Navigating the Role of a Backbone Organization in Collective Impact for Cancer Prevention

The Tarrant County Cancer Disparities Coalition (TCCDC) emerged in 2012 with a mission to serve, support and represent the interests of medically underserved, uninsured or underinsured cancer populations. The University of North Texas Health Science Center (UNTHSC) funded the development of the TCCDC through an NIH-designated center of excellence award, under which it committed to collective impact for cancer prevention through a community-based participatory research (CBPR) approach, which seeks to equitably involve all partners in the research process. While UNTHSC has systematically sought to work side-by-side with the community, research has also shown that strong backbone organizations are critical to successful collective impact initiatives. We first discuss the planning and development of the TCCDC through engagement of community-based and institutional representatives, as well as assessment activities including cluster mapping,  community-based dialogue  and secondary data analysis. Secondly, we analyze the role of the UNTHSC as a backbone organization within the context of CBPR, drawing on perspectives of TCCDC members to illustrate negotiation and problem solving within early stages of the coalition’s development. As part of this analysis, we describe how UNTHSC and the TCCDC responded to an outside funding opportunity for two pilot projects by creating specific roles and responsibilities within a loosely defined structure. Finally, we evaluate the increase in community capacity resulting from the first pilot project, a county-wide breast cancer screening event. As part of this evaluation, we administered surveys to TCCDC members following the event to capture growth in network partnerships, knowledge transfer, problem solving and infrastructure.