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

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.