Engaging Community Members Affected by Health Inequities

Communities affected by health inequities should be given opportunities to shape programs and policies that affect their well-being. Community members should be authentically involved in all steps of program development and implementation, such as designing and administering needs assessments, validating findings from data collection, identifying priority issues for their communities, and advancing strategies to achieve health equity.

Rural communities should avoid tokenism and instead promote authentic engagement of community members who experience inequities. Tokenism occurs when individuals are included for symbolic purposes but are not authentically engaged in the process to advance their priorities. Rural communities should consider how their health equity efforts allow communities that experience health inequities to not only consult on proposed activities but also make decisions about how to proceed. Research on rural multi-sector collaborations has shown that partnerships with shared leadership structures are often effective at fostering communication and engaging partners over time.

The Public Health Accreditation Board's Health Departments and Authentic Community Engagement report provides a range of recommendations from local health departments for building effective partnerships. The Minnesota Department of Health also developed Principles of Authentic Community Engagement that may help rural communities understand how to meaningfully engage communities. Key principles include:

• Fostering trust, which involves relationship-building, the ability to listen, and being intentional about addressing power imbalances when engaging community members.
• Supporting community-led solutions, including sharing power with communities that experience inequities and allocating resources to support the sustained involvement of community members in creating solutions.
• Promoting social change, which refers to a long-term commitment to addressing structural roots of inequities and strengthening communities.

The Washington State Hospital Association created a Community Engagement Toolkit for Rural Hospitals that emphasizes the importance of community engagement for the future sustainability of rural providers. For example, rural hospitals are increasingly participating in value-based payment mechanisms that require demonstrating clinical outcomes affected by addressing the social determinants of health. Building trusting relationships with community members can also encourage them to seek local care. The toolkit provides recommendations for engaging community partners to create a shared vision — including exercises like community asset mapping — and design the initiative, which may include creating a logic model that links inputs, activities, outputs, and intended effects.

Rural Examples of Authentic Engagement to Advance Health Equity

• The Southeast Arizona Area Health Education Center (SEAHEC) Healthy Farms Program first trained community members to serve as promotores de salud, with the goal of building trust between the Winchester Heights community and local health and social services organizations. SEAHEC provided training and capacity-building assistance to guide the promotores as they built a system to help residents navigate local resources. Promotores also collected information about priority health issues and began mobilizing residents to help improve community health.
• The West Marion Inc. in rural McDowell County, North Carolina, hosts forums that empower residents to develop a shared vision for their neighborhoods, engage in open and honest dialogue, identify barriers, build relationships, and develop plans for action. This work is rooted in structurally excluded communities in McDowell County, NC, including: West Marion, East Marion, and Old Fort.
• The American Indian Cancer Foundation (AICAF) works with tribes and tribal organizations to assist them with identifying and implementing strategies to prevent cancer that are rooted in indigenous ways of knowing. The approach emphasizes the importance of relationship-building and community conversations where tribal community members are empowered to develop solutions.
• The California Accountable Community for Health Initiative sites (including rural Humboldt County) engaged in training to authentically engage their communities in conversations around systems-level approaches to improving health. The Accountable Community for Health program is organized around the Theory U framework, which emphasizes shared intent and gaining a systems perspective.

Implementation Considerations

Rural communities should carefully consider barriers that may prevent community members from participating in initiatives to advance health equity. Potential barriers include:

• Language access and availability of translation services
• Fear of drawing attention to citizenship status
• Lack of transportation to in-person meetings
• Lack of childcare
• Lack of broadband or facility with technology to participate in Zoom meetings
• Inability to miss work for engagement opportunities

One way to help address these barriers is working with community liaisons like community health workers or social service providers who have close relationships with communities that experience inequities. These individuals can provide recommendations for helping address challenges to participation.

Questions for Consideration

• How are we facilitating participation of communities that experience inequities (for example: meeting time, compensation, meeting location, language services)?
• Are we engaging community members to inform our understanding of the policy environment?

Program Clearinghouse Examples

• Southeast Arizona Area Health Education Center (SEAHEC)
• West Marion Inc.
• American Indian Cancer Foundation (AICAF)

Resources to Learn More

Authentic Engagement Of Patients And Communities Can Transform Research, Practice, And Policy
Document
Discusses authentic stakeholder engagement in population health research where all relevant stakeholders are full partners actively involved in each stage of the study. Identifies two examples demonstrating this concept: engaging patients in practice-based research and engaging the community in health equity research.
Author(s): Woolf, S. H., Zimmerman, E., Haley, A., & Krist, A. H.
Citation: Health Affairs, 35(4)
Date: 4/2016

Engaging Communities Through Issues Forums: A How-To Guide for Onsite and Online Community Engagement
Document
Offers suggestions to Cooperative Extension staff using issues forums to engage communities.
Author(s): Braun, B., Pippidis, M., Ketterman, J. M., Inwood, S., & Wright, N.
Organization(s): The Ohio State University Extension, University of Delaware, University of Maryland
Date: 3/2022

Principles of Community Engagement: Second Edition
Document
Provides an overview of community engagement principles and a guide for public health professionals, healthcare providers and organizations, researchers, and community-based leaders working to improve population health through community collaboration. Includes examples of community engagement in rural communities.
Organization(s): National Institute of Health (NIH), Clinical and Translational Science Awards Consortium
Date: 6/2011