Can adaptation to ‘extraordinary’ times teach us about ways to strengthen community-based chronic disease prevention? Insights from the COVID-19 pandemic

The COVID-I9 pandemic represents a massive challenge to the ordinary work of community-based organisations. We present results from a study of the actions and experiences of community-based organisations and funding agencies in the context of a grants program for chronic disease prevention in Tasmania, Australia during 2020. Community-based organisations had just received funding to implement programs targeting smoking, obesity, nutrition and physical activity when the first lockdowns were put in place. Though the rapid changes triggered by the pandemic placed strain on organisations in certain ways, we record the adaptive practices that took place as the pandemic unfolded. We observed two levels of adaptation: 1) program-level adaptation, as new ways of reaching people and delivering planned services were devised; and 2) system-level adaptation, as funding agreements were revised and the range of organisational procedures were altered, new partnerships were formed and the span of operations were rewritten. The suspension of usual rules and activities gave permission to experiment with new roles and ‘blue sky’ ideas. Organisations who provided compelling accounts of adaptation had leaders and past history that enabled them to tap into wide networks to access resources and coordinate action. We suggest that these insights from ‘extraordinary’ times are helpful for priming or building greater adaptability and transformability in community-based prevention programs, their host organisations and their funders in ‘ordinary’ times. Drawing on the theoretical foundations of liminality theory, complexity, and viable systems theory, we consider how (better) system-level capability for chronic disease prevention is built.