Achieving Health Equity and Systems Transformation Through Community Engagement: A Conceptual Model
What is the dynamic relationship between engagement & meaningful outcomes?
Community engagement is not a single event or goal, but a complex process that changes across time and location. As that process takes place, it is equally complex to understand that the engagement is meaningful, impactful, and leads to promising outcomes.
The Assessing Community Engagement Conceptual Model centers community engagement and core engagement principles and identifies outcomes associated with meaningful community engagement that can form the basis for assessment or measurement efforts across various stages, models, processes, and partnerships of engagement.
Assessing Meaningful Community Engagement: A Conceptual Model to Advance Health Equity through Transformed Systems for Health
Community Engagement
Community engagement is the linchpin or central focus of the Conceptual Model. Engagement of the community, defined as “groups of people affiliated by geographic proximity… or similar situations to address issues affecting the well-being of those people” (CDC Principles of Community Engagement), represents both the start and the hub of movement toward outcomes. It is only with community engagement that it is possible to achieve and accelerate progress toward the goal of health equity through transformed systems for health.
Click on the model to zoom in or view the core principles.
Core Principles
The core principles identify attributes that are foundational to the process of community engagement. Those involved must ensure that community engagement is grounded in trust, designed for bi-directional influence and information flow between the community and partners, inclusive, and premised on culturally-centered approaches. The core principles also include equitable financing, multi-knowledge, shared governance, and ongoing relationships that continue beyond the project timeframe and that are authentic and enduring. Engagement should be co-created and participants should be considered co-equal. Principle-informed community engagement creates a readiness that can propel teams into productive motion and accelerate engagement outcomes and the ultimate goal of health equity and systems transformation.
Strengthened Partnerships & Alliances
The first assessment domain identified by the Organizing Committee relates to strengthened partnerships and alliances, which the Committee defines as how participants emerge from engagement with new, improved, or stronger relationships that are carried forward.
Click on the model to zoom in or view the eight indicators for this domain.
Diversity and inclusivity
Diversity and inclusivity ask for constant consideration of the representation, inclusion and lived experiences of those who are and should be engaged in the efforts. Representation should be intentionally diverse, comprising multicultural, multiethnic, and multigenerational perspectives, particularly those not traditionally invited or involved in efforts to improve health and health care policies and programs. Perspectives should reflect the composition of the community, be based in the culture of the community, and reflect multidisciplinary expertise from the community. Diversity and inclusivity should also be reflected in intentional integration of the interests and, importantly, knowledge, resources, and other valuable contributions from all community members during conversations and deliberations.
Partnerships and opportunities
Partnerships and opportunities ensure that those who are engaged are fully benefiting from participation through deepened and mutually supported relationships. This indicator assesses if participants have benefitted from bi-directional mentorship or other forms of professional investment; gained access to new financial or non-financial opportunities; received certificates, degrees or otherwise benefited from skills development; or shared and connected to an expanded network of partners, influencers, and leaders.
Acknowledgment, visibility, recognition
Acknowledgment, visibility, and recognition reflects the degree to which community participants are seen and recognized as contributors, experts and leaders and are able to benefit from their participation. This indicator encompasses public acknowledgement of participant contributions, as well as recognizes the legitimacy of the partnership.
Sustained relationships
Sustained relationships require that the community, institutions and relevant disciplines maintain continuous and ongoing conversations that are not time-limited or transactional. The community should be engaged at the beginning of an effort and normalized as an essential stakeholder. Involvement and engagement of community should have depth and longevity.
Mutual value
Mutual value ensures that communities engaged are equitably benefitting from the partnership. This indicator requires balanced engagement between community and others involved in the partnership, as marked by reciprocity that considers how the community will benefit from, not just contribute to, the effort. The value exchange can be financial or non-financial, but must be defined by, not prescribed for, the community. Mutual value is grounded in the need for understanding and respect for the community and all partners. It requires valuing the knowledge and expertise of all individuals, agreeing to a shared set of definitions and language, and committing to bidirectional learning.
Trust
Trust is a core component of engagement. It requires showing up authentically, being honest, following through on commitments, and committing to transparency in order to build a long-lasting and robust relationship. Genuine partnerships grounded in trust require change on the part of all partners. Trust also requires that entities engaging communities commit themselves to being trustworthy. Mistrust among communities of representatives of health care and other systems is often an adaptive response to historical and contemporary injustice perpetrated by these systems. A foundational component of building trust with communities is demonstrating that community trust is warranted, will not be abused or exploited.
Shared power
Shared power is fundamental to strong and resilient partnerships with the community. Shared power reflects that community participants are involved in leadership activities such as co-designing and developing the shared vision, goals, and responsibilities of the partnership. It emphasizes that members of the community have influence and can see themselves and their ideas reflected in the work being done. Shared power includes true equitable partnership and governance structures that ensure community partners occupy positions of leadership, and wield demonstrable power equivalent to other partners. Shared power relies on collaborative and shared problem-solving and decision-making, joint facilitation of activities, and shared access to resources, such as information and stakeholders.
Structural supports
Structural supports for community engagement provides the infrastructure needed to facilitate continuous community engagement. This indicator asks about operational elements for engagement such as established and mutually agreed-upon financial compensation for community partners, requirements for equitable governing board composition, protocols to ensure integration of community partners into grant writing and management, and equitable arrangements for data sharing and ownership agreements, among others. These structural supports ensure the longevity of community engagement and the sustainability of the partnership over time.
Expanded Knowledge
The second domain, expanded knowledge, refers to the creation of new insights, stories, resources, and evidence, as well as the formalization of respect for existing legacies and culturally-embedded ways of knowing that are unrecognized outside of their communities of origin. When co-created with community, expanded knowledge creates new common ground and new thinking, and so can catalyze novel and more equitable approaches to the transformation of health and health care.
Click on the model to zoom in or view the three indicators for this domain.
New curricula, strategies, and tools
New curricula, strategies, and tools are formal products of community engagement that encapsulate new knowledge and evidence in ways that allow it to be disseminated, accessed, replicated and scaled. This indicator looks for the development of new curricula, strategies, and tools that enable other partnerships to learn from, build on, and advance new practices in their community engagement.
Bi-directional learning
Bi-directional learning is when community and partners are able to collaboratively generate new knowledge, stories, and evidence that reframe how community is described and appreciated. This indicator looks for representations of community that are asset- and resiliency-based; for improved cultural knowledge and practices among partners; and for broader cultural proficiency and respect for community differences across the partnership. Bi-directional learning equally values all forms of knowledge and wisdom, including stories and lived experience.
Community-ready information
Community-ready information is an indicator referring to the creation of actionable findings and recommendations that are returned to the community in ways they understand, value and can use.
Improved Health & Health Care Programs & Policies
The third domain of the Conceptual Model is improved health and health care programs and policies. This is the stated goal of many partnerships; however, creating programs and policies that address community needs and priorities requires alignment between those who administer programs, services, and policies and those who use them. Community engagement is essential to creating a productive context for developing solutions that are “fit to purpose,” as well as embraced and championed by those who they are designed to serve.
Click on the model to zoom in or view the three indicators for this domain.
Community-aligned solutions
Community-aligned solutions come from and speak to the priorities of the community. This indicator looks for community-defined problems, shared decision-making, and cooperatively defined metrics. It also ensures that care models, communication, and solutions are tailored to the community setting and needs
Actionable, implemented, and recognized solutions
Actionable, implemented, and recognized solutions are important indicators of success. Results should be visible within and across communities. This indicator looks for solutions that are recognized and endorsed by community members and leverage the assets in the community and the partnerships that produced them; are referenced publicly or within academic literature; and show measurable adoption, growth, and reach.
Sustainable solutions
Sustainable solutions reference new interventions, programs, and policies that can extend past their initial period of support. This indicator looks for residual infrastructure and other resources that remain in the community to support sustainability and further adjust or refine solutions in the future, if needed.
Thriving Communities
As motion accelerates through strengthened partnerships and alliances, expanded knowledge, and improved health and health care policies and programs, assessing the impact of community engagement moves to the fourth domain: Thriving communities.
Click on the model to zoom in or view the five indicators for this domain.
Physical and mental health
Physical and mental health reflect a “whole-person” view of health. Additionally, physical and mental health include a shared awareness and view of health and health-related activities; self-efficacy in managing health and chronic conditions; shared decision-making in health care treatments and priorities; increased confidence and capacity to make decisions that improve an individual’s own health; and increased resiliency.
Community capacity and connectivity
Community capacity and connectivity speaks to a growth in skills and capacity of community, both as individual members and as a whole, to act on its own behalf. This indicator highlights the connectivity between community members and between community members and available resources; how engaged and activated community members are; and the investments available to develop new community leaders (e.g., financial, educational, career).
Community power
Community power manifests in a sustained paradigm shift that ensures processes and procedures are favored, initiated, and guided by the community. Community power arises with an increased rate of new efforts in the community and new efforts that are defined, initiated, and owned by the community. Community power is also indicated by cultural change – including changes in community dynamics, such as expectations that they will be meaningfully invited to and want to participate in problem-solving and priority-setting and will experience true equity (e.g., social equity, racial equity, health equity, equity across the drivers of health).
Community resiliency
Community resiliency refers to the overall strength of a community and its internal capacity to self-manage. This indicator reflects the ability of the community to recognize and mount a locally relevant response to new adversities and to engage and advance culturally-effective strategies to strengthen the community over time. The inherent culture and strengths of the community should be both visible and valued. Importantly, resiliency must not be invoked as a backstop for initiatives that perpetuate trends of a lack of external investments, protections, and support for community. In other words, resilience is valuable for the internal benefits and strengths that it generates among community members; it is not, however, a replacement for adequate and tangible external investments in the resources that communities need to thrive.
Life quality and well-being
Life quality and well-being refer to improvements in the drivers of health (e.g., education, economic and racial justice, built environment). The ability to heal, to hold hope for the future, and to experience greater joy, harmony, and greater social equity are highlighted in life quality and well-being.
Drivers of Health, Drivers of Change & Context
Impact in the four domains and their associated indicators creates motion and catalytic action that leads to the fundamental goal of health equity and well-being through transformed systems, and is influenced by several contextual factors, including the drivers of health, drivers of change in health and health care, and social, political, racial, economic, historical, and environmental context. The Organizing Committee believes that with meaningful community engagement it is not only possible to motivate health equity through transformed systems for health, but to also significantly transform and positively alter these contextual factors. As such, a feedback loop is created and reflected through the arrows that move from community engagement, the core principles, and the domains of meaningful engagement through to these contextual factors. Learn more about these factors below.
Drivers of health
Drivers of health, many of which align with the social determinants of health, expand far beyond “traditional” factors like health status and health care into factors that ultimately influence and impact well-being such as food, transportation, housing, community attributes, affordable childcare, and economic and racial justice, among many others.
Drivers of change
Drivers of change are the key levers that influence stakeholder action, including data-driven, evidence-based practice and policy solutions; the power and priorities of constituencies; market forces; policies; and financial incentives, to name a few.
Social, political, racial, economic, historical, and environmental context
Community power manifests in a sustained paradigm shift that ensures processes and procedures are favored, initiated, and guided by the community. Community power arises with an increased rate of new efforts in the community and new efforts that are defined, initiated, and owned by the community. Community power is also indicated by cultural change – including changes in community dynamics, such as expectations that they will be meaningfully invited to and want to participate in problem-solving and priority-setting and will experience true equity (e.g., social equity, racial equity, health equity, equity across the drivers of health).
Acknowledgments
The Organizing Committee would like to thank Kim Irwin, Director of the Equitable Healthcare Lab and Professor of Practice at the Institute of Design at Illinois Tech, for development and design of the Assessing Community Engagement Conceptual Model; and Tomoko Ichikawa, Clinical Professor of Design at the Institute of Design at Illinois Tech, for information design support.
We want to hear from you!
Assessing community engagement involves the participation of many stakeholders. Click here to share feedback on these resources, or email [email protected] and include “measure engagement” in the subject line to learn more about the NAM’s Assessing Community Engagement project.
