Examining changes in coalition dynamics to support opioid fatality reduction

Abstract

Introduction
The goal was to evaluate how changes in coalition capacity and leadership were related to adoption and reach of overdose education and naloxone distribution (OEND) in communities participating in the HEALing Communities Study (HCS).
Study Design
Multi-site, cluster randomized waitlist-controlled trial; analysis of Wave 1 data only.
Setting/Participants
Longitudinal analysis of cross-sectional surveys completed by coalition members from 33 communities in four states based on data collected from January 2021 to June 2022.
Intervention
Study coalitions (N=33) received the Communities That HEAL (CTH) intervention to support expansion of evidence-based practices, including OEND, to curtail opioid-related fatalities.
Main Outcomes
Coalition capacity and leadership were measured at the midpoint and end of the intervention using validated scales averaged at the community level. Community adoption and reach of OEND were assessed as changes in the rate of community partners implementing OEND strategies and naloxone units distributed from midpoint to the end of the intervention. Negative binomial and linear models, adjusted for baseline characteristics, were conducted in 2024.
Results
Increases in general coalition capacity, adjusted for changes in OEND-specific coalition capacity, were significantly associated with higher rates of community partners engaged in OEND implementation. There was a 56% increase over time in community partners engaged in OEND implementation per unit increase in general capacity scores among coalitions receiving CTH. Changes in coalition leadership and capacity did not significantly correlate with changes in naloxone being distributed.
Conclusion
Strengthening general coalition capacity is vital for increasing community partner engagement to expand adoption of OEND. Findings support ongoing investment in coalition capabilities to enhance the effectiveness of public health interventions seeking to reduce opioid-related fatalities. Efforts to strengthen general capacities of coalitions, such as data-informed decision making and collective goalsetting, may accelerate implementation and scaling of evidence-based practices like OEND.