Challenges in Community Engagement: Insights from a Participatory Evaluation of a Health Program Serving Minoritized Older Adults in Indiana

The dichotomy of commissioning Indigenous health and wellbeing program evaluations: What the Funder wants vs what the Community needs.

How societal expectations, new digital tools, andthe COVID crisis are driving a step-change in human centric remediation.

Extract Rural veterinary practice faces difficulties in many parts of the world. Falling farm incomes and increasing costs have sometimes resulted in reduced use of veterinary services. There seems to be widespread agreement that an increased emphasis on preventive medicine would improve the situation for both the farmer and his veterinarian. There appear to be no commonly agreed formal criteria for the development and evaluation of health programmes, either in human or veterinary medicine, but increasing attention is being paid to the problem(1) (12) (14) (15), In some ways the evaluation of animal health programmes should be the easier, for there are fewer ethical problems and economic criteria are of paramount importance in rural practice.

Purpose The purpose of this paper is to provide an overview of consumer and community engagement in health service planning, quality improvement and programme evaluation in Australia, and key components and importance of a strong suite of tools for achieving effective outcomes. Design/methodology/approach This paper is a non-systematic review of Australian national, state and territory websites in relation to policy commitment to consumer engagement, best practice framework for consumer engagement and recent project example. Findings Consumer engagement is a recognised component of the Australian health system. It is reflected in the national and state health policy and is a mandatory requirement of hospital accreditation. The application of co-design principles is gaining increasing popularity in health service planning and programme evaluation. Co-design is an important enabler of patient/community-centred service planning and evaluation; however, on its own it may lead to poorer outcomes. Co-design must occur within a broader systemic framework. Practical implications The research identifies a conceptual framework, approaches and tools of value to health service management and planners. Originality/value Consumer and community engagements are critical to the development of consumer-centric services. However, this should complement and add value to, not divert attention away from established principles of service planning, continuous quality improvement and programme evaluation. To do so may result in poorer quality health and well-being outcomes, reduced efficiency and ultimately reduced consumer and community satisfaction with services. This paper examines consumer and community engagement within the broader planning and quality improvement framework and practical implications for keeping planning, research and evaluation on track.

Community Policy Brief S. Megan Berthold, PhD, LCSW, Sengly Kong, PhD, Theanvy Kuoch, MA, LPC, Elizabeth A. Schilling, PhD, Rasy An, MA, Mary Blatz, MA, Rorng Sorn, MS, Sivheng Ung, BA, Yorn Yan, MBA, Mary Scully, APRN, Seiya Fukuda, MSW, MA, and Lorin Mordecai, MSW, LSW COMMUNITY POLICY BRIEF What Is the Purpose of this Study? • This study engaged Cambodian-led nonprofit organizations in six regions of the United States in a community–university partnership that used a community-based participatory research (CBPR) approach to: 1 further develop the Cambodian American community's capacity to design and conduct health research meaningful to their community via a CBPR approach; 2 train and deploy bilingual community health workers to gather health-related data from their communities using mobile technology; and 3 measure the feasibility and effectiveness of our efforts. What Is the Problem? • Cambodians who came to the United States as refugees have experienced high rates of trauma during the Khmer Rouge genocide and in refugee camps on the Thai–Cambodian border. • Those Cambodians who were adolescents in the United States have faced significant community violence and racial discrimination, and these experiences are associated with posttraumatic stress disorder and depression. • Cambodian Americans have higher rates of persistent health and mental health problems compared to the general U.S. population; are more likely to experience posttraumatic stress disorders, major depressive disorder, and co-occurring post-traumatic stress disorder and depression; and are also at greater risk for hypertension, diabetes, and cardiovascular disease. • Limited systematic study of community health and a relatively modest community capacity for collecting data contribute to these disparities. What Are the Findings? • Community health workers, leaders, and community members reported largely positive experiences with the iPads and spoken Khmer format of the community health survey, despite inconsistent Internet connectivity. • The institutional capacity of Cambodian American community-based organizations to collect health-related data in their own communities was strengthened. • Our efforts proved to be both feasible and effective. [End Page 107] Who Should Care Most? • Community-based organizations providing services to Cambodian communities or other vulnerable populations. • Cambodian community members living in the United States as well as other trauma survivors or refugees. • Health and mental health service providers. • Researchers studying the feasibility of using mobile technology in CBPR health studies. Recommendations for Action • CBPR approaches that use technology should continue to be used to research health disparities in Cambodian American and other communities. • Community engagement in this research is essential. • Trained and experienced community health workers and community leaders are an asset to their communities and uniquely placed to protect the rights and well-being of their community members. [End Page 108] S. Megan Berthold University of Connecticut School of Social Work Sengly Kong Khmer Health Advocates Theanvy Kuoch Khmer Health Advocates Elizabeth A. Schilling Center for Public Health and Health Policy, InCHIP, UConn Health Rasy An Cambodian Mutual Assistance Association of Greater Lowell Mary Blatz Mount Carmel Cambodian Center Rorng Sorn Cambodian Association of Greater Philadelphia Sivheng Ung Cambodian-American Community of Oregon Yorn Yan United Cambodian Association of Minnesota Mary Scully Khmer Health Advocates Seiya Fukuda Health Services Research Division, Bedford Veterans Affairs Medical Center Lorin Mordecai University of Connecticut School of Social Work Copyright © 2017 Johns Hopkins University Press

The Business Case for Investing in Place-Based Public Health Initiatives

There has been growing interest in nonmainstream approaches to assessing health programs, but methodological strategies have not been a concern. In this article, we review methodological strategies used in emergent evaluations of health policies and programs in Iberoamerica, focusing on participatory, qualitative, critical, hermeneutical, bottom-up, collaborative, and transdisciplinary approaches. A literature search was performed combining strategies: database review, consultation of bibliography, expert interviews, and search engines. The review took place from 2003 to 2006. Research published in the past two decades was included. Nearly 70 articles were found on emergent research and evaluation of health programs in the region. Participatory and qualitative approaches were the most used. Theoretical issues are more emphasized than are methodological ones. Data gathering also was more explored than were design, participant selection, or analysis. The frequently used methodological strategies contradict some basic assumptions of the emergent evaluative research, such as its participatory and collaborative nature.

Background: Our project is a collaboration among community members, a hospital, and community organizations aimed at advancing health equity within historically underserved communities. By training community members as citizen-researchers, we conduct needs assessments that inform priority setting and resource allocation. We use mixed methods to evaluate our approach and partnership through process and outcome evaluations.Our audience is healthcare delivery organizations, researchers, policymakers, and community members interested in partnering with the public and utilizing research and evaluation to improve health and health equity. Approach: Our project leverages Community Health Ambassadors (CHAs) local residents who often serve as community leaders and reflect the diversity of their neighborhoods to address ongoing community needs. Over the past year, we engaged in extensive dialogue with partners to identify key areas of community need, focusing on underlying social determinants of health.We deployed and modified a survey to collect health and equity data directly from residents through a collaborative process with CHAs to ensure cultural sensitivity and relevance to residents' lived experiences. CHAs received training in data collection, privacy, equity, diversity, inclusion, conflict resolution, and evaluation techniques.Our team consists of seven CHAs led by two researchers, a CHA lead, and a community project manager. This group is accountable to a leadership team that includes decision-makers from each partner organization. We identified two equity-deserving communities for the test of change, selecting buildings with frequent emergency room users identified via heatmap techniques. A pilot project, utilizing door-to-door and lobby interactions, is underway in these buildings to refine our approach. We established a community of practice to gather CHA feedback after each outreach. Results: Outcome Evaluation: Data collection in one neighborhood yielded 86 completed surveys, with a majority being East Asian (70%), female (52%), and an average age of 48. The survey revealed significant issues, including participants experiencing food insecurity and substantial percentages struggling to pay for rent, utilities, phone/internet, and medication. Participants frequently mentioned struggling with long emergency department wait times, lack of access to family physicians, lack of mental health services, lack of job opportunities, and high cost of living. Factor analysis is currently underway.Implementation Evaluation using Focus Groups, Observation, and Interviews: Our process evaluation revealed barriers and facilitators to community engagement in research.Barriers: Governance Structure: Disparities in compensation and differences in employment conditions among CHAs create challenges, highlighting the need for a centralized governance structure.Coordination: Improved coordination of on-the-ground work is necessary to ensure effective implementation.Language Accessibility: Surveys need to be translated into several languages to accommodate the diverse community.Facilitators:Capacity Building and Professional Development: To avoid tokenism and ensure the project's sustainability, it is crucial to have plans for capacity building and professional development for CHAs. Training CHAs in data collection and evaluation, including obtaining certifications and enhancing their skills, empowered them as researchers. Additionally, assisting them in publishing their work and updating their CVs provided valuable professional development opportunities.Creating an MOU: Establishing a Memorandum of Understanding (MOU) that clearly outlines the responsibilities and expectations of all partners is essential for effective collaboration and project success. Implications: Next steps include expanding our partnership with the city and local organizations to address the identified community needs, such as organizing job fairs and enhancing food bank services. Additionally, there is a need for advocacy to reallocate resources and transform our social and healthcare systems. Our findings underscore the importance of community engagement and collaborative approaches in addressing health inequities, providing valuable lessons for an international audience on effective community partnerships and the use of citizen-researchers to drive equitable health outcomes.

Cultural competency is a multifaceted intervention approach, which needs to be implemented at various levels of health-care systems to improve quality of care for culturally and ethnically diverse populations. One level of health care where cultural competency is required is in the provision of health promotion services and programs targeted to diverse patient groups who experience health-care and health inequalities. To inform the implementation and evaluation of health promotion programs and services to improve cultural competency, research must assess both intervention strategies and intervention outcomes. This scoping review was completed as part of a larger systematic literature search conducted on evaluations of cultural competence interventions in health care in Canada, the United States, Australia, and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched. Overall, 64 studies on cultural competency interventions were found, with 22 being health promotion programs and services. A process of thematic analysis was utilized to identify key intervention strategies and outcomes reported in the literature. The review identified three overarching strategies utilized in health promotion services and programs to improve cultural competency: community-focused strategies, culturally focused strategies, and language-focused strategies. Studies took different approaches to delivering culturally competent health interventions, with the majority incorporating multiple strategies from each overarching category. There were various intermediate health-care and health outcomes reported across the included studies. Most commonly reported were positive reports of patient satisfaction, patient/participant service access, and program/study retention rates. The health outcome results indicate positive potential of health promotion services and programs to improve cultural competency to impact cardiovascular disease and mental health outcomes. However, due to measurement and study quality issues, it is difficult to determine the extent of the impacts. Examined together, these intervention strategies and outcomes provide a framework that can be used by service providers and researchers in the implementation and evaluation of health promotion services and programs to improve cultural competency. While there is evidence indicating the effectiveness of such health promotion interventions in improving intermediate and health outcomes, further attention is needed to issues of measurement and study quality.

Although Colombia has a health system based on market and neoliberal principles, in 2004, the government of the capital-Bogota-took the decision to formulate a health policy that included the implementation of a comprehensive primary health care (PHC) strategy. This study aims to identify the enablers and barriers to the PHC implementation in Bogota. The study used a qualitative multiple case study methodology. Seven Bogota's localities were included. Eighteen semi-structured interviews with key informants (decision-makers at each locality and members of the District Health Secretariat) and fourteen FGDs (one focus group with staff members and one with community members) were carried out. Data were analysed using a thematic analysis approach. The main enablers found across the district and local levels showed a similar pattern, all were related to the good will and commitment of actors at different levels. Barriers included the approach of the national policies and a health system based on neoliberal principles, the lack of a stable funding source, the confusing and rigid guidelines, the high turnover of human resources, the lack of competencies among health workers regarding family focus and community orientation, and the limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. Significant efforts are required to overcome the market approach of the national health system. Interventions must be designed to include well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.

Improving Medical Education and Patient Care Through Community-Academic Health Center Partnerships David M. Levine, MD, MPH The development, implementation, and effective use of community–academic health center partnerships continues to be a most significant and challenging issue, with vast implications for the health of the public, medical education, research, and patient care. Considerable past research and policy proposals addressed this issue. They provided examples of how mutually developed community–academic health centers are instrumental to improving the health and functional status of communities in need.1–4 Simultaneously, the academic health center has benefited from enhanced community support, use of community resources, and the bringing of community-based participatory approaches into medical education, research, and patient care. Despite this, Boutin-Foster, Palermo, Phillips-Caesar, and associates5 forcefully and appropriately reminds us that much work needs to be done to achieve the full benefit of community–academic health center partnerships. This article highlights that although, "Academic health centers and community organizations are structurally and philosophically different, they share a common mission, which is to provide a greater public good." The authors present informative examples from their work, demonstrating the mutual benefit to communities and academic health centers of a true partnership approach. Of particular note is their model, "The Harlem Community and Academic Partnership (HCAP), a diverse partnership of community residents, community-based organizations and service providers, academia, and public health institutions." This partnership utilized the principles of community-based participatory research to develop initiatives that mutually benefit both the community and the academic health center in regard to community enhancement, improved health care, medical education, and research at the community level. Medical and public health students are now gaining important clinical and research experience in the community. Community members and academic partners launched novel community-based research studies. Research projects hired community members as liaisons, addressing major problems such as obesity among women of color. Academia and specific communities developed increased linkages and partnerships in order to prioritize health issues so they could be mutually addressed. This article, furthermore, emphasizes the beneficial contributions of a community-based participatory model and the role of community health workers, community leaders, and organizations. Simultaneously, the authors remind us that there are continuing barriers to further development and dissemination of the community–academic medical center model. Among these are continuing skepticism by communities of the depth and sustainability of these partnerships by the academic health center, and skepticism by the academic health center of this type and degree of community involvement, and the implication of this for scholarship, training, and research. To address this, the authors conclude that a paradigm shift is necessary for academic health centers, in which they add another fundamental component to their mission-building strong community partnerships. This effort would be a strategic goal. The authors are to be complemented for this work and the conclusions they present. A community–academic center approach is fundamental to addressing continuing disparities in health care in the United States. The majority of academic health centers are physically located in communities with excess premature morbidity, disability, and mortality. Although our current academic health centers were frequently founded to and have historically committed themselves to addressing the health care of communities and populations most in need, a community–academic center model has much to offer to enhance this societal role. [End Page 1] David M. Levine The Johns Hopkins School of Medicine, Department of General Internal Medicine

In this issue of JME, Watson et al call for research evaluation of government health programmes and identify ethical guidance, including the Ottawa Statement on the ethical design and conduct...

COVID-19, climate change, and communities

Efforts to include community voice in health policy and service planning are gaining recognition and support in the United States. Findings suggest community involvement can contribute to a better understanding of systems and factors that impact health, and, subsequently, more effective and sustainable policy and program design. Additionally, engagement can increase community buy-in, and community members can gain a greater awareness of services; increased confidence navigating systems; feelings of social connectedness; and capacity to advocate around issues through participation. Despite these findings, the extent to which community members are engaged in planning and decision-making varies considerably. Researchers from Georgia State University conducted a review of state plans on aging using the Person-Centered Outcomes Research Initiative (PCORI) Engagement Principles and the Health Research & Educational Trust’s Community and Patient Engagement Spectrum as frameworks to assess evidence of community engagement. The frameworks recognize engagement throughout the planning process, including design, data collection and interpretation, and dissemination. The review revealed that few planning processes described significant engagement, but rather met the minimal requirements established by federal policy. Federal guidance on community-informed planning practices is sparse, as are resources to support states in adopting these processes. To address this gap, the research team drew on the frameworks and other promising practices to design two community engagement projects, both in partnership with Georgia’s Division of Aging Services. Methods for participant engagement, data collection, interpretation and application of results, and lessons learned through both projects will be discussed, as well as potential implications.

Empowerment evaluation: a stakeholder involvement approach.