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Equitable Community Engagement for Health Program Design, Delivery & Evaluations

By Jenna Berent, MPH, Senior Program Manager

At Activate Care, our north star is health equity. Health-related social needs (HRSN) are driven by social determinants of health (SDOH) that impact certain communities more than others due in part to inequitable policies, infrastructure, built and natural environments, and other conditions that affect our health. We seek to reduce health disparities and promote health equity by implementing our evidence-based program, Path Assist. The Path Assist program is designed to improve the health of historically marginalized populations through Community Health Navigator-led resource navigation, goal-setting, and skill-building.

Before launching Path Assist in a new geographic territory, our team engages local communities in critical formative work through “community assessments” to better understand community strengths and challenges, resources and accessibility, and barriers and facilitators to health and social care. We also seek community-driven ideas for reducing health disparities and promoting well-being. To do this, we recruit diverse individuals with lived experiences to participate in interviews, focus groups, and surveys. The information we learn then shapes how we tailor our Path Assist program for this population and helps ensure that our efforts will be accepted and effective. 

Individuals with lived experience have been “directly affected by social, health, public health, or other issues and by the strategies that aim to address those issues” (DHHS 2022). Hearing directly from those with lived experiences is essential to advancing health equity. These firsthand experiences give insights and perspectives that are critical for informing programming, policies, and practices that will benefit them. I found this especially important in my work with resettled refugee families. Learning about their unique experiences and perspectives was eye-opening, as it often challenged my assumptions about what would be most helpful to them. 

Hearing from many different people also sheds light on the diversity of opinions and thoughts – reinforcing that there is often no “one size fits all” solution, and a tailored approach is usually required. Too often, many voices are neglected and programs and policies fail to produce the results they set forth to achieve because decisions are based on assumptions. That is not only a waste of time, money, and other resources but can also foster distrust and cause harm.

Five equitable engagement strategies and considerations 

Equitably engaging individuals in program design, delivery, and evaluation must be done with core principles in mind. Taking the easiest road to engagement can be both wasteful and harmful – even with good intentions. Here are five strategies to promote equitable engagement:

1. Seek out – and accommodate – the hardest to reach individuals

Although all voices bring value, try to engage individuals who may have yet to be heard. Consider which perspectives are often over or under represented. In many cases, underrepresented individuals could be the most marginalized or excluded and have high distrust. In other cases, they might be experiencing the most complex health or social needs with the most significant barriers to being heard. 

Consider strategies for far-reaching recruitment. Engage key stakeholders and community leaders with existing community relationships and offer flexibility around how and when individuals can participate to accommodate different needs. Putting in the extra effort and resources is worth it.

2. Foster a safe, trusting space 

Facilitators of conversations, such as focus groups and interviews, must be trained to foster a safe, trusting environment that promotes openness, empathy, and cultural humility. Hiring facilitation staff with diverse lived experiences and perspectives might also be helpful. If you engage the right individuals, but the environment feels unsafe for them to open up, you will not hear honest input and instead might be met with silence, criticism, or only part of the story. 

3. Compensate individuals for their time 

Demonstrate that you value the insight and perspectives that the participants are voluntarily sharing with you. Accommodate them financially for taking the time to share their thoughts. In some cases, providing additional stipends, such as for childcare or transportation, will remove barriers to participation and demonstrate your commitment to them and what they have to say. 

4. Acknowledge racism and historical injustices 

Communities of color historically and presently experience racism, marginalization, and other injustices through systems, policies, and people, which have contributed to a high level of distrust and a reluctance to welcome new programs or services. Recognition and validation of their experiences are critical to fostering trust and being welcomed into their community. But most importantly, taking this approach ensures that programs are designed and delivered with every effort to negate the chance of harm. 

5. Utilize collaborative strategies to promote power-sharing 

Ideally, engagement should be taken to the next level — empowerment. Employing collaborative approaches, such as co-design, co-delivery, and co-evaluation allows those with lived experiences to be part of these deeper processes beyond information sharing. Participants can share vital contributions to ensure the program design meets their needs, is delivered equitably and appropriately, and is evaluated with their insight rather than just on numbers.  

Equitable engagement means going the extra mile. It requires additional resources and considerations that might impact your timeline or budget. Deepening one’s understanding of health equity is a journey that requires continuous learning and challenging personal biases. Although this requires extra effort, it is critical to improve program acceptance and effectiveness and to reduce the chance of imparting more harm to already harmed communities and instead impact them positively. As people say, ‘you reap what you sow,’ but for equitable engagement in health program design and delivery, you will reap much more. 

Join us at Camden Coalition’s Putting Care at the Center conference, where we’re presenting “Integrating Community Voice into Program Design and Delivery” Thurs, November 2, 2023 at 10:30 am, highlighting our Omaha Community Health Equity Project Case Study.