Investigating the Formation of a Black Health Coalition Responding to a Community Health Crisis: Findings from a Reflexive Exploratory Qualitative Study

Background and purpose: The COVID-19 pandemic exposed longstanding racial disparities across the United States, revealing the important need for structural supports in crisis and community engagement. Existing literature on grassroots responses to COVID-19 addresses health awareness, advocacy, and culturally grounded interventions, but internal processes, strategic decision-making, and long-term sustainability mechanisms of such efforts remain underreported. This study addresses that gap by documenting the formation and early experiences of the Milwaukee Black Grassroots Network for Health Equity, offering a framework for community-driven coalition development in response to health crises.

Methods: Using a reflexive exploratory qualitative design, we conducted a focus group with seven community leaders and residents in Milwaukee, Wisconsin, including two co-coalition founders, three coalition members, and two community partners. Data were analyzed using the content analysis procedures outlined by Elo and Kyngäs (2008), which proceeds through three phases: a preparation phase involving the selection of units of analysis and immersive familiarization with the data through repeated reading; an organizing phase involving opening coding, grouping similar codes, creating categories, and abstracting categories into higher concepts, and; a reporting phase requiring transparent documentation of both the analytic process and resulting findings. Reflexivity was central to the study's rigor. The research team shared positionality as community leaders with lived experiences on how their lived experiences influenced the design of the study, facilitated trust and recruitment, and supported the interpretation throughout.

Results: Three categories captured the coalition’s formation, activities, and community impact: 1) pathways to collective engagement and mobilization, 2) emergent network formation and early capacity building, and 3) collective transformation and community impact. Residents described how personal and community-level exposure to COVID-19 disparities, combined with information exchange among Black residents, sparked initial mobilization. Early capacity building centered on cultivating trust, sharing resources, and forming strategic partnerships. Collective impact was evidenced through improved community access to health resources, early steps towards systemic change, and deepened community ownership. Notably, residents identified long-term financial investment and sustained human capital as critical conditions for the sustainability of the coalition.

Conclusion and Implications: The study offers an empirically grounded framework for coalition formation in response to community health crises, with direct relevance for the Black community navigating structurally embedded health inequities. Findings underscore that grassroots coalitions are an effective vehicle for crisis response when adequately resourced and institutionally supported. For practitioners and policymakers, the study calls for intentional, sustained partnerships between community-led coalitions and public institutions that integrate the voices of community-led coalitions to address community needs. Future research should examine coalition sustainability over time and the transferability of this framework across different community contexts.