An action research partnership in an urban Texas county to explore barriers and opportunities for collaborative community health needs assessments.

Background: The Affordable Care Act mandated triennial community health needs assessments (CHNAs) for greater nonprofit hospital accountability in responding to community health needs. Over 10 years later, hospital spending on community benefits remains largely unchanged. While greater collaboration in CHNA implementation can increase hospital investment in community-based initiatives, nonprofit hospitals in conservative states are subject to policy, political, and economic factors that inhibit public health partnerships and magnify existing disparities in health care access. This participatory action research study explores the decision-making environment of collaborative CHNA implementation within a group of nonprofit hospitals in a north Texas urban county. Methods: In 2017 faculty from an urban anchor institution initiated an academic-community partnership with a coalition of nonprofit hospitals, public health departments, and academic institutions. An interdisciplinary research team engaged in multi-method document review and qualitative data collection to describe historical barriers for local CHNA processes and develop practical strategies for joint CHNA initiatives. Local CHNA documents were first reviewed through team-based content analysis and results applied to develop a qualitative study protocol. Key informants were recruited from county-based nonprofit hospitals, community-based nonprofit organizations, and public health systems. Seventeen senior- and mid-level professionals participated in semi-structured research interviews to describe their perspectives relating to CHNA-related planning and implementation decisions. Through iterative data collection and analysis, the research team explored CHNA-related knowledge, experiences, and processes. A constructivist lens was subsequently applied to examine historical barriers and future opportunities for local collaboration. Results: Findings reveal CHNA implementation is a multi-stage cyclical process in organizational environments with accountability to a wide range of public and private stakeholders. This promotes varied levels of inclusivity and conservatism in data collection and community benefit implementation. Decisions to collaborate are hindered by competing priorities, including compliance with existing guidelines, administrative simplicity, alignment with health care service delivery, and efficient resource use. Efforts to promote greater CHNA collaboration may be facilitated through intentional alignment with organizational priorities and clearly communicated benefits of participation for leaders in both public and private nonprofit health systems. Discussion: We consider implications for policymakers and health systems in restrictive political environments and advance a conceptual framework for greater CHNA collaboration.

Advancing shared accountability for meaningful community engagement with socially vulnerable communities: Lessons learned from COVID-19 health education and general outreach in an urban region.

As COVID-19 public health emergency measures come to an end, socially vulnerable communities have reduced access to resources that address social and health disparities created or exacerbated by the pandemic. Social workers must uphold access to healthcare as a human right in the post-pandemic era by reducing social vulnerability and strengthening community resilience to respond to future health emergencies and natural disasters. This paper draws on the experiences of a team of social work researchers, students, and practitioners engaged in efforts to disseminate information on COVID preventive measures and broker access to local health and social resources. This project, based in one of the fastest-growing metropolitan areas in the United States, formed part of the federal research response to promote community engagement in regions most disproportionately impacted by the COVID-19 pandemic. Through participation in health fairs and community events that targeted persons with limited access to healthcare resources, we gathered critical insights on how to build community capacity for meaningful community engagement. Drawing on a conceptual model for evaluating community engagement strategies, we describe three main barriers to collaborative community outreach: weak organizational communication and coordination, inconsistent strategies for requesting on-site health services, and low neighborhood awareness of outreach events. We advance strategies for improvement that engage community-based organizations, health systems, backbone organizations, and community members in targeted activities to build community resilience. This includes inter-organizational communication during outreach event planning, formal processes to promote greater use of mobile health services, centralized event communication, and grassroots outreach event promotion.

Alors que les mesures d'urgence de santé publique liées au COVID-19 prennent fin, les communautés socialement vulnérables ont un accès réduit aux ressources permettant de remédier aux disparités sociales et de la santé créées ou exacerbées par la pandémie. Les travailleurs sociaux doivent défendre l'accès aux soins de santé en tant que droit humain dans l'ère post-pandémique en réduisant la vulnérabilité sociale et en renforçant la résilience des communautés pour répondre aux futures urgences sanitaires et catastrophes naturelles. Cet article s'appuie sur les expériences d'une équipe de chercheurs, d'étudiants et de praticiens en travail social engagés dans des efforts visant à diffuser des informations sur les mesures préventives du COVID et à faciliter l'accès aux ressources santé et sociales locales. Ce projet, basé dans l'une des zones métropolitaines urbaines à la croissance la plus rapide des États-Unis, faisait partie de la réponse fédérale en matière de recherche visant à promouvoir l'engagement communautaire dans les régions les plus touchées de manière disproportionnée par la pandémie de COVID-19. Grâce à notre participation à des foires sur la santé et à des événements communautaires ciblant les personnes ayant un accès limité aux ressources de santé, nous avons recueilli des informations essentielles sur la manière de renforcer les capacités communautaires pour un engagement communautaire significatif. En nous appuyant sur un modèle conceptuel pour évaluer les stratégies d'engagement communautaire, nous décrivons trois principaux obstacles à la sensibilisation communautaire collaborative : une communication et une coordination organisationnelles faibles, des stratégies incohérentes pour demander des services de santé sur place et une faible sensibilisation du quartier aux événements de sensibilisation. Nous proposons des stratégies d'amélioration qui engagent les organisations communautaires, les systèmes de santé, les organisations de base et les membres de la communauté dans des activités ciblées visant à renforcer la résilience communautaire. Cela comprend la communication inter-organisationnelle lors de la planification des événements de sensibilisation, les processus formels visant à promouvoir une plus grande utilisation des services de santé mobiles, la communication centralisée des événements et la promotion des événements de sensibilisation au niveau local.