Table_1_From the national to the local: Issues of trust and a model for community-academic-engagement.DOCX

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.

美国在健康与医疗保健领域的不平等现象已持续数十年，而COVID-19疫情对公平性的影响也不例外。除了疾病在各个人群中带来的不均衡负担外，疫情还提出了若干挑战，进一步加剧了这些既有的不平等。这无疑加深了公众对医学研究和医疗服务的深深不信任，尤其是在历史上和结构上受压迫的群体中。2020年夏日，鉴于疫情带来的系列社会不公以及高度曝光的警察暴力事件，特别是乔治·弗洛伊德的谋杀案，美国医学院协会（AAMC）召集了全国性的协作组织——AAMC健康平等协作：行动、研究、生成证据（CHARGE）1，旨在建立一种三方合作伙伴关系，以汇聚和优先考虑来自美国多个地区对学术医疗中心（AMCs）在推进健康和社会正义中所扮演角色之观点和亲身体验。鉴于疫情造成的物理聚集限制，我们对全国30位种族和民族多样化的社区成员进行了虚拟访谈，他们表达了对医学教育、临床护理和研究如何或已经如何影响其健康经历的看法。这些访谈是在历史受压迫群体与COVID-19疫苗临床试验之间关系的大背景下进行的。通过与AAMC、AAMC CHARGE参与者和来自种族和民族多样化的30位社区成员形成的三方合作伙伴关系，定性方法提供了支持其他文献关于受压迫社区与AMCs之间缺乏信任的亲身体验。这导致了信任原则（PoT）工具包的制定，其中包含十项原则，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，这种三方合作伙伴关系成为其他国家级医疗和健康组织建立社区参与流程的典范，该流程能够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。