Identify Stakeholders and Build Trusting Relationships
Building trusting relationships with individuals and organizations in the community fosters an inclusive environment that promotes a sense of joint ownership of the CHA process. Such trust can ultimately contribute to better health outcomes when strategically applied to shared goals. Although trusting relationships are central throughout the CHA process, this particular step focuses on how to build those essential relationships and in turn develop the CHA and sustain those relationships over time.
Be Intentionally Inclusive
Engaging stakeholders is a deliberate and intentionally inclusive process. CHA developers and community stakeholders may have different ideas of what engagement looks like. To reach consensus, community stakeholders and hospital-based CHA developers work together to define their roles and responsibilities and agree upon expectations for involvement. Ensuring a shared understanding of CHA goals and expectations will facilitate collaboration.
Identify Stakeholders to Participate in the CHA
Stakeholders can be individuals or organizations, from the hospital or from the community. They should represent diverse races, ethnicities, genders, experiences and abilities. All these voices are valuable.
On this list, we provide examples of community sectors and groups to include in your CHA process and ensure everyone is heard. It is particularly important to engage representatives of people experiencing health disparities to gain firsthand information on root causes, develop culturally appropriate approaches for dialogue and ultimately effectively address root causes. For more information on specific types of community members to engage, refer to this list.
Form Your CHA Advisory Committee
The CHA process doesn’t occur in a silo but rather depends on varied perspectives. An important component, therefore, is a CHA advisory committee that includes diverse stakeholders as well as community members to guide the process. Although this committee will look different in different hospital and community contexts, it will work best when it includes hospital and community stakeholders who:
- come from different interests and sectors;
- are open to consensus-oriented approaches;
- represent all community voices;
- bring different strengths and/or resources to support the process; and
- are energetic, committed and willing to collaborate.
Consider seeking guidance on council membership from existing groups, such as Patient and Family Advisory Councils and Community Advisory Councils.
You can best ensure a vibrant, engaged CHA advisory committee by defining:
- The the approach of the committee (e.g., advisory versus steering)
- Staff and committee members’ specific roles and responsibilities
- Committee structure and leadership or chairperson responsibilities
- Committee participation guidelines, including any expectations related to time commitments, meeting frequency and opportunities for lesser or greater involvement
- Decision-making processes and responsibilities
- Any reimbursement you may offer to community members or individuals with lived experience whose participation is not part of their employment
- Shared language, expectations and goals for the CHA; for example, reference the AHA Glossary of Health Equity Terms
Community Sectors and Groups to Consider for Partnership in the CHA Process
Farmers (including farmers’ markets), food banks/pantries, restaurants
Self-employed individuals, small businesses, corporations with local offices
Libraries, 221 systems, newspapers, magazines, radio, TV, social media, blogs, online news magazines, non-English media outlets
Theaters, orchestras, museums, galleries, supporters of the arts
Public and private K–12 schools, preschools/early childhood education, colleges and universities, boards of education, English-as-a-second-language programs, teachers, school administrators, homeschool organizations, charter schools
Environmental advocacy organizations, conservation land trusts, environmentalists, hunters/fishers, biologists, outdoor enthusiasts
Regional, provincial, state and local governments; tribal governing bodies; elected officials; public health agencies; planning departments
Patients; caregivers; medical, dental and mental health providers; hospitals and health care systems; community clinics/federally qualified health centers; alternative health practitioners; health insurance companies; retail clinics; ambulance companies/paramedics
Public and nonprofit housing agencies, organizations that provide rent subsidies or affordable housing, developers, affordable housing advocates
Geographically linked online communities such as Nextdoor or a locally focused Reddit group
Public and non-profit organizations with missions related to community health and health equity
State, tribal, local and territorial health departments; public health organizations; nonprofit organizations
Local and state police, court systems, judges, probation officers, prosecutors, defense lawyers, prisons and jails, fire departments
Places of worship and their members and associated organizations
Lions, Masons, Rotary, Kiwanis, American Association of University Women, college fraternities and sororities
United Way; nonprofit organizations that provide services such as job training, food, shelter, advocacy and other services, including for older adults, for individuals with disabilities and for immigrants
Sports clubs, parks and recreation departments, athletic associations, YMCAs, gyms, coaches, athletes, sports spectators and supporters
Public transit, bicycle advocates, transportation departments, safe routes to school programs
Local non-profit organizations that support veterans and their families such as American Legions, VFWs, and Wounded Warrior chapters
Political activists, block/neighborhood associations, community coalitions
Individuals under 18 and the organizations that work with them, Big Brothers Big Sisters, Boys & Girls Clubs, Boy Scouts, Girl Scouts, 4H
Community-based Participatory Research (CBPR) Methodology
|CBPR Principles||Relation to CHA Process|
|Recognizes community as a unit of identity.||The unit of analysis for CHAs is the geographic community.|
|Facilitates collaborative partnerships in all phases of the research.||CHA developers can foster long-term, collaborative partnerships with community members and stakeholders throughout the process.|
|Integrates knowledge and action for the mutual benefit of all partners.||The hospital or health system gains a more nuanced perspective of community health issues.|
|Promotes a colearning and empowering process that attends to social inequalities.||Engaging the community throughout the CHA process promotes a sense of joint ownership and equity between the hospital/health system and community.|
|Involves a cyclical and iterative process.||The CHA process is an ongoing cycle that should include periodic reflection and course correction.|
|Addresses health from positive and ecological perspectives.||CHA developers are encouraged to target the social drivers of health in the community to address the upstream factors affecting health.|
|Disseminates findings and knowledge gained to all partners.||CHA results are publicly available and widely distributed to participants, stakeholders and the community at large.|
Patients and Caregivers
Patients are individuals who have received any sort of health care. Caregivers are individuals who serve a patient care role, such as relatives — a parent, child, brother, aunt — or a significant other, friend or neighbor. Individuals who have interacted with the health care system may have nuanced insights into how your hospital addresses the health needs of the community.
Volunteers include those who freely offer their time, services, and/or skills within the hospital or health care system. These can include individuals who are part of the community, patients and family member groups.
Hospital employees include hospital administrators, CHA developers, community benefit staff, clinicians, social workers and community health workers. Increasing engagement in the CHA process within your hospital and health system strengthens relationships across departments and professions. Employees are your first-level community.
Hospital and health system leaders — C-suite executives and trustees — may be particularly strong partners in a CHA process because they can advocate for the integration of prioritized community health needs into operations and link population health management strategies with the CHA.
Populations Experiencing Health Disparities
It is particularly important to reach out to populations that are known to have significant health challenges, such as historically marginalized individuals, people experiencing homelessness, legal and undocumented immigrants, incarcerated persons, older adults, individuals with physical and developmental disabilities, pregnant women, children living in poverty and members of medically underserved and minority populations or their representatives. It is particularly important to build relationships with these individuals because any implementation strategies may address their community’s health needs.
CHA stakeholder organizations may be public or private entities from a wide range of sectors interested in the health of community members. Engaging stakeholders from a wide range of sectors allows diverse perspectives to be represented. Organizations that serve communities with health disparities can provide unique insights and function as implementation strategy partners. The table below suggests potential partners in a CHA process.