Data_Sheet_3_From the national to the local: Issues of trust and a model for community-academic-engagement.PDF

Inequities in health and health care in the United States have persisted for decades, and the impacts on equity from the COVID-19 pandemic were no exception. In addition to the disproportionate burden of the disease across various populations, the pandemic posed several challenges, which exacerbated these existing inequities. This has undoubtedly contributed to deeply rooted public mistrust in medical research and healthcare delivery, particularly among historically and structurally oppressed populations. In the summer of 2020, given the series of social injustices posed by the pandemic and highly publicized incidents of police brutality, notably the murder of George Floyd, the Association of American Medical Colleges (AAMC) enlisted the help of a national collaborative, the AAMC Collaborative for Health Equity: Act, Research, Generate Evidence (CHARGE)1 to establish a three-way partnership that would gather and prioritize community perspectives and lived experiences from multiple regions across the US on the role of academic medicals centers (AMCs) in advancing health and social justice. Given physical gathering constraints posed by the pandemic, virtual interviews were conducted with 30 racially and ethnically diverse community members across the country who expressed their views on how medical education, clinical care, and research could or did impact their health experiences. These interviews were framed within the context of the relationship between historically oppressed groups and the COVID-19 vaccine clinical trials underway. From the three-way partnership formed with the AAMC, AAMC CHARGE participants, and 30 community members from racially and ethnically diverse groups, qualitative methods provided lived experiences supporting other literature on the lack of trust between oppressed communities and AMCs. This led to the development of the Principles of Trustworthiness (PoT) Toolkit, which features ten principles inspired by community members' insights into how AMCs can demonstrate they are worthy of their community's trust2. In the end, the three-way partnership serves as a successful model for other national medical and health organizations to establish community engaged processes that elicit and prioritize lived experiences describing relationships between AMCs and oppressed communities.

美国在健康和医疗保健方面的不平等问题已持续数十年，COVID-19大流行对公平性的影响也不例外。除了疾病在不同人群中造成的负担不均之外，大流行还带来了一系列挑战，这些挑战加剧了既有的不平等。这无疑加深了公众对医学研究和医疗服务的根深蒂固的不信任，尤其是在历史上和结构上受到压迫的群体中。2020年夏季，鉴于大流行引发的一系列社会不公以及警察暴力事件的高度曝光，尤其是乔治·弗洛伊德的谋杀案，美国医学院协会（AAMC）召集了一个全国性合作组织——美国医学院协会健康平等协作组织（CHARGE）1，以建立一种三方合作关系，该合作将汇集并优先考虑来自美国多个地区的社区观点和亲身体验，探讨学术医疗中心（AMCs）在推进健康和社会正义中的作用。鉴于大流行带来的物理聚集限制，对全国30位种族和民族多元化的社区成员进行了虚拟访谈，他们表达了自己对医学教育、临床护理和研究如何或实际上如何影响他们的健康体验的看法。这些访谈是在历史上受压迫群体与COVID-19疫苗临床试验的关系背景下进行的。通过与AAMC、AAMC CHARGE参与者以及来自种族和民族多元化的30位社区成员建立的三方合作关系，定性研究提供了支持其他文献中关于受压迫社区与AMCs之间缺乏信任的亲身体验。这导致了“可信度原则”（PoT）工具包的制定，该工具包包含十个原则，这些原则灵感来源于社区成员对AMCs如何证明其值得社区信任的洞察。最终，这种三方合作关系成为其他全国性医疗和健康组织建立社区参与流程的成功典范，以唤起并优先考虑描述AMCs与受压迫社区之间关系的亲身体验。