Meaningful Community Engagement Research Articles

Research ethics preparedness during outbreaks and public health emergencies: Focus on community engagement

Research represents an essential component of the response to infectious disease outbreaks and to other public health emergencies, whether they are localised, of international concern, or global. Research conducted in such contexts also comes with particular ethics challenges, the awareness of which has significantly grown following the Ebola outbreak in West Africa, the Zika outbreak in Latin America and the COVID-19 pandemic. These challenges include the need for implementing meaningful community engagement with the researched communities, not just to build unidirectional trust towards the research team, but to achieve a genuine and mutually respectful partnership before, during and after the research. Here, we describe the real-life experience of 10 well-established research clinics in Nairobi, where a successful experience of community engagement linking prevention and care to research was interrupted during the COVID19 pandemic. We contrast this experience with the concept and processes of community engagement as described in selected scientific manuscripts and guidelines, to formulate some conclusions and recommendations. We contend that more action is needed, from research ethics committees and other key-research stakeholders, to align policies and practices with ethics guidance and with evidence-based recommendations from the academic literature, to achieve meaningful community engagement during emergency research, irrespective of the scale and location of an outbreak or public health crisis. Failure to do so, will aggravate the (postcolonial) asymmetries of power in global health and local systems.

Forest Disputes: Socially Engaged Art and Forest Science for Understanding Sustainability Challenges

This paper explores activist art's potential in promoting environmental awareness and community engagement, drawing from the International Socially Engaged Art Symposium (ISEAS). Focused on a Western Lapland ISEAS event, the study highlights art workshops addressing forest use conflicts facilitated by artist-scientist teams. These workshops offer a secure space for participants to express environmental concerns, fostering creative expression and dialogue. The study suggests that art-based interventions powerfully promote environmental awareness and community engagement by creating safe spaces for collaborative dialogue. Through ISEAS experiences, the paper demonstrates how activist art facilitates meaningful community engagement, fostering a deeper understanding of environmental challenges.

Meaningful community engagement through advanced indicator systems for sustainable destination planning

This study advances the measurement of sustainable development in communities and destinations examining socio-ecological, environmental, cultural, and economic dimensions. By integrating qualitive insights within established indicator systems such as the European Tourism Indicator System, it addresses the limitations of traditional, solely quantitative approaches. Carrying out over 400 resident surveys in Co. Clare, Ireland, the research established sustainable indicators and assessed the destination's sustainability through resident-based metrics. For instance, 87% of residents believed that tourism benefits their community, yet only 23% of residents were satisfied with their involvement in planning. Thematic analysis of the open-ended responses provided crucial themes for sustainable destination management, highlighting resident concerns on transport, planning, management, and community involvement and benefits. The study concluded that relying solely on quantitative indicators, limits Destination Management Organizations (DMOs) and planners to Likert scale results, failing to capture nuanced impacts observed by destinations. The study highlights the insufficiency of solely using quantitative indicators, which risk oversimplifying community inputs and misinterpreting resident dissatisfaction, signally a need for diverse solutions to address varied concerns. The study also identified survey fatigue as a governance challenge, potentially hindering future sustainable development efforts. Aligning with the socio-ecological indicators of the community-environment-development nexus call for papers, this interdisciplinary research demonstrates the value of advanced indicator systems in promoting meaningful community engagement and supporting policy formulation for sustainable destination development. It offers a comprehensive framework for integrating resident perspectives and thematic insights into destination management, contributing to a more inclusive and community-based approach to tourism development.

Meaningful community engagement and involvement in global health and research: 'Changing mindsets with a million conversations' in Sierra Leone.

Meaningful community engagement and involvement in global health and research: 'Changing mindsets with a million conversations' in Sierra Leone.

Increased community engagement of Indigenous Peoples in dementia research leads to higher context relevance of results.

Health research that focuses on Indigenous Peoples must ensure that the community in question is actively engaged, and that the results have context relevance for Indigenous Peoples. Context relevance is "the benefits, usability, and respectful conduct of research from the perspective of Indigenous communities." The purpose of this study was to apply two tools within an already-published scoping review of 76 articles featuring research on cognitive impairment and dementia among Indigenous Peoples worldwide. One tool assessed levels of community engagement reported in the corpus, and the other tool assessed the context relevance of recommendations in the corpus. We hypothesized that research with higher levels of reported community engagement would produce recommendations with greater context relevance for Indigenous Peoples. We employed semi-structured deductive coding using two novel tools assessing levels of reported community engagement and context relevance of recommendations based on studies included in the existing scoping review. Application of the two tools revealed a positive relationship between increasing community engagement and greater context relevance. Community engagement primarily occurred in studies conducted with First Nations, Inuit, and Métis populations in Canada and with Australian Aboriginal and/or Torres Strait Islander Peoples. Research with Alaska Native, American Indian, and Native Hawaiian Peoples in the USA stood out for its comparative lack of meaningful community engagement. There is opportunity to utilize these tools, and the results of this assessment, to enhance training and mentorship for researchers who work with Indigenous populations. There is a need to increase investigator capacity to involve communities throughout all phases of research, particularly in the pre-research stages.

Enhancing the social outcomes from restrictions on arrivees during global public health emergencies: A Social Impact Assessment perspective

Restrictions on travel and quarantine on arrival are typical strategies imposed by public health authorities during pandemics. While much research has analyzed the consequences of policies about global public health emergencies including COVID-19, to date there has been little discussion of the social consequences of these policies. We undertook an exploratory study using qualitative research to understand the social impacts experienced by travelers as a result of the restriction policies implemented in China following its implementation of a zero-COVID policy. Using online sources and 40 interviews with quarantine hotel staff, government officials, and arrivees to China, we found that the people with a strong justification for travelling during the pandemic were significantly affected by the restrictions, resulting in them experiencing a wide range of negative social impacts, including on their: psychosocial health and wellbeing; family cohesion; social networks; the experience of unexpected and unpleasant circumstances; and a sense of persecution. These outcomes were partly a consequence of the characteristics of Chinese society and the returnees themselves, and were influenced by the government's COVID management strategies. With medical experts having dominated the battle against the virus, ordinary people's feelings and concerns were ignored. We argue that these also need to be understood and considered in the planning of public health strategies. To improve outcomes in future situations, much can be learned from the field of Social Impact Assessment (SIA), especially in terms of understanding how people are affected, and to achieve acceptance and a social licence for pandemic management strategies, the importance of meaningful community engagement, ongoing monitoring, adaptive management, and an effective grievance redress mechanism. Our paper enriches the understanding of SIA when applied in the policy arena, and it demonstrates the value of a SIA perspective for improving social outcomes in public health emergencies. It also adds to understanding the consequences of pandemics and restriction policies on people.

Unpacking the complexities, challenges, and nuances of museum community engagement practitioners' narratives on knowledge production in Scotland

AbstractThis paper explores how community engagement practitioners understand their knowledge production work in facilitating and choreographing dialogical spaces (Freire, 2005) within which “organic intellectuals” (Gramsci, 1971) and “alternative” knowledge emerge. Using a qualitative, phenomenological research strategy, data were generated through semi‐structured interviews with community engagement practitioners in Scotland. Practitioners emphasize the importance of equity in the relationship with project participants in knowledge production. Practitioners' narratives reveal how those relationships are realized and how these inform their own and the museum institutions' practice. We acknowledge that community‐based project participants' expertise is prioritized by practitioners as critical to effective community engagement. We argue for a nuanced conceptualization—and appreciation—of the complexities inherent in museum community engagement practice, which is often absent in museum studies work. This conceptualization is embedded in practitioners' subjective experiences and reflections, as well as structural contexts, which simultaneously enable and constrain meaningful community engagement work.

Factors Impacting Participatory Post-Disaster Relocation and Housing Reconstruction: The Case of Tsholotsho District, Zimbabwe

Relocation is not typically considered the best planning option for post-disaster reconstruction and rehabilitation, but it may be necessary if the site has suffered severe damage or is at imminent risk. There is a growing recognition that strong community participation is necessary in the post-disaster relocation decision-making process since relocation can have detrimental effects on a community’s livelihood, cultural system, and way of life, among others. However, the realization of this still needs to be improved. As of yet, few studies have examined a comprehensive account of meaningful community engagement in post-disaster relocation and reconstruction, particularly in developing countries. This study investigated what factors influenced local communities’ participation in post-disaster relocation and reconstruction works after the 2017 Cyclone Dineo flood disaster in the Tsholotsho District of Zimbabwe. Qualitative research methods such as face-to-face interviews, observations, and focus groups were used to collect qualitative data from a purposive sample of 25 community members and 6 stakeholders. This empirical investigation showed that despite the fact that the relocation project was conceived as a community-centered project, there was no meaningful community engagement, due to the absence of a participatory framework or planning guidelines for stakeholder engagement, as well as the lack of political willingness among government officials. The study concluded that the lack of community involvement led to local communities abandoning the reconstruction sites because relocation projects failed to accommodate the cultural beliefs, place attachments, and livelihood concerns of local communities. This study suggested that it is imperative to enhance the awareness of government officials and other stakeholders about the importance of community participation for the effective implementation of post-disaster relocation works. Meaningful community participation can also provide avenues for incorporating local needs and concerns, cultural beliefs, and alternative and sustainable livelihood restoration, which are essential for effective reconstruction after disasters. This research aimed to enrich the academic discourse by providing valuable insights into the intricacies of post-disaster recovery initiatives in the country.

Charting a Course: Navigating Rigor and Meaning in Global Health Research.

In the rapidly evolving landscape of global health research, the tension between scientific rigor and contextual meaning presents a critical challenge. Drawing on our work with the Global Diet and Physical Activity Network, this commentary explores the complexities of conducting environmental audits for physical activity and diet in 4 rapidly urbanizing African cities: Yaoundé, Lagos, Cape Town, and Soweto. We illustrate the competing demands and tensions that researchers face in balancing rigor and meaning. We discuss the adaptation of internationally validated audit tools to local contexts and the importance of area-level deprivation in interpreting data. We also examine the feasibility of virtual assessment tools, emphasizing the value of local expertise. We argue for a balanced approach that marries research rigor with contextual meaning, advocating for transparency, humility, and meaningful community engagement.

Urban Rats ( Rattus norvegicus ) through a One Health Lens: Social and Ecological Factors Promote Opportunities for Urban Leptospirosis in Rats, Dogs, and People

Abstract Living in cities creates One Health challenges because urban environments can promote pathogen transmission in wildlife and human-wildlife interactions with commensal species such as rats. In this study, we examined social and ecological processes that lead to an elevated risk of leptospirosis, a fatal rat-associated disease transmitted through Leptospira interrogans bacteria in urine. We examined rat and human factors associated with (1) human exposure to rat urine in the home environment, (2) the presence of rats carrying L. interrogans on the block, and (3) environmental conditions associated with rat infection. We surveyed residents and trapped rats on the same 16 blocks in four neighbourhoods in Chicago. Survey respondents were more likely to observe rat urine in their homes if they had lower incomes. Blocks where rats were carrying L. interrogans had higher rat abundance and respondents with higher incomes, who reported dogs dying from leptospirosis, children playing in yards with rat waste, flooded yards, and gardens with rat burrows. Rats were more likely to be infected with L. interrogans if they were trapped on a block with more accessible garbage and if they were older. Our results highlight that rat presence alone does not determine the risk of close contact with rat-associated pathogens; socio-economics can affect an individual’s ability to exclude animals from living spaces. In addition, improved waste management may help mitigate disease risks for humans, wildlife, and domestic animals. We also discuss opportunities for public education about rat-associated zoonoses and lessons learned about meaningful community engagement in One Health work. Information © The Authors 2024

Process evaluation of a parent-child communication intervention for adolescent sexual and reproductive health in Uganda

BackgroundPrevious initiatives concerning adolescent sexual and reproductive health (SRH) education in Low-or-Middle Income Countries (LMICs) have been limited by cultural norms and misinformation perpetuated within families. Responding to the paucity of research on the implementation of SRH interventions in LMICs and limited knowledge regarding their mechanisms, this study undertakes a process evaluation of a parent-focused intervention to promote parent-adolescent communication about SRH in Uganda.MethodsThis paper explores the implementation, contextual factors and mechanisms of impact of the intervention, using the Medical Research Council (MRC) guidelines for process evaluations. Implementation was evaluated through indicators of dose, fidelity and adaptations, acceptability and feasibility. The contextual factors and mechanisms of impact were evaluated to refine the intervention’s causal assumptions. Data was collected during April - October 2021 in South-Western Uganda using a mixed-methods approach, including document analysis, intervention observations, interviews, focus group discussions and most significant change stories.ResultsThe acceptability of the intervention was related to its community engagement, the strong rapport with delivery agents, and individual characteristics of participants. Five contextual factors influencing implementation were highlighted; (i) cultural norms, (ii) perceptions about youth SRH, (iii) poverty, (iv) Covid-19 pandemic, and (v) prior research projects in the community. When considering the intervention’s mechanisms of impact, four causal pathways were identified; (i) Awareness of SRH needs helped parents overcome stigma, (ii) Parenting skills training improved SRH communication, (iii) Group learning stimulated shared parenting, and (iv) Group learning improved co-parenting.ConclusionThe paper presented three key learnings and corresponding recommendations for future research. Firstly, implementation success was credited to meaningful community engagement which improved acceptability and uptake. Secondly, the complex influences of contextual factors highlighted the need for contextual analysis in research studies to inform intervention design. Finally, this evaluation recognised the interplay between mechanisms of impact and suggested further research consider such combined impacts when designing intervention content.

Engagement of vulnerable communities in HIV prevention research in India: a qualitative investigation

BackgroundMeaningful community engagement (CE) in HIV prevention research is crucial for successful and ethically robust study implementation. We conducted a qualitative study to understand the current CE practices in HIV prevention research and to identify expressed and implicit reasons behind translational gaps highlighted by communities and researchers.MethodsFor this exploratory qualitative study, we recruited a purposive sample of participants from Indian government-recognised key populations such as men who have sex with men, transgender women, people who inject drugs and female sex workers; general population adults and adolescents/youth; and researchers. We conducted 13 virtual focus groups (n = 86) between July and October 2021. Data were explored from a critical realist perspective and framing analysis (i.e., examining how the participants framed the narratives).ResultsParticipants reported that study communities, especially those from key populations, were primarily involved in data collection, but not necessarily with optimal training. Involvement of communities before the start of the study (e.g., obtaining feedback on the study’s purpose/design) or once the study is completed (e.g., sharing of findings) were highlighted as priorities for meaningful engagement. Participants suggested meaningful CE in all stages of the study: (1) before the study—to get inputs in finalising the study design, drafting comprehensible informed consent forms and culturally-appropriate data collection tools, and deciding on appropriate monetary compensation; (2) during the study—adequate training of community field research staff; and (3) after the study—sharing the draft findings to get community inputs, and involving communities in advocacy activities towards converting evidence into action, policy or programs. Timely and transparent communications with communities were explicitly stated as critical for gaining and maintaining trust. Mutual respect, reciprocity (e.g., appropriate monetary compensation) and robust community feedback mechanisms were considered critical for meaningful CE. ConclusionsThe findings highlighted the translational gaps and priority areas for capacity building to strengthen CE in HIV prevention research. It is not only important to engage communities at various stages of research but to understand that trust, dignity, respect, and reciprocity are fundamentally preferred ways of meaningful community engagement.

A National Approach to Promoting Health Equity in Cardiovascular Disease Prevention: Implementation Science Strengths, Opportunities, and a Changing Chronic Disease Context

In the USA, structural racism contributes to higher rates of cardiovascular disease (CVD) including hypertension, heart disease, and stroke among African American persons. Evidence-based interventions (EBIs), which include programs, policies, and practices, can help mitigate health inequities, but have historically been underutilized or misapplied among communities experiencing discrimination and exclusion. This commentary on the special issue of Prevention Science, “Advancing the Adaptability of Chronic Disease Prevention and Management Through Implementation Science,” describes the Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention’s (DHDSP’s) efforts to support implementation practice and highlights several studies in the issue that align with DHDSP’s methods and mission. This work includes EBI identification, scale, and spread as well as health services and policy research. We conclude that implementation practice to enhance CVD health equity will require greater coordination with diverse implementation science partners as well as continued innovation and capacity building to ensure meaningful community engagement throughout EBI development, translation, dissemination, and implementation.

Empowering the voices of persons with disabilities: Co-creating and implementing a community engagement framework for inclusive program design and organizational development

Increasing efforts in public and patient engagement have resulted in several approaches, theories, models, and frameworks. While many of these efforts have merit, they tend to be designed for engagement in healthcare organizations and services, or research. Focusing on these specific areas is useful, but these approaches lack the contextual considerations community-based organizations must work through when looking to change or improve their engagement practices. March of Dimes Canada (MODC) is a complex national organization that serves people with disabilities, operating across multiple jurisdictions and health authorities to provide community health and social care services, conducts research, provides peer support programming, and engages in advocacy work. MODC recognizes the need to improve engagement practices across all aspects of the organization, however it is difficult to implement a single engagement model or framework consistently across the organization. For this reason, our study aimed to co-create a community engagement framework that is contextually relevant to MODC and our communities, supporting the improvement of engagement practices within all aspects of the organization. 
 We are using a co-design approach to complete the study; inviting MODC’s clients, who are people with disabilities to participate as co-researchers in this work. The co-creation of the framework is currently underway and consists of three phases. Phase one included: conducting surveys, group interviews, and a document analysis of current organizational engagement practices. Phase two included: conducting an environmental scan of other community organizations’ engagement practices; and completing a rapid review to identify theories, models and frameworks for client and public engagement. Phase three, which is currently underway, includes establishing an advisory committee of individuals who: 1) reside in Canada, and 2) have experience living with a disability. The advisory committee will co-design the engagement framework and co-create the implementation materials and processes for the resulting framework. During this phase we will also convene working groups with specific populations (i.e., caregivers, youth and their families, frontline staff, management etc.) to review the framework for validation and further refinement. 
 
 To date results from phase one have found Canadian non-profit organizations that provide services and supports for people with disabilities are moving towards including clients more meaningfully through advisory committees, having people with disabilities as board members, and moving away from the charitable model of disability and tokenism. Some barriers to meaningful client engagement include funding constraints, organizational policies, accessibility, and lack of action following client feedback. These findings, along with the rapid review findings will inform the engagement framework co-design with the advisory committee. 
 This study can provide insight on the process of developing and implementing a contextually relevant engagement framework that guides more meaningful community engagement for program design, creating organizational policies, conducting research and advocacy activities, and strategic planning. The framework will be evaluated following its implementation for continuous refinement and improvement across all levels of the organization. There will also be ongoing knowledge translation and mobilization activities to share the process, experiences, and results from the framework development within the disability and non-profit communities.

Using Design Thinking to Solve Real-World Problems

This paper presents an innovative pedagogical model that incorporates components of team-based learning, problem-based learning, and design thinking in the context of a community-engaged applied learning experience. Students participating in this project build 21st century skills needed to be successful in their future educational and career pursuits. Undergraduate sociology and master's level social work students partnered with community organizations to solve a real-world problem for that organization. They were coached through the process by their instructors. Before participating in the project, students reflected on what they hoped to get out of the experience. After completion, they reflected on the process and what they learned. Analyzing student reflection papers, we found three themes: excitement and fears, challenges and opportunities, and personal and professional growth. We conclude by describing how instructors can incorporate aspects of this model into their own classroom, and the importance of teamwork skills, design thinking skills, and meaningful community engagement.

Advancing shared accountability for meaningful community engagement with socially vulnerable communities: Lessons learned from COVID-19 health education and general outreach in an urban region.

As COVID-19 public health emergency measures come to an end, socially vulnerable communities have reduced access to resources that address social and health disparities created or exacerbated by the pandemic. Social workers must uphold access to healthcare as a human right in the post-pandemic era by reducing social vulnerability and strengthening community resilience to respond to future health emergencies and natural disasters. This paper draws on the experiences of a team of social work researchers, students, and practitioners engaged in efforts to disseminate information on COVID preventive measures and broker access to local health and social resources. This project, based in one of the fastest-growing metropolitan areas in the United States, formed part of the federal research response to promote community engagement in regions most disproportionately impacted by the COVID-19 pandemic. Through participation in health fairs and community events that targeted persons with limited access to healthcare resources, we gathered critical insights on how to build community capacity for meaningful community engagement. Drawing on a conceptual model for evaluating community engagement strategies, we describe three main barriers to collaborative community outreach: weak organizational communication and coordination, inconsistent strategies for requesting on-site health services, and low neighborhood awareness of outreach events. We advance strategies for improvement that engage community-based organizations, health systems, backbone organizations, and community members in targeted activities to build community resilience. This includes inter-organizational communication during outreach event planning, formal processes to promote greater use of mobile health services, centralized event communication, and grassroots outreach event promotion.

The Arctic Rivers Project: Using an Equitable Co‐Production Framework for Integrating Meaningful Community Engagement and Science to Understand Climate Impacts

AbstractAs the Arctic and its rivers continue to warm, a better understanding of the possible future impacts on people would benefit from close partnership with Indigenous communities and scientists from diverse fields of study. We present efforts by the Arctic Rivers Project to conduct community‐engaged research to increase collective understanding of the historical and potential future impacts of climate change on rivers, fish, and Indigenous communities. Working in central to northern Alaska and the Yukon Territory in Canada, the project seeks to engage with Indigenous communities in ethical and equitable ways to produces science that is useful, useable, and used that may serve as an example for future research efforts. Toward this goal, we formed an Indigenous Advisory Council and together developed project‐specific knowledge co‐production protocols. This paper provides a novel model of design and implementation to co‐produce knowledge with communities across a large study domain.

Catalyzing alignment and systems transformation through cross-sector partnerships: Findings from the California Accountable Communities for Health Initiative.

To describe the impact of Accountable Communities of Health (ACHs) on organizational and community partnerships and explore how ACHs contribute to systems change. The California Accountable Communities of Health Initiative (CACHI) was a 5-year, $17 M investment in community health transformation in 13 ACH sites. Data sources include two surveys, key informant interviews, small group conversations, and ACH meeting observations and document review. This was a mixed-methods, observational study. Surveys conducted in 2021 and 2022 focused on ACH progress in building organizational and community partnerships and ACH impact on partners and systems, respectively. Interviews and small group conversations were conducted toward the end of the CACHI grant period and designed to complement the surveys. Survey respondents included ACH backbone agency staff and partner organization representatives (n = 141 in 2021 and 88 in 2022). Semistructured individual interviews and group conversations were conducted with 40 ACH backbone staff and partners. Documents were collected via grant reporting and directly from ACH staff. Data were analyzed descriptively and thematically. ACHs appear to have supported organizational partnerships and collaboration. Seventy-six percent of survey respondents reported that their ACH had strengthened organizations' ability to work together and 65% reported developing new or deepened connections. While ACH participants reported a better understanding of community needs and priorities, progress on community relationships, and greater attention to equity and racial justice, many saw room for improvement on meaningful community engagement. Systems changes and precursors of systems change observed across ACH sites included strengthened partnerships, enhanced knowledge, increased capacity, more collaborative ways of working, and new funding streams. The ACH model is effective at strengthening organizational partnerships and catalyzing other systems changes and precursors including enhanced knowledge, increased capacity, more collaborative ways of working, and new funding.

Exploring Nursing Strategies to Engage Community in Cardiovascular Care.

This review aims to highlight some of the strategies nurses use to engage community members in cardiovascular care. We also elaborate on opportunities for improving community engagement. Community engagement occurs across a continuum of progressive levels of community involvement, impact, trust, and flow of communication. Successful community engagement has been shown to improve both patient-centered care and intervention design, implementation, and dissemination. Nurse strategies used for engaging community in cardiovascular care included more examples of outreach, consult, and involvement than collaboration and shared leadership. More attention is needed toward strategies that embrace collaboration and enhance trusting relationships to advance to shared leadership. Nurses must intentionally work in partnership with communities to improve cardiovascular health for all. Furthermore, assessing meaningful community engagement is necessary to achieve the desired outcomes, including optimal cardiovascular health and thriving communities.

Scaling and sustaining COVID-19 vaccination through meaningful community engagement and care coordination for underserved communities: hybrid type 3 effectiveness-implementation sequential multiple assignment randomized trial

BackgroundCOVID-19 inequities are abundant in low-income communities of color. Addressing COVID-19 vaccine hesitancy to promote equitable and sustained vaccination for underserved communities requires a multi-level, scalable, and sustainable approach. It is also essential that efforts acknowledge the broader healthcare needs of these communities including engagement in preventive services.MethodsThis is a hybrid type 3 effectiveness-implementation study that will include a multi-level, longitudinal, mixed-methods data collection approach designed to assess the sustained impact of a co-created multicomponent strategy relying on bidirectional learning, shared decision-making, and expertise by all team members. The study capitalizes on a combination of implementation strategies including mHealth outreach with culturally appropriate messaging, care coordination to increase engagement in high priority preventive services, and the co-design of these strategies using community advisory boards led by Community Weavers. Community Weavers are individuals with lived experience as members of an underserved community serving as cultural brokers between communities, public health systems, and researchers to co-create community-driven, culturally sensitive public health solutions. The study will use an adaptive implementation approach operationalized in a sequential multiple assignment randomized trial design of 300 participants from three sites in a Federally Qualified Health Center in Southern California. This design will allow examining the impact of various implementation strategy components and deliver more intensive support to those who benefit from it most. The primary effectiveness outcomes are COVID-19 vaccine completion, engagement in preventive services, and vaccine confidence. The primary implementation outcomes are reach, adoption, implementation, and maintenance of the multicomponent strategy over a 12-month follow-up period. Mixed-effects logistic regression models will be used to examine program impacts and will be triangulated with qualitative data from participants and implementers.DiscussionThis study capitalizes on community engagement, implementation science, health equity and communication, infectious disease, and public health perspectives to co-create a multicomponent strategy to promote the uptake of COVID-19 vaccination and preventive services for underserved communities in San Diego. The study design emphasizes broad engagement of our community and clinic partners leading to culturally sensitive and acceptable strategies to produce lasting and sustainable increases in vaccine equity and preventive services engagement.Trial registrationClinicalTrials.gov Identifier: NCT05841810 May 3, 2023