Sprague Martinez and Peréa Respond

Abstract

The benefits of engaging community stakeholders in research have been well documented.1,2 Community-engaged research has the potential to yield local level data needed to inform the design of interventions reflective of community priorities and assets.1–3 We have found that partnering with community advances the research and can benefit community and academic stakeholders.4–6 However, we are sensitive to the challenges of research partnerships. The potential of hospitals and local health authorities (LHAs) to partner with diverse community stakeholders to conduct health assessments is an exciting proposition. If stakeholders can unite to collaboratively engage entities and sectors across communities, perhaps a shared community health improvement agenda can be generated. However, we can’t help but wonder how such an endeavor will be operationalized. As such, we raise three practical and logistical questions for consideration. Is there a desire to engage in research partnerships and dedicate the time and effort needed to develop trust and the meaningful relationships successful partnerships require? A systems approach entails a contextualized understanding of the community as well as a certain degree of humility to engage partners who are broadly representative of the so-called community. Lastly, collaborative planning takes time and requires a thoughtful process. Dialogs that are bidirectional and include diverse sectors of community life are needed. Engaging diverse stakeholders and maintaining momentum throughout the assessment process entails substantive financial and human resources, as well as community connections. Do LHAs have the infrastructure and capacity to engage in community health assessments? While in theory LHAs are well poised to lead Community Health Needs Assessments and support hospital efforts, they are not homogeneous. LHAs are organized differently across and within states; their resources, skill sets, relationships with the greater community, and overall capacity vary greatly. How will such variation be reconciled? Communities are complex and host multiple networks, and embedded power dynamics. For example, in Boston, many local organizations rely on the LHA and on hospitals for funding—how and by whom will power dynamics be managed? Will the voices of less financially independent organizations and grass roots residents be heard and equitably represented throughout the decision-making process? These are just a few questions needing attention as this policy is operationalized. There are many more. Nonetheless, this is an important conversation and needs to continue in diverse and accessible forums.