This section describes best practices for engaging communities in data interpretation and decision-making and introduces measures and tools to provide community-level contextual information.
Intro summary
The purpose of contextualizing data is to frame data in ways that allow it to be interpreted and understood in the larger context of historical and structural factors at play within communities, including systems of oppression (e.g., racism, sexism), rather than only focusing on individual health outcomes and behaviors.1This allows you to identify the root causes of inequities and design solutions in collaboration with community partners that directly address structural factors. Without this process, data often become race-neutral or race silent.
Contextualizing data begins with identifying the population or community that will be centered in the work and describing it as specifically as possible. The community that will be centered is the one experiencing the inequity directly and is often a group that has been historically marginalized or under-resourced. The goal is not simply to describe the community of interest, but also to center them. To “center in the margins”2 is to shift the focus from the advantaged group’s perspective (those groups with more optimal health), which is the traditional approach, to that of the marginalized group or groups (those experiencing the inequity).
It is important to understand how best to address, communicate with, and engage the community being centered. Some things to consider include their geographic location, race, ethnicity, language(s) spoken, socio-economic status, cultural values, sexual orientation or gender identity expression, age, etc.
Engaging the community
Once the population being centered has been specifically and carefully defined, it is crucial to engage or re-engage with that population. Community engagement is essential for understanding and interpreting data because it can help frame program data in the context of historical and current policies and identify systemic factors that impact the health of communities. Without this element, programs and practices are likely to fail, or worse, to further reinforce existing inequitable power structures. Figure 5.1 describes the continuum of community engagement processes which ranges from simply informing a community (creating a pamphlet or holding a health fair) to having an initiative be community-led/driven (community members lead the initiative with your program joining as a participant or advisor).
Figure 5.1: Community engagement processes
What is Community Engagement?
Community engagement processes are ongoing relationship between community partners, community-based organizations, consumers, residents, local public health, providers and more. Different levels of community engagement can be most appropriate for different proposed projects and steps in the decision making process based on goals, needs, resources, and other important factors. This is why true community engagement is a continuum:
Figure 5.1: Community engagement processes
To effectively engage communities, it is important to recognize the ways in which your program or agency has historically interacted with the community. If your agency has made positive impacts on the specific population in the past, investigate the effective strategies and use them to strengthen existing relationships. If your agency has had negative impacts in the past, reflect on ways to mend these relationships, restore trust, and ensure respectful engagement of community members.
Key points to consider when compensating community members:
Make sure to compensate community members in a timely manner and inform them when they can expect their compensation
If applicable, provide information about filing tax returns on the money they receive and address any concerns or questions they may have
If possible, avoid compensation methods that might suggest the work of the community is not as valuable to those of others (e.g. the use of gift cards)
Be flexible when scheduling meetings and choose times for community members so they can participate without having to miss work or add additional expenses.
Not all words used in professional settings are appropriate or respectful to the community. Agencies should familiarize themselves with respectful language as part of this process. The Progressive’s Style Guide3 can provide guidance for using culturally appropriate language.
Common challenges and barriers to effective community engagement include lack of funding, staff, or direct connections to community members. It is crucial to not only make community partnerships a priority but also involve the community in all activities from planning and implementation to evaluation.
Quantitative tools for contextualizing community level and structural factors
Once the community is engaged, it is time to contextualize the data and inequities you observed. Examining data on community-level, structural, and historical factors can help you think critically about whether your program will be able to effectively meet the needs of the community you serve and what structures or systems may be limiting your program’s ability to reach its potential. Understanding this context is also important for future prioritization work in Prioritizing Strategies.
A root cause analysis is a systematic process that helps to identify causes associated with a problem and to think about the “why” behind the problem. There are a number of tools that can be used to help understand why certain inequities exist, including:
The Massachusetts Population Health Information Tool’s (PHIT) Community Reports describe the social determinants of health (e.g., different factors that affect health) for each community of the Commonwealth, while highlighting structural and historical inequities. This short video explains the concept of the social determinants of health and introduces the PHIT Community Reports.
The Environmental Public Health Tracking (EPHT) tool brings together health data and environmental data and provides supporting information to make the data easier to understand. Massachusetts EPHT data are available on an interactive web portal.
There are also individual-level measures that can provide valuable context to help you understand and interpret your data. For example, perceived experiences of discrimination (individual level) can be measured using the Everyday Discrimination Scale.
Figure 5.2: Example of contextualizing data during the State Health Assessment/State Health Improvement Plan reframing
Before: Identifying disparities by subgroups is useful for planning interventions and targeting policies aimed at improving access for members of those subgroups. More than one-third of Black non-Hispanic adults (35.6%) were obese compared to Hispanic (28.9%), and White non-Hispanics (22.7%).
After: The conditions in which people live, learn, work, and play do not offer all citizens of the Commonwealth equal opportunity to modify their behavior. For example, a history of policies rooted in structural racism has resulted in environments with inequitable access to healthy foods, safe spaces for physical activity, walkable communities, quality education, housing, employment, and health care services. The health implications of these structural inequities are evident in the fact that Black and Hispanic residents of the Commonwealth are consistently and disproportionately impacted by obesity and its related conditions. For example, more than one-third of Black non-Hispanic adults (35.6%) were obese compared to Hispanic (28.9%), and White non-Hispanics (22.7%).
Note:This example not only provides data, but also explicitly names and provides details about the structural factors that play into differences in outcomes.
Reflection
Once you have engaged the community and contextualized your data, reflect on what you’ve learned.
What story do the data tell now that they have been contextualized?
What additional information do you need?
Who else may need to be engaged in the process?
Does the community being centered agree with the results?
You may need to further stratify your data, rethink your analysis, explore other sources of data to better understand the community context, or engage other community members to help interpret the data. This is an expected part of the racial equity journey.
Resources
The following resources provide additional best practices, guiding principles, and tools for engaging and compensating communities and their members:
Toolkit Activity 2: Mapping Assets and Engaging Community
The Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN) 2.0: Toolkit to Build Parent Leadership in Continuous Quality Improvement
A Framework for Assessing Family Engagement in System’s Change
1 “How can we avoid “blaming the victim” when we present information on poor outcomes for different racial, ethnic, language or immigrant groups in our community?” Center for Assessment and Policy Development, 2013
