Barriers and facilitators to community-led interventions to improve housing stability: A case study across four communities

Abstract

Objectives

In communities across the U.S., lack of affordable and stable housing is a growing public health problem. Limited practice-based evidence is available to support community-engaged efforts to address housing instability via local-level policy and system changes. Using a case study approach, our evaluation aimed to assess community-engaged approaches to address housing instability; and to identify facilitators and barriers that influence progress towards local-level policy and system-level changes to advance housing stability.

Study design

Mixed methods evaluation approach.

Methods

Four community-based organizations (CBOs) in Colorado were included in the evaluation between 2021 and 2024. CBOs were funded as part of a larger a multi-site evaluation assessing community-engaged efforts to advance health equity through policy- and system-changes in their local community. Data were triangulated across multiple sources including semiannual reporting of core evaluation metrics, quarterly progress reports, and qualitative interviews.

Results

CBOs identified key factors that influenced their efforts to advance housing stability in their community. Embedded historic social inequities emerged as a salient factor that impeded progress towards policy and system-level changes. The triangulated evaluation findings revealed three overarching strategies used by CBOs to advance their work: 1) Community engagement and capacity building proved meaningful tools to CBOs; 2) Strategic partnerships were critical, though organizations in smaller communities had fewer local resources available; 3) Understanding and adapting to local conditions was necessary for organizations to capitalize on social momentum.

Conclusions

While housing instability is a growing public health challenge that will require multilevel solutions, local-level efforts will be important to develop tailored interventions that account for the unique contextual factors contributing to local challenges. Our findings aim to support CBOs working to improve housing stability and provide a model for successful approaches to community-led initiatives, especially for smaller and more remote communities.

What this study adds:

• -Describes challenges and successes experienced by community-based organizations (CBOs) seeking to address housing instability in their community via local-level policy and system changes.
• -Identifies promising strategies that can be used by CBOs to advance community-engaged efforts to address local housing challenges.

Implications for Policy and Practice:

• •Community engagement and capacity building are important tools in addressing housing instability at the community level
• •Strategic partnership between CBOs and their local government officials, other local organizations, and community members is an important tool to utilize when working to address housing instability
• •Tailoring upstream interventions to local community needs and context allows housing work to progress; CBOs should be willing to adapt to shifting societal trends and community defined needs.

1. Introduction

Housing instability - which encompasses difficulties accessing and maintaining affordable, stable, high quality, and safe housing - is an important social determinant of health (SDoH) that plays an influential role in health and disease [1]. Over the past decade, housing instability has become a growing public health challenge across the U.S. More recently, notable increases in housing instability are being reported among smaller and more remote communities [[2], [3], [4]]. For example, one in seven Colorado residents living in rural and smaller communities report housing instability – a rate more than double the state's average [5]. While the unique contextual factors contributing to increasing rates of housing instability – overall and among smaller communities – have been documented, little is known about local community efforts to identify and address this SDoH. Public health practitioners have increasingly recognized the need for community-engaged interventions at the policy and system-level to address housing instability. While several promising interventions have been studied (e.g., Moving to Opportunity), there remains a need to generate practice-based evidence that identifies promising strategies for communities to pursue in an effort to support the development and adoption of policy and system-level changes to improve housing opportunities in their local community [6]. A better understanding of the unique factors contributing to housing stability in diverse settings is needed to support tailoring of intervention strategies to improve housing conditions. Using a case study approach among four communities, our evaluation documents community-engaged approaches to address housing instability and identifies facilitators and barriers that contribute to or deter progress towards local housing-related policy and system-level changes.

2. Methods

The Colorado Department of Public Health and Environment's Health Disparities and Community Grants Program aims to advance health equity through policy and system-level interventions to address a SDoH in their community (e.g., housing instability). This evaluation aims to assess a subset of community-based organizations (CBOs) funded to address local housing issues in their communities (n = 4). Each CBO, supported by community members and their organizational partners, aimed to drive the development and adoption of a policy or system-level change to support housing opportunities in their local community (e.g., changing local housing and land use policies) (see Supplemental Table 1). CBO initiatives were funded for three years (Dec. 2021-Nov. 2024).

2.1. Evaluation approach

This mixed-methods evaluation was designed to 1) assess community-engaged approaches to improve housing stability; and 2) identify factors that contribute to or deter progress towards housing-related policy and system-level changes. Primary CBO activities included 1) establishing and maintaining diverse cross-sector partnerships; 2) engaging and building the capacity of community members; and 3) collectively building community power to develop and advance a policy or system-level intervention to address a local housing issue. The evaluation took place from January 2022 – May 2024. This study was reviewed by Kaiser Permanente Colorado's Institutional Review Board and was deemed Not Human Subject Research.

2.2. Evaluation methods

To address the evaluation objectives, data was collected from CBOs via semi-annual reporting of core evaluation metrics, quarterly review of CBO progress reports, and key informant qualitative interviews. Core evaluation metrics were reported by CBOs every six months through a web-based monitoring system and included documentation of efforts to build community power (e.g., community engagement and capacity building activities; partnership development and structures; and progress along the policy/system change continuum). Quarterly progress reports were reviewed to contextualize CBO-reported activities and supplement quantitative metrics. Four key informant interviews were conducted (one per community). Participants included leaders and team members supporting each CBO's funded initiative (ranging in attendance from 1 to 3 persons). Trained evaluators conducted the interviews virtually using a semi-structured interview guide that included 11 questions across three domains (i.e., housing landscape, intervention approach, and barriers/facilitators to success). Each interview lasted between 30 and 60 min. Interviews were recorded, transcribed, and coded using a deductive qualitative analysis approach to identify overarching themes [[7], [8], [9]]. The themes drawn from each source were then triangulated to validate the findings and allow for a more complete understanding through complementary perspectives. Detailed methods have been previously published [10].

3. Results

CBOs identified key factors that contributed to or deterred progress in the development of the policy or system-level intervention to improve housing stability in their community. Embedded historic social inequities emerged as a salient factor that impeded progress towards policy and system-level changes to improve housing stability in each community. Smaller communities were disproportionately affected by three additional factors. First, CBOs working in smaller communities cited a more pronounced disparity between housing cost and income, putting specific strain on those working in the community like public servants. Second, the rise in remote work during the COVID-19 pandemic uniquely impacted smaller communities as people relocated from cities to more remote areas, displacing residents. Third, smaller communities described a less diverse housing landscape with more large homes and short-term rentals, leaving many residents without appropriate housing options.

To counter these noted barriers, the triangulated evaluation findings revealed three overarching strategies used by CBOs to advance their work. Table 1 describes each strategy and provides representative quotes, supporting data points, and real-world examples of the work.

Table 1.

Triangulated Evaluation Themes. Strategies supporting progress towards community-led policy- and system-level interventions to improve housing stability.

Qualitative Theme	Description	Supporting Data from Core Evaluation Metrics & Progress Reports	Representative Quote from Key Informant Interview
Building community power	Engaging the community and building their capacity to address housing instability can empower community members to bring their experiences to local decision makers and advocate for better housing solutions.	5300 community members engaged and/or received training to support local efforts to improve housing stability. Community members became active partners in the work.	“… [Residents] are getting to see that when they all come together and they discuss the issues that are going on … they see that a lot of the issues are the same. And so then when they have an opportunity to speak up and say something … If they're concerned about [a local problem] they could do it as a group and … it's even more powerful.”
Leverage Strategic Partnerships	Engaging local decision makers. Interfacing between the community and local government for housing advocacy was shared as key strategy. Though some noted difficulties with local leaders being open to receiving and considering community input – involvement of local decision makers was noted as a critical component to progress.	While all CBOs noted the importance of engaging decision makers, only CBOs working in smaller and mid-sized communities reported a formal partnership with their local decision maker(s) to support their work (including non-elected local government employees and elected officials).	“One of our leaders was sworn in to the Zoning and Policy Commission for the city, which is essentially what the goal is, to not just teach them how to speak in front of City Council, but how to be the ones that are actually making the recommendations. And who knows, maybe one of these days will have one of them running for office and it will be amazing.”
	Tailor partnership to local context. Diverse contributions and shared learnings were key contributions of organizational partners. Communities noted that tailoring partnership to their local context contributed to progress.	Partner sectors and roles varied across CBOs – highlighting the importance of tailoring to local context and needs as the work evolves. Compared to CBOs in larger metropolitan areas, partner organizations in small and mid-sized communities were more likely to have a role in providing resources and represented more sectors.	“And I think one thing that we've kind of heard in our conversations with cities and towns is that … they all want to learn from each other, which I think is it's different and it's unique, right. Like it's not a competition necessarily between the cities or towns.”
Capitalize on Social Momentum	Understanding and adapting to local cultural context is essential to housing progress, especially as social influences change over time.	While the effects of the pandemic were devasting, it also served as a catalyst for local efforts to address housing issues. The COVID-19 pandemic increased awareness of housing challenges and built societal motivation to address these issues. Community leaders, organization, and members came together to improve housing stability during this challenging period.	“When you put it into perspective like your teachers, your firemen, your police officers when they can't afford housing, they are not going work here. … [then we] are not going be able to provide those services. … Ironically, COVID taught a lot of people that … we are not really prepared for something like that to happen. … Now we can kind of direct our focus into what's really important and what's causing these [housing] issues.”

3.1. Theme 1: Building community power

Community engagement and capacity building are essential tools for CBOs working to improve housing stability. Across CBOs, interventions prioritized trainings and educational events that aimed to build community capacity to engage in the work. These events aimed to empower community members to share their lived experiences with local decision makers, advocate for better housing practices and options, and support efforts to improve housing stability in their community. CBOs also reported engaging housing stable community members who were often more affluent. These efforts were described as important steps to address challenges of ‘NIMBYism’, overcome resistance to housing-supportive interventions, and build empathy through the sharing of diverse housing experiences and challenges experienced by community residents.

3.2. Theme 2: Leveraging strategic partnerships

Strategic partnership is key to CBO progress toward goals, though available partners vary based on community context.

3.2.1. Engaging local decision makers

Collaboration between the CBOs and local government for housing advocacy was described by all CBOs, though this partnership was especially intertwined and significant for organizations in smaller and more remote communities. While CBOs in larger and urban communities reported resistance from local government, CBOs in smaller and more rural settings described government leaders as more receptive to community member input related to improving housing opportunities.

3.2.2. Tailor partnership to local context

The work done by CBOs in larger communities also functioned within a network of local, similarly motivated organizations, occupying a niche that complemented those of other partners. CBOs in smaller communities reported less access to local resources/supports. As a solution, they described the benefit of collaborating with other smaller communities to leverage resources to address the unique needs of their smaller communities.

3.3. Theme 3: Capitalize on social momentum

Continually adapting to local conditions and social context benefits housing-related work. In addressing housing instability, CBOs highlighted the importance of examining local social factors and considering the relative influence of decision makers within the community when developing policy and system-level initiatives. For example, the COVID-19 pandemic led to an increase in social awareness and momentum to address housing issues. CBOs described their efforts to capitalize on this social momentum to gain support from residents and community leaders in implementing interventions to improve housing stability, allowing for progress toward community housing goals.

4. Discussion

Housing instability is a growing public health challenge that will require multilevel efforts at the federal, state, and local levels to address housing issues. Efforts at the local level are important to help tailor housing interventions to the unique contextual factors that contributed to local challenges and inform strategies to improve housing. CBOs in this evaluation described a variety of barriers to addressing housing instability in their communities, but an overarching theme amongst them was historical structural inequities that continue to prevent progress in building affordable housing and improving housing stability of residents. Community engagement and capacity building were important shared tools in understanding housing challenges and informing promising strategies to address housing instability within each community. Dynamic partnerships were also noted as key factors supporting progress towards policy and system-level changes to support housing stability. Aligning with prior work, this brief report highlights the importance of collaboration between decision makers, community members, and organizational partners, emphasizing the importance of tailoring collaborations to local context [10]. Social trends in the broader community can be influential in the successes or failures of community-based upstream interventions, and CBOs can leverage these shifts to advance their work. Unique challenges to addressing housing instability were noted among smaller and more remote communities. This highlights the importance of this research and future efforts to understand and build community-engaged interventions to address rural housing instability. In conclusion, these preliminary findings can serve as a source of support for CBOs working to improve housing stability and provide a model for successful approaches to community-led initiatives, especially for smaller and mor remote communities. Ongoing evaluation efforts will continue to document emerging strategies and successes of CBOs working to improve housing stability across diverse community landscapes.

Ethical statement

The evaluation was deemed not human subjects research by the Kaiser Permanente Interregional Institutional Review Board.

Funding

Support for the parent evaluation was provided by the Colorado Department of Public Health and Environment's Office of Health Equity as part of their Health Disparities and Community Grant Program (July 2022 - April 2025). This project was completed as part of Ms. Goodman's medical school curriculum as a student scholarly project with guidance from Dr. Morgan Clennin (mentor). Authors have no financial disclosures to report.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Appendix A. Supplementary data

The following is the Supplementary data to this article: