157 - Barriers and Facilitators for Achieving Health Equity in Washington State: Centering Community Coalition Voices through Qualitative Methods

Abstract Information: We present the health equity evaluation of the Community Prevention and Wellness Initiative (CPWI) that is implemented in Washington state to assist high-need communities to prevent youth substance misuse by reducing risk and promoting protective factors. This health equity-focused study was conducted to advance the understanding on what facilitates or hinders health equity work in these underserved and underrepresented communities and help establish a starting point for more granular equity evaluations in the future. Considering the scarcely explored nature of the topic, we applied qualitative methods to collect context specific data. We conducted semi-structured interviews with 16 new and more experienced coalition coordinators that represented urban and rural communities. We adapted team-based qualitative analysis and used Dedoose software 9.0.62 for qualitative coding. This approach helped us to accelerate analysis by capitalizing on teamwork and conducting focused coding. Using thematic analysis, the codes were summarized under four overarching themes. Analysis of interviews indicates that the context of health equity work varies across communities and the context drives the different approaches to achieving health equity. However, community support, strong partnerships, and trusting relationships with community members were identified as facilitators of health equity work. The frequently mentioned barriers included low community readiness and capacity, and insufficient and siloed funding and resources. The results from this study will advance equity in prevention by informing CPWI implementation. More broadly, our work can guide other evaluators engaged in multi-sector collaborative efforts to incorporate a health equity lens for evaluating complex prevention initiatives.

Relevance Statement: Evaluating complex and multi-sector community initiatives through equity lens can be challenging due to lack of context specific information. The contextual variability between communities also adds to the methodological challenges to systematically collect and analyze data in a short timeline. To establish a starting point and gain in-depth and nuanced community perspectives, we selected qualitative methods to collect health equity data from Washington state coalitions implementing Community Prevention and Wellness Initiative (CPWI) which aims at increasing protective factors and decreasing risk factors of substance use among adolescents. As the team had a limited time to collect, analyze the qualitative data and share the findings, we reviewed the literature for rapid qualitative analysis techniques (Hemmler et al., 2022; Vindrola-Padros & Johnson, 2020; Watkins, 2017). We adapted and revised the technique suggested by Hemmler and colleagues (2022) and developed a protocol to guide the data collection and team-based thematic analysis. The rationale for selecting team-based thematic analysis was to accelerate analysis by capitalizing on teamwork and conducting focused coding without compromising on rigor. The developed 10-step protocol describes the data collection, preparation, and analysis details, including creating a codebook, piloting the codebook, and achieving coding consistency through team discussions. We used both inductive and deductive approaches and started with a codebook that was developed based on the familiarity of the team with the data through data collection and by reviewing five transcripts for note taking (first and second authors). Throughout the analysis process, the codebook and coding process were refined by the team members collaboratively and inter-coder consistency were achieved through weekly meetings and discussions (all four authors). We believe the technique we applied for qualitative data collection, coding and analysis contributes to rapid qualitative methods as evaluators face time and resource related challenges to systematically and effectively compile qualitative data and share the findings to inform the funders, communities and other stakeholders. We systematically adapted and applied the methodological knowledge to identify and address the success stories, barriers and lessons learned to promote equity in prevention work in CPWI communities and understand how the communities can be better supported. However, we also acknowledge that the utilization of rapid qualitative technique we propose would require consensus building among the team of the evaluators and needs adaptations to different settings. Another limitation of our technique is that we have not compared our method to more conventional qualitative analysis processes as recommended by Vindrola-Padros and Johnson (2020) and further peer review of our process may reveal other limitations. References Hemmler, V. L., Kenney, A. W., Langley, S. D., Callahan, C. M., Gubbins, E. J., & Holder, S. (2022). Beyond a coefficient: an interactive process for achieving inter-rater consistency in qualitative coding. Qualitative Research, 22(2), 194–219. https://doi.org/10.1177/1468794120976072 Vindrola-Padros, C., & Johnson, G. A. (2020). Rapid techniques in qualitative research: A critical review of the literature. Qualitative health research, 30(10), 1596–1604. https://doi.org/10.1177/1049732320921835 Watkins, D. C. (2017). Rapid and rigorous qualitative data analysis: The “RADaR” technique for applied research. International Journal of Qualitative Methods, 16(1). https://doi.org/10.1177/1609406917712131