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>> Tiffany Powell Wiley:
Hello, my name is Dr. Tiffany

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Powell-Wiley, and I'm
Chief of the Social

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Determinants of Obesity
and Cardiovascular Risk

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Laboratory at the
National Heart, Lung,

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and Blood Institute.

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Today I'll be talking about
community engagement,

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and community based
participatory research.

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And this is part one of
a three-part series.

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As far as an outline for today,

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the first I'll discuss the role
of community engagement

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to address conditions

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impacted by social
determinants of health.

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I'll then go into the continuum
of community engagement

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and the differences
between community engagement

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and patient engagement.

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I'll then talk about the role
of community engagement

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for improving the diversity
of clinical trials.

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And finally, I'll talk about
the types of interventions

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that can happen
at multiple levels

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and that can incorporate
community engagement

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to promote health equity.

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Community engagement is critical

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in addressing complex
chronic diseases,

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particularly those
that are intersectional

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and act synergistically.
And we can consider obesity,

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diabetes, and
cardiovascular disease

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to be these types of diseases.

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All of these diseases
work together

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and are impacted by
social determinants of health,

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like economic disadvantage,
environmental factors,

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and psychosocial stressors.
And community engagement

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can help to understand
biological pathways

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that connect social factors
to chronic diseases.

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For instance,
community engagement

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provides an opportunity
to understand stressors

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that have the most
impact in the daily

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lives of community members.

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And the trust built through
community engagement

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allows for detailed
examination of health factors

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that are influenced
by these stressors.

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Ultimately, the goal
is to build solutions

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that are not only to understand

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what is happening
in the communities

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but also to address the health
needs within communities.

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We can define a community
based on geography,

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race/ethnicity, gender,
sexual orientation,

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disability, health condition,

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or a combination of
any of these factors.

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And communities
are typically groups

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with a common cause or interest
and can be connected by the fact

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that they obtain care
in the same place

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or are provided health care
through similar agencies,

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or that they have a common
public health cause,

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and work together towards
addressing solutions

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for that public health concern.

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And communities can be also
brought together by state,

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local or tribal leaders,
as well as policymakers

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to address a public
health concern.

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Community engagement works
along the continuum

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with the least amount
of community engagement,

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researchers design,
and all aspects of the study,

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and the community really works

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only in answering
the research questions.

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At the other end with complete
community engagement,

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the community
drives the research

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and defines the issue
and the question.

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As a part of the research,

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the community creates
the data collection tools

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and leads in the
implementation of the study.

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The community also leads
and runs data analysis

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and dissemination
of the study findings.

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And with complete
community engagement,

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researchers collaborate
to help facilitate the process.

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And between the two
ends of the spectrum,

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community members and
researchers work collaboratively

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in the design, implementation,

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and dissemination
of study findings.

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There are important differences

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between community engagement
and patient engagement.

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For instance, in building
trust with stakeholders,

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community engagement typically
built on relationships

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between academic partners

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and community members
or organizations,

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while patient engagement is
typically built on relationships

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that are established
in the healthcare setting.

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Community engagement
is also typically built

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on a common interest around
a public health issue

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that affects an
entire community.

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While the source of common
interest and patient engagement

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is typically a family
or personal health issue,

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or an experience related
to medical care.

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Community engagement
typically involves a diverse

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set of stakeholders
from local government,

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schools, or faith-based
organizations,

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for instance, but
patient engagement

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typically includes
patients and clinicians.

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We can think of several
types of patients

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and community engagement,
practice-based research networks

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are a type of patient engagement

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where clinicians and
patients are involved

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in deciding what to
study, how to study it,

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and how to evaluate
and present the results.

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For instance, this type of work
can help in quality improvement

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in health care settings.

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Community oriented primary care

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brings elements of community
engagement into primary care.

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And the main features of
community oriented primary care

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are providing clinical
care for individuals

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and families in the community
with special attention

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and focus on the
community as a whole,

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and the different parts
of the community

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when thinking about
the needs for care,

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planning and providing services,

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and evaluating
the effects of care.

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And then finally, community
based participatory research

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is clinical research that really
maximizes community engagement,

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and where the
research is designed

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and driven by community members.

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Community engagement
is an excellent way

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to overcome mistrust
of the healthcare system

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and mistrust of
clinical research,

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particularly for
populations underrepresented

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in biomedical research.

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We know that historical
events many decades ago,

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but also more recently,
contribute to this mistrust

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that communities feel
and bias and mistreatment

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that exists and occur
in the healthcare system

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also contribute
to this mistrust.

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This mistrust can really occur
at multiple levels,

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and it can influence
the patient as well.

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Community engagement can work
at each of these levels

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by gaining input from caregivers
as well as family members,

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as well as community members
outside of the family unit

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to help in providing

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input on the design of
clinical research studies,

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particularly research studies
that can affect the health

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of those most impacted
by health disparities.

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Studies have examined
how community engagement

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can influence representation
of populations who are

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traditionally underrepresented
in biomedical research.

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For instance, research done at
Beth Israel Deaconess Hospital

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in Boston

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examined cardiovascular disease
intervention trials

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that were done
between 2000 and 2019

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to examine the recruitment of
black adults into these studies.

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This work showed that only
21 percent of studies

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that were done during that time
period, specified recruitment

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strategies for reaching
underrepresented populations.

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Only 13 percent of studies

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use community-based
recruitment techniques.

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And only 5 percent
of the studies

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described engaging community
members in study design efforts.

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And really these
findings highlighted

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that those who were defined --

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and those studies that
defined recruitment targets

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for underrepresented populations
actually had higher recruitment

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of black participate
-- participants.

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And it also highlighted that
there's room for improving

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recruitment and using community
engaged strategies

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in the recruitment of
underrepresented populations,

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particularly for cardiovascular
disease studies.

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Community engagement
can also be the basis

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for developing interventions

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not only at the
individual level,

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but also at the community
and policy level

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to improve the
treatment of obesity,

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diabetes, and
cardiovascular disease.

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And this just highlights some of
the potential interventions

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that can happen at
different levels.

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It's also important to consider
how to tailor strategies

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for building sustainable
community partnerships.

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And these sustainable
partnerships

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can come from recognizing
resilience factors and assets

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with that exists
within all communities,

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looking to communities
for cultural interpretation

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of study findings,

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fostering upward mobility within
a partnership of community

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members and community leaders,

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remembering that community
health is holistic

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and there are minty -- many
interconnected approaches

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that can work in improving
community health.

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Additionally,
research approaches

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can work at multiple levels
to address community needs.

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It's also important to
rely on successful models

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by identifying
community champions

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as strategic partners
for advancing and adopting

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interventions and developing
sustainable interventions.

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So, in summary,
community engagement

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can aid in building trust
for sustainable interventions,

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particularly when they account
for social determinants

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of health, that promote
chronic diseases

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like cardiovascular disease,
obesity, and diabetes.

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And these interventions
can begin to uncouple

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these chronic diseases
and reduce prevalence.

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Community engagement
can work at both --

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within the clinical
research realm

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but also within the
healthcare system

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to reduce health disparities
and promote health equity.

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Our first question is
which of the following

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can define a
specific community?

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A) Geography? B)
Health condition? C)

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Local groups with common
public health concerns?

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Or D) All of the above?

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And the answer is D)
All of the above.

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The second question is
which of the following

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are examples of engagement
approaches to conduct

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clinical research studies
in community settings?

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A) Practice based
research networks? B)

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Community based
participatory research, C)

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Community oriented
primary care, or D)

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All of the above?
And the answer is D)

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All of the above.

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Thank you.