younger women to join coalitions and making sure that outreach efforts are reaching young women. Morales agreed, and also recommends ensuring that men are not undermining women or taking up too much space compared to women in coalition discussions. 

Have a Clear Leadership Structure

Another key finding in the new study was that effective coalitions have clear and hierarchical leadership structures. “What makes these groups especially potent in their ability to increase their knowledge and engagement was having a small number of leaders rather than diffuse leadership across many people,” Moore said.

Having a clear, small, and hierarchical leadership structure increases effectiveness because it helps coalition members know how to focus their efforts. Leadership among too many people can create confusion, obscure the mission of a coalition, and spread everyone’s efforts across too many projects. “There really needs to be consensus about what needs to happen on the ground,” Moore said.

Morales cautions, though, that leaders still need to be oriented toward the needs of their community. “We all have a common goal of helping our community, but we often get into these spaces where our attitude can be, ‘What’s in it for me?’” she said. “That can be challenging.”

One way to foster good leadership practices within a coalition is to ask those in leadership roles to take an organized leadership training course from outside the coalition, Moore said.

Know When Change is Needed

Watch for warning signs within your coalition that signal the need for change. For example, frequent or unresolved interpersonal conflicts may point to a leadership issue.

A decline in coalition engagement is another red flag. If you notice that happening within your own group, consider whether you’re addressing the issues that matter to members and focusing on the most pressing needs within the community, Moore suggests.

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