Contextual factors are the external factors or conditions that exist within the environment that can enhance or inhibit sustainability. These factors permeate the conceptual model at all levels. They can impact the coalition’s enabling characteristics, activities, sustainability actions, sustainability, expansion, and outcomes. Examples of contextual factors are provided below:
A seminal or precipitating event impacts the responsiveness of the community to the coalition’s activities (e.g., community rallies around the coalition’s goal to improve access to dental services because a local child died from complications associated with a tooth abscess)
Policies, laws, and regulations (e.g., reduced Medicare or Medicaid reimbursement rates affect a provider’s ability to provide free services to the uninsured as part of the coalition’s network)
The implementation of a new organization in the community (e.g., a sustained coalition expands its goals because it included a new community partner that brings a new perspective)
The priorities of a funder (e.g., a new funder indicates that resources can only be used for delivering services rather than for core coalition operations)
The contextual factors in the community are also affected by the community coalition’s outcomes. For example, if the community coalition creates a local-level policy change, then the political or economic climate of the community may also change.