Inter-organizational networks in rural smoke-free policy development over time

A wide variety of organizations are involved in promoting smoke-free policies in rural communities. Few studies have examined the structure of the existing systems to improve coordination among these groups. Network analysis was used to assess inter-organizational partnerships related to smoke-free policy development over time in 40 rural Kentucky communities. The study was part of a five-year RCT to test the effects of a tailored, stage-based intervention on community readiness and policy outcomes. A network of 40 community coalitions (22 treatment; 18 control) and 29 individual and organizational partners were assessed through annual key informant telephone interviews over 5 years, 2007-2011. Partnership ties, support ties, and resource sharing ties were examined at two levels: internal community ties to local organizations and external links to state-level agencies. Network density and degree centrality were assessed. Density scores were higher over time for partnership contacts in treatment but not control networks. An increase in average degree centrality was observed in both the treatment and the control group over time. Lead agencies within the networks were identified (e.g., locally, Health Departments and ASAP boards were consistently central; while physicians, faith-based and business organizations played an increasingly central role over time). The intervention may have been effective in strengthening inter-organizational tobacco control networks in rural communities. These findings provide a base for future research that could include structural evaluation of rural tobacco control networks and evidence-based recommendations for developing effective relationships. Longitudinal network analysis can be useful in developing process indicators for rural policy change.