Community Coalitions Implementing and Sustaining Policy, Systems and Environment Strategies for Rural Health Equity

= 121) revealed that implementation barriers included challenges with staff and partner transitions, and lack of capacity and resources. Staff engagement, community rapport and partner-provided resources facilitated the implementation of strategies across several coalitions, highlighting the important role partnerships and community buy-in have with community-based PSE implementation approaches. At Year 5, among nine coalitions who provided sustainment data, a higher percentage of PSE strategies (95.6%) were sustained compared to programmatic strategies (42.9%), demonstrating the importance of PSE change approaches in community health equity efforts.