Introduction
People and the communities they are a part of—defined as “groups of people affiliated by geographic proximity . . . or similar situations to address issues affecting the well-being of those people”—are deeply impacted by the systems that drive and influence their health; however, they are often not included in the process to create or restructure programs and policies designed to benefit them (CDC, 2011). When health and health care policies and programs designed to improve outcomes are not driven by community interests, concerns, assets, and needs, these efforts remain disconnected from the people they intend to serve. This disconnect ultimately limits the influence and effectiveness of interventions, policies, and programs.
Over the last several years, health and health care entities, including advocacy organizations, philanthropic and funding agencies, care systems and hospitals, and academic and research organizations, among others, are recognizing the need to engage the communities they serve. Yet, many entities only conduct superficial engagement— the community is denied access to the decision-making process, and interactions tend toward tokenism and marginalization, or the community is simply informed of plans or consulted to provide limited perspectives on select activities (Carman and Workman, 2017; Facilitating Power, 2020). True, meaningful community engagement requires working collaboratively with and through those who share similar situations, concerns, or challenges. Their engagement serves as “a powerful vehicle for bringing about environmental and behavioral changes that will improve the health of the community and its members. [It] often involves partnerships and coalitions that help mobilize resources and influence systems, change relationships among partners, and serve as catalysts for changing policies, programs, and practices” (CDC, 2011). Shifting toward meaningful community engagement often requires decision makers to defer to communities and move to power-sharing and equitable transformation—necessary elements to ensure sustainable change that improves health and well-being (Facilitating Power, 2020). It is important to note that meaningful community engagement requires working closely with communities to understand their preferences on how, when, and to what level and degree they want to be engaged in efforts. Some communities may prefer to only provide input or be consulted at certain times, while others may prefer shared power and decision-making authority.
Tools and resources are available to provide practical guidance on and support for community engagement (CDC, 2011). Yet, the intention to engage does not always translate to or ensure effective engagement (Carman and Workman, 2017; Facilitating Power, 2020). In other words, the fundamental question is not whether entities think they are engaging communities but whether communities feel engaged. Bridging this gap requires the ability to define meaningful community engagement and assess its impact—especially related to specific health and health care programs, policies, and outcomes.
With these realities in mind, the National Academy of Medicine’s Leadership Consortium: Collaboration for a Value & Science-Driven Health System, with funding from the Robert Wood Johnson Foundation and guidance from an Organizing Committee, is advancing a project to identify concepts and metrics that can best assess the extent, process, and impact of community engagement. The Organizing Committee comprises experts in community engagement—community leaders, researchers, and policy advisors—who are diverse in many ways, including geographic location, race and ethnicity, nationality, disability, sexual orientation, and gender identity (see Box 1). This effort aims to provide community-engaged, effective, and evidence-based tools to those who want to measure engagement to ensure that it is meaningful and impactful, emphasizing equity as a critical input and outcome. As work began on the project, the Organizing Committee realized the need for a conceptual model illustrating the dynamic relationship between community engagement and improved health and health care outcomes. This commentary will describe how the Organizing Committee arrived at the conceptual model, the critical content that the model contains and expresses, and how the model can be used to assess meaningful community engagement.
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