Developing a Productive Workgroup Within a Community Coalition: Transtheoretical Model Processes, Stages of Change, and Lessons Learned

Background: Addressing complex problems such as health disparities requires collaboration among individuals and agencies. Yet, methods by which productive and cohesive community-based volunteer workgroups are developed and activated to improve health outcomes are often not discussed. Objective: Using the transtheoretical model (TTM) as a framework, we discuss effective processes for developing an action-oriented community-based workgroup committed to producing evidence-based information relevant to health policy. Methods: Workgroup members answered open-ended survey questions and participated in focused coalition-wide discussions to identify factors that facilitated movement of the embedded workgroup from precontemplation to committed action. Frequency and content of e-mail exchanges and workgroup meetings were also considered. Results and Lessons Learned: Activating the group's process of social support or helping relationships was essential throughout the stages of change to promote cohesion and trust. Consciousness raising (awareness), and dramatic relief (emotional arousal) were particularly critical for initial movement from precontemplation to contemplation to preparation. Using group tune to promote member's self-reevaluation (how work is relevant) and self-liberation (commitment) prevented attrition and facilitated effort. As the workgroup enacted planned activities, stimulus control and reinforcement management processes facilitated movement through the action and maintenance stages of change. Conclusions: By attending to both individual and organizational processes of change, we effectively created an action-oriented multidisciplinary workgroup focused on obtaining evidence to guide local and regional health policy decisions and improve health outcomes for under-resourced patients.