Summary

To date, there has been limited evaluation of how impacted communities are included in US-based Health Impact Assessment (HIA) practice. This two-year study highlights why community participation is important:

• HIA values include democracy and reducing health inequities. Involving those most affected by policies and programs is essential to advancing equity.
• Practitioner experience shows that successful HIAs depend, in part, on meaningful community engagement.
• The resources used to engage community members vary significantly.

The evaluation provides new data on community participation in HIA practice. It is intended to support HIA practitioners, researchers, funders, and others committed to authentic community engagement. This is the first national study to assess:

Outcomes

• The impact of community participation on civic agency—the ability of community members to organize and take collective action.
• The relationship between community participation and HIA success.

Process

• How HIA practitioners implement community participation.
• Barriers and facilitators to meaningful participation.

Key Findings

• Most respondents reported moderate levels of community participation, at the "involve" level of public participation.
• 84% reported that community participation had a positive impact on HIA success.
• 73% said their HIA led to positive community changes; 70% said it influenced decision-making; and 65% said decision-makers were receptive to HIA findings.
• Community participation was associated with increased civic agency, including greater engagement with decision-makers and increased advocacy skills.
• Higher levels of civic agency were linked to greater influence on decision-making.

Many HIAs engaged community members at moderate levels, suggesting room to improve toward higher levels of participation, such as collaboration and empowerment.

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Facilitators and Barriers

‍Effective community engagement was supported by:

• Partnerships with local organizations and existing community networks.
• Hiring community engagement specialists.
• Outreach strategies such as key informant interviews, public meetings, data collection involvement, and inclusion on steering committees.
• Resources like established relationships, government agency participation, facilitation skills, and cultural competency.

The most common barriers were lack of time and resources. Most HIA teams spent 30% or less of their time on community participation, and 70% of community participants were not compensated.

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Conclusions

‍Engaging impacted communities at higher levels can increase transparency, accountability, and the success of HIAs. Community participation builds civic agency and strengthens democracy and equity in decision-making. Activating existing relationships with community organizations is key to meaningful engagement.

Recommendations

• Plan ahead by developing relationships and community engagement plans.
• Build facilitation and communication skills.
• Share responsibility with community partners.
• Reduce barriers to participation, including providing compensation and logistical support.
• Make participation meaningful by clarifying roles and incorporating feedback.
• Integrate community participation into HIA evaluations and monitoring.
• Enhance civic agency by increasing community contact with decision-makers and supporting community action.

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