“Community-engaged research” has become a buzzword in translational research, but what does it mean in practice?

Finding out was the aim of Laboni Hoque, MD, a 2024 graduate of Harvard Medical School (HMS), when she signed up for a practice placement through Harvard Catalyst’s Community Engagement Program (CEP). Embedded with The Community Builders (TCB), a housing non-profit dedicated to developing high-quality affordable homes for families, seniors, and people with disabilities, Hoque got a crash course in how to build community engagement – and how not to. She then applied those learnings to her senior scholarly project at the same organization two years later.

The work earned her the Robert Ebert Prize for Health Care Delivery Research or Service, awarded annually at the Soma Weiss Student Research Day. Next up is residency in internal medicine at Yale Medical School. She’s pursuing primary care, she said, because she wants to develop the kind of meaningful, long-term relationships with her patients that would enable social determinants of health such as housing and food security to be addressed.

What drew you to the community-engaged student practice placement program?

I wanted to learn what community engagement really meant. In healthcare we often talk about how important it is. We throw around phrases such as “developing partnerships” and “listening to the community,” but we don’t always know what it means to actually do the work. I wanted to work directly with a community organization to see what that looks like on the ground.

“I wanted to learn what community engagement really meant.”

I have always been interested in housing, primarily on the advocacy side. In my first year of medical school, I worked with a member of the Cambridge City Council to advocate for more non-congregate shelters, which were especially critical during the Covid-19 pandemic. During my first and second years, I volunteered at shelters in Boston and Cambridge.

When I learned that one of the placements being offered through CEP was with The Community Builders, I was immediately interested. TCB is specifically focused on affordable housing and related programming for seniors and others in need, and they wanted more health programming. That was a great fit with my medical training.

What did the first project consist of?

For me, part of the project’s value was that it wasn’t a traditional medical school experience.

I worked with the director of community life at two main sites in Boston to identify programming needs and figure out how they could be met, including partnering with other community organizations. Then I reached out to a number of organizations to explore small-scale programming possibilities.

For example, through a partnership with Samaritans, Inc we brought in mental health programming for elderly residents to explore topics such as resilience and coping with grief. We hosted grocery store bingo to help people learn about healthy food choices.

Another aspect of my job was just getting to know the residents. The directors of community life were really helpful in guiding me to just sit with residents and learn about them before jumping in with programming that we think they might need.

By meeting people at their own community events and talking to them about their needs, strong and fun relationships naturally arose. That enabled me to see firsthand the challenges that people face such as organizing transportation to appointments and getting regular access to affordable, healthy food.

You returned to The Community Builders (TCB) for your graduate-year scholarly project. What was your goal this time?

I was tasked with interviewing “health champions” and their supervisors at two TCB housing sites: Avondale, Cincinnati, where the program started, and Boston. We wanted to hear from health champions directly to see what lessons could be learned.

The Avondale program was interesting because it has been around for seven years. The people identified as health champions hadn’t necessarily signed up to be community health workers per se, but that’s essentially what they’ve become. And I think it’s a really interesting type of community health worker because they are residents themselves and experience some of the same issues as the people they’re trying to help.

They were all passionate about their work. They talked about how helping their community is something they feel drawn to and gain satisfaction from. They talked about how they’ve grown more confident and feel a sense of empowerment through this role. Many have put it on their resumes and advanced their careers as a result. That’s been really valuable and inspiring.

I qualitatively analyzed the data, and then we developed tools and resources to help implement the findings and investigated new funding sources to expand the program. We created training handouts and social media posts to target issues commonly mentioned in the interviews. I presented my findings  to the staff, and they hope to use some of the quotes and takeaways in their own presentations to support the program’s continued expansion.

What was your takeaway from the two experiences?

I went into the project thinking community-engaged research would be a lot neater. I thought it’d be very organized, that I’d just get everyone in a room and ask them what they think. But I didn’t consider that everyone would have different schedules, or that some people need to process things on their own timeline.

I found that it’s more about just sitting with people, forming those relationships, and learning over time what their values are. Part of the fun is getting to know people and just having a good time with them. That creates the space for allowing opinions and concerns to come to the forefront more naturally.

“The first thing is to know the community. Don’t go in with an agenda. Go to community events and sit down to talk with people.”

I didn’t realize how leaders naturally arise in every community. When I was working at TCB residences in 2022, I noticed that some people just naturally talked to everyone else and collated the opinions of the community. They were the ones who were really engaged in the work of trying to represent others, even though that was never a formalized role for them. They were just doing it naturally.

It was interesting to come back two years later for the health champions project and see how that role could be formalized. In my analysis, I found that the health champions who most naturally fit the role were the ones who were already doing it. They were already going up to people and asking: What do you need? How can I help? Their natural role had just been formalized and was now being monetarily compensated.

What would you tell your fellow doctors and researchers interested in engaging communities in more meaningful and effective ways?

I would say the first thing is to know the community. Don’t go in with an agenda. Go to community events and sit down to talk with people. Go play bingo. Go to the ribbon-cutting ceremony. Meet people first. Learn what is needed and how you might help provide it. After that you can try to develop relationships with leaders.

It was good to have a formalized process through which to develop a relationship with a community organization over a longer period of time. Having a specific, well-defined project to work on and having regular check-ins with mentors both at CEP and at the community sites helped me feel as if I was contributing toward a goal.

Every other time I’ve been engaged in community work, it’s been through my own interest. I’ve had to figure out my own projects without knowing which organizations would be open to partnering with a student. As a result, they were much less defined and more difficult to organize. So it was really helpful to have the support of the CEP and to learn what it should look like from people who know.