This study was conducted in four counties in South Carolina with diverse characteristics, including two rural and two urban, representing four different regions of the state (Table 1). Organizations in the counties were invited to partner with our study team based on recommendations from state and community leaders and their local infrastructure to conduct community engaged research. We sought communities with an active organization or group to lead local efforts, that had been working in their community for at least 2 years, and the ability to find a CHW in the area. Additional criteria included variation in community setting (e.g., urban and rural contexts), variation in topic area and/or population served, willingness to share lessons learned with the research team, and current representation from each sector involved in the initiative. Using these criteria, we identified four partner organizations that reflected variation across these dimensions. After identification, we contacted each organization to assess interest in partnering and conducted follow-up discussions to confirm alignment with project goals and overall fit. Three of the four organizations agreed to participate, which included a county coordinating council, a youth empowerment initiative, a health coalition, and an informal group of community partners organized for community wide impact. In the fourth community, a group of individuals who were already working together served in an advisory capacity for their community. These organizations and groups were critical to understanding the communities and gaining access. For example, community organizations facilitated connections between the research team and the community, brokered connections to identify CHWs to participate on the research team, and provided concrete supports (including meeting space), and supported the dissemination of results and findings into the local community.

A team of two CHWs from the Center for Community Health Alignment (CCHA) and two academic public health researchers developed the initial research plan and goals. For implementation, three more CHWs that currently lived in (and were native of) three of the counties were hired as Community Health Worker Researchers (CHWRs); the fourth community was led by a CCHA CHW who was native to that community. CHWRs were recruited via widely shared job postings in partnership with local organizations. Once hired, formative interviews were conducted with the CHWRs to understand their research experience and skills, and to determine their research training needs. They were then provided with tailored training by study team members with methodological expertise in qualitative methods to ensure all CHWRs were comfortable using them. The CHWRs also received certification in the ethical conduct of research.

Once CHWRs were trained, we hosted community discussion sessions in the four counties. The sessions were called “open mic” (microphone) community conversations.¹ Several methods were used to recruit, including direct recruitment by CHWs and project partners, word of mouth, flyers, and social media postings. Some participants invited friends to attend with them or to participate in the next cohort (snowball sampling). Sessions were held in diverse neighborhoods; individuals from different demographic groups were recruited to ensure a range of perspectives. A total of 24 sessions were held across the four communities, ranging from 5 to 14 participants. Table 2 provides participant demographics by community. Participants were mostly female and African American, but were diverse in education, age, and current level of community engagement.

We hosted two series of three open mic sessions in each of the four communities (24 sessions). Participants were asked to attend all three sessions in the series since conversations were designed to build across sessions. They received a $30 gift card for each session attended, as well as a meal for in-person sessions. While the COVID pandemic required our team to shift between virtual and in person sessions, we used a structured protocol for all sessions to ensure consistency.

Sessions were facilitated by a CHWR, conducted in English, and lasted about 1.5 h. The first two sessions in the series were focused on learning about the community, hearing members’ perspectives on effective strategies for community engagement, facilitators of and barriers to engagement, and key community challenges. A discussion guide was used for both sessions, but session two was designed to build upon the previous conversation. Session three was for member checking whereby participants received a summary of sessions one and two and then provided additional feedback. Discussions were recorded with permission and the recordings were transcribed for analysis.

Analysis began as data were collected, with discussions among all research team members about early findings and interpretations. Formal coding of transcripts used Dedoose, a qualitative data analysis software (29). The research team, including both public health researchers and CHWs from CCHA and CHWRs, analyzed all transcripts using an inductive approach. Such approaches allow for concepts or themes to emerge from raw data, rather than using prior assumptions or theory to guide the analysis (30). We used the constant comparison technique, with repeated review of data to allow key themes to emerge (31). These themes are presented in the results section. We used member checking in the last session to verify initial interpretations and to improve the credibility of our findings; feedback gathered helped clarify important nuances about the way that results were portrayed and gather additional details (for example, breaking down acronyms to ensure clear understanding) (32).

In defining community, participants focused on relationships and connections rather than places. For example, a participant from Community 3 explained, “community to me is more than the place where I live…my community…it’s just people that I can help.” Many reflected pride in their communities, it was ‘home’ to them. They shared stories of growing up in these communities, setting down ‘roots’, and having a connection to the people they have shared experiences with. Overall, participants said their communities have strong, resilient roots and people look out for one another. They noted that their communities include people who share common goals. For example, someone from Community 1 shared their perspective of how people are a community asset: “There are a lot of really, really good people here…and a lot of people who just want what’s best for their children no matter which socioeconomic group they are a member of.”

The strong, caring spirit of the communities was evident in conversations, as was the desire to help their communities thrive. Though much of their conversations focused on community issues, it was clear that participants felt their communities were caring places and they were optimistic about the future. For example, a participant from Community 4 shared their views on how people from their area come together in times of need:

One theme was the history of racism and its connection to many of the social issues communities face. Two communities shared specific examples in their history of traumatic events rooted in racism. These events are an unacknowledged ‘elephant in the room’ that must be addressed and reconciled for true healing and progress. Another theme was related to the history of African American communities being ignored. For example, a participant from Community 3 explained how history shapes the perception of their community:

There was also discussion about how information needed to access resources and events is kept from certain populations, including people of color. Therefore, a need was identified to diversify methods of communication with the community to ensure information reaches those who need it most. A participant from Community 4 shared their perspective on this:

Participants frequently discussed a history of broken promises from local policymakers, developers, and others, which leads to an overwhelming lack of trust in elected officials and other decision makers. Participants explained that politicians come into their communities to campaign, making promises to get votes, but are never seen again once elected. Someone from Community 2 explained:

Others shared that efforts to engage the community thus far have been selective, at the convenience of outsiders. Moreover, these selective engagement opportunities are seen as inauthentic or disingenuous; for example, to create a photo opportunity or to raise a politician’s profile. For example, a participant from Community 1 described it as: “doing the least amount to look good.” Another participant from Community 2 echoed these frustrations, explaining:

Conversations often tracked back to community social issues that affect quality of life and how these issues are oftentimes top of mind for community members, whereas sometimes those that come into their communities to work with them have their own priorities and may not understand or may ignore these issues. Many participants voiced concerns over violence and how it hinders sense of community and safety. Some explained that they have been accustomed to violence, drugs, crime, and other destructive behaviors, but, as someone from community 3 explained, “we do not have no voice at all.”

One participant from Community 2 explained that they came to the open mic discussion specifically to voice their concerns over violence in their community:

Participants expressed how there is good happening in their communities, but it is overshadowed by the violence and other disorder that commonly gets reported in the news and media. People commented on how other aspects of neighborhood disorder including crime, substance abuse, drug dealing, gambling, and gang activity impact their quality of life too. One resident from Community 2 explained how gang activity impacts their community:

Others commented on the lack of pride some have in their neighborhood, which contributes to a sense of apathy. Participants talked about how in the past, residents used to sweep their stoops and participate in other community activities. Because of the many social issues in their communities, participants shared that there is a sense of hopelessness amongst some residents. The lack of action, development, and growth in their communities can prevent people from getting involved. One participant from Community 4 shared how people can feel hopeless: “Sometimes you been beat down so bad by the system and people…you are just like, what’s the use?”

The lack of engagement with teens and young adults was a barrier. A participant from Community 1 explained their concerns about youth: “I’d say the younger people are getting left behind…we actually forgot about the youth and now, they are looking to the others who are actually getting them in a lot of trouble.” By listening to the ideas and desires of young people, they may become empowered to engage more. Participants discussed the need for programs and support to guide youth, as they can get involved in gangs and other bad influences if they do not have activities and mentoring in the community. Participants across the state emphasized the need for free and low-cost outlets for youth. One participant from Community 2 explained:

Lack of affordable housing, economic development, and other resources (including education, childcare, transportation, and jobs) were also significant concerns. Residents discussed the lack of development in certain neighborhoods, and how development has displaced residents due to high costs or broken promises (e.g., promising local improvement or employment that never materializes). Participants explained the complexities of housing and how issues like gentrification, unfair housing subsidy rules, and lack of affordability affect lives. A participant from Community 4 shared:

Transportation is lacking, especially for youth and senior citizens in rural communities. Two communities in particular have very rural areas. Residents from those counties spoke about how geographic isolation in rural communities result in lack of access to resources including jobs, education, childcare, quality grocery stores, and healthcare. Participants also spoke of how the lack of resources for youth and family recreation is a key challenge. Someone from Community 1 explained:

In addition, participants shared how the lack of resources in their small towns impacts their ability to keep young residents. For example, residents from one of the very rural communities explained how the lack of economic and infrastructure development in small towns results in young people leaving the community. A resident of Community 3 explained their perspective:

Participants shared frustration with outsiders coming into neighborhoods and making decisions without community input, which leaves people feeling disenfranchised. A participant from Community 1 explained:

Another resident from Community 4 explained the need to ask residents for their perspectives in a respectful way:

Participants in one county reported being left out of decisions on what schools will remain open or be consolidated, or what incentives businesses will receive for moving into an area. Others voiced frustration over liquor stores, payday loan companies, and other negative businesses preying on poor communities and local government showing no support for Black owned businesses. Outside people or organizations come in and deploy programming that do not match community needs, resulting in apathy and frustration. One person from Community 4 explained:

A number of participants explained that many people are “just trying to survive,” working multiple jobs, raising children, and/or caring for older family members. Others emphasized the need to increase awareness of existing community grassroots efforts to reduce duplication, collaborate, and act together. One resident of Community 2 explained how their family commitment limits the extent to which they can be involved:

Participants discussed challenges in connecting to resources from two different perspectives. First, they explained that people in need do not know how to access existing supports, resources, and programming. In addition, people shared the need to create linkages between existing community-based efforts to enhance collective impact. Several conversations highlighted that people need help connecting with and navigating to available services. This stems from a lack of awareness that resources exist, as well as people not knowing how to access available resources or navigate the process. Some participants knew of resources that others did not, so the open mic discussions were facilitative for individuals to make connections. This illustrated the challenges that many residents have in finding and connecting to available resources.

However, some noted that there is a disconnect between what the community needs and available services and resources. Some attributed the disconnect to a lack of effective communication and the need to share information with people on their terms and “in a way that speaks to them.” One person from Community 3 explained how this stems from a lack of attention to community needs:

There was also significant conversation around the challenges of working in silos, duplication of efforts, lack of communication among community members, and lack of connectivity. Participants talked about how working in silos promotes the lack of unity in their communities and how it inhibits collective action. They explained that people often get inspired to work on a local problem but often work on their own and do not seek out others doing similar work.

People mentioned lack of trust in organizations, hospitals, and state agencies, noting that they make decisions without the community’s best interest and do not represent community voices. Discussion focused on a history of negative experiences, community needs not being met, and lack of communication. Others emphasized that the priorities of public sector agencies are driven by politics, ignoring community input. One person from Community 2 shared their perspective on this:

The importance of trust and relationship building was common across all communities. Building trust was explained as making genuine connections, taking the time to listen, and seeing things from someone else’s perspective. It takes acknowledging the past and how the community may have been mistreated. Listening to the community and asking for feedback can help identify community assets to build upon. A participant from Community 2 explained:

Participants agreed that trusted individuals are usually from within the community and trust is built through consistency, commitment, honesty, and follow through. Residents want people who come into their community to have a reliable presence and establish long-term connections. Someone from Community 2 explained:

Trust develops when people listen to the community and work with them to get what they need and address problems important to them. The value of being open-minded, humble, and open to other people’s ideas was also emphasized. Multiple communication strategies are needed to reach community residents, as described by someone from Community 1:

Timing and location of outreach activities also matter. People may want to participate in an event, but because it occurs at a time that does not work for their schedule. A participant from Community 4 shared how community enthusiasm may consequently “slide by the wayside.” Others suggested working through trusted organizations including churches, as they are often a gathering place. Additional trusted organizations mentioned included schools, food banks, fraternities/sororities, and organizations with CHWs. Neighborhood associations were also mentioned several times.