Community coalitions are a common implementation strategy for addressing public health challenges, such as the opioid epidemic. There remains a lack of understanding of the factors that support implementation effectiveness for community coalitions. This study leverages the HEALing Communities Study (HCS) which tested the Communities That HEAL (CTH) approach to supporting community coalitions to increase delivery of opioid overdose and naloxone distribution (OEND) and medication for opioid use disorder (MOUD) through facilitation, data-driven decision making, and a communications campaign. Using a parallel convergent, nested serial case study with a positive deviance design, we selected high performing waitlist control communities participating in the HCS for further examination. Performance was defined based on average ranking across a set of implementation measures; the top performing urban and rural community within each of the four HCS sites was then selected for in-depth case study. For selected sites, we conducted thematic analysis of qualitative interviews with coalition members (n = 41) conducted at the end of the implementation phase. Analysis was aligned with the PRISM/ RE-AIM framework. Despite achieving top performance, these communities still faced persistent and varied challenges related to OUD service delivery and access. However, community assets and policy changes provide a foundation for improvement. Implementation success was supported by representative coalition membership, high engagement, and alignment with coalition goals. Coalition members were highly collaborative and shared a vision for their community. Implementation success was also supported by coalition buy-in to the CTH process. Structured data connectivity and sharing facilitated effective strategy selection, while multi-channel communications campaigns increased awareness and uptake of OUD and MOUD services. No differences were observed across urban and rural communities. Implementation success reflects the synergy among external context, coalition strength, and intervention processes. Community coalition–based strategies benefit from ensuring representative membership and shared goals to build buy-in, while also leveraging data infrastructure and communication campaigns to promote effective implementation of EBPs. NCT04111939.
Walker et al. (Sat,) studied this question.