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Mobilizing community-driven health promotion through community granting programs: a rapid systematic review

BMC Public Health volume 24, Article number: 932 (2024) Cite this article

Abstract

Background

Effective health promotion responds to the unique needs of communities. Community granting programs that fund community-driven health promotion initiatives are a potential mechanism to meet those unique needs. While numerous community health-focused programs are available, the various strategies used by granting programs to foster engagement, administer grants and support awardees have not been systematically evaluated. This rapid systematic review explores the administration of community granting programs and how various program components impact process and population health outcomes.

Methods

A systematic search was conducted across three databases: Medline, SocINDEX, and Political Science Database. Single reviewers completed screening, consistent with a rapid review protocol. Studies describing or evaluating community granting programs for health or public health initiatives were included. Data regarding program characteristics were extracted and studies were evaluated for quality. A convergent integrated approach was used to analyze quantitative and qualitative findings.

Results

Thirty-five community granting programs, described in 36 studies, were included. Most were descriptive reports or qualitative studies conducted in the USA. Program support for grant awardees included technical assistance, workshops and training, program websites, and networking facilitation. While most programs reported on process outcomes, few reported on community or health outcomes; such outcomes were positive when reported. Programs reported that many funded projects were likely sustainable beyond program funding, due to the development of awardee skills, new partnerships, and securing additional funding. From the perspectives of program staff and awardees, facilitators included the technical assistance and workshops provided by the programs, networking amongst awardees, and the involvement of community members. Barriers included short timelines to develop proposals and allocate funds.

Conclusions

This review provides a comprehensive overview of health-related community granting programs. Grant awardees benefit from technical assistance, workshops, and networking with other awardees. Project sustainability is enhanced by the development of new community partnerships and grant-writing training for awardees. Community granting programs can be a valuable strategy to drive community health, with several key elements that enhance community mobilization.

Registration

PROSPERO #CRD42023399364.

Peer Review reports

Background

Communities have unique health needs and priorities determined by, among other factors, population characteristics, built environments and social determinants of health [1, 2]. Public health is tasked with assessing the needs of the communities they serve and implementing programs, services, and policies that align with community priorities to prevent injury, illness, and premature death [3,4,5,6]. Understanding community context is a cornerstone of the evidence-informed approach to public health practice, where evidence from research and practice are integrated in decision-making [7, 8]. Health promotion is a critical function of public health and includes implementing interventions that enable individuals and communities to improve their health. For example, such programs can support healthy nutrition, physical activity, and mental wellness [9]. However, it can be challenging for public health to meet distinct health promotion needs of communities within the populations they serve; what works in one community may not be as effective in another [7, 10].

It has been suggested that the effectiveness of health promotion efforts may be improved by community-informed approaches that build on particular strengths and respond to needs of the community [11]. Community involvement in developing health promotion initiatives empowers community in driving their own health outcomes [12]. Where health behaviour changes require multiple and persistent influences to support sustained changes, community engagement can drive these influences [13]. While public health often engages community members in consultation for program and service development, community-driven initiatives are those that have been developed by the community, for the community [14]. While community-driven approaches have also been conceptualized as community-based health promotion, community-led programs, or community-based participatory research, the common thread is that change is initiated and driven by community members, rather than by government or academic bodies [14,15,16,17]. A recent systematic review of community-driven health promotion and disease prevention initiatives found promising results for urban community-driven interventions in improving health outcomes [17]. Another systematic review of community participation in health services demonstrated positive outcomes at community and individual levels [11]. Impacts were greatest for non-communicable disease health outcomes, such as physical activity and quality of life, which align well with health promotion activities [11]. For populations made vulnerable through structural inequities, a meta-analysis of public health interventions for a broad range of health topics found that community engagement was associated with significant effects for health behaviour outcomes, health behaviour self-efficacy and perceived social support [18].

Fostering community action by providing funding for community-driven health promotion initiatives is a potential mechanism to address unique local health needs [11, 19, 20]. There are numerous community health-focused granting programs available at local, regional, and national levels in Canada and beyond. For example, municipalities and regions offer grants to fund community-led projects that promote health and well-being [21, 22]. Many provinces and territories in Canada fund health, recreation, and culturally-focused community building grants [23,24,25]. There are also community health granting programs available through non-profit and for-profit organizations, as well as the federal government, for community-driven health initiatives. [26,27,28,29,30,31,32]. Community granting programs typically administer a pool of funds available to community-based organizations to implement projects. Often, grant applications from community-based organizations propose projects within a scope defined by the granting organization. The community granting program sometimes provides support to awardees, such as training to develop relevant skills and technical assistance consultations from program staff to support planning, implementation, or evaluation of projects. There are no set standards for administering a health promotion grant program. Examples of community granting programs in the literature vary in terms of application and reporting requirements, the supports available to applicants and awardees, and the reporting of program-level and project-level outcomes.

Community granting programs are well-suited for health promotion projects, as both focus on strengthening community action [4]. Small community grants for health promotion have been found to stimulate innovations and engage new community organizations [15]. While community grants for health promotion are prevalent in Canada and worldwide, there has not yet been a systematic review exploring how different components of granting programs affect their success. This paper takes a rapid systematic review approach to address this gap, in order to inform the development of a community granting program in a Canadian province within a discrete timeline. Rapid reviews allow for the production of evidence syntheses within a shorter timeframe, allowing for timely access to synthesized evidence [33]. While there are methodological limitations to a rapid approach to reviews, various efforts can minimize these limitations [34]. This rapid systematic review explores: 1. how community granting programs have been administered, and 2. which components are associated with success, both in terms of process outcomes and achieving population health outcomes. Specifically, this review includes papers that describe or evaluate the granting programs themselves, rather than the projects that they funded. This review will inform the design and implementation of health-focused community granting programs that mobilize community-based organizations in addressing the unique health needs of their communities.

Methods

Study design

This review was completed by the National Collaborating Centre for Methods and Tools’ Rapid Evidence Service [35, 36]. The review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews and meta-analyses [37]. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; Registration CRD42023399364).

Information sources and search strategy

A health librarian supported search strategy development and conducted the search on March 16, 2023. The following three databases were searched from inception: Medline, SocINDEX, and Political Science Database. Databases were searched using combinations of terms related to “grant”, “subsidy”, “endowment”, “financing” and “community”. The full search strategy is included in Appendix 1.

DistillerSR software was used to screen articles. Two reviewers screened a subset of 100 articles at the title and abstract level, achieving over 90% agreement. A single reviewer screened the remaining titles and abstracts of retrieved studies. A second reviewer screened full texts of included studies. Duplicate screening was not used for the entire reference set, consistent with a rapid review protocol [36].

Eligibility criteria

English-language primary studies with either experimental or observational designs were eligible for inclusion. Syntheses, such as literature and systematic reviews, were excluded. Eligibility criteria are reported in accordance with a PICOS (Population, Intervention, Comparator, Outcomes, Setting) question framework [38].

Population

Studies of granting programs available to communities and non-profit community groups were included. Communities were broadly defined as social groups that have a common trait, such as their location of residence, culture or faith, or institution (such as a school or workplace). Community groups eligible for grants included youth-serving organizations, non-government organizations, business communities or municipalities. Grant programs for professional groups, consumers, labour unions, researchers or research consortia were excluded.

Intervention

Community granting programs for projects related to health or public health topic areas were included, such as health promotion, the structural determinants of health or environmental health. Studies of programs with total annual budgets of greater than $500 000 CAD were excluded to allow application of this review’s findings to the development of a smaller-scale community granting program. Crowd funding initiatives were excluded.

Granting programs linked to research funding were included when the project funding was awarded to paired researchers and community partners to implement community-driven participatory research projects. For inclusion in this review, project proposals must have been developed in partnership with community-based organizations or individuals.

Comparator

Given the nature of the intervention, studies were not required to have included a comparator for inclusion. Qualitative studies and descriptive case reports were eligible for inclusion in this review.

Outcomes

Outcomes that were measured either qualitatively or quantitatively were included. Quantitative outcomes included the number and types of projects proposed or implemented, as well as community-level or population-level outcomes. Given the expected heterogeneity in study designs and reported outcomes, any type of community or population-level outcomes were eligible for this review. This includes health behaviour outcomes, e.g., reports of physical activity or diet; population levels of health-related screening, e.g., for cancer or sexually transmitted infections; changes to the built environment, e.g., development of green space; or reports of community knowledge, e.g., for health-related topics. Qualitative findings on lessons learned, facilitators and barriers for community granting programs were included.

Setting

Studies conducted in low- and middle-income countries were excluded to allow application of this review’s findings to the development of a community granting program in Canada, [39].

Quality Assessment

The Joanna Briggs Institute (JBI) suite of critical appraisal tools was used to evaluate the quality of included studies [40]. Single-group pre-post studies were assessed using the JBI Checklist for Quasi-Experimental Studies. Qualitative and cross-sectional studies were assessed using their corresponding JBI checklists. Studies were rated low, moderate, or high quality according to critical appraisal results. Two reviewers completed quality assessment independently and conflicts were resolved through discussion. Descriptive studies provided an overview of a granting program or its implementation, reporting on some outcomes and the authors’ reflections on the program. Since these studies did not conduct a formal analysis or program evaluation they were not appraised for methodological quality.

Data extraction

Data extraction was completed by a single reviewer and verified by a second reviewer. Data on the study design, location, grant size, granting organization, eligible projects and recipients, program components, and outcomes were extracted when reported.

Data analysis

A convergent integrated approach was used to synthesize quantitative and qualitative data simultaneously [41]. Common granting program elements were extracted and summarized, including grant application processes, application review and selection processes, reporting requirements, technical assistance provided by the granting program, and project sustainability. Qualitative findings were reviewed for commonalities and differences. Concepts were grouped and summarized by common themes [42].

Due to the heterogeneity in study outcomes and descriptive nature of many included studies, the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) [43] approach was not applied to the findings of this review.

Results

A total of 6611 records were retrieved after database searching. Following the removal of duplicates, 6497 records were screened by title and abstract, of which 6259 were assessed as not relevant. The remaining 238 reports were reviewed at the full text level, of which 36 articles were included. A PRISMA flow chart illustrating the article search and selection process is included in Fig. 1. While the reason for study exclusion at the full text level was not recorded for all studies, consistent with a rapid review methodology, there were 22 studies of community grant programs that were excluded because the total funding pool of the program was greater than $500 000 CAD. Other studies were excluded because they focused on an evaluation of funded projects, rather than the granting program, or because they focused on community initiatives that were not funded by a granting program.

Fig. 1
figure 1

PRISMA 2020 Flow chart

Full size image

Study Characteristics

There were two included articles that explored the same community granting program during separate time periods [44]. The description of the program and findings from these studies have been merged and considered as a single study for the purposes of this review. Nineteen studies that provided a descriptive overview of a granting program and its implementation, without a formal analysis or program evaluation, were labelled as descriptive studies and not appraised for quality. The overall characteristics of included studies are summarized in Table 1.

Table 1 Included studies of community granting programs
Full size table

Approximately one-third of included studies were qualitative in design, (n = 13, 37%), and explored program implementation from the perspectives of program staff and/or awardees through interviews or open-ended survey questions [44, 45, 53, 56, 58, 59, 64, 66, 68, 69, 71, 73, 75]. Qualitative analyses of responses identified facilitators, barriers and lessons learned in program implementation. One article used a mixed methods design [69]; however, only the quantitative portion of the study was not relevant to this review and therefore the study was analysed and appraised as a qualitative study. Of the qualitative studies, four were rated as high quality [45, 59, 64, 75], eight as moderate quality [44, 53, 56, 58, 66, 68, 71, 73], and one as low quality [69]. Quality assessments are included in Supplemental Table A2c.

There were also three studies that used a quantitative design. Two were two single-group pre-post evaluations [62, 79] of which one was rated high quality [62] and the other was rated low quality [79], as shown in Supplemental Table A2a. The other study was cross-sectional and rated low quality [57], see Supplemental Table A2b for the detailed quality assessment.

Program Characteristics

Most of the 35 programs were based in the USA (n = 31, 89%), while the remaining programs were based in Canada [44], Australia [51], Ireland [58], and the Netherlands [68]. In terms of scope, two programs were available to community groups nationally, [44, 71], while two-thirds of programs, n = 23 (66%) were offered across one or several states [45, 46, 48, 49, 51, 52, 54,55,56,57, 59,60,61,62,63, 65, 69, 72, 74,75,76, 78, 79], and ten (29%) were available within local communities [47, 50, 53, 58, 64, 66, 68, 70, 73, 77].

In describing program development, approximately half (n = 19, 54%) of community granting programs cited one or more models or frameworks. There was little consistency, with 15 different frameworks cited across 19 programs. Three programs developed original frameworks or adapted frameworks to their contexts [48, 54, 64]. The Socioecological Model [80] was cited by four programs [50,51,52, 74] and the Community-Based Participatory Research model [81] was cited twice [47, 53]. Of the 19 community granting programs that cited a framework or model, 12 reported positive health, community or social outcomes and 11 reported on outcomes related to sustainability, such as securing additional funds, strengthened applications for additional funds, and partnerships (Table 1).

Ten (29%) programs were developed in partnership with academic or research institutions, offering grant funding for community participatory research projects [46, 47, 53, 60, 61, 64, 65, 72, 73, 76]. Community projects funded by these programs were similar to other community granting programs but required ethics review and additional evaluation for research outcomes.

Programs reported grant size differently, where some reported total funding pool amount, the amount available for individual grants, or both. The smallest total funding pool was reported as $10 000 USD (approximately $13 000 CAD). This review excluded community granting programs with funding pools over $500 000 CAD. Individual grant size varied considerably, with awards as small as €200 (approximately $300 CAD) and as large as $25 000 USD (approximately $34 000 CAD).

Project eligibility

Program Focus

Community granting programs were designed to address broad or narrow scopes of community health priorities. Approximately two-thirds of programs (n = 24, 69%) focused on a specific public health topic area, including physical activity and nutrition [44, 45, 51, 59, 68, 74, 77], cancer prevention [49, 60, 63, 73, 75, 76, 78], environmental health [50, 57, 66, 70], HIV prevention [62, 79], breastfeeding [52], diabetes education and prevention [54], mental health, trauma, safety and violence [55] and the built environment [69]. The remaining 11 (31%) programs were broader in their focus, and accepted proposals for any aspect of community health.

Evidence-based Proposals

Some community granting programs required that project proposals were based on evidence (n = 7, 20%). Granting programs implemented this requirement in different ways, defining evidence as either data for community needs or research-based interventions. Two programs required proposals to address priority needs for their communities, based on community-level data [47, 50]. The Community Health Innovation Awards used a community survey to identify priority concerns and accepted project proposals that addressed these concerns [47]. The Environmental Public Health Tracking Network program shared community data through an online portal to inform project proposals [50]. Five programs required that project proposals were based on research evidence and referred applicants to databases of evidence-based interventions [45, 60, 63, 75, 78]. Health promotion community granting programs referred applicants to the Community Preventive Services Task Force’s Community Guide to Preventive Services Creating or Improving Places for Physical Activity, the Centers for Disease Control and Prevention’s Recommended Community Strategies and Measurements to Prevent Obesity in the United States. Cancer prevention community granting programs referred applicants to the National Cancer Institute’s Cancer Control P.L.A.N.E.T. website and Research Tested Intervention Programs database. Of the seven community granting programs that required evidence-based project proposals, four reported positive health or community outcomes.

Eligible Community Groups

Community granting programs offered grants to various types of community groups. These include non-profit organizations, neighbourhood associations, community health centres, educational institutions, student organizations, faith-based organizations, state, local, or county public health departments, and other nongovernmental agencies.

Grant Program Administration

Dissemination

Community granting programs used various methods to disseminate information about available grant opportunities. Calls for applications were shared both digitally (through listservs, granting program websites and partner websites) and physically (with paper brochures and posters).

Application requirements

Application requirements varied across community granting programs. Common application elements included a statement of purpose, description of the project or project work plan, statement of community need, the potential impact or description of how the project addresses community needs, the team’s experience and capacity to implement the project, list of partners and their roles, anticipated health outcomes, timeline, evaluation plan, and a budget with justification.

Application review

Several (n = 4, 11%) community granting programs required that applicants submit a letter of intent prior to submission of a full proposal [46, 47, 69, 70]. Less than a third (n = 10, 29%) of programs used a formal rubric to rate applications. The 9-point National Institutes of Health scoring scale [65] was used by three programs, of which two programs modified the scale to meet their needs [46, 76]. One program invited applicants for interviews with the selection committee [69], while another program required a presentation by applications to the selection committee [47]. The application review process was not described by the remaining programs.

For most programs, selection committees consisted of program leadership or staff. For community-research partnership programs, both community and research representatives reviewed applications and informed selection. Two programs involved community members in the application review process [55, 64]. To encourage nonfunded applicants to reapply, three programs provided feedback on non-funded applications [61, 65, 78].

Reporting requirements

Twenty-seven studies described reporting requirements for funded projects (75%), which typically included mid-project and final budget updates and reports on progress toward project goals. Mid-project updates often provided opportunity for awardees to share concerns and obtain additional support from program staff. Three community granting programs concluded their programs by convening all awardees at an event to present their completed community projects [46, 63, 66].

Program components

Technical Assistance

Most commonly, programs provided technical assistance to applicants or awardees (n = 25, 71%). Program staff provided technical assistance to address various needs and challenges, including application development, program planning and implementation, or evaluation. Technical assistance was provided to interested applicants to support application development by 14 (40%) programs. This includes seven programs that held virtual or in-person information sessions [61, 63, 70, 72, 73, 76, 78] and seven programs that made program staff available to provide support on an ad hoc basis [47, 51, 60, 65, 66, 75, 77]. For awardees, technical assistance supported all stages of project planning, implementation, and evaluation. Program staff provided assistance through regularly scheduled meetings [52, 60, 69], on an ad hoc basis [51, 53, 62, 63, 65, 75, 78], or both [48, 59, 66]. Four programs noted that technical assistance was provided to awardees, but do not provide additional details [55, 57, 71, 74]. Program staff for four programs visited project sites to conduct on-site consultations [52, 54, 62, 66]. Finally, one granting program described matching dedicated program staff to funded projects to provide continuous support [50].

Workshops and training

Workshops or training was made available to interested applicants or grant awardees by most community granting programs (n = 22, 60%). Studies noted that workshops often provided opportunities for program staff and awardees to connect, and for awardees to network and share learning. Workshops focused on topics to support application development and project implementation, including project planning [54, 62, 69], implementation [60, 62, 66, 70], evaluation [48, 53, 54, 62, 66], dissemination [53], partnership development [53, 72], community engagement [61, 77], and budget development [66]. Two programs that required proposals based on research evidence provided workshops on finding, selecting and adapting evidence-based interventions [60, 75], including a workshop based on the National Cancer Institute’s “Using what works” curriculum [75]. Several programs provided workshop sessions focused on social action, including anti-racism and diversity [48, 56], and policy and advocacy [55, 64, 69]. To enhance the long-term sustainability of funded projects, some programs offered sustainability-focused training [60, 69] or workshops to develop grant writing skills in order to support securing additional funding [47, 56, 69]. In response to the diverse needs and strengths of awardees, community granting programs also offered workshops to develop soft skills, such as participating in meetings, serving on boards of directors, leadership, innovative thinking and idea development [47, 56, 69]. Community granting programs that funded community-based participatory research through community-research partnerships also provided workshops on the principles of participatory research and research ethics [53, 72].

Websites

Of the 35 programs, only 6 (17%) described a program website to support the community granting program as an online hub to facilitate administration, a collection of digital resources to support applicants and awardees, or both. The website for the Women's Active Living Kits Community Grant Scheme included program details, profiles and updates of funded projects, and a discussion board for applicants and awardees [51]. The Community Access to Child Health Program website was used to collect applications and project reports [71]. The Teen Challenge program website provided awardees with support for community engagement, including guidance on engaging adolescents, infographics, and posters [44]. To support the development of evidence-based proposals, the Appalachia Community Cancer Network program website included links to sources of evidence-based interventions [75]. The Community Empowerment Center Funded Mini Grant Project website was not described in detail [70].

Networking facilitation

Program staff were tasked with facilitating connections between grant awardees with similar projects for two community granting programs [50, 76]. Four (11%) programs sought to connect awardees and community partners to leverage existing partnerships within the community [59, 66, 69, 78].

Outcomes

Outcomes were mostly reported in terms of the granting program, e.g., the number of proposals received and the number of projects funded. However, there were several examples of community impact, health-related outcomes, and outcomes related to sustainability reported.

Community outcomes

Overall, positive impacts on the community were reported by community granting programs in qualitative and case report studies. Social cohesion and enhanced community engagement in health-promoting activities were specifically noted [45, 63]. Reports indicated that priority community groups were engaged by community-led projects [51] and that granting programs strengthened their connections with the communities they serve [50, 52, 63, 64, 77].

Most studies did not report on health-related outcomes or specify whether health outcomes were measured in funded projects. For studies that did report on health outcomes, the validity and reliability of measures was not reported. The two studies that reported on health-related outcomes measured environmental health outcomes, and knowledge of health-related topics and of intention to engage in healthy behaviours. This includes the study of the Environmental Public Health Tracking Network granting program, which reported the addition of cooling centres during extreme heat and additional testing of well water during extreme flooding [50]. As well, the study of the Somos Fuertes: Strong Women Making Healthy Choices program reported increased participant knowledge and planned safe behaviours for HIV prevention [79].

Other outcomes reported by studies included beneficial skills for awardees, including project planning and implementation and securing grant funds [46, 56,57,58]. Programs also reported that awardees developed valuable partnerships to support longer-term goals [46, 49, 52, 53, 60, 64, 66, 71, 77].

Sustainability

Project sustainability was typically evaluated at program completion, rather than after a longer term, so most findings reflect the potential sustainability of projects. Only the Community Access to Child Health Program followed up with awardees in the years following project completion and contacted awardees after two years [71].

Several programs (n = 6, 17%) noted that awardees were successful in securing additional funding to continue or expand their projects [45, 53, 55, 61, 66, 76]. In addition, awardees with two community granting programs were reported to have submitted applications for additional funding, but it was not noted if these applications had been successful [74, 78]. Awardees from another program noted that the preliminary data gathered during the project was used to strengthen subsequent funding applications [46], although awardees from a different program felt that the short funding period did not provide enough time to collect enough data to support applications [57]. Finally, one community granting program reported that a project was able to use funds to establish a community project that was then funded in the long-term with ongoing participation fees [68].

In addition to reports of additional funding, awardees also reported that through project implementation and participation in workshops provided by the community granting program, they gained valuable and transferable skills for new projects [56, 62]. Partnerships were also noted as a key indicator of project sustainability, reported by eight (23%) of the community granting programs. These partnerships were expected to support projects in the long term and to help generate new community projects [46, 52, 53, 60, 64, 66, 71, 77].

Programs that funded projects that changed the built environment (for example, through the construction or improvement of trails or parks, or projects that purchased equipment for the community) were noted to have inherently longer-term impact as these changes continued to be available after project completion.

Facilitators and barriers

Facilitators

Due to the heterogeneity in reported study outcomes, it was not possible to determine if there were any granting program components with greater contribution to overall program success. Rather, community granting programs reported on facilitators more broadly as they related to various program components and overall implementation. These facilitators were identified by both program staff and grant awardees. For program components, the factors most often cited for project success were the technical assistance and workshops provided by the community granting program [45, 50, 52, 53, 56, 59, 66, 71, 75, 78]. In additional, two programs noted that soliciting ongoing feedback from awardees was critical to informing the technical assistance and workshops offered [62, 72]. Networking amongst awardees often occurred at workshops and was cited as a valuable resource for knowledge sharing [52, 53, 66, 69, 70]. Workshops were also described as an opportunity to build trust between program staff and awardees [78]. For granting programs that hosted a program website, the website was described as a valuable asset that facilitated applications and connections, both amongst awardees and between awardees and program organizers [51].

Engaging the community and responding to community needs were also noted to impact project success. One community granting program emphasized community involvement at all stages of project planning, to ensure projects meet community needs [55]. Another granting program noted that inviting community members to join a program advisory panel helped facilitate engagement with community groups that may have otherwise been difficult to reach [68].

Barriers

Program staff and awardees also identified barriers that hindered program administration and project success. Most commonly, timelines were cited as a challenge. Applicants noted that the time between the program’s call for application and its subsequent deadline was not sufficient to complete application requirements [49, 52, 61, 64]. Other awardees noted that the funding period was insufficient to spend the full amount of awarded funds [45, 78].

Application requirements were also reported as a barrier, noting that requirement may not align with the language and education of potential applicants [73]. Awardees from a program that required projects to follow evidence-based interventions noted that interventions available in the research literature did not fit their community’s needs and required significant changes, raising doubts as to their effectiveness [75].

Discussion

The findings of this review explore many examples of community-driven health or public health projects funded through community granting programs. Findings characterize the scope of projects, grant administration, and outcomes. Evidence for the relative success of programs is less clear, due to the heterogeneity of study outcomes and small number of programs that evaluated the health outcomes of funded projects, but qualitative data does provide evidence for key program components.

Nearly half of included studies report using an existing framework or model to guide community granting program development and implementation. There were examples of programs that used a framework or model reporting positive community and sustainability outcomes. The use of a framework or model may help guide the development of a granting program or community initiative and improve community mobilization and sustainability. Implementation science research supports the value of using frameworks and models in developing and implementing programs [82, 83]. Lack of theoretical guidance for design, implementation and evaluation of public health initiatives may contribute to a lack of sustainability of the funded community initiatives [84]. In this review, the most frequently cited framework or model was the Socioecological Model [80], cited by four granting programs. This model considers the interaction of four levels to impact health: individual, relationship, community and societal, reinforcing the critical role of social and structural determinants of health [85]. A socioecological approach is well-suited to designing strategies for community health improvement, as it provides a systems-oriented perspective to addressing unique health challenges of the community [16].

Using an evidence-informed approach to planning funded projects can help improve community health outcomes. Evidence used to inform projects should include data from the community as well as from the best available research literature [7]. In this review, only seven programs required that project proposals were informed by evidence. Two focused on community evidence, where community data was used to establish need, and five focused on published research evidence for effective interventions. These programs demonstrated an association between requiring an evidence-informed proposal and reporting positive health and community outcomes. There were several different sources of evidence used by programs in included studies, such as the Community Preventive Services Task Force’s Community Guide to Preventive Services Creating or Improving Places for Physical Activity and the National Cancer Institute’s Research Tested Intervention Programs database. Finding, using and applying evidence is inherently challenging for inexperienced community members, but community granting programs can help overcome this challenge by providing training and/or technical assistance and connecting applicants with pre-appraised, synthesized, and translated evidence. There are other sources of trustworthy evidence for interventions, such as the Health Evidence™ database [86], Health Systems Evidence [87], the World Health Organization’s guidelines [88], or the What Works for Health database [89].

There were several key components for community mobilization through community granting programs, including technical assistance and training, networking opportunities within the program, and skill-building for subsequent grant applications to promote sustainability of projects. Technical assistance and training were the most common program components described in studies, and were implemented in various ways, such as regular or ad hoc, and for a variety of topics for program implementation and other skills. Technical assistance and training are both common implementation strategies, shown to build the capacity of individuals to implement an intervention [90]. While most implementation strategies are provided to professionals, it is especially important to provide technical assistance and training to community members who may not have the relevant knowledge and skills to develop and implement a health-focused community project. Networking opportunities between awardees were also considered highly valuable. This aligns with evidence supporting peer-led learning as an effective strategy for adult learning [91,92,93,94].

Barriers to the completion of funded projects included timelines and the brevity of funding periods, noting difficulties in spending the full award in the allowed time. This aligns with the findings of the study that compared two models for community granting programs: one administered through a state health department, and another administered through an academic research organization [15]. This study found that a particular limitation within government-run models were the funding structures, which contributed to inflexible time lines and rigid accounting and reporting requirements [15]. Study authors note that frustrations due to funding negatively impacted the relationships between program staff and awardees [15]. The findings of this review reinforce the need for granting programs to be designed to be flexible to adequately meet the needs of community members and community-based organizations.

Finally, training for grant writing enhanced sustainability. While funding in included studies was time-limited, grant-writing training supported some awardees to secure additional funds. Several programs reported having secured additional funding, and awardees noted the value of training in grant writing for sustainability. Investment in this training can likely have long term effects on awardees’ impact on their communities.

Studies describe projects funded by community granting programs that were designed to meet the needs of populations that experience health inequities within their communities. These include programs designed for minority youth, Latinx communities and low-income populations [48, 52, 55]. Members of the community and community-based organizations are uniquely suited to develop projects that meet the needs of these communities [11]. Community-driven projects mobilize the community in driving their own health outcomes, by responding to needs and building on the strengths of those communities [12]. While only a handful of studies included in this review reported on community-level outcomes, those studies report positive impacts on social cohesion and community engagement in health promotion [45, 51, 63]. The positive impact on communities and numerous examples of engagement of populations subject to inequities reinforces the potential for community granting programs as a tool to empower these communities in reducing inequities.

A limitation of this review is that most of the included studies did not report outcomes on program goals for community mobilization and therefore an analysis of the relative contribution of various program components to community mobilization was limited. Future reporting of community mobilization targets, in addition to program outcomes, will enable a more robust analysis of the effect of community granting program components. Another limitation is that most studies did not report whether funded projects impacted community health outcomes. This is likely due to the challenges of data collection for awardees, who were often members of the community without experience in evaluation for health outcomes. Timelines for data collection were also likely a factor, as it may be difficult to measure health outcomes within a granting term. Future community granting programs may consider providing training for awardees in evaluation, providing additional funding for evaluation activities or evaluation experts, or requiring that awardees collect and report, however, the feasibility and additional administrative burden on awardees must be considered. Conducting this review as a rapid systematic review may increase the risk of bias in the review findings. The review was completed within a rapid timeline to inform the development of a provincial community granting program in Canada. Modifications to the full systematic review approach include using a single screener to determine eligibility of retrieved studies, and not blinding the second review to data extraction and quality assessment completed by the first reviewer. The impact of these modifications on potential bias in the review are likely minimal, given the efforts made to minimize potential bias, which included piloting a subset of references for screening and data extraction prior to completion by a single reviewer.

Conclusion

This review provides a comprehensive overview and synthesis of studies of health-related community granting programs. The use of frameworks to guide program development supports a foundation for program success, by considering the various structural influences on community health. Grant awardees benefit from technical assistance, training, and networking opportunities for shared learning, and the sustainability of projects is enhanced by providing grant-writing support to awardees. Findings reinforce the potential for community granting programs to empower community-driven health promotion and improve community health outcomes. Several key components for granting program implementation were apparent, including guiding frameworks, providing technical assistance and training, networking opportunities for awardees, and skill-building for grant writing. There are fewer examples of community granting programs taking an evidence-informed approach to project selection and planning, but included studies provide insights into implementing evidence requirements for applicants. Overall, community granting programs can be a valuable strategy to drive community health outcomes, with several key elements supporting their success.

Availability of data and materials

All data supporting the findings of this study are available within the paper and its Supplementary Information.

Abbreviations

GRADE:

Grading of Recommendations, Assessment, Development and Evaluations

HIV:

Human immunodeficiency virus

JBI:

Joanna Briggs Institute

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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Acknowledgements

The authors would like to acknowledge the NCCMT’s Rapid Evidence Service, particularly Leah Hagerman and Caitlin Ford, for their contributions to this review. The authors would also like to acknowledge Tracey Zurich for her contributions to the search strategy for this review.

Funding

This project was funded in part by the Canadian Institutes of Health Research (CIHR). The National Collaborating Centre for Methods and Tools is hosted by McMaster University and funded by the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.

The funders had no role in the design of the study, collection, analysis, or interpretation of data or in writing the manuscript.

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  1. National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada

    Emily C. Clark, Trish Burnett, Karlene Stoby & Maureen Dobbins

  2. Department of Health and Wellness, Government of Prince Edward Island, Chief Public Health Office, 16 Fitzroy St, Charlottetown, PE, C1A 7N8, Canada

    Shamara Baidoobonso, Karen A. M. Phillips, Laura Lee Noonan & Jiselle Bakker

  3. School of Nursing, McMaster University, Health Sciences Centre 2J20, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada

    Maureen Dobbins

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Contributions

E.C.C. and M.D. designed the study. S.B., K.P., L.L.N., and K.A.M.P., informed question development. E.C.C., T.B., and K.S. completed screening, quality assessment and data extraction. E.C. and M.D. analyzed study results. E.C.C. and T.B. wrote the manuscript in consultation with M.D. All authors read and approved the final manuscript.

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Clark, E.C., Baidoobonso, S., Phillips, K.A.M. et al. Mobilizing community-driven health promotion through community granting programs: a rapid systematic review. BMC Public Health 24, 932 (2024). https://doi.org/10.1186/s12889-024-18443-8

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