Strengthening Community Engagement Through Collaborative Technical Assistance

WE’RE ALL IN THIS TOGETHER Strengthening Community Engagement Strategies Through a Collaborative Technical Assistance Model PREPARED BY: PUBLIC HEALTH INSTITUTE CENTER FOR WELLNESS & NUTRITION TABLE OF CONTENTS Introduction 03 Results Part II: Identifying Facilitators and Barriers to Community Engagement 08 Methods & Results 04 Results Part I: Successful Community Engagement Recruitment and Promotion Strategies 05 Success Story: American Heart Association 07 Success Story: Healthy Savannah 15 Success Story: Eastern Michigan University 11 Discussion 16 Limitations & Recommendations 17 Results Part III: PHI CWN Efforts to Support Community Engagement Strategies 12 THIS PROJECT WAS SUPPORTED BY COOPERATIVE AGREEMENT NUMBER 066600102 FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION TO THE PUBLIC HEALTH INSTITUTE. ITS CONTENTS ARE SOLELY THE RESPONSIBILITY OF THE AUTHORS AND DO NOT NECESSARILY REPRESENT THE OFFICIAL VIEWS OF CDC. INTRODUCTION Progress with implementation of community engagement strategies; Facilitators and barriers in implementing community engagement strategies; Ways in which PHI CWN technical assistance, trainings, and peer learning opportunities supported recipients’ community engagement work. The Public Health Institute Center for Wellness and Nutrition (PHI CWN) through funding from the Center for Disease Control and Prevention provided trainings and technical assistance to the 2018 Racial and Ethnic Approaches to Community Health recipients across the country. More specifically, the trainings and technical assistance were focused on community engagement utilizing participatory approaches and lifting community voice and participation in local coalitions using a health equity framework. In 2019, PHI CWN conducted baseline key informant interviews with the Racial and Ethnic Approaches to Community Health recipients to measure their level of community engagement before the training and technical assistance provided by PHI CWN. In 2021, PHI CWN conducted follow-up key informant interviews with recipients to identify the following: In addition to the results from the key informant interviews, specific case examples of community engagement work will be highlighted through a selection of Success Stories. PAGE 03 //COMMUNITY ENGAGEMENT STRATEGIES CENTERFORWELLNESSANDNUTRITION.ORG PAGE 04 //COMMUNITY ENGAGEMENT STRATEGIES METHODS Eight recipient organizations had been previously interviewed by the PHI CWN in 2019 and had received high-touch technical assistance (TA) and training from PHI CWN were selected to participate in follow-up key informant interviews. High-touch TA refers to recipients that attended trainings with PHI CWN in addition to participating in 1:1 technical assistance. Once selected, representatives from all eight organizations received an invitation to participate in key informant interviews. In total, seven recipient organizations participated in both baseline and follow-up interviews. Interviews were conducted virtually via Zoom, with participants providing verbal consent to participate and record the interviews. Notes were transcribed from each interview and were combined into an Excel file. Qualitative analysis was conducted, first examining responses to identify themes, and then categorizing responses by theme. Quotes were extracted to serve as illustrative support for identified themes. In addition, Success Stories were gathered from recipients to highlight specific examples of successful community engagement work. A story template was provided by CWN and completed during calls. METHODS RESULTS Seven of the eight selected recipient organizations agreed to participate in the key informant interviews. Most organizations selected one to two individuals to participate in the interview. Participants included program managers, community engagement specialists, program evaluators, and community health workers, among others. Figure 1: DNPAO Recipients receiving CWN TA CENTERFORWELLNESSANDNUTRITION.ORG “[W]e have a great community navigator...that is really involved in those communities, and we found that trying to engage residents and get participants for events or things like that is way more effective when it’s coming from someone like [the community navigator] than when it’s coming from us and so I think that that’s again an area where we really lean on our community partners, to kind of generate that engagement.” “It’s very important because [salons] are where people literally and figuratively “let their hair down” and really speak on personal issues – where people are more comfortable and can address what really their health issues are or their concerns or fears.” PAGE 05//COMMUNITY ENGAGEMENT STRATEGIES Part I: Successful Community Engagement Recruitment and Promotion Strategies Successful recruitment and engagement strategies included snowball recruitment, recruiting through established community organizations, social media outreach and community promotions and campaigns, and partnering with trusted community sites like barber shops or local churches. Recipients reported community promotions and campaigns through distributing flyers, putting up posters, and using television or radio advertisements. Respondents shared several strategies that they used to engage community residents. The use of snowball recruitment strategies through engagement with community leaders, community-based groups, or local businesses was commonly reported. Snowball recruitment is a technique in which participants ask community leaders to identify other potential leaders or groups to become involved. Respondents shared that identifying strong community leaders led to greater trust in the project, resulting in more community members becoming involved in a participatory role. One grantee described their experience partnering with a community navigator: One recipient shared that they engaged community members in health education and screenings in barbershops and beauty salons. The recipient described this approach as a way to connect with community members in trusted community spaces. In addition to leaning on trusted leaders in the community for recruitment, some respondents shared that partnering with community-based organizations, doing similar work was the most effective approach for them. One recipient stated: CENTERFORWELLNESSANDNUTRITION.ORG PAGE 06 //COMMUNITY ENGAGEMENT STRATEGIES “A lot of times being a [non-Community-Based Organization] will already be the first roadblock to us actually doing community work in that we are kind of that “ivory tower”, you know, not fully in the community, especially right now with the pandemic – and so, [we] partner with a lot of local non- profits.” Recipients also reported the use of social media outreach for their recruitment, although some admitted that a “boots on the ground” or community “word of mouth” approach had been more effective in their work. “Social media pushes are also being done but it can be hard to confirm if we are reaching our target population with that, but we have had some success.” Recipients also shared that putting

we are kind of that “ivory tower”, you know, not fully in the community, especially right now with the pandemic – and so, [we] partner with a lot of local non- profits.” Recipients also reported the use of social media outreach for their recruitment, although some admitted that a “boots on the ground” or community “word of mouth” approach had been more effective in their work. “Social media pushes are also being done but it can be hard to confirm if we are reaching our target population with that, but we have had some success.” Recipients also shared that putting up flyers in locations where community members frequented and trusted was important and that using translated materials was critical for recruitment within the communities they served. Role of Community Residents Recipients were asked to share the roles that community residents played in their Racial and Ethnic Approaches to Community Health (REACH) projects. Several recipients shared that community residents act as community champions, promotoras, or in some cases breastfeeding counselors. In addition to acting as community champions or health workers, the role of community residents was described as one in which they were invited to share information through focus groups and invited to participate in planning meetings. Recipients were then asked to share about the processes used to engage community residents in identifying problems and solutions in their community. One respondent described a community resident coalition that was formed from a walk audit that was conducted for the improvement of physical activity infrastructure in their city. “We’ve engaged residents in walk audits where residents of the city actually completed walk audits entirely on their own, and we were able to gather that data and then create a community coalition to really pinpoint areas that need direct action right now and things that they would like to see...to give them as much power within the initiative as possible.” CENTERFORWELLNESSANDNUTRITION.ORG Next, a Success Story will be shared by the American Heart Association that highlights the role of community residents in a smoke-free campaign. Background Horizon City, a suburb of El Paso, Texas, was the last municipality without a smoke-free policy for public places including workplaces. Previous efforts to pass smoke-free policies were unsuccessful as perceptions of efforts were driven by outside influence and not community residents. Through the Centers for Disease Control and Prevention’s (CDC) REACH grant, the American Heart Association (AHA) garnered community buy-in with support from a Horizon City coalition comprised of community residents, parents, youth, and school district officials. The PHI CWN, a TA provider, offered trainings, tools, and insights to support authentic community engagement strategies. Community Engagement Successes In January 2020, AHA gauged community sentiment for smoke-free environments and hosted town hall meetings about the health risks of second-hand indoor/outdoor smoke that disproportionately impacts low-resourced Latinos. The Smoke-Free Horizon City Workgroup was created, comprised of 15 community residents. Due to the COVID-19 pandemic, workgroup members shifted capacity, resources, and activities online. AHA and collaborators utilized social media to educate, engage, and gain residents’ support, resulting in a local champion and influential church leaders. PHI CWN provided TA and photovoice resources. AHA facilitated regional tobacco training sessions with workgroup members, which led to the development of educational videos and other social media posts increasing community awareness. Students produced videos in their own words as to why a smoke-free Horizon City is important and boosted them on social media resulting in 11,831 views and 22 messages from community residents supporting smoke-free environments. In October 2020, four invited workgroup members provided public comments on the benefits of a smoke-free policy. The workgroup recruited community residents to share their own stories and testimonials. Through the tenacity of engaged community residents, Horizon City now has a smoke-free ordinance: No smoking in all indoor air and outdoor parks. An unexpected outcome is a young person engaged in this effort is now with the national tobacco-free campaign serving on the AHA youth advisory board. Future Efforts AHA will continue engaging parents and youth and partner with local school districts interested in adopting and implementing a holistic, non-punitive approach regarding students caught on campus using any tobacco product. AHA will continue to partner with PHI CWN to expand its community engagement efforts and acquire new tools and strategies. The participatory process that AHA followed put the power back into the community’s hands and has started a local movement towards community-led approaches. AMERICAN HEART ASSOCIATION HORIZON CITY SMOKE-FREE CAMPAIGN COMMUNITY ENGAGEMENT PROJECT HIGHLIGHT PAGE 07 //COMMUNITY ENGAGEMENT STRATEGIES CENTERFORWELLNESSANDNUTRITION.ORG PAGE 08 //COMMUNITY ENGAGEMENT STRATEGIES Part II: Identifying Facilitators and Barriers to Community Engagement “Giving [community residents] those steps and resources on how to participate. We gave [a 6th grader] flyers and infographics...that he could then take back to his school to his teachers and principal – so, giving them the resources and empowering them to talk about that subject, that way they can continue to stay engaged.” Recipients also described the importance of partnering with trusted community leaders to ensure there was buy-in for successful community resident engagement. One respondent stated that “[community leader] support is big because they’re the messengers [to the community]." Facilitators to Community Resident Engagement One main facilitator of community engagement was co-developing a plan of action for implementation with community members. Six of the seven organizations described involving community residents in the decision-making process surrounding the project and resource development and some described co-developing an implementation plan. Several recipients stated that providing resources and building skills to empower community residents was critical to the success of continued community engagement and their REACH work. One recipient described an example of a youth who participated in local city council meetings: CENTERFORWELLNESSANDNUTRITION.ORG PAGE 09 //COMMUNITY ENGAGEMENT STRATEGIES Outcomes from Engaging with Community Residents Respondents reported the benefits they observed from engaging community residents in their work. Some common themes that emerged were a “domino effect” of community engagement, increased community trust, community resident ownership of projects, and improved initiatives that included community voices and ideas. Recipients

co-developing an implementation plan. Several recipients stated that providing resources and building skills to empower community residents was critical to the success of continued community engagement and their REACH work. One recipient described an example of a youth who participated in local city council meetings: CENTERFORWELLNESSANDNUTRITION.ORG PAGE 09 //COMMUNITY ENGAGEMENT STRATEGIES Outcomes from Engaging with Community Residents Respondents reported the benefits they observed from engaging community residents in their work. Some common themes that emerged were a “domino effect” of community engagement, increased community trust, community resident ownership of projects, and improved initiatives that included community voices and ideas. Recipients shared that when community residents would see others involved, they felt comfortable and inspired to also get involved. One recipient stated that “community engagement begets community engagement” and another shared that when one community is involved in local infrastructure or policy improvements, neighboring communities see this and feel motivated to do something similar. “With [us] developing the [breastfeeding] training based on feedback from community residents – the information really resounded with the people who participated in the program...we believe that the community has the answer and so when you do that, the program is developed in a way so that it speaks to [community residents], versus us just being in the room coming up with the curriculum or deciding ‘this is what I think they need to know’.” Recipients also shared that involving community residents builds deeper trust in relationships over time between the community and those funding and/or leading the project. Recipients also described the beneficial outcome of community residents taking ownership of the projects in their communities, as well as community residents being hired on as staff in certain cases. “One of our resident champions - she has been able to help us running the EBT cashier stand at the farmer's market. Last year, she was a volunteer and this year she is hired by the administration.” CENTERFORWELLNESSANDNUTRITION.ORG “Finding the virtual space to make everyone feel comfortable, that it was accessible for everyone, that they knew how to navigate through it, was the most challenging part." PAGE 10 //COMMUNITY ENGAGEMENT STRATEGIES Barriers to Community Resident Engagement Recipients described some barriers that they faced with engaging community residents in their REACH work. Several recipients shared that community residents had a difficult time generally trusting projects like these. However, recipients shared how they approached establishing trust with community residents through showing up consistently, maintaining transparent communication, and working with trusted local community leaders. Recipients also reported barriers related to competing priorities for resources, like the time of residents and community leaders and the underfunding of city and county programs. In addition, recipients cited community fatigue as a barrier to engaging community residents. One recipient stated that the community fatigue is related to the mistrust that residents have around government projects. CENTERFORWELLNESSANDNUTRITION.ORG Accessibility barriers were cited by multiple recipients, including transportation, weather, and technology barriers. In addition, several recipients cited the importance of having translators on- site to reach the intended population in the appropriate language, as language could be a barrier to community engagement without this support. Accessibility barriers were also cited as they related to virtual programming. One site, stated that “the digital divide” was a challenge, particularly for some of their older community resident participants. “The [city comes] in so many times and they the community didn’t get what they wanted out of it. People are sick of taking surveys and not seeing changes out of it.” Next, another Success Story from Eastern Michigan University demonstrates how engaging with community residents led to successful outcomes to improve street safety and active transportation. Background In 2011, Hamtramck, a small city surrounded by Detroit, was named Michigan’s most walkable community; but in recent years, crumbling infrastructure and dangerous traffic speeds have left residents with safety concerns. Many Hamtramck residents do not drive, further establishing the importance of safe active transport options. A team from Eastern Michigan University (EMU) partnered with the Community and Economic Development Department to address Hamtramck’s infrastructure concerns. They developed a comprehensive plan to improve safety and walkability, but through TA provided by PHI CWN, they quickly realized the importance of involving community residents in the process. EMU went back to the drawing board, to authentically engage the community in a resident-informed plan of action. Community Engagement Success A multi-generational community coalition known as the Quick Build Team was formed with local business owners, high school students, and residents. EMU provided education on quick builds and infrastructure principles and residents shared their experiences riding bikes and walking through town. The Quick Build Team contributed to drawing design mockups of where to put bike lanes and midblock crosswalks. EMU team polished the mockups into professional designs and they collaboratively presented their plan to the City Planning Department. The result: An alley activation plan that would align with the Joe Lewis Greenway, a 27.5-mile largescale greenway development project in the area. As plans progressed, the Quick Build Team elevated concerns expressed by the larger community about including the alley activation. They began plans for the quick build event, as an opportunity to get feedback from more residents on the design and to ask questions in real-time. Through TA calls with PHI CWN during the planning process EMU brainstormed numerous techniques to engage the community in providing valuable feedback at this event as possible. The Quick Build Team with 20 community volunteers coordinated and facilitated a successful 3-day ally activation. The event engaged more than 52 community residents with QR code virtual surveys, interactive dot surveys, and community-facilitated speed rating observations. Future Efforts The Quick Build Team is still actively engaged and planning to incorporate community feedback into future infrastructure designs. Murals are being painted and two small-scale art installations are planned for the Spring. Truly, the alley activation was not a one-time event –it is a dialogue that will continue as the Hamtramck community leads efforts to improve street safety and active transportation in their city. EASTERN MICHIGAN UNIVERSITY