Abstract
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.