Health care organizations that implement successful community engagement strategies can expand their approach to improving health in the communities they serve. At its core, community engagement can address socioeconomic issues that are the root causes of many health issues. By engaging with stakeholders in the community to address those socioeconomic issues, health care organizations can improve health outcomes and reduce the costs of services.
What Is Community Engagement in Health Care?
When they participate in community engagement programs, health care organizations expand beyond their traditional role of treating the effects of health issues. Instead, they also become active players in influencing the determinants of health. In defining what is community engagement for health care organizations, it is useful to examine the overall focus, goals, and stakeholders involved in community engagement programs.
Focus of Health Care Community Engagement Programs
Health care organizations’ community engagement programs often focus on the social determinants of health. The U.S. Department of Health and Human Services (HHS) defines those determinants as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks,” and it groups these determinants into five categories:
- Economic stability
- Education access and quality
- Health care access and quality
- Neighborhood and built environment
- Social and community context
Specific examples of social determinants of health include safe housing, transportation, and neighborhoods; education, job opportunities, and income; and access to nutritious foods and physical activity. Recognizing how those determinants affect health enables health care organizations to expand beyond their customary functions and play an active role in community engagement programs.
Goals of Health Care Community Engagement Programs
Engagement programs typically concentrate on areas such as the following:
- Improving health
- Preventing disease
- Reducing disparities in health care
- Preventing violence
- Promoting safety
- Improving access to health care
Forming an understanding of how these goals intersect with the social determinants of health can enable health care organizations to develop effective community engagement programs. For example, a program to promote healthy eating may not be effective if access and transportation issues are the root causes that prevent individuals from making healthy nutritional choices.
Stakeholders in Health Care Community Engagement Programs
Through community engagement programs, health care organizations collaborate with a variety of stakeholders to achieve their goals.
- Public health agencies
- Religious organizations
- Public safety agencies
- Charitable organizations
- Environmental organizations
Partnering with a range of stakeholders helps ensure that a community engagement program recognizes and benefits from differing perspectives and insights. In addition, working to create a sense of joint ownership among stakeholders can be key to the program’s success.
The extent of collaboration can vary based on the program’s needs. For example, stakeholders can agree to engage in these coordinated strategies.
- Share information
- Make referrals to other participating stakeholders
- Coordinate services
- Share staff or resources
- Co-locate and integrate their programming, planning, and funding operations
Why Is Community Engagement Important?
When stakeholders begin to ask why community engagement is important, they can discover a host of benefits. While improving community members’ health might be viewed as the primary benefit, the advantages of a health care organization’s participation in community engagement programs extend far beyond that.
- Community engagement programs can use limited resources in ways that better align with a community’s health needs.
- The collaboration of multiple stakeholders in community engagement programs can improve the effectiveness of health initiatives and make them more sustainable.
- Community engagement programs can place greater attention on the social determinants of health and address the root causes of health issues.
- Members of the community can gain a new perspective of a health care organization’s role in promoting health.
- Enhanced communication among stakeholders can lead to further collaboration and understanding.
- When stakeholders participate in community engagement programs, they can apply their unique knowledge and experiences to improve community health.
- Collaboration can expand the capacity of a community’s health care system.
Community Engagement Programs Can Result in Cost Reductions
Another potential benefit of community engagement is a reduction in health care costs. Promoting awareness of health issues through engagement programs helps community members identify issues early and obtain preventive care. That helps reduce the need for hospital visits, which minimizes health care costs. Focusing on particular social determinants of health is critical in reducing costs.
- Community nutrition programs have resulted in health cost savings because malnourished patients cost more to treat than well-nourished patients.
- Programs to reduce homelessness have enabled health care organizations to reduce the frequency and cost of emergency care they provide to homeless individuals.
- Programs to improve patients’ access to transportation have reduced costs associated with missed appointments and procedures.
Health Care Community Engagement Programs Can Benefit Rural Communities
The benefits of community engagement programs are especially important to the unique health care challenges that rural communities face. These challenges can include reduced access to health care, substance abuse, poverty, and chronic disease. Forming partnerships with local entities such as schools, churches, law enforcement agencies, and businesses can enable rural health care organizations to maximize their scarce resources and build trust with community members.
Developing relationships with organizations outside of their communities, such as regional health care networks and multicounty entities, also enables rural health care organizations to realize other advantages. For example, they can obtain technical assistance and share data to compare health indicators in their communities with those of peer communities.
Examples of Community Engagement Strategies
At the worldwide, national, state and local levels, examples of community engagement strategies and programs illustrate how effective community engagement can be.
Worldwide Community Engagement Programs
International organizations aim to tackle some of the world’s most serious health issues.
The World Health Organization’s (WHO) Healthy Environments for Children Alliance (HECA)
HECA is a worldwide alliance whose goal is the reduction of environmental risks to children’s health. It focuses on the places where children live, learn, play, and sometimes work. Through HECA, 16 pilot projects in 13 countries perform activities such as conducting children’s environmental health profiles and needs assessments, and developing action plans to address children’s environmental health issues.
The United States Agency for International Development’s (USAID) Child Survival and Health Grants Program (CSHGP)
The CSHGP has partnered with citizens, governments, civil society organizations, and communities to empower families and communities to make informed health decisions. The CSHGP’s goals are to improve health literacy and engage community members to strengthen health systems. Through partnerships in 65 countries, USAID estimates the program reduced the number of deaths among children under age 5 from 13 million in 1985 to 6 million in 2015. Additionally, it estimates the program reduced the number of women dying during pregnancy and childbirth from 523,000 in 1990 to 303,000 in 2015.
The World Bank’s COVID-19 Response
The World Bank has worked with more than 100 countries to mobilize and deploy staff, supplies, and financing to address the COVID-19 pandemic. Those efforts have focused on public health interventions, nutrition and essential services, and outreach to vulnerable groups such as the elderly and health care workers. Through those efforts, the World Bank has provided personal protective equipment (PPE) to health care workers and equipment to intensive care units. It also has mobilized communities to promote public health, ensure continuity of services and supplies, and promote responsibility in the form of behavior change.
National Community Engagement Programs
National organizations have taken on health issues from COVID-19 to cancer.
The National Institutes of Health’s (NIH) Community Engagement Alliance (CEAL) Against COVID-19 Disparities
Through CEAL, the NIH engages with trusted members of communities across the U.S. on a number of COVID-19 issues and strategies. The goals are to gather input on addressing misinformation and mistrust regarding COVID-19, raise awareness about the COVID-19 pandemic, and develop strategies to ensure that COVID-19 prevention and treatment clinical trials include people who are most affected by the pandemic.
The American Hospital Association (AHA) and the National Urban League (NUL) Alliance
Through their alliance, the AHA and NUL work to advance health equity and diversity in health care leadership in communities across the U.S. They connect hospital and health system chief executive officers with local Urban League leaders who would like to serve on boards at hospitals and health systems, share best practices on community health worker programs, and promote solutions to the health challenges of vulnerable communities.
The National Cancer Institute’s (NCI) National Outreach Network (NON)
Through NON, the NCI strives to provide regionally and culturally tailored education and outreach to underserved communities. Working through community health educators in 38 cancer centers around the U.S., the NCI aims to adapt and test culturally relevant education and outreach activities to address cancer health disparity.
State and Local Community Engagement Programs
Regional organizations can often address local issues more efficiently than those entities that have a wider scope.
Texas Health and Human Services’ Community Partner Program (CPP)
Through its CPP, Texas Health and Human Services has developed a network of community organizations (such as community health clinics or local mental health centers) to help Texans apply for and manage their food, cash, and health care assistance. The CPP trains organizations in its network to assist individuals in applying for services and conduct case management services.
West Side United (WSU)
WSU is a collaboration of health care institutions, residents, educators, nonprofit organizations, businesses, government agencies, and faith-based institutions that promotes community health and economic wellness in 10 neighborhoods on Chicago’s West Side. WSU works to address issues such as adult obesity, smoking, and behavioral health.
Healthy Adams County (HAC)
With a goal of improving health and wellness in the community, HAC is a collaboration of stakeholders in Adams County, Pennsylvania formed as a result of the county’s first health needs assessment. Through HAC, organizations such as the local United Way, local hospital, and youth and family services organizations work to address issues in areas such as health care access, children’s health and safety, behavioral health, and domestic violence.
How to Build Community Health Programs
The Association for Community Health Improvement (an affiliate of the American Hospital Association) has developed a nine-step toolkit for assessing community health. The goal is to implement community health programs through community engagement. While the scope of a particular assessment dictates the exact process, the steps outlined below provide an overall framework for assessment.
Step 1: Reflect and Strategize
Reflecting on previous community health assessments, their successes, and their challenges is a good starting point for developing a community health program. It is helpful to collect feedback from stakeholders, review available data, and confirm support from key organizational leaders (for example, a hospital’s board of directors). At this step, it also is important to build a staff to plan the remainder of the process and identify resources available to assess community health.
Step 2: Identify and Engage Stakeholders
Identifying stakeholders and engaging them in the process helps form a relationship of trust that can be a foundation for the subsequent development of the program. The stakeholders should be representative of all concerned parties, such as the recipients of health care benefits, representatives of government and nonprofit organizations, and religious organizations. After identifying stakeholders, it is helpful to engage them on a committee assigned to specific responsibilities.
Step 3: Define the Community
Defining the target community involves identifying both geographic focus and specific population characteristics. The geographic focus might be a county, city, or hospital services area. Examples of population characteristics include age, race or ethnicity, income level, insurance status, or gender. In defining a population, it also is useful to explore whether other organizations are conducting similar needs assessments of the identified population.
Step 4: Collect and Analyze Data
Data collection and analysis can help identify a community’s specific health needs. In general, the data should include information on demographics, health disparities, and populations that face health care inequities. Data sources vary widely, but examples include public health departments, volunteers, and public health institutes. Conducting community surveys, interviewing stakeholders, and holding focus groups and town hall meetings can all help in data collection.
Step 5: Prioritize Community Health Issues
When prioritizing community health issues, it is important to use criteria such as prevalence, existing interventions, and availability of resources. After criteria are defined, the selection of the priority issues should occur through an established process that involves stakeholder representatives. When specific needs of a community are not prioritized, it is helpful to provide an explanation that addresses why those needs will not be addressed.
Step 6: Document and Communicate Results
Writing an easy-to-understand report and sharing it with stakeholders helps inform all concerned parties as to how an assessment was conducted and its conclusions. Examples of items a report should cover include the service area and community served, list of parties that collaborated on the assessment, the process for identifying and prioritizing needs, a prioritized list of health needs, and the resources and strategic measures to address prioritized needs.
Step 7: Plan Implementation Strategies
Planning specific strategies to address prioritized health needs works best when all parties have input into the process. Including everyone from hospital staff through C-suite executives and board members helps ensure buy-in and improves the chances of success. Creating an implementation committee that includes representatives from all stakeholders is one way to help ensure that all viewpoints are considered. Developing strategies also involves identifying the anticipated effects of the strategies and planning how to evaluate those effects.
Step 8: Implement Strategies
Implementation should include developing an action plan that contains items such as specific objectives, responsibilities, and timelines. Another critical aspect of implementation is budget creation. It can be helpful to establish an implementation team for each strategy, and then task the teams with regularly reviewing progress and making adjustments to the action plan. Those teams should represent all stakeholders.
Step 9: Evaluate Progress
Progress evaluation starts with determining a baseline for performance measurement. Other elements that are important in evaluating progress include ensuring the evaluation focuses on priorities, collecting reliable evidence of progress, and regularly measuring progress. Evaluation should include developing a feedback loop to make improvements based on its conclusions, and communicating the results to stakeholders.
Building Strong, Healthy Communities
The depth and breadth of the community engagement programs in which health care organizations participate vary widely, but all of those programs share one thing in common: the potential to make significant and lasting improvements in the health of the people they serve.
Pursuing Ohio University’s online Master of Health Administration program is one way individuals can acquire valuable knowledge and skills to make a difference in health care community engagement.