The community engagement course and action network: strengthening community and academic research partnerships to advance health equity

Background: Historically Black Colleges and Universities and Minority Serving Institutions are uniquely positioned to implement community-campus research partnerships based on a history of service, the pursuit of community trustworthiness and student demographics often similar to surrounding marginalized communities. The Morehouse School of Medicine Prevention Research Center collaborates with members of Historically Black Colleges and Universities, Minority Serving Institutes, and community organizations on the Community Engaged Course and Action Network. This network is the first of its kind and aims to strengthen members’ ability to implement Community-Based Participatory Research (CBPR) principles and partnerships. Projects address public health priorities including mental health among communities of color, zoonotic disease prevention, and urban food deserts.

Materials and methods: To assess the effectiveness of the network, a Participatory Evaluation framework was implemented to conduct process evaluation which included review of partnership structures, operations, project implementation processes, and preliminary outcomes of the research collaborations. A focus group of Community Engagement Course and Action Network members (community and academic) was also conducted to identify benefits and challenges of the network with emphasis on key areas for improvement to further enhance the relationships between partners and to facilitate their subsequent community-campus research.

Results: Network improvements were tied to themes strengthening community-academic partnerships including sharing and fellowship, coalition building and collaboration, and greater connections and awareness of community needs through their current community-academic partnerships. The need to conduct ongoing evaluation during and after implementation, for determining the early adoption of CBPR approaches was also identified.

Conclusion: Evaluation of the network’s processes, infrastructure, and operation provides early lessons learned to strengthen the network. Ongoing assessment is also essential for ensuring continuous quality improvement across partnerships such as determining CBPR fidelity, assessing partnership synergy, and dynamics, and for quality improvement of research protocol. The implications and potential for advancing implementation science through this and similar networks are great towards advancing leadership in modeling how foundations in community service can advance to CBPR partnership formation and ultimately, health equity approaches, that are local defined and assessed.

Introduction

Community engaged research is defined as the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the wellbeing of those people (1, p. 7). It is focused on building and sustaining strong community-academic partnerships and operates along a continuum of increasing community involvement in research activities. Community-based participatory research (CBPR) is a type of community engaged research, emphasizing equitable community engagement in research. Historically Black Colleges or Universities and Minority Serving Institutions are uniquely positioned to implement effective CBPR based on a history of service and the pursuit of community trustworthiness central to their missions.

The Community Engaged Course and Action Network was designed to establish a capacity building, CBPR infrastructure for and by Historically Black Colleges and Universities and Minority Serving Institutions adapting an established CBPR model led by Morehouse School of Medicine. Most of these schools are entirely integrated into their surrounding communities (e.g., most students are commuters especially at the public institutions) often with shared social, cultural values, behaviors and demographics of surrounding marginalized communities. It is no coincidence that rural areas and the portions of the Micropolitan Statistical Areas containing historically black colleges or universities are also some of the most underserved areas in terms of healthcare accessibility and inversely these areas experience high rates of poverty and income inequality. Thus, there is a great need and potential to educate faculty at these institutions to learn and model CBPR partnerships to address local health priorities for the future public health leaders at these institutions.

Partnership and administrative factors are assessed through a Participatory Evaluation framework. This approach has been previously employed by the Morehouse School of Medicine Prevention Research Center to equitably and strategically, engage project implementation partners and stakeholders due to the welcome complexities of CBPR and historical power inequities detailed earlier. We seek to facilitate a supportive network towards advancing related partnerships in response to local health priorities for a network of newly partnered collaborators. Participatory Evaluation approaches are designed to address needs mutually identified by partners to assure that initiatives are: (1) audience-driven; (2) foster sustained ownership of evaluation processes; and (3) are central to program decision-making and sustainability (2). This also provides accountabilities to sponsors towards ensuring that recommendations, concerns, and preferences are heard towards sustaining program strengths and making quality improvements of identified challenges or weaknesses. Hence, the purpose of this study is to evaluate the community-academic partnership and research administration using process evaluation techniques.

Background

Morehouse School of Medicine is one of ten Historically Black Colleges and Universities in Georgia and one of only four Historically Black Medical Colleges in the United States. Morehouse School of Medicine holds over four decades in globally recognized implementation of a cross-cutting (clinical, research education and service) community-centered vision - to lead the creation and advancement of health equity (3). The Morehouse School of Medicine Prevention Research Center is the designated center for CBPR within the institution. For over two decades, through collaborative relationships with community members and organizations, Morehouse School of Medicine Prevention Research Center has been competitively funded to conduct applied to HIV/AIDS, substance abuse, cardiovascular, diabetes, oral health, behavioral, clinical and translational research as well as lead related research infrastructure and capacity building efforts (4–17). The Morehouse School of Medicine Prevention Resource Center has collaborated with its Community Coalition Board to build trusting and mutually beneficial relationships with communities. The Center is governed by the Board, which was established in 1999 to articulate community priorities and advance health equity (10, 18–21).

The Community Engagement Course and Action Network, established in 2019, is an extension of the Morehouse School of Medicine Prevention Research Center mission to strengthen community engagement, research, leadership and partnership models designed to innovatively, advance health equity through strategically identified potential partner communities. The network was established to strengthen the capacity of minority serving institutions to develop locally responsive community-campus CBPR partnerships. The goal of the network is to strengthen the ability of Historically Black Colleges and Universities, Minority Serving Institutions, public health agencies, medical practitioners, students, and multi-sector partners in CBPR and community engaged research.

Materials and methods

Community engagement course and action network

Structure

The network began with 10 Georgia Historically Black Colleges and Universities and Minority Serving Institutions when the network was launched in May 2020. Due to the global COVID-19 pandemic and other factors, four Georgia academic institutions remained committed to working with MSM. These included: Dalton State College, Fort Valley State University, Georgia State University, and Savannah State University. Table 1 details the health conditions in communities in the counties surrounding each school supporting the rationale to offer intensive outreach, education and capacity building to Historically Black Colleges and Universities, Minority Serving Institutions, and partnering communities towards applied public health prevention research and implementation strategies. The Center launched a mini-grant program to support community-university research partnerships, facilitate community input into university research, and to increase health research in community settings that is both responsive and relevant to the health needs of the community. Projects, partners and focus areas are detailed in Tables 2,3.

TABLE 1

Table 1. Socioeconomic characteristics of CECAN research partner counties.

TABLE 2

Table 2. CECAN research partners and projects.

TABLE 3

Table 3. CECAN prioritized populations/communities.

Operations

To support community leadership, the network is led by the chair of the Morehouse School of Medicine Prevention Research Center Community Coalition Board. Essential to the Center’s mission, the Board chair has been community and research identified as a community developer, civic engagement practitioner, and health advocate. His work ensures community-centered, led and translated health equity leadership and governance to support network members. He is a community economic development practitioner and long-time Morehouse School of Medicine community partner. His leadership with and for diverse groups of community advocates, academic partners, and agencies in strategies to achieve equity and enhance the built and natural environment that reduce health disparities and promote community-campus partnerships using the CBPR makes him a valued leader of the network. He is supported by staff of the Center’s to facilitate meetings, convening, communication, and evaluation processes.

A qualitative assessment of the community-academic partnership was conducted by reviewing the Community Engagement Course and Action Network establishment, structure, partnership dynamics, and outcomes of partnerships based on the alignment with the CBPR principles. A review of partnership formulation documents, funding structures, and reports from meetings, webinars, technical assistance and support, and workshops provided additional contextual data for assessment of the network partnership dynamics. In addition, a focus group (N = 12) of Community Engagement Course and Action Network members (both community and academic partners) was conducted face-to-face and supported by Mentimeter, a survey polling tool (22). The focus group was designed to identify benefits and challenges of the network with emphasis on key areas for improvements to further enhance the relationships between partners and to grow the network. The group, together, identified areas of success and areas for improvements in creating synergy and cohesiveness within the network. This PE framework was essential to ensuring that all community-campus partners involved in the network share and hear the similar and disparate issues central to their participation and perceived network success. This was critical given the CBPR network being facilitated and the well understood power differentials address through CBPR that the network is designed to dismantle and collaboratively support towards responsive, partners community response.

Process evaluation involved review of partnership documents aforementioned. Focus group data analysis was manual and involved two coders that developed an initial codebook informed by questions guiding the focus groups discussion. Summary points were transferred into.

a matrix to systematically code responses. Emerging codes were noted and included in the final coding guide (23). Themes associated with codes were reviewed by the Center’s Community Coalition Board Chair (network facilitator) and Center staff and identified detailed in the section that follows.

Results

Key themes

The findings of the qualitative assessment of Community Engagement Course and Action Network research partnership were subdivided into sections, in relation to commonly identified themes, to summarize the outcomes of the collaboration between partners based on the CBPR framework.

Building and strengthening partnership

Despite the well-documented benefits of CBPR [(24, 25); Jagosh, et al., 2012], there are challenges in building and maintaining community-academic research partnerships to improve community health outcomes. It is critical before establishing community-academic partnerships for CBPR to first find out the issues that are affecting the community and understand the interest of the community. Georgia State University CECAN research project is a testament of academic partners working collaboratively with the community to overcome challenges in conducting research in barbershops and barber schools across metro Atlanta. After listening to these community partners and valuing their contributions, the university designed a pilot study aimed at appropriately evaluating and improving a novel program that trains barbers and barber students to be mental health advocates. Considerable formative work went into establishing and strengthening a community-academic partnership well before the research began, and these efforts continue throughout project (i.e., “cradle to grave”) to ensure that the community’s voice, ideas, and concerns are foundational to this collective work. Through focus group discussions with this community of interest (i.e., barbers, barber students, and shop owners) – as well as participant surveys and barber advisory board input – the partners were able to collect process and outcome data that will be used to enhance the training program. Ultimately, the program will better meet the needs and interests of barbers trained to serve as mental health advocates in their communities. Researchers should approach partnership within communities with honest intentions and humility, recognizing that building such relationships takes time and unwavering efforts over the long-term.

Establishing authentic partner engagement

Effective evaluation of partnership efforts requires a clear conceptual framework that links group dynamic characteristics of equitable partnerships (e.g., shared leadership, meaningful participation, and power sharing) with the effectiveness of partnership efforts to intervene and reduce health inequities more broadly (26). For example, for the networks research project, Developing Culturally Appropriate Mental Health Network for Latino/a Community, Dalton State College worked with Coalicion de Lideres Latinos a Latino/a grassroot community advocate group, to assess and identify the need for mental health services within the Latino/a community. Coalicion de Lideres Latino/a assumed the role of cultural broker to continue building trust and rapport with community members. Researchers should collaborate with community partners to ensure that that they are recognized and valued within the community as a trusted agent of change. Being present in the community helps to build trust and commitment to engagement and ultimately establish co-leadership for research.

Network synergy and expansion

A critical dimension in many CBPR frameworks is the concept of partnership synergy, or synergy that arises from collaboration among members of diverse knowledge, perspectives, cultures, and social positions (27). Synergy is the concept of gainfully accomplishing more collaboratively, opposed to separately which is critical to partnership effectiveness and expansion. For example, Savannah State University collaborated with their community partner, Harambee House to address the challenges of urban food desserts in underserved rural communities, while embracing the idea of a community-led project approach. Harambee House is well-known for promoting civic engagement, environmental justice, and social change but needed further guidance on how to properly execute CBPR. The partnership was initially hampered because the responsibilities of both partners were not clearly defined or based on the expertise of each partner. For the second round of funding, the community partner, instead of the academic institution, became the lead, which resulted in a delay in implementation of the research project causing both partners to reevaluate their roles and responsibilities. In CBPR, addressing the structural, social, and cultural differences between community and academic is critical for successful implementation of research projects. Sharing knowledge, expertise, decision-making, capacity building of community partners, and other resources would help in breaking down silos and strengthening unity for the success of such partnerships.

Institutional and leadership support

Researchers invested in community– academic partnership requires institutional and leadership support to be successful (28). This level of partnership investment requires commitment in creating an environment of co-leading, co-learning, and capacity building that is beneficial for all members of the partnership (29). While the Community Engagement Course and Action Network research projects were well supported by academic researchers, there is limited knowledge of whether the community-academic partnership was supported by each university/college academic leadership. Morehouse School of Medicine Prevention Research Center’s leadership fully embraced the use of CBPR model and expressed its commitment to the establishment of community-academic partnerships for the Community Engagement Course and Action Network research projects by contracting with its Community Coalition Board chair, a non-academic leader, to serve as a coordinator and facilitator for community engagement. The Community Coalition Board chair has 15 years of experience working with diverse groups of community advocates, academic partners, and agencies to develop strategies aimed at reducing health disparities and promoting community-academic research partnerships using the CBPR framework and a reflection of the leadership model with the Morehouse School of Medicine Prevention Research Center. This leadership structure allows for power-sharing between community and academia by building on existing trusting relationships as promoted by the Morehouse Model for Community Engagement. The Morehouse School of Medicine Prevention Research Center leadership team also offers technical assistance to the network research partners in areas of project administration, community partnership engagement, evaluation, and research translation and dissemination.

Partnership and network engagement

One benefit of community engagement in research is gathering valid and credible evidence of diseases and designing meaningful and impactful culturally appropriate interventions based on the lived experiences of affected community members. The Fort Valley State University researchers admitted that their research on zoonotic diseases was strengthened by directly involving Department of Natural Resources technicians who were at increased risk for exposure to pathogens of the diseases and who had practical solutions for disease prevention and control. Upon conducting a 2022 focus group discussion among Community Engagement Course and Action Network research partners, we learned the expectations and benefits from both the academic and community-based organizations of participating in the network. Expectations and benefits coincided to include “sharing and fellowship, coalition building and collaboration, and greater connections and awareness of community needs,” (see Table 4). Community Engagement Course and Action Network research partners also expressed some of the successes (wins) they achieved through the network and recommendations for improving their project plans to strengthen the community-engaged approach. One of the most salient wins was “bringing national attention to the concept of community engaged research at undergraduate level,” (see Table 5). Recommendations for Community Engagement Course and Action Network improvements were tied to lessons learned from their current community-academic partnerships.

TABLE 4

Table 4. CECAN partner reasons for joining and benefits of the network.

TABLE 5

Table 5. CECAN partnership successes and opportunity for project improvement.

Discussion

Evaluation of the Community Engagement Course and Action Network research partnership facilitated an assessment of fidelity in application of the CBPR principles. By conducting a qualitative review of partnership structure, project implementation processes, and outcomes of the research collaboration, it was clear that consistent monitoring and technical assistance is essential for success of community-academic partnerships. There was evidence to support the claim that breakdown in communication between partners can result in undefined expectations and delay in the execution of research processes. Focus group discussions among the network’s partners did reveal some positive results regarding the benefits of the network with key areas for improvements to further enhance the relationships between partners and to grow the network. Noteworthy in informing other initiatives is that CBPR capacity building and partnership development support towards community-driven intervention, is the goal of the network. The focus of this manuscript was process evaluation of the network function and CBPR partnership formation to date. As the network and funded projects evolve (projects and processes are still underway) CBPR principles, in practice, will be comprehensively assessed.

The qualitative data provided great insights into the challenges that were experienced by the Community Engagement Course and Action Network research partners from which to learn and grow the network for the next phase of project implementation. One of the most important lessons learned is the need to conduct ongoing evaluation of networks collaboration efforts to improve synergy among community-academic partners and for effective project functioning. Establishing clear roles and responsibilities to ensure accountability for governance of the research project processes, including invoicing and reporting. Engaging community partners during the selection of pertinent issues prior to project developing and planning phase is critical to ensure that community needs are being prioritized in research. Building relationships with community partners prior to the research also allows for equal distribution of power between the community and academia, consistent with the co-leadership principle of CBPR. From the focus group discussion, academic partners are aware of the importance of engaging community partners and that their level of contributions will determine the success of the research project. However, the timeline for engagement should be clearly defined and the process of engagement needs to be better streamlined (Table 6).

TABLE 6

Table 6. Recommendations for CECAN project and network enhancements.

To our knowledge, this is the first is the first network of Historically Black Colleges and Universities and Minority Serving centered on increasing CBPR capacities and conjointly providing funding to support skills and partnership acquired. Second a nationally recognized community leader, rather than Morehouse School of Medicine Prevention Research Center facilitating this network and partners were led by the chair of the Community Coalition Board at Morehouse School of Medicine Prevention Research Center collaborated with underserved communities and academic leaders representing unique priority population groups within the urban and rural areas of Georgia. We conducted a formative, participatory process evaluation study amongst network partners, both community and campus-based, who served as equitable experts on relevant community and partnership priorities and challenges.

A more comprehensive assessment of the community-academic partnership is warranted. Baseline data at the initiation of the Community Engagement Course and Action Network regarding the partnership structure, application of the CBPR principles in partnership, research design, and implementation, coupled with ongoing partnership evaluation would reveal areas of growth and areas for improvement over time. Conducting a partnership assessment after the mid-term implementation of the network’s research projects provided only a snapshot of the successes and challenges that were achieved over the two funding cycles. Nonetheless, the qualitative data collected on partnership dynamics can be used to enhance collaboration and strengthen cohesiveness between members of the network as it continues to progress.

The Morehouse CBPR Model with the complementary tools promotes collective reflection that, among other constructs, leads to our central theory of change—collective empowerment (30). Reflecting on the partnerships and the projects that Community Engagement Course and Action Network partners implemented, the research partners were asked about changes they would make to their projects and the network based on lessons learned and to develop next steps for enhancement of the partnership and network, (see Table 5). Recommendations were aimed at building/strengthening community-academic partnerships and increasing the legitimacy of the network’s research projects among researchers, communities (local, regional, and statewide), funders, policymakers, and other stakeholders.

Conclusion

It is essential to assess community-academic partnership at initiation, during, and after research project implementation to determine its alignment with CBPR principles and to ensure continuous quality improvement across partnerships in a myriad of contexts. The results of such ongoing evaluation can be used to develop strategies to enhance partnership functions and to strengthen the cohesiveness of the partners within the network. The unique history and position of Historically Black Colleges and Universities and Minority Serving Institutions present opportunities to understand the conditions through with CBPR partnership development despite cross-cutting dedication to community trust, take place. The heterogeneity of institutions require attention to the contexts in which community-campus partnerships are successful, given differences in identity (private/public, teaching/academic health center, geography, and track record of relationship and power sharing among community-campus partners). The implications and potential for advancing implementation science through this and similar networks are great towards advancing leadership in modeling how foundations in community service can advance to CBPR partnership formation and ultimately, health equity approaches, that are local defined and assessed. Collaboration amongst Community Engagement Course and Action Network partners will expand the influence of Historically Black Colleges and Universities and Minority Serving Institutions which is vital for sharing ideas, knowledge, expertise, and other resources that advance their collective impact as strategic public health change agents.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Author contributions

THA, RB, and LH: conceptualization. THA, RB, LH, and SS: writing—original draft development. THA, RB, LH, and TJ: designed research questions, and analysis tools. THA, RB, LH, and SS: conducted data analysis. THA, RB, LH, SS, NDB, MF, RF, AG, PO, QP, TR, OS, and TT: prepared original manuscript, and revised draft of manuscript. THA, RB, LH, SS, KD, TJ, NDB, NF, RF, AG, JH, RM, CO, PO, QP, OS, and TT: contributed to data collection, reviewing, and editing of revised manuscript drafts. All authors contributed to the article and approved the submitted version.

Funding

This project was supported through funding from the Centers for Disease Control and Prevention (Grant # U48DP006411) and the National Center for Advancing Translational Sciences of the National Institutes of Health (Grant #UL1TR002378).

Acknowledgments

We thank the Morehouse School of Medicine Prevention Research Center and Georgia Clinical and Translational Science leadership, faculty, staff and students for contributing to these efforts.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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