Assessing Collective Impact in a Community Health Worker Initiative: A Local Health Department’s Multilevel Approach to Collaboration

Abstract

BACKGROUND: Collective Impact has become a powerful tool for organizing cross-sector collaboration around a complex issue. Cross-sector collaboratives, like Mecklenburg County Public Health’s Community Health Worker Initiative (CHWI) Network require multilevel collaboration and coordination across multiple sectors and stakeholders to achieve its shared goals. Limited evidence supports the application, development, and implementation of Collective Impact within localized settings, particularly in local health department (LHD)- led initiatives. This study aimed to evaluate the CHWI’s Network in Mecklenburg County by assessing its composition, collaborative nature, and intermediate outcomes. METHODS: A concurrent embedded mixed methods design was used in primary data collection via surveys and key informant interviews to identify the stakeholders and organizations that participate in the network, current, and future perceptions of collaboration success within the network, participant’s commitment, and collaborative efforts that took place within the CHWI Network between 2021-2025. RESULTS: Of the 80 participants, the majority were women (82.5%) and less than half were between the ages of 35-54 years (47.5%). About half of them had a graduate/professional degree (47.5%), were Black/African American (52.5%), and identified as a CHW (46.3%). Overall, CHWI network participants perceived themselves as collaborative. Specifically, the study found network participants’ race/ethnicity identity (p<.05) and service area (p<.01) to be associated with perceived effective collaboration in the multivariate analysis. Gender was also found to be associated with perceived collaboration success (p<.05), while race/ethnicity identity was found to be associated with perceived change efficacy (p<.05). Moreover, network participants were found to be working towards shared goals as outlined in Cultivating Community Change Together. These shared goals reflect Collective Impact’s utility and ability to strengthen collaboration between community health workers (CHWs), organizational leaders, and other community partners in Mecklenburg County. It also underscores LHDs influence when seeking to improve relationships and outcomes in a localized setting. CONCLUSION: This study demonstrated the effectiveness of the CHWI’s collective impact approach to influence collaboration and coordination through five study aims. Aims 1-4 revealed perceived change efficacy, perceived collaboration success, perceived change commitment and perceived effective collaboration to be associated with various covariates in the quantitative analysis. While, Aim 5 revealed perceived change commitment, perceived change efficacy, self-efficacy, and eight behavioral outcomes as noted perceptions and actions demonstrated by CHWI network participants in the qualitative analysis. Community health worker initiatives benefit from Collective Impact implementation through its ability to organize, plan, and coordinate activities among CHWs, organizational leaders, and other community partners. This study confirms that LHD leadership is prominent for promoting health equity through innovative models that foster collaboration and social transformation in diverse communities.