Translating community voices to build meaningful engagement: a Community Health Worker led study

Understanding community perspectives on barriers and facilitators of meaningful engagement, equitable decision making, and sustainable community improvement is critical for advancing health equity. Community Health Workers can make significant contributions to research teams, as they are bridges into communities and bring unique perspectives. This study describes community voices on barriers to authentic engagement and insights on strategies to build trust, as well as the way in which these data were translated into a tangible assessment tool and a community-facilitated learning academy.

A team of Community Health Workers led a series of 24 'open mic' discussions in four South Carolina communities. Verbatim transcripts were analyzed inductively.

Participants were mostly female (83%), African American (88%), and had a range of education, ages, and levels of engagement. Community concerns (violence, lack of resources, and insufficient economic development) were a primary focus of conversation. Barriers to community engagement include not having sufficient input into what the engagement focus should be, mistrust in outsiders (which in part stems from a history of racism), lack of voice in decision-making, and broken promises. Participants view trust as the essential building block for community engagement, which takes genuine connections, listening, consistency, commitment, and follow-through. These data were used to inform the Prioritizing Long-lasting Actionable Community Engagement & Equity (P.L.A.C.E.) Academy, which aims to equip community leaders with tools for meaningful engagement.

Our findings confirm the Aligning Systems for Health framework, which calls for attention to equity, power dynamics, trust, and the need to let community generate priorities and solutions. Academic, public health, healthcare and social service partners must work with communities to ensure that community issues are addressed respectfully and equitably. Our data driven curriculum is a critical step toward stronger engagement, enhanced communication, and improved health outcomes. Developing research teams that include Community Health Workers is a pragmatic strategy that can lead to better insights, greater trust, balances in power, and ultimately, greater health equity.