Background:

Lack of digital readiness is a public health crisis that exacerbates healthcare inequities in underserved communities. 40% of Bronx residents lack reliable internet access, limiting their ability to engage with essential health services. The Pesquisa project evaluated barriers to digital readiness and applied Levesque’s healthcare access framework to assess how digital readiness affects healthcare access.

Methods:

Using principles of community-based participatory research, mixed-method, pre- and post-intervention surveys were conducted to assess digital readiness. Outreach events were held at the study site, a commercial residential building in the Bronx. Focus groups in Spanish and English were held to evaluate digital readiness, identify barriers to healthcare access, and collaboratively develop a solutions-oriented intervention.

Results:

Preliminary data from 2022, representing 42% (n=26) of households at the study site, showed that 19% did not have a smart device. 23% lacked internet access. In addition, 19% were uncomfortable using a smart device to access the internet, with 40% relying on a cohabitant for assistance with device use. 23% shared a device for school or work with 1-9 people during the COVID-19 lockdown. Of those who were uncomfortable using a smart device, 31% reported reliance on technology hindering their access to necessary health-related services, food assistance, and doctor appointments. Focus group findings informed the development of a digital literacy intervention, with training sessions planned for implementation.

Conclusion:

Limited digital readiness significantly impacts healthcare access. Next steps include further data analysis and the collaborative development and implementation of digital literacy training sessions.

Background During public health emergencies, Community-Based Organizations (CBOs) provide critical social and economic support, filling gaps in housing assistance, food, health services, and workforce development. The COVID-19 pandemic highlighted this dual challenge, as CBOs simultaneously worked to help their communities while struggling to endure the crisis themselves. We aim to understand how CBOs navigated funding and policy changes, institutional challenges, partnership development, and sustainable community health worker programs while maintaining and expanding resources and services during COVID-19.

Methods Interviews were conducted in English over zoom between November and December 2023. They were audio recorded with the consent of participants and lasted about 60 minutes long. All interviews were transcribed verbatim in their original language using Zoom. Transcripts were uploaded into Dedoose, a qualitative data analysis software for analysis. Transcripts were analyzed using a thematic analysis approach.

Results A total of 16 interviews were conducted representing 14 CBOs across the San Joaquin Valley, California. Most organizations (79%) had operated for over 21 years, employed more than 16 staff (72%), served 1,000-10,000 people annually (50%), and managed budgets exceeding $1 million (72%). These CBOs provided diverse services including healthcare access, mental health support, food assistance, immigration services, housing assistance, and immunizations at various locations (on-site, schools, community centers, churches, and local events). They primarily served immigrants, refugees, and low-income communities with specific focus on African American/Black, Hmong, Latino, LGBTQ+, and Punjabi populations. Identified themes encompassed: (1) flexible funding and policy changes, (2) forming collaborations and coalitions, and (3) moving forward post-pandemic.

Conclusions The lessons learned about organizational challenges and resilience may be applicable to future public health emergencies. The pandemic-era experiment in funding flexibility revealed the benefits of less restrictive funding mechanisms for CBO effectiveness and responsiveness. As funders develop post-pandemic policies, our findings suggest that maintaining certain aspects of funding flexibility could enhance the sector's ability to address complex community needs.

Since the Affordable Care Act non-profit hospitals must conduct a community-health needs assessment (CHA) every three years to prioritize the greatest health needs of a community. Local health departments must do the same for national accreditation, and some state requirements. Most needs assessment processes require substantial community input however collecting community input is often through quantitative survey or key informant interview which often don’t get at the true root needs of community members.

In Monroe County, New York we implemented PhotoVoice to elicit input from Public Health AmeriCorps members, highly representative of the most marginalized groups in our community. Photovoice is a participatory research method where individuals, often from marginalized communities, use photography and storytelling to document and reflect on their experiences, empowering them to share their perspectives and advocate for change. Twenty members of the Flower City Public Health AmeriCorps team were asked to document their health priorities through photo and narrative. Results from the PhotoVoice discussion, as well as the twelve final posters were shared with the hospital and health department CHA planning team and the city mayor.

The PhotoVoice posters including photo, narrative and contributor were shared with the entire group of AmeriCorps members (in public health and social services) to spur discussion at a scheduled meeting. This session of 32 members and 2 staff (78% Black, 10% white, 10% Latinx, 2% other ethnic groups) included a two-hour conversation where members discussed what they thought heath agencies should be doing to improve the health of the community. Individual responses were collected and categorized by common themes, which were summarized as:

1. Better quality care - improved access, wait times and communication
2. More health education and prevention
3. Mental health and well-being
4. Social determinants of health including housing and nutrition

This community input was included in the county CHA and was instrumental in the selection of addressing stress and anxiety as one priority area for community intervention.

PhotoVoice is a straightforward and inexpensive process, easily replicated in a short amount of time. PhotoVoice galvanizes often overlooked communities to significantly contribute to the community health planning efforts of hospitals and health departments.

Introduction: There are many opportunities to learn and practice in forming and maintaining engaged, empowered community advisory boards (CABs). We describe our process, which reflects a community-led approach to health and wellness.

A role play experience will demonstrate how potential CAB members participate in co-designing the assessment criteria for candidates. At the end of this session, participants will be able to describe two key components of a group interview for selecting CAB members, and detail how the group interview may provide a more accurate representation of CAB members’ leadership strengths.

Evidence used to inform program development: The community-centered approach used to form this CAB is rooted in strengths-based empowerment models of community participatory leadership. It also utilizes a well-documented assessment tool, the eco map.

Program activities: We invited all candidates to participate in a group interview, allowing them to authentically demonstrate their leadership skills and experiences. In one key activity, candidates reflected on what areas of knowledge, attitudes, and skills CAB members should possess. In this process, they unknowingly co-designed with the project team the selection rubric for assessing candidates. A second activity involved the creation of eco maps: each person discussed their support at home and in their larger community that would facilitate their success as a CAB member.

Conclusion: The project team’s practice of co-sharing leadership with the community created unique opportunities for project success and sustainability that build on the natural strengths of these leaders and the communities they come from and serve. The group interview allowed us to see applicants’ leadership and engagement skills in action. The eco mapping helped them learn and practice ways of leading in- and outside of the CAB, enhancing community capacity for growth beyond the current project.

Recommendations for practice: To create effective and empowered CABs, projects should prioritize a community-centered and strengths-based approach. The facilitated group interview is an effective tool to achieve this. It enhances the selection process and empowers candidates by recognizing and building upon their lived experiences and community knowledge. Adopting such approaches can contribute to long-term community capacity building and the sustainability of public health initiatives.

A governmental commitment to understanding community’s keen awareness of historical and current power imbalances that reinforce health inequities requires a shift in engagement to support community power building. To advance health equity and improve health outcomes for the individuals of San Mateo County (SMC), the SMC Health Division of Public Health, Policy, and Planning (PHPP) engaged community to design and implement an authentic community-led decision-making structure.

We utilized community based participatory research to co-design a structure known as the Public Health Community Collaborative (PHCC). The PHCC was created with CBO leaders and representatives forming a working group to guide PHPP direction and decision making. Diverse community groups across SMC hosted community input sessions. These resulted in recommendations for building trust and for a formal community engagement structure. With guidance from the working group, PHPP committed to funding a convening community organization to lead a collaborative group whose scope spanned the social determinants of health and addressing emergent community needs.

The PHCC consists of multisectoral partners county wide. Preliminary goals of the collaborative include formalizing a governance structure, strengthening partnerships to build community trust, supporting priority public health efforts, comprehensive community health planning, and empowering local communities. The PHCC supports the coordination and monitoring of the three priority areas of the County’s first Community Health Improvement Plan. Within the first year of the PHCC, the collaborative established a baseline for and identified mechanisms to build trust and facilitate power-sharing. This will continue to be evaluated on an ongoing basis.

This structure is a model of how community collaborative spaces support just governance as it is led by the community and those most impacted. We must co-design more community-centered decision-making processes that widen the range of people and communities involved in efforts to reduce inequities. Community collaborative structures should be community-led, bi-directional in relationships, and resourced with institutional funding and backbone administrative support. This includes efforts to understand the community's health needs and to develop community health improvement plans. Building trust with the community is an important mechanism for authentic community collaboration.