Community-engaged Approach Research Articles

Mitigating Cancer Disparities Through an Innovative Navigation Program.

The Office of Cancer Health Equity at the Atrium Health Wake Forest Baptist Comprehensive Cancer Center used a community-engaged approach to develop an innovative Population Health Navigation Program designed to improve access to cancer care and reduce cancer disparities.

The Most Vulnerable Children Faced Unique Risks During COVID-19: How Agencies Communicated with Communities on Parenting in Low Resource and Humanitarian Settings

Evidence suggests that children in low resource and humanitarian settings experienced added mental health burdens and violence in the home during the SARS-CoV-2 (COVID-19) pandemic, which may have affected their health and development. For humanitarian response agencies, conducting child protection services during this pandemic had been constrained by safety concerns related to the risk of COVID-19 transmission, and logistical issues aligned with social and public health measures. This paper describes how agencies responded to the identified risks children face, integrating remote risk communication and community engagement approaches and safe in-person dialogues with parents and caregivers into child protection interventions to educate about the disease and prevention, encourage a positive parenting environment and mitigate negative effects on children. United Nations (UN) agencies and non-government organizations (NGOs) must reflect on these different approaches and share lessons learned and best practices internally and at an inter-agency level to support evidence-based responses for future epidemics and pandemics.

Exploring and addressing the sexual and reproductive health and other related rights of transgender women in Bangladesh: A mixed methods protocol under the policy analysis framework.

Transgender women (hijra) in Bangladesh are declared as a separate gender category by the Government. However, research revealed that they experience transphobia, which could potentially affect their physical and mental health outcomes, and their access to SRHR-related care. This warrants an exploration of their SRHR-related rights issues, particularly using a community-engaged approach. Moreover, it is crucial to operationalize these findings into actionable policies and practice. This study aims to explore and address the SRHR and other rights-related challenges experienced by hijra under the framework of policy analysis. The study population will include hijra in four selected service centers in Dhaka, Bangladesh. In the first phase, evidence will be generated through desk review and mixed methods research. The desk review will consist of reading and analyzing literature to understand the difference between policy and reality. For the quantitative component, a first-come-first-serve sampling approach will be used on a total sample size of 296. This will be complemented by the qualitative component, which will entail in-depth interviews, focus groups and key informant interviews. Moreover, life case histories will be conducted for particularly compelling cases. These findings will be collectively analyzed through the policy analysis framework, to analyze the differences between the policy and reality, which will ultimately generate a lay summary for stakeholders. Univariate and multivariate analysis will be used for the quantitative component whereas thematic analysis will be used for the qualitative component. In the second phase, the findings from the lay summary will be shared with stakeholders and hijra community members through a series of discussions. There are a few limitations of the study. In particular, this study consists of various activities which may require substantial time and effort to complete. Additionally, this study merely goes up to the policy recommendation formulation stage, as opposed to formulating an intervention design. Moreover, the findings will be disseminated through various platforms, including dissemination seminars, scientific articles and the study report.

Translating research evidence into youth behavioral health policy and action: using a community-engaged storyboard approach.

There is nationwide shortage of child and adolescent behavioral health providers. Lack of diversity in the mental health care profession compounds workforce capacity issues, contributing to greater disparities in treatment access and engagement for youth from historically disenfranchised communities. Strategies are needed to foster cross-sector alignment to inform policy which can improve mental health care access and reduce disparities. This current case study details a specific research-practice-policy partnership strategy, storyboarding, as a method to engage community partners in Washington State to deliberate on information drawn from research on non-specialist models of child and adolescent mental health care to support the behavioral workforce expansion. Research evidence from a scoping literature review on non-specialist models of child and adolescent mental health care was shared via storyboards with community partners to inform policy efforts around the behavioral health workforce expansion. In Phase 1, community members with lived experience and clinical expertise contributed to the storyboard design process. In Phase 2, a broader community partner group shared their perspectives on the models of care presented in the storyboards via Qualtrics survey with open-ended questions. Listening sessions were also held with non-English speaking refugee and immigrant communities to elicit feedback on whether these models of care would meet their needs. Qualitative data was coded to explore emerging themes using a rapid deductive approach. Community partners shared mixed responses to models of care presented from the research literature. Immigrant and refugee communities explicitly stated these existing models would not fit their context. Regarding partnership strategy success, the smaller community partner group was engaged in the storyboard design process. The broader community interacted with and provided detailed responses to the models of care presented in the storyboards. Success was also reflected in community partners' continued participation in the next stage of the project. Findings demonstrate how storyboarding can be effectively used to translate research evidence into accessible information to promote community partner engagement and capture community voice in policy processes. More work is needed exploring how such methods can be used to increase the use of research evidence in policy and practice spaces.

Identifying facilitators and barriers to the uptake of medication for opioid use disorder in Washington, DC: A community-engaged concept mapping approach.

Opioid overdose is a major public health challenge. We aimed to understand facilitators and barriers to engagement in medication for opioid use disorder (MOUD) among persons with OUD in Washington, DC. We used a cross-sectional mixed-methods concept mapping approach to explore MOUD engagement between 2021-2022. Community members at-large generated 70 unique statements in response to the focus prompt: "What makes medication for opioid use disorder like buprenorphine (also known as Suboxone or Subutex) difficult to start or keep using?" Persons with OUD (n = 23) and service providers (n = 34) sorted and rated these statements by theme and importance. Data were analyzed with multidimensional scaling and hierarchical cluster analysis, producing thematic cluster maps. Results were validated by our community advisory board. Seven themes emerged in response to the focus prompt: availability and accessibility; hopelessness and fear; unmet basic needs; characteristics of treatment programs; understanding and awareness of treatment; personal motivations, attitudes, and beliefs; and easier to use drugs. "Availability and accessibility," "hopelessness and fear," and "basic needs not being met" were the top three identified barriers to MOUD among consumers and providers; however, the order of these priorities differed between consumers and providers. There was a notable lack of communication and programming to address misconceptions about MOUD's efficacy, side effects, and cost. Stigma underscored many of the statements, showcasing its continued presence in clinical and social spaces. This study distinguishes itself from other research on MOUD delivery and barriers by centering on community members and their lived experiences. Findings emphasize the need to expand access to treatment, dismantle stigma associated with substance use and MOUD, and address underlying circumstances that contribute to the profound sense of hopelessness and fear among persons with OUD-all of which will require collective action from consumers, providers, and the public.

Mapping projects for expanding rapid HIV testing in key populations, Brazil, 2004-2021.

The HIV/AIDS epidemic remains a persistent and real issue, especially in key populations such as men who have sex with men (MSM), travestis and transgender persons. Projects for expanding rapid HIV testing are strategic initiatives aimed at the earliest possible identification of individuals' serological status and thus early treatment, screening of sex partners, and upscaling of preventive actions to interrupt the transmission chain. This study thus maps, describes, and systematizes the projects for expanding rapid HIV testing implemented from 2004 to 2021 in Brazil, highlighting the on-going contribution of civil society organizations and discussing the interoperability and cooperation resulting from public governance processes. We selected 67 documents for analysis, including 30 scientific publications retrieved from electronic databases and 37 documents produced by government institutions and nongovernmental organizations (NGOs). Find Out (Fique Sabendo), I Want to Get Tested (Quero Fazer), The Time is Now (A Hora É Agora), Live Better Knowing (Viva Melhor Sabendo), and Live Better Knowing Young (Viva Melhor Sabendo Jovem) were the projects mapped. Results show that the projects have used strategies adapted to the key population, such as mobile testing units, peer education, and innovative community engagement approaches. Such actions were enabled by effective cooperation and interoperability between participating stakeholders, especially NGOs.

Applying the resource management principle to achieve community engagement and experimental rigor in the multiphase optimization strategy framework.

Preventing and treating mental health and substance use problems requires effective, affordable, scalable, and efficient interventions. The multiphase optimization strategy (MOST) framework guides researchers through a phased and systematic process of developing optimized interventions. However, new methods of systematically incorporating information about implementation constraints across MOST phases are needed. We propose that early and sustained integration of community-engaged methods within MOST is a promising strategy for enhancing an optimized intervention's potential for implementation. In this article, we outline the advantages of using community-engaged methods throughout the intervention optimization process, with a focus on the Preparation and Optimization Phases of MOST. We discuss the role of experimental designs in optimization research and highlight potential challenges in conducting rigorous experiments in community settings. We then demonstrate how relying on the resource management principle to select experimental designs across MOST phases is a promising strategy for maintaining both experimental rigor and community responsiveness. We end with an applied example illustrating a community-engaged approach to optimize an intervention to reduce the risk for mental health problems and substance use problems among children with incarcerated parents.

COVID-19 Vaccine Policy Implementation and Differential Vaccine Uptake Trajectories in Chicago Communities.

Since the onset of the COVID-19 pandemic, multiple public health interventions have been implemented to respond to the rapidly evolving pandemic and community needs. This article describes the scope, timing, and impact of coordinated strategies for COVID-19 vaccine uptake in Chicago for the first year of vaccine distribution. Using a series of interviews with public health officials and leaders of community-based organizations (CBOs) who participated in the implementation of the citywide COVID-19 vaccine outreach initiatives, we constructed a timeline of vaccine outreach initiatives. The timeline was matched to the vaccine uptake rates to explore the impact of the vaccine outreach initiatives by community area. Finally, we discussed the nature of policy initiatives and the level of vaccine uptake in relation to community characteristics. The Chicago Department of Public Health (CDPH) implemented myriad vaccine outreach strategies, including mass vaccination sites, improved access, and community-level vaccine campaigns. Protect Chicago+ was the primary vaccine outreach effort initiated by the CDPH, which identified 15 highly vulnerable community areas. More than 2.7 million (67%) Chicagoans completed the vaccine regimen by December 2021. Black (51.3%) Chicagoans were considerably less likely to be vaccinated than Asian (77.6%), White (69.8%), and Hispanic (63.6%) Chicago residents. In addition, there were significant spatial differences in the rate of COVID-19 vaccine completion: predominantly White and Hispanic communities, compared with Black communities, had higher rates of vaccine completion. The community outreach efforts to improve COVID-19 vaccine uptake in Chicago have shown the importance of community-engaged approaches in pandemic responses. Despite citywide efforts to build community infrastructure, Black communities had relatively lower levels of vaccine uptake than other communities. Broader social restructuring to mitigate disinvestment and residential segregation and to ameliorate medical mistrust will be needed to prepare for future pandemics and disasters.

Pendampingan Usaha Mikro Kecil Menengah (UMKM) melalui Pemanfaatan Platform Digital di Desa Tambang Besi

This research aims to improve the skills and knowledge of Micro, Small, and Medium Enterprises (MSMEs) in Tambang Besi Village, focusing on the production and marketing of traditional snacks. With an emphasis on product diversification and the utilization of digital marketing, the research objectives encompass enhancing local economic growth, expanding market access, and preserving the authenticity of traditional flavors. The study employs a community engagement approach involving both faculty and students in mentoring activities. Data collection methods include interviews, observations, document analysis, and mentoring. The findings of the research are as follows: 1) The planning phase involves setting objectives and identifying the strengths and weaknesses of MSMEs. The implementation phase includes socialization, product creation, and promotion through social media. Evaluation is conducted through survey-interviews and social media analysis to measure the progress of MSMEs during the development period. 2) The addition of dumplings as a diversification effort has successfully aligned with the tastes of children and teenagers, enhancing the appeal of MSME products. The effective use of digital marketing through social media has increased product visibility, evident in the rise in likes, comments, and shares. 3) The mentoring activities also identified weaknesses, such as limited knowledge in marketing, insufficient skills in innovation, and restricted market access. Based on the research outcomes, it is recommended to continuously integrate innovative products following the latest food trends and strengthen digital marketing strategies. MSME participants should consistently receive guidance in managing and expanding market access while enhancing skills in utilizing social media.

"What if that's your last sleep?" A qualitative exploration of the trauma of incarceration and sleep.

Sleep is an underexplored factor in the health of people involved in the criminal legal system. This study addresses the paucity of research on how individual, social, and physical environmental factors impact sleep health during and after incarceration by highlighting the voices of people involved in the criminal legal system through a community-engaged qualitative research approach. We conducted 20 semi-structured interviews with men recently released from prison for a study on trauma and healthcare during incarceration and after release. Interviews were coded and analyzed using reflexive thematic analysis and a critical realist framework. Our research team included people with a history of incarceration who performed central roles in the research process. Three themes emerged from participants' descriptions of sleep during and after incarceration: (1) concerns about health contributing to sleep problems, (2) lack of access to treatment for sleep disorders leading to ongoing sleep problems, and (3) issues of safety contributing to sleep problems during incarceration and after release. This study identifies factors and domains influencing sleep during and after incarceration. By identifying which interpersonal, environmental, and structural factors impact sleep quality, medical and carceral staff are better equipped to ameliorate sleep health disparities within populations with a history of incarceration and those actively bound by the criminal legal system. Future research should examine other factors impacting sleep in incarcerated and recently released populations and develop multi-level interventions to improve sleep health. This paper is part of the Sleep and Circadian Health in the Justice System Collection.

A STAKEHOLDER-PARTNERED APPROACH TO INEQUITIES AFFECTING HOME HEALTH CARE WORKERS, OLDER ADULTS, AND CAREGIVERS

Abstract Home health aides (HHAs) provide on-site support for homebound older adults with cognitive impairments, while lessening strain on familial caregivers. However, HHAs face structural challenges in work-related transportation. Massachusetts General Hospital (MGH) researchers partnered with community and corporate stakeholders to inform a study evaluating whether on-demand transportation for HHAs via Uber rides will: 1) Improve metrics among HHAs (total visits, total unique patients, hours/week and days/week worked, missed visit/no-show rates, work satisfaction); 2) Increase racial, ethnic, socioeconomic and geographic diversity of older adults with cognitive impairments receiving homecare. Community partner CCHERS (Center for Community Health Education Research Services) helps residents of public/publicly-assisted housing in high-need areas of Greater Boston gain training and entry-level employment in healthcare as HHAs. Through its collaborations with other groups (e.g., Mothers for Justice & Equality, HomeCare Aide Council, Mass HomeCare Alliance), CCHERS identified that lack of affordable, accessible, reliable transportation was among the most-cited barriers affecting HHAs and equitable homecare delivery. Corporate partner Uber Health, through work in preliminary social-impact case studies, identified the platform’s central ride-coordination approach as preferred by Black and Hispanic women in the 18-45y age group (~80% of the local HHA workforce). MGH researchers’ study goals and metrics were informed by input of partners. With its community-engaged approach, innovative partnerships, and focus on achieving equity objectives to benefit patients and homecare workers alike, this project has potential for strong local impacts and future implications for state and/or national policies to provide high-quality, equitable homecare by directly addressing employment transportation-related barriers.

Racial and ethnic inequities in stillbirth in the US: Looking upstream to close the gap: Seminars in Perinatology

Though stillbirth rates in the United States improved over the previous decades, inequities in stillbirth by race and ethnicity have persisted nearly unchanged since data collection began. Black and Indigenous pregnant people face a two-fold greater risk of experiencing the devastating consequences of stillbirth compared to their White counterparts. Because race is a social rather than biological construct, inequities in stillbirth rates are a downstream consequence of structural, institutional, and interpersonal racism which shape a landscape of differential access to opportunities for health. These downstream consequences can include differences in the prevalence of chronic health conditions as well as structural differences in the quality of health care or healthy neighborhood conditions, each of which likely plays a role in racial and ethnic inequities in stillbirth. Research and intervention approaches that utilize an equity lens may identify ways to close gaps in stillbirth incidence or in responding to the health and socioemotional consequences of stillbirth. A community-engaged approach that incorporates experiential wisdom will be necessary to create a full picture of the causes and consequences of inequity in stillbirth outcomes. Investigators working in tandem with community partners, utilizing a combination of qualitative, quantitative, and implementation science approaches, may more fully elucidate the underpinnings of racial and ethnic inequities in stillbirth outcomes.

Participant-oriented evaluation through participatory action research: a case study of a community engagement approach

PurposeThis article explores the applicability of participatory action research (PAR) on two levels: on the one hand, as a participatory evaluation method for community engagement and community development; on the other hand, as a tool to link ex ante and ex-post evaluation that situated at various stages of the policy cycle.Design/methodology/approachThrough a practice-based case study of the community engagement process of Valletta Design Cluster, this paper aims to illustrate how PAR can offer collaborative and continuous evaluation by facilitating social action through a practical, situative, context-bounded, responsive and transformative framework.FindingsThe study explores how PAR can contribute to cultural sustainability by linking community development with participatory evaluation, and it offers new perspectives on the applicability of PAR as a tool to link ex ante and ex-post evaluation, situated at various stages of the policy cycle.Research limitations/implicationsAlthough based on a single case, the paper demonstrates that the method has the potential to be applied in various contexts, as it helps to foster local ownership and to develop future cultural strategies, thus providing a base for cultural sustainability.Originality/valueThe novelty of this study is to link evaluation – a majorly top-down and ex ante approach – with participatory planning. PAR-E offers a continuous participatory framework for the whole European Capitals of Culture (ECoC) cycle, as well as serving as a tool for empowerment and community development.

Community‐informed design: Blending community engagement and museum design approaches for sustainable experience development

AbstractThe museum field currently and historically has centered on the needs of White, educated, privileged, and affluent people, and changing that reality requires new ways of conceptualizing, organizing, and assessing our core practices. Practice‐based models—including specific stories of how museums and communities work together—are still needed in our field, both as guidance for structuring future projects and as inspiration for what is possible. We share a case study of a 10‐year makerspace design process and identify key features for sustaining community–museum relationships over an extended period of work, which we call community‐informed design. We describe five key aspects that promote sustainability in terms of community–museum relationships and the creation of high‐quality experiences: naming values and assumptions, emergent planning, flexible and distributed staffing, organization‐to‐organization relationships, and layered data.

Healthcare experiences among Black and White sexual and gender minority cancer survivors: a qualitative study.

The purpose of this study was to explore healthcare experiences of Black and White sexual and gender minority (SGM) cancer survivors across the cancer care continuum. This was a qualitative analysis of two focus groups and eight individual interviews completed as part of a larger initiative using a community-engaged research approach to reduce cancer disparities in marginalized communities. There was a total of 16 participants in the study (9 were White, 7 were Black) and data were collected between 2019 and 2020. Three main themes emerged from the thematic analysis: strategically coming out, provider preferences, and health system challenges. Participants noted that they often came out through their support system, decided to come out based on the relevance of their SGM identity that they perceived, and expressed a desire for privacy. Lack of an accessible and competent PCP was tied to delayed cancer diagnosis and many participants voiced a preference for consistency when they found a provider they liked. Providers across specialties can address barriers for SGM patients by not making assumptions about patient sexual orientation or gender identity. Institutions should systematically collect sexual orientation and gender identity information. Primary care providers should be aware that due to resistance to switching from trusted providers, they may need to take greater initiative to facilitate cancer screenings for their patients when appropriate or take special care when making referrals to ensure they are using SGM-affirming providers. SGM cancer survivors often benefit from a cultivating relationship with a trusted PCP or other provider.

A Community-Engaged Approach to Understanding Suicide in a Small Rural County in Georgia: A Two-Phase Content Analysis of Individual and Focus Group Interviews.

Suicide is a significant public health problem, with disproportionate rates in rural areas. Rural communities face substantial structural and cultural barriers to suicide prevention. This study aimed to gain a deeper understanding of the need for suicide prevention and gauge the appropriateness of prevention efforts in the context of a rural Georgia county by leveraging existing community resources and knowledge. Twenty one-on-one, semi-structured interviews and two focus groups were conducted, with participants recruited via purposive snowball sampling. Data analysis included qualitative deductive and inductive content analysis from individual interviews and focus groups with community stakeholders. The findings highlight how rural contexts exacerbate drivers of death by suicide and how the substantial loss of community members to suicide contributes to the ongoing crisis and reduces available support. Access to mental health care often depended on a connection to an established public system such as schools, a military base, or Veterans Administration. There were perceived gaps in crisis and post-crisis services, with participants actively trying to address these gaps and build community support through coalition building. This study contributes knowledge to contextual drivers of suicide in rural areas beyond individual-level risk factors. Community-engaged suicide prevention research in rural areas is promising, but there is a need to develop interventions to best support coalition building and capacity development.

Abstract IA040: Promoting engagement of evidence-based interventions for Latinos: Cultural adaptation of an online intervention for Latina breast cancer survivors and their partners

Abstract Although public health emphasizes the use of evidence-based interventions (EBIs), often they are not developed with diverse populations in mind, limiting engagement and cultural relevance. This presentation discusses the cultural adaptation of EBIs for Latinos using the adaptation of the online OurRelationship couple's intervention for Latina breast cancer survivors and their partners as a case example. The study used systematic, iterative, and community-engaged approaches, including formative research and patient-centered verification techniques, with ongoing feedback from the community advisory board. Adaptations went beyond translation, aiming for conceptual equivalence. The adapted program – Juntos Despues Del Cancer (JDC) - incorporated cancer-related stressors, coping techniques, social, cultural, and gender norms influencing couples' communication within the context of cancer survivorship. JDC maintained the integrity of OurRelationship while acknowledging the lived experience of Latino couples affected by breast cancer. Lessons learned include navigating fidelity versus fit tensions, focusing on conceptual translations, and recognizing Latino heterogeneity. The online nature of JDC allows for accessibility and nationwide availability. This cultural adaptation approach has broad applications, advancing public health practice and making EBIs more accessible to a diverse audience. Citation Format: Dinorah (Dina) Martinez Tyson, Melody Chavez, Gabriela Sanabria, Sejal Barden, Marangelie Velez, Erik Ruiz, Brian Doss. Promoting engagement of evidence-based interventions for Latinos: Cultural adaptation of an online intervention for Latina breast cancer survivors and their partners [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA040.

An Update on the Building Bridges Study: Examining the effects of two interventions on trust in medical researchers and research attitudes among African American participants

AbstractBackgroundData suggest that establishing trust supports willingness to participate in research studies; yet there is a shortage of standardized systematic studies testing the effectiveness of various methods of building trust. The Building Bridges pilot study examined ways of establishing trust in communities of color comparing two different interventions.MethodUsing African American community leaders’ input, we conducted a mixed method study to investigate participants’ 1) preferred format for community‐based interventions, 2) comfort with discussing dementia with researchers/healthcare providers, and 3) attitudes of trust about research and researchers. African American subjects (age ≥ 45 years) without self‐reported cognitive impairment completed research attitudes (RAQ) and trust in medical researcher questionnaires, pre‐ and post‐intervention; individual medication reviews (n = 48) and/or public community talks (n = 49). Quantitatively, we compared pre‐ and post‐ intervention outcomes with paired Wilcoxon non‐parametric sign rank tests; all qualitative themes were analyzed using Nvivo QSR 12.ResultParticipants’ mean age was 64 (SD = 9.9). See Table 1 for demographics. Quantitatively, there was greater change in research attitudes and trust following a medication review intervention compared to experiencing a community talk (Figure 1); e.g., participants expressed “positive views about medical research in general” on questionnaires following medication reviews (p = 0.007). Qualitatively, we found a similar trend during our focus group discussions. Focus group members expressed more comfort with the medication review than the community talk resulting from “positive bedside manners, positive feedback, personal 1‐on‐1 interactions and race concordance.” Focus group participants noted a willingness to participate in future studies because of trust built from their Building Bridges team interactions. “Commonality, better connection, relatability, affinity and cultural similarities” all influenced trust and willingness to participate in future studies. Factors found to reduce trust included: “negative feedback, stereotypes, predominantly white practitioners in medicine and research, clinician unskillfulness, and not feeling seen as a “whole person” by providers” (Figure 2).ConclusionFindings continue to support our hypothesis that more personalized community engagement approaches have a greater influence on participants’ research attitudes and build interest in research. Additional studies of person‐centered recruitment strategies are essential to understanding how to improve trust and positive research attitudes among communities of color.

Engaging Predominantly Black Churches in an Intervention to Improve Cardiovascular Health and Reduce Racial Inequities.

Cardiovascular disease (CVD) is the leading cause of mortality in the United States and disproportionately impacts Black adults. Effective implementation of interventions to improve cardiovascular health in the Black community is needed to reduce health inequities. The Church-Based Health Intervention to Eliminate Health Inequalities in Cardiovascular Health (CHERISH) study is implementing interventions recommended by the 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD in Black communities to improve cardiovascular health and reduce health disparities. The recently completed 3-year planning phase of CHERISH has focused on engaging with the predominantly Black church community in New Orleans with the goals of informing study protocol development and recruiting churches for study participation. Community engagement approaches include convening a community advisory board (CAB), conducting qualitative and quantitative needs assessments, and hosting and attending church events. These activities have resulted in an engaged CAB that has contributed meaningfully to planning activities and the study protocol. The needs assessment found that while there are substantial barriers to cardiovascular health, such as knowledge, access to healthy foods, and safe spaces for physical activity, people are willing to make lifestyle changes and think that the proposed intervention components are feasible. Community engagement activities have resulted in the recruitment of 50 geographically and denominationally diverse predominantly Black churches willing to participate in the study (exceeding our goal of 42). Overall, a multicomponent approach to extensive community engagement has produced effective church enrollment for study participation and meaningful input on study design and implementation.

Barriers to Policy, Systems, and Environment Work: Using Community Engagement as a Tool in SNAP-Ed’s Multi-Level Comprehensive Programming

Implementing policy, system, and environmental (PSE) changes has several well-known challenges that have been documented in Supplemental Nutrition Assistance Program Education’s (SNAP-Ed) comprehensive approach to obesity prevention and reduction. The purpose of the current study was to explore the use of community engagement (CE) as a strategy to address the common challenges experienced in implementing a multi-component community-based program. Phone interviews (N = 7) were conducted with SNAP-Ed educators in Utah using semi-structured interviews. Emergent themes were identified as transcripts were coded independently by two researchers until a high level of agreement was achieved. Four themes emerged from the interviews: barriers to PSE progress, educator CE, the perceived value of using a CE approach to PSE work, and future supports that could increase educators’ ability to use CE when doing PSE work. While effective at eliciting long-term improvements among priority populations, there are several well-documented challenges associated with developing, implementing, and sustaining PSE projects. CE, defined as the process of involving members of a community in the planning, design, implementation, and improvement of a community-based initiative, may be an effective strategy to overcome many of these challenges and lead to long-term PSE changes and improved health outcomes.