Culture-centered design, implementation, and evaluation of programs can be an arduous and complex task for health professionals who are outside of, but working in, communities different from their own. The consequences of not doing this well can be profound; the long-standing history of institutional discrimination against communities of color, for example, has resulted in distrust of governmental and health agencies. In addition, barriers such as language and cultural differences, lack of transportation, and inflexible working schedules may prevent communities of color from participating in health-related initiatives.
These factors may help explain the overall underrepresentation of communities of color in health-related programs. This lack of representation often results in programs that do not adequately meet the health needs of these communities, which can lead to adverse outcomes. There is a need for comprehensive and participatory approaches that establish collaborative partnerships with communities of color. Such collaborations would invite and welcome people of color as strategic decision makers in every step of the design, implementation, and evaluation of health initiatives for their community.
The diverse communities of Mexico City, circa 2013; building connections is critical to trust and outcomes. (Photo by Nayeli Y Chavez-Dueñas and Hector Y. Adames)
We offer the following strategies, organized into three domains, for engaging communities of color in local health initiatives.
Domain 1: Building Empathy
To effectively engage communities of color, it is paramount that health professionals build empathy for how culture, racism, and history influence initiatives and their evaluation by:
- Recognizing both universal and culture-specific factors that influence participation in health initiatives and evaluations, perhaps by using the approach outlined in the Multiracial, Multiethnic, Multicultural Competency Building Model, which requires thoughtful action at four levels: intellectual, emotional, behavioral, and practical.
- Understanding how racism and ethnocentrism operate with the aim of developing evaluation methodologies that are respectful of diverse communities
- Appreciating the historical context in which evaluations have taken place, paying close attention to the negative affect on communities of color and their resulting loss of trust in agencies
- Developing an understanding of the interface between individuals’ ethnic and racial experiences and their health beliefs; such knowledge may strengthen both the design of interventions and evaluation approaches.
A number of continuing-education programs focus on meeting the above-mentioned criteria. The Winter Roundtable at Columbia University’s Teachers College, for example, focuses on cultural issues in psychology and education. The One America in the 21st Century: The President’s Initiative on Race initiative has also issued a helpful tool for organizing and conducting a community discussion on race.
Domain 2: Nurturing Self-Awareness
To effectively engage communities of color, we encourage health professionals to:
- Become aware of their attitudes, biases, prejudices, and resulting stereotypes; failing to do so may detrimentally affect the establishment of trust with the communities they wish to engage
- Develop the ability to see and understand the cultures of people of color as sources of strength and resilience
- Gain awareness of the racial and cultural socialization of individuals in communities of color, as it may assist in finding culturally congruent ways to connect and build trust
- Be mindful of similarities and differences between how health professionals view and conceptualize health and healing practices, and how communities of color view them
A tool that can help health providers assess biases and attitudes is the Implicit Association Test, a multi-university collaboration that started in 1998 and has led to a substantial web-based infrastructure for supporting behavioral research and education on implicit bias, diversity, and inclusion, with a view to applying the science to practice.
Domain 3: Developing Skills
To effectively engage communities of color, we invite health professionals to demonstrate their commitment to promoting health among those communities by:
- Participating in training programs to learn cultural nuances, including ways to communicate and interpret verbal and nonverbal messages appropriately
- Assisting community members to develop an understanding about the process of evaluation, its rationale, and its expectations; such understanding may facilitate their engagement in health initiatives
- Developing partnerships with local agencies and providers of health services that are respected by the community, as a way to facilitate establishing trust between the community members and evaluators
- Implementing a strategic decision-making approach, where the voices of the community are included in every step of the evaluation process.
The Patient-Centered Outcomes Research Institute (PCORI) funds health programs that exemplify effective community engagement in health-related initiatives.
Overall, we invite health professionals to start—or continue—to learn how to strategically engage communities of color in collaborative partnerships. Such engagement may serve to promote health behaviors that affirm the humanity of racially and ethnically minoritized communities. A commitment from health professionals to behave in ways that demonstrate that they have the community’s best interest in mind is pivotal for engaging communities of color. Furthermore, many of these strategies are important best practices for all community work, which inevitably brings together community members and health professionals with diverse backgrounds. Ultimately, the design of health initiatives and their evaluations will reach their optimal potential when all individuals are invested in establishing relationships based on reciprocal trust.
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Read more stories by Nayeli Y Chavez-Dueñas & Hector Y. Adames.