Fontaine et al.

BMC Public Health (2024) 24:784 BMC Public Health

https://doi.org/10.1186/s12889-024-18270-x

RESEARCH Open Access

One size doesn’t fit all: methodological

reflections in conducting community‑based
behavioural science research to tailor COVID‑19
vaccination initiatives for public health priority
populations
Guillaume Fontaine1,2†, Maureen Smith3†, Tori Langmuir1, Karim Mekki4, Hanan Ghazal4,
Elizabeth Estey Noad5, Judy Buchan5, Vinita Dubey6, Andrea M. Patey1,7,8, Nicola McCleary1, Emily Gibson1,
Mackenzie Wilson1, Amjad Alghamyan9, Kateryna Zmytrovych10, Kimberly Thompson11, Jacob Crawshaw12,
Jeremy M. Grimshaw1,2,7, Trevor Arnason4, Jamie Brehaut1,7, Susan Michie13, Melissa Brouwers1,7 and
Justin Presseau1,7,14*

Abstract
Background Promoting the uptake of vaccination for infectious diseases such as COVID-19 remains a global chal-
lenge, necessitating collaborative efforts between public health units (PHUs) and communities. Applied behavioural
science can play a crucial role in supporting PHUs’ response by providing insights into human behaviour and inform-
ing tailored strategies to enhance vaccination uptake. Community engagement can help broaden the reach of behav-
ioural science research by involving a more diverse range of populations and ensuring that strategies better repre-
sent the needs of specific communities. We developed and applied an approach to conducting community-based
behavioural science research with ethnically and socioeconomically diverse populations to guide PHUs in tailoring
their strategies to promote COVID-19 vaccination. This paper presents the community engagement methodology
and the lessons learned in applying the methodology.
Methods The community engagement methodology was developed based on integrated knowledge translation
(iKT) and community-based participatory research (CBPR) principles. The study involved collaboration with PHUs
and local communities in Ontario, Canada to identify priority groups for COVID-19 vaccination, understand factors
influencing vaccine uptake and co-design strategies tailored to each community to promote vaccination. Community
engagement was conducted across three large urban regions with individuals from Eastern European communities,
African, Black, and Caribbean communities and low socioeconomic neighbourhoods.
Results We developed and applied a seven-step methodology for conducting community-based behavioural
science research: (1) aligning goals with system-level partners; (2) engaging with PHUs to understand priorities; (3)

†
Guillaume Fontaine and Maureen Smith are co-first authors of the paper.
*Correspondence:
Justin Presseau
jpresseau@ohri.ca
Full list of author information is available at the end of the article

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecom-
mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Fontaine et al. BMC Public Health (2024) 24:784 Page 2 of 19

understanding community strengths and dynamics; (4) building relationships with each community; (5) establish-
ing partnerships (community advisory groups); (6) involving community members in the research process; and (7)
feeding back and interpreting research findings. Research partnerships were successfully established with members
of prioritized communities, enabling recruitment of participants for theory-informed behavioural science interviews,
interpretation of findings, and co-design of targeted recommendations for each PHU to improve COVID-19 vaccina-
tion uptake. Lessons learned include the importance of cultural sensitivity and awareness of sociopolitical context
in tailoring community engagement, being agile to address the diverse and evolving priorities of PHUs, and building
trust to achieve effective community engagement.
Conclusion Effective community engagement in behavioural science research can lead to more inclusive and rep-
resentative research. The community engagement approach developed and applied in this study acknowledges
the diversity of communities, recognizes the central role of PHUs, and can help in addressing complex public health
challenges.
Keywords Community-based participatory research, Community engagement, Citizen engagement, COVID-19,
Behavioural science, Vaccination

Background leaders, and vaccine confidence, which have influenced

With over 769 million confirmed cases and 6.9 million behaviours towards these health measures and vaccina-
deaths, the coronavirus disease 2019 (COVID-19) contin- tion efforts, hindering their effectiveness [16–19]. Health
ues to pose significant public health challenges across the inequities for structurally marginalized Canadians were
globe [1]. Health systems, economies, and social struc- exacerbated by COVID-19, underscoring the need for
tures have been widely impacted by COVID-19, lead- community-specific and responsive solutions [20–22].
ing to changes in public health policy in many countries These solutions should be based on an understanding of
[2–4]. Epidemiological data shows that the infection can the unique barriers and facilitators to information dis-
affect people of all ages, although older adults and those semination and uptake within different communities
with underlying medical conditions are at increased risk to ensure their relevance and acceptability [20, 23, 24].
of severe illness and death [5]. Certain racial and ethnic Factors such as language barriers, socioeconomic sta-
groups, as well as those living in densely populated areas, tus, access to technology, and historical experiences with
are also at increased risk [6–9]. For example, individu- healthcare systems can significantly impact the relevance
als of Black and Asian ethnicity are at increased risk of and acceptability of public health measures [20, 23, 24].
COVID-19 infection compared to white individuals [10]. Therefore, addressing the health inequities exacerbated
Several factors contribute to higher rates of infection in by the pandemic requires a comprehensive approach
ethnic minority groups, including racism and structural that prioritizes responsive solutions, ensuring that these
discrimination, lower socioeconomic status, living in are tailored to the assets, needs and challenges of each
larger and multi-generational households with shared community.
facilities, and being employed in essential jobs with fre- In Ontario, Canada, Public Health Units (PHUs)
quent exposure to infection and proximity to others [10]. have been at the forefront of the pandemic, battling not
Addressing these inequities requires multifaceted only the disease but also facing operational, ethical and
interventions, from mitigating structural disparities to communication challenges [25]. Ontario PHUs are the
promoting the uptake of public health and social meas- agencies responsible for delivery of local public health
ures aimed at preventing the transmission and spread programs and services. One of the main challenges has
of COVID-19 [10, 11]. While a wide range of measures been the scale of the pandemic, highlighting critical
have been recommended by the World Health Organi- weaknesses in health systems. These weaknesses include
zation [12], the challenge lies in their effective imple- limitations in the capacity and flexibility of service deliv-
mentation, especially concerning vaccination. Globally, ery with PHUs struggling to manage the large number of
promoting COVID-19 vaccination uptake (and boosters) cases; inconsistencies in decision-making and coordina-
during the ongoing (and constantly evolving) pandemic tion at different levels of the health system and govern-
remains a challenge [13–15]. This is complicated by the ment; and the significant strain on the health workforce
politicization of COVID-19, the pervasive spread of mis- revealing shortages and the need for additional training
information within social media platforms, the mistrust in epidemic management [26]. PHUs navigated com-
of scientific authorities and institutions, cultural norms plex ethical and political issues related to the pandemic
related to family, peers, religious leaders, and community response, such as balancing individual rights and public
Fontaine et al. BMC Public Health (2024) 24:784 Page 3 of 19

health priorities, as well as tensions between government sources [40]. More specifically, community engagement
and PHUs [27, 28]. In Canada, while the federal govern- can support counter-messaging to address circulating
ment provides overall guidance, PHUs, operating at the misinformation, designing impactful messaging appeals,
municipal or regional level, are primarily funded and and identifying trusted health messengers within the
governed by provincial or territorial governments [29]. community [22, 41–43]. Achieving a balance between
This can lead to discrepancies in resource allocation, pri- public health priorities, which require urgent action, and
orities, and decision-making processes, impacting pub- building trust with communities, which requires time
lic health initiatives. PHUs have also faced challenges and resources, is challenging but necessary for effective
in communicating with the public, especially dispelling communication and increased uptake of health informa-
misinformation and countering increasing mistrust [30]. tion from credible sources [44]. There is a need to con-
There is a need for increased collaboration and coordi- duct community-based, behavioural science research
nation among public health authorities at the global, with marginalized populations to identify community-
national and sub-national levels to share best practices, specific and responsive solutions.
resources and expertise; PHUs need access to timely There is a knowledge gap in understanding how effec-
and reliable data to inform their decision-making and tive collaborations and relationships can be established
response efforts. between PHUs and communities to conduct behavioural
Applied behavioural science has the potential to science research. This paper presents the methodology
play an important role in supporting PHUs’ programs we developed for community engagement with ethnically
and strategies during public health emergencies such and socioeconomically diverse populations in Ontario,
as the COVID-19 pandemic [31, 32]. Behavioural sci- Canada to conduct behavioural science research to guide
ence provides understanding of how key healthcare PHUs in their strategies to promote COVID-19 vacci-
actors—including individuals, communities, health- nation uptake. We share lessons learnt in applying the
care professionals, and policy-makers—interact within methodology, covering key considerations for fostering
health-related areas. It enables better knowledge about effective research partnerships with communities.
the attitudes and beliefs, and decision-making processes
of these actors, and understanding of the underlying Methods
processes and mechanisms that drive specific health- Study design and context
related behaviours [33, 34]. Behavioural science also pro- This is a nested study within the OPTimise project, a
vides evidence about effective (and just as importantly responsive and agile platform enabling PHUs to apply
– ineffective) ways to support behaviour change [35, 36]. behavioural science-informed strategies in ways that
Evidence-based solutions grounded in social and behav- reflect their evolving priorities and complement their
ioural science have been shown to be more effective and existing efforts (hereafter ‘OPTimise Platform’). Partner-
sustainable in the long run [32, 37]. This is key for PHUs ships were established with PHUs, community leaders
to design and implement more effective interventions to and residents in two large cities (Ottawa, Toronto) and
prevent the spread of COVID-19 [33, 34]. An area where one region including two cities and a town (the region of
behavioural science has provided important evidence Peel, including Mississauga, Brampton and Caledon) in
is the factors that influence vaccination uptake [38]. By Ontario, Canada. The OPTimise Platform was developed
drawing on this evidence, PHUs could develop more to generate generate an understanding of what influences
effective campaigns and interventions that resonate with individuals to engage in specific behaviours (e.g., getting
the public and encourage vaccination uptake [31]. PHUs vaccinated). This was used to create strategies to promote
have long-standing partnerships with specific communi- uptake of these behaviours in ways that reflect the reali-
ties, which could be leveraged to introduce behavioural ties of priority groups in each setting, including histori-
science to develop effective solutions. cally excluded and equity-denied groups. The approach,
Community engagement has been integral to the while comprehensive, was designed to be adaptable to
pandemic response [39]. A recent review revealed a time-sensitive situations, notably via the use of rapid
disconnect between communities and government in analysis approach for the interviews conducted with
disseminating public health information during the residents. The OPTimise Platform was approved by the
pandemic [40]. To bridge this gap, engaging with local Ottawa Health Sciences Network Research Ethics Board
communities and community organizations to address (#20,200,285-01H). The research team included behav-
specific health information needs and provide tailored ioural scientists, health services researchers, and a citizen
strategies to various groups and communities can help partner with extensive experience in COVID-19 citizen
in re-establishing public trust, enhancing inclusivity and engagement. Table 1 presents the terms used to desig-
increasing uptake of health information from credible nate the different community-based individuals involved
Fontaine et al. BMC Public Health (2024) 24:784 Page 4 of 19

Table 1 Terms used to designate community-based individuals in the OPTimise platform

Term Definition

Citizen partner (MS) Patient with extensive experience in COVID-19 citizen engagement recruited during the development of the grant applica-
tion to provide high-level input and support throughout the project, including reviewing all project materials and co-leading
community engagement.
Community member Umbrella term designating all individuals from a community engaged in the project, including community leaders and resi-
dents.
Community leader Individuals from the communities of interest in the OPTimise Platform holding leadership or professional roles in various
organizations serving their community (e.g., cultural community organization, community health centre).
Community resident Individuals from the communities of interest in the OPTimise Platform.

in the OPTimise Platform. In this paper, we focus on the to achieve high vaccination coverage in different contexts
methodology we developed for community engagement, [51–53].
and the lessons learnt in applying the methodology. We
discuss decisions that we made to collaborate effectively Community engagement process
with PHUs, tackle the broader context of the politiciza- As presented in Fig. 1, we developed and applied a seven-
tion of COVID-19 and the polarization of views regard- step approach to community engagement: (1) aligning
ing the issue, how we built trust and ensured that the goals with system-level partners; (2) engaging with PHUs
voices of community members were captured. to understand priorities; (3) understanding community
strengths and dynamics; (4) building relationships with
Guiding principles each community and establishing the community engage-
The overall project was based on the principles of inte- ment framework; (5) establishing partnerships with com-
grated knowledge translation (iKT) [45, 46] and the munity members; (6) involving community members in
approach to community engagement drawn from the the research process; and (7) feeding back and interpret-
field of community-based participatory research (CBPR) ing the research findings.
[22, 43, 47]. iKT is a model of research involving collabo-
ration between researchers and knowledge users (KUs; Step 1 – Aligning goals with system‑level partners
such as policymakers, healthcare providers, or commu- To initiate community engagement, the research team
nity members) throughout the research process [45, 46]. began by meeting with decision-makers of system-level
This approach emphasizes the integration of knowledge partners—Ministry of Health of Ontario and Ottawa,
generation and application, ensuring that research is Peel and Toronto PHUs—to assess needs and estab-
directly relevant and useful [45, 46]. CBPR is a research lish shared goals. Discussions led the Ottawa, Peel and
approach that involves community members as active Toronto PHUs to identify a need for a behavioural sci-
partners in the research process [22, 43, 45]. It seeks to ence approach to inform PHU activities to promote vac-
address community-identified issues and work towards cination at a community-level. This step occurred during
solutions collaboratively with the community [48]. the second year of the COVID-19 pandemic, when the
iKT and CBPR converge towards a shared objective: first few waves had passed, and vaccines were readily
the collaborative generation of knowledge that arises available. On a societal level, some of the trust that char-
from the expertise of KUs and researchers and that is acterized the early stages of the pandemic was eroding or
directly applicable and beneficial to the community and lost by this point [54, 55]. For example, some people felt
KUs involved [45, 49]. Previous research has shown that forced to take the vaccine or were hesitant to do so, and
iKT and CBPR successfully support production of cul- others were apprehensive about how recommendations
turally and logistically appropriate research, recruitment regarding vaccination were constantly evolving [38, 56,
of participants to projects and interventions, and capac- 57].
ity building of academic and community partners [46,
50]. These approaches can also enable conflict resolution Step 2 – Engaging with PHUs to understand priorities
and negotiation processes, sustain project goals beyond During this step, the research team had to develop an
funded time frames, and generate systemic changes [46, understanding of the goals and needs of PHUs. The
50]. Immunization research has shown participatory research team engaged with PHUs to understand how
community engagement to be cost-effective, increase regional priorities varied due to differences in popula-
vaccine uptake and reduce healthcare resources needed tion density, demographics, health status, political and
Fontaine et al. BMC Public Health (2024) 24:784 Page 5 of 19

Fig. 1 Illustration of the community engagement process alongside key actors

economic structures, healthcare systems and resource in Ottawa, Peel Region and Toronto. This was crucial
access. Additionally, the team aimed to identify which because each neighbourhood has a distinct community
doses in a vaccination series were of greatest interest to and public health infrastructure, leading to variations in
the PHUs, considering that individuals’ psychological sociocultural practices and healthcare behaviours. Fur-
and behavioural states are likely to differ at each stage, thermore, perceptions and attitudes towards vaccination
influencing the assessment of barriers and facilitators to varied markedly across communities, potentially influ-
vaccination in the next phase of the study [36, 38]. Work- encing the engagement process. In parallel, we conducted
ing with PHUs, we employed a prioritization matrix to a detailed environmental scan to identify how the three
determine the focus on specific vaccination doses and PHUs promoted COVID-19 vaccination amongst key
communities (see Supplementary Material 1). populations, classify existing strategies/resources used
Two PHUs (Peel and Toronto) identified getting the by these PHUs and identify the barriers and enablers to
first dose of the COVID-19 vaccine as their initial prior- vaccination that these strategies are designed to address.
ity. The Peel PHU initially prioritised individuals between This behavioural science-informed scan is reported in a
the ages 30 and 49 years who are members of Eastern separate paper [58].
European communities (e.g., Polish, Ukrainian, or Rus-
sian), and later broadened it to individuals from Eastern Steps 4 and 5 – Building relationships with each community,
European heritage, ages 18 years or older and from any establishing the engagement framework and establishing
neighbourhood. The Toronto PHU prioritised individu- partnerships with community members
als ages 18 years or older who are members of African, The research team continued to build relationships with
Black, and Caribbean communities from five neighbour- members from each community, following our planned
hoods with the lowest rates of vaccination. Peel and approach to community engagement (see Fig. 2). This
Toronto also prioritised the third or “booster” dose later involved working with PHUs to identify community lead-
in the year. The Ottawa PHU prioritised the 3rd dose and ers or organizations who would then select members to
individuals ages 18 years or older from five fifth-quintile form Community Advisory Groups (CAGs) for each city.
socioeconomic status neighbourhoods (i.e., low-income). Each CAG, comprising 5 to 10 members per PHU, collab-
orated with the team on key research activities, such as
Step 3 – Understanding community strengths and dynamics recruiting individuals for qualitative interviews. The aim
To understand the strengths (sociocultural, health- of the CAGs was to guide the community engagement
seeking) and vaccination behavioural dynamics of com- process, and support the investigator team in under-
munities prioritized by PHUs, the research team first standing unique neighbourhood health dynamics, and
held meetings and engaged with community leaders analyze the factors influencing healthcare behaviours,
Fontaine et al. BMC Public Health (2024) 24:784 Page 6 of 19

Fig. 2 Approach to community engagement involving the Public Health Unit (PHU), community leaders, community residents and a Community
Advisory Group (CAG)

more specifically COVID-19 vaccination, in each com- materials, promoting the project and/or recruiting par-
munity. When recruiting CAG members, we aimed for ticipants within their community, interpreting the analy-
broad representation aligned with the characteristics of sis of the results of the qualitative interviews, reviewing
the public health priority populations, however there was and participating in the elaboration of recommenda-
no formal mechanism in place to ensure equitable repre- tions for PHUs and supporting the dissemination of the
sentation according to sociodemographic factors. results to their communities, the general public and other
During this process, we finalized the engagement partners. Throughout the process, we produced short
framework, outlining the principles, values, and practices documents titled “What We Heard/What We Did” to
that guided the development of trust and the partnership summarize feedback received and explain what feedback
between academic researchers and community members we were able to incorporate and what we could not and
in this project. The community engagement framework in why (see Table 3). This feedback mechanism proved use-
the OPTimise Platform was based on the Patient Engage- ful for communicating scope of the project, the research
ment In Research (PEIR) Framework developed by Ham- process, and the requirements of the research ethics
ilton and colleagues [59] and on strategies identified by board. It also demonstrated to the CAGs that we were
De Weger and colleagues (see Table 2) [60]. The PEIR actively listening and valued their contributions.
Framework is an empirically based conceptual frame- With support from the CAGs, we conducted theory-
work for effective PEIR founded on a patient perspec- informed interviews guided by the Theoretical Domains
tive. The PEIR Framework includes eight key organizing Framework (TDF) and explored barriers and enablers to
themes: (1) procedural requirements, (2) convenience, COVID-19 vaccination along 14 domains (e.g., environ-
(3) contributions, (4) team interaction, (5) research envi- mental context and resources; social influences; emotion;
ronment, (6) support, (7) feel valued, and (8) benefits. behavioural regulation) [35, 61]. Individual interviews
The guiding principles for community engagement in were preferred over focus groups; while focus group dis-
the OPTimise Platform were structured according to cussions can offer valuable insights into interpersonal
these themes. The main principles of the engagement and community dynamics, we were concerned about
framework were introduced during initial discussions potential censoring of views in the presence of others and
with community leaders. Our framework emphasized the influence of dominant voices in such settings particu-
mutual respect, shared decision-making, and measures larly given the sensitive and politicized nature of COVID-
to promote equitable partnerships, reduce power imbal- 19 vaccination. To mitigate the risk of bias and ensure a
ances, and enhance the validity and relevance of research more comprehensive capture of community attitudes
conducted. towards vaccination, we employed a purposive sampling
strategy and stratified our sampling based on the number
Step 6 – Involving community members in the research of COVID-19 doses received (unvaccinated, 1–2 doses,
process and 3 or more doses). Data saturation was assessed using
From the onset, before partnerships were formalized and Francis’ 10 + 3 rule for theory-informed interviews [62].
again during the first meeting of each CAG, we discussed We conducted 22, 21, and 25 interviews in Ottawa, Peel
options for the roles and tasks of community members to and Toronto, respectively. These included 14 interviews
elicit their preferences and ensure that they were com- with people who were not vaccinated, three with peo-
fortable with their level of engagement. The tasks that ple who had the first dose, and 36 with people who had
members of CAGs could help us with included assisting the second dose. Additionally, we interviewed 15 people
with the development of our recruitment and interview who had 3 or more doses. Despite efforts to achieve more
Table 2 OPTimise platform community engagement framework, based on work by Hamilton and colleagues [59] and De Weger and colleagues [60]
Organizing themes Guiding principles Operationalization in OPTimise Platform

1. Procedural requirements Ensuring sufficient and diverse representation • We worked to identify community members who can represent
Procedural details involved in managing the inclusion of com- the perspectives and interests of the priority group
munity members in a research project to ensure their experi- Clarifying roles • From the onset, we discussed options for roles and tasks
ences are rewarding and productive with community members to elicit their preferences and ensure
they were comfortable with the level of engagement
Fontaine et al. BMC Public Health

• These roles included:

◦ Assisting with development of our recruitment and interview
materials
◦ Promoting the project and/or recruiting participants
within their community
◦ Interpreting the results of the interviews
◦ Participating in the development of recommendations
(2024) 24:784

for Public Health Units

Offering compensation • Each community leader/resident was offered a set compensa-
tion amount for assisting with the project and compensation
for additional contributions; we consulted with them to offer this
compensation in a way that worked best for them (e.g., cheque,
electronic or mailed gift cards)
Using plain language • We made sure the documents developed for community
members were in plain language and, in some cases, translated
in Arabic and French
2. Convenience Ensuring accessibility • We scheduled meetings at times convenient to community
Importance of choice and accessibility, including sufficient members and offered alternative ways to contribute (e.g., email,
time to engage, and the flexibility to choose how and when telephone calls)
to contribute • We ensured there was sufficient time for contributing dur-
ing meetings
• We circulated project and meeting materials (e.g., slide decks,
recruitment posters) through different communication platforms
(e.g., email, WhatsApp) and created a shared online folder for all
materials
Ensuring flexibility • We offered community members the opportunity to join
the meeting through different means (e.g., joining Zoom by call-
ing on telephone)
• We clarified that we understand if not all meetings can be
attended and offered individual meetings or telephone calls
to cover missed material
• We used different approaches to receive feedback (e.g.,
one on one conversations for feedback on interview guides)
and encouraged the use of individuals’ preferred methods of com-
munication (e.g., text, call, voice messages, email)
3. Contributions Providing constructive feedback • We provided regular, constructive feedback on the roles
Roles and tasks assumed by community members and tasks assumed by community members; we explained
how their feedback was shaping the project
Page 7 of 19
Table 2 (continued)
Organizing themes Guiding principles Operationalization in OPTimise Platform

4. Team interaction Identifying one person who can be contacted • We identified one consistent “point” person on the research
Importance of positive research team interaction team whom community members could contact if they needed
information or support
Ensuring a reciprocal relationship and positive social interactions • We engaged regularly with community members not only in
a ‘research’ context, but also socially through informal conversa-
Fontaine et al. BMC Public Health

tions
• We emphasized the importance of mutual respect and trust
5. Research environment Fostering a safe and trusting environment • By clearly stating values of inclusiveness and respect
Importance of having a positive and inclusive organiza- from the onset, we fostered a safe and trusting environment
tional/team culture that allows partners to feel comfortable enabling community members to provide input
and accepted as equal team members working together • The research team played a mediating role by encouraging hon-
(2024) 24:784

est feedback, actively listening and ensuring tensions could be

openly discussed
Acknowledging power imbalances • We acknowledged and addressed community member experi-
ences of power imbalances between citizens and health care
professionals
• We had discussions about what community members brought
to the table (e.g., feedback, comments, expertise, background)
6. Support Reimbursing expenses related to project engagement • In addition to compensating community members, we offered
Financial support that covers engagement-related expenses to reimburse any additional project engagement expenses (e.g.,
and instructional support provided training to improve under- extra meetings)
standing of research language and processes Providing skills/instructional support • At the first meeting, we explained research language and pro-
cedures
• We integrated training into our meetings based on the needs
of the specific group (e.g., information about the role of research
ethics boards, how this impacts recruitment and interviews)
• We offered additional on-demand instructional support, includ-
ing in the individual’s first language when possible
7. Feel valued Considering the community KUs’ motivations • We explored the community members’ motivations for join-
Ensuring that community members feel equally important ing the project and considered how we can align the project
on the research team by demonstrating appropriate recognition with these motivations
and respect Acknowledging contributions • We reviewed community member’s contributions and successes
at each meeting and stressed the importance of their expertise
• We demonstrated their impact on the project (e.g., “What we
heard/What we did” – see Table 3)
Creating quick and tangible wins • We structured each meeting with community members
to provide quick and tangible wins (e.g., collecting specific input
about the interview guides that would help us move forward)
Page 8 of 19
 Fontaine et al. BMC Public Health
(2024) 24:784

Table 2 (continued)
Organizing themes Guiding principles Operationalization in OPTimise Platform

8. Benefits Highlighting the benefits of engagement • We highlighted the benefits of engagement for community
Importance of community members to derive benefits members, including gaining confidence, knowledge and skills
from their engagement to communicate their perspective in a research team and learning
about COVID-19 and vaccination
• We communicated how the research team had benefitted
from their engagement (e.g., personal growth, better understand-
ing of complex issues and challenges faced by their communities)
Investing in citizens who are less often provided with opportuni- • We provided engagement and learning opportunities to com-
ties to engage with researchers munity members who felt they lacked the skills and confidence
to engage
• We offered to make them aware of further opportunities
for engagement
KU knowledge user
Page 9 of 19
Fontaine et al. BMC Public Health (2024) 24:784 Page 10 of 19

Table 3 Example of a ‘What We Heard/What We Did’ document in the initial stage of the community engagement with the Ottawa
CAG for recruitment posters
What we heard What we did

Conversations is a better term than « interviews» ✓ From now on, we will use conversation! Thank you!
The reading level is too high ✓ We’ve decreased the reading level.
There is too much information ✓ We’re reduced the content by about 30%.
Concerns with putting “vaccine” in the heading You made a good point about people being tired to speaking about vac-
cination, but research projects must follow very strict rules from a “Research
Ethics Board” (a group of people, including citizens, who make sure
that people who participate in research are protected). We must state
the purpose of the interview very clearly up front.
Concerns with putting 3rd dose/booster in the heading; people We must be clear that it is for ­3rd dose/booster. We can’t think of a simpler
have lost track of what they have received so this could be confusing way of saying this.
Add a QR code on the poster ✓ We will do this
We like the subheadings (What do I have to do?… We’d like to hear ✓ Glad to hear this. We’ve kept them in the new version.
your thoughts about…)
Nice graphics, especially hands symbolizing collaboration ✓ Thank you. We’ve kept the hands!
The poster needs to be more colourful, with bigger logos & pictures, ✓ Great advice! We have made the poster more colourful.
and less “institutional”
Make poster available in different languages (e.g., Arabic, French) ✓ We will do this.

balanced samples, more women than men participated in they were shared with PHUs. At the end of the commu-
interviews. nity engagement process, we held a final meeting with
each CAG to reflect on our collective progress, areas of
Step 7 – Feeding back and interpreting research findings learning and mutual growth, and highlighting how their
Once the qualitative interviews with members of each input directly influenced public health recommenda-
community were completed, additional meetings with tions. Members of each CAG also received the findings
CAGs were held to discuss and interpret findings. Indi- of an independent evaluation of the engagement process
vidual interviews were triangulated with insights for the to demonstrate the value of the study. Recommendations
CAGs and existing literature. This triangulation helped were then shared through policy briefs with key stake-
in validating the insights gained from interviews and holders from each PHU, and meetings were held to dis-
in constructing a more comprehensive picture of com- cuss recommendations. The PHUs received these briefs
munity dynamics and attitudes. Based on this data, we and recommendations favourably and spurred further
developed ‘personas’, who represented fictitious individu- follow-up discussions with PHUs on opportunities to
als in each community, as a way of presenting the themes action the recommendations, indicating that our com-
and perspectives derived from the qualitative interviews munity-engaged approach produced actionable insights
(see Fig. 3). Three to four personas were created per com- tailored to their specific needs and contexts.
munity by the team members conducting data analysis,
and these were then examined and refined by the com- Results
munity engagement co-leads. The CAGs recognized that Our study yielded insightful findings on the complexi-
the fictitious personas represented familiar perspectives ties of aligning public health needs, community engage-
of their neighbours and peers, which facilitated rich ment and behavioural science research. We explored the
observations of what types of strategies could resonate nuances of working with diverse communities, and the
with these personas. critical role of trust-building in fostering effective part-
When it was time to develop recommendations for nerships. We outline here the lessons learnt in applying
PHUs based on the analysis of the results of qualitative the methodology.
interviews, we produced ‘What We Heard’ documents
to present a summary of the feedback from each CAG Lessons learnt
from the previous meeting regarding each potential rec- One size doesn’t fit all: tailoring community engagement
ommendation (see Table 4). These in-depth feedback Early in the engagement process, the research team
sessions enabled members of each CAG to validate rec- recognized the necessity for tailored approaches for
ommendations emerging from their community before each community, considering the broader sociopolitical
Fontaine et al. BMC Public Health (2024) 24:784 Page 11 of 19

Fig. 3 Personas used to guide discussions around strategies to promote the uptake of vaccination with the Toronto Community Advisory Group
(CAG)

Table 4 Example of a ‘What We Heard’ document in the latter stage of the community engagement process with the Toronto CAG for
recommendations to the PHU (details regarding each recommendation added to clarify recommendations)
Recommendation idea What we heard

Use windows of opportunity to start conversations • Not sure if people will be receptive to a rebranding campaign
• Use March 11, 2023 (3rd anniversary of pandemic) to launch a new cam- • The word “anniversary” implies celebration: COVID is not something
paign about what we have learned about COVID and the vaccines to celebrate
Empower trusted sources • It’s true that faith leaders have a lot of influence
• Make sure people are aware of their important role in affecting • Reach leaders through the higher-ups in the church system (the top dogs)
the COVID-19 vaccination decisions that their patients, congregation, Strategically choose churches for campaigns
family, friends, and peers make • Include Black health professionals and experts
Roll with resistance • This one is great
• Empower (through offers to support training) trusted sources to draw • The non-judgmental piece is important
from the principles of motivational communication to keep the door • Respect people’s right to make their own decisions
open by “rolling with resistance” where the goals are to avoid defensive-
ness and encourage people see different perspectives
Clarify key information • Good information, can accompany with visuals
• Acknowledge that the messaging around COVID has been mixed/ • Great use of language to explain things in a new way (immune system
unclear, and clarify that it is less about how many doses you had part)
and more about having a dose recently, so that your body is ready • Need to clarify what different variants mean
to fight COVID
Use stories alongside statistics • Use videos, audio, people learn differently
• Identify examples from within communities where people have • In-person also very important e.g., wellness clinics
changed their minds about the vaccine to amplify; stories from local com- • Could be playing on the screen at wellness clinics etc., people will watch
munity leaders, community ambassadors and relatable “regular people” while they’re waiting around

context, the polarization of views regarding COVID-19, every step of the way, we had to consider the implica-
the geographic distance of the research team to priori- tions of working on a topic that became highly politi-
tised communities, and the distinct needs and cultural cized with the potential for generating strong emotional
backgrounds of the communities. While the original reactions, influencing who ended up wanting to col-
strategy involved partnering with PHUs to identify laborate on this project. This necessitated tailoring the
community leaders or organizations, who would in turn engagement process to each community, grounded in a
help us select local residents to form CAGs for collabo- fundamental respect for their diverse perspectives and
rative research in each city, this method proved unfea- needs. The study required adaptations to the envisioned
sible across all locations. Across all communities and at approach, particularly in forming Community Advisory
Groups (CAGs).
Fontaine et al. BMC Public Health (2024) 24:784 Page 12 of 19

In Ottawa, we implemented the approach the research organizations in Peel, working specifically with the com-
team had originally envisioned. The process began with munities with whom we sought to connect, and sev-
meetings at the Ottawa PHU, where key partners helped eral had left Ukraine because of the Russo-Ukrainian
identify individuals from diverse community organiza- War. Although exact educational backgrounds were not
tions, such as Community Resource Centres (CRCs) and explicitly detailed, many had some tertiary education.
Community Health Centres (CHCs). These community Several newcomer members viewed their participation
leaders, holding roles like Community Development as a means for professional advancement in Canada,
Facilitator, Health Promoter, COVID-19 Coordinator and with some offering indispensable language support for
Community Capacity Coordinator, identified residents to interviews.
form a CAG. From the residents approached, a group of Overall, the experiences in these regions underscore
six individuals agreed to form the Ottawa CAG, estab- the importance of flexibility, responsiveness and cultural
lishing a strong local connection. Our research team’s sensitivity in community engagement, particularly in
citizen partner led Ottawa’s community engagement, diverse and dynamic sociopolitical contexts.
utilizing skills as a second language teacher and a person
who is experienced in bridging the gap between the pub- Involvement of the community advisory groups
lic and researchers. This intermediary role between the in the research process
researchers and the community leaders seemingly helped Across sites, we used different methods of engaging com-
mitigate barriers to engaging in research (e.g., accessible munity members in the research process. In Ottawa, our
language, understanding of research systems, tokenism) approach was shaped by the research readiness of our
that people from equity-denied groups face. community members. Most were new Canadians and not
In Toronto, it was necessary to adopt a different familiar with research practices. To enable effective par-
approach as the PHU did not directly connect us with ticipation in the research process, each meeting included
community organizations related to the priority group. some type of training. Throughout our collaborative
Despite extensive discussions with community lead- sessions, we discussed topics such as the importance of
ers and several unsuccessful attempts at recruiting resi- research ethics board requirements when co-creating
dents, we adapted our strategy due to historical mistrust recruitment documents or asking community members
and injustices, which were intensified by COVID-19. We if they were interested in interviews. In later stages, our
cold-called relevant organizations and had discussions discussions were mostly focused on anecdotes and per-
with a Black researcher in Toronto, which allowed us to sonal stories that reflected the community’s experiences
identify eight community leaders from Black, African and shaped our recommendations in a way that was close
and Caribbean communities with connections to various to the community.
organizations (e.g., Jamaican Canadian Association, Gre- In Toronto, where prioritized populations were Afri-
nada Cultural Association, Community Health Centres) can, Black, and Caribbean communities, our discus-
interested in forming a CAG. Most community leaders in sions reflected the community leaders’ expertise in their
the Toronto CAG did not live within the five neighbour- communities and were focused on intersectional issues
hoods, but were members of African, Black, and Carib- and structures of power within society. They helped us
bean communities, and some worked in close proximity understand the factors that influenced their community’s
to the neighbourhoods. behaviours, what could potentially be done to repair rela-
In Peel, like in Ottawa, connections were established tionships, and provided messaging that resonated with
with community agencies and organizations through their communities. There were open and honest con-
introductions from the PHU. However, this initiative versations about how unethical research and systemic
intersected with the geopolitical upheaval following racism continues to have profound repercussions on
Russia’s invasion of Ukraine in February 2022, leading African, Black, and Caribbean communities’ relation-
to a pause in community engagement efforts. A break- ships with the healthcare system, the government, and
through came in spring 2023 with introductions from the scientific community. As health and social services
the Peel PHU to community organizations, as was the professionals, community leaders shared how they inter-
case in Ottawa. This led to a successful Zoom presenta- acted with people from those communities and what they
tion to about 45 organizations, which, along with PHU heard about COVID-19 and vaccination. We were able to
connections, enabled the formation of a Peel CAG with delve more deeply into behavioural science approaches
community residents. The CAG included eight commu- as, in general, there were fewer barriers and differences
nity residents primarily of younger age from Ukrainian, related to language skills and overall health literacy.
Polish and Bosnian backgrounds. Several community The involvement of the Peel CAG was multifaceted,
partners were employed as staff at various community reflecting their cultural expertise, personal background
Fontaine et al. BMC Public Health (2024) 24:784 Page 13 of 19

and professional experience. To navigate the intricacies of other two PHUs were more interested in working with
the Eastern European community in Peel, members of the communities where they had existing relationships but
CAG offered valuable insights into the politics, history, still faced low vaccine uptake rates. Furthermore, a sig-
and structures of power within various Eastern European nificant aspect that came up during the prioritization
countries. CAG meetings in Peel revealed substantial process was defining what constituted a community in
learnings about the cultural and political context, such as the context of the project. We adopted a broad defini-
the influence of war in Ukraine and attitudes toward vac- tion of community, recognizing that communities may
cination in other countries. Feedback from the CAG and be arrayed along a spectrum of cohesiveness, with a dif-
community leaders emphasized a deeply rooted mistrust ferent set of characteristics (e.g., common culture and
in government and its extensions, including research traditions, canon of knowledge, and shared history;
entities, due to historical political corruption in Eastern health-related common culture; legitimate political
Europe. This necessitated building trust bridges, which authority; representative group/individuals; mechanism
the CAG aptly facilitated, highlighting the indispensable for priority setting in health care; geographic localiza-
nature of their involvement in the research process. On a tion; common economy/shared resources; communi-
practical level, some CAG members actively participated cation network; self-identification as community) [63].
in interviews by assisting with language interpretation, Consequently, our definition broadened to include not
translating information ‘on-the-fly’, ensuring that the just geographic proximity but also shared identities,
nuances were preserved. interests, cultural practices, and social connections. One
PHU expressed a desire to focus on communities with
Navigating diverse public health unit priorities low socio-economic status (SES), while the other PHUs
To effectively navigate the complexities of the OPTimise preferred to focus on specific cultural population groups,
Platform, a wide range of questions emerged throughout acknowledging the unique challenges and opportunities
the project (see Table 5). These guiding questions should in enhancing vaccine uptake within these communities.
be kept in mind from the onset of projects involving col- These distinct priorities shaped our approach to commu-
laborations between PHUs and behavioural scientists. nity engagement, tailoring it to the specific vaccination
This process can generate tensions, therefore efficient, goals and the communities prioritized by each PHU.
transparent communication is key to ensuring balance
between the respective interests of each group. In the Building trust for effective community engagement
OPTimise Platform, this required not only a clear under- The trust-building process in this study was crucial for
standing of each party’s objectives but also a commit- effective community engagement and research partner-
ment to open dialogue and collaboration, ensuring that ships, especially with communities impacted by discrimi-
both the practical needs of the PHUs and the scientific nation, racism, and systemic inequities. This process was
goals of the researchers were adequately addressed and influenced by historical trauma, pre-existing mistrust
harmonized. towards researchers, healthcare professionals, and gov-
The prioritization discussions within the project ernment, community governance, resources and chal-
revealed differing preferences among the PHUs for the lenges posed by COVID-19 and geographic distances.
types of support they needed. While one PHU was seek- The team identified five key trust-building mechanisms
ing assistance in reaching out to communities where based on their experience: (1) getting acquainted; (2)
establishing connections had proven challenging, the ensuring cultural and linguistic competence of the

Table 5 Guiding questions when developing collaborations between behavioural scientists and public health units

1. What are the specific public health challenges faced by Public Health Units (PHUs), and how do these translate to their goals and needs?
2. How can applied behavioural science contribute to addressing these goals and needs (e.g., exploring barriers to vaccination, designing strategies
to promote vaccination)?
3. What are the metrics of success for PHUs, and how can these be aligned with behavioural research findings?
4. How can the collaboration between PHUs and behavioural scientists be structured to ensure mutual benefit?
5. How can the partnership between PHUs and behavioural scientists remain flexible to adapt to new public health emergencies or changes in com-
munity health profiles?
6. What communication strategies can be employed to effectively convey the findings and benefits of behavioural science interventions to diverse
stakeholders?
7. What are the best practices to build capacity within PHU staff in the principles and applications of behavioural science to enhance in-house exper-
tise?
Fontaine et al. BMC Public Health (2024) 24:784 Page 14 of 19

research team; (3) working out differences and resolv- A central trust-building mechanism during our CAG
ing conflicts; (4) acknowledging the validity of mistrust meetings was acknowledging the validity of mistrust
and damaged relationships based on past experiences; and damaged relationships based on past experiences.
and (5) addressing ethical considerations and ensuring Acknowledging and addressing historical and systemic
reciprocity. injustices was central to the community engagement pro-
Getting acquainted was a crucial trust-building mech- cess. Discussions with Toronto community leaders led us
anism as it allowed for the establishment of mutual to understand that not all of them felt comfortable refer-
respect, understanding and shared goals between ring community residents to us to form a CAG due to the
researchers and community members. This was achieved highly politicized and polarized nature of COVID-19, as
through the research team learning about the commu- well as historical mistrust in healthcare professionals and
nities, engaging in active listening and demonstrating a decision-makers. There were people sympathetic to anti-
genuine interest in the community’s concerns and per- vaccine sentiments in the CAG; however, the research
spectives during meetings with community leaders. team and the CAG were able to engage in constructive
Ensuring the cultural and linguistic competence of the discussions which respected the different perspectives.
research team was also fundamental since we engaged During our meetings with community leaders from
with people from diverse sociocultural backgrounds Black, African and Caribbean communities, we discussed
who spoke different languages and had varying levels of the historical and systemic injustices that have contrib-
health and research literacy. Although the research team uted to mistrust (e.g., the Tuskegee syphilis experiment)
was prepared to do this, it was not until the PHUs were and worked to understand concerns and experiences. We
identified and the prioritised communities were chosen learned a great deal about the impact of mandates (e.g.,
that we were able to address the cultural and linguistic mandatory vaccination, travel restrictions) on commu-
competence of our team. Working with different groups nities and how it affected community relationships with
from widely different sociocultural backgrounds required health professionals.
the team to be especially conscious of what they knew A final trust-building mechanism, operationalized
and also what they did not know, and to seek advice and mainly when partnerships were established and the
to secure external support when required. We recruited Ottawa, Peel and Toronto CAGs were formed, was
team members fluent in different languages (e.g., Ara- addressing ethical considerations and ensuring reci-
bic, French, Ukrainian) to help support community procity. Many ethical issues emerged that needed to be
engagement meetings and conduct the qualitative semi- addressed when working with these equity-denied com-
structured interviews to identify barriers and enablers munities. These included achieving a true “community-
to vaccination uptake in the prioritised communities. driven” agenda, addressing insider–outsider tensions,
Throughout the project, we consulted with community racism, limitations of “participation,” as well as issues
members to ensure culturally appropriate activities (e.g., involving the sharing, ownership and use of findings [48,
acknowledging Black History Month, sensitivity in rela- 64].
tion to the Russo-Ukrainian War).
Working out differences and resolving conflicts helped Discussion
build and maintain trust among community members We developed and applied a dynamic community engage-
at different levels. This involved acknowledging and ment approach involving close collaboration with PHUs,
addressing power imbalances, communicating openly community leaders, and residents. This approach facili-
and honestly and using a collaborative problem-solving tated community-based behavioural science research
approach. For example, during the cold-calling process in with equity-denied groups to inform public health strate-
Toronto we were confronted with questions from several gies to enhance vaccination uptake and curb the spread
intermediaries inquiring why, if we wanted to work with of COVID-19. After PHUs identified priority communi-
people from Black, African, and Caribbean communi- ties and vaccination targets, we collaborated closely with
ties, we did not have individuals from these communities community members. This collaboration helped in the
represented on the research team. We carefully explained recruitment of their peers for theory-informed interviews
that the OPTimise Platform was designed to be agile and and facilitated in-depth understanding of, and com-
flexible in working with a wide range of communities, munity-driven perspectives on, the factors influencing
while recognising that indeed this was a limitation in the COVID-19 vaccination uptake, as well as interpretation
composition of our team and why we sought to partner. of findings and co-design of timely recommendations tai-
Thus, our plan was to engage members of the specific lored to each PHU in Ottawa, Peel and Toronto.
communities we would be working with before embark- Our study shows why and how a ‘one size fits all’
ing on research activities to ensure local representation. approach to community engagement does not work
Fontaine et al. BMC Public Health (2024) 24:784 Page 15 of 19

when engaging with individuals from a wide range of the researcher will parachute in, take what they need
sociocultural backgrounds, particularly around a highly and walk away from the community without concrete
politicized and polarized subject. The principle of ‘one measures to give back to the community [64]. Research
size does not fit all’ starts at the study design and grant involving community engagement has immense value
application stage; we must be nimble and prepared to for addressing issues that are relevant to communities
adapt based on the community and their needs as they and for proposing solutions informed by the expertise
evolve throughout the project. While we aimed to adopt of the end-users in these communities. “Nothing about
a rapid, agile approach to the current project given the us, without us” is at the heart of community engage-
pandemic context (including the use of a novel, rapid ment. The voices of diverse members of the community
analysis approach for interviews with residents), it still are especially important in non-disease specific topics
took several months to recruit enough participants to like public health, where people are coming to the table
achieve a desirable sample size in target populations, to share lived experience as members of a community,
conduct the co-design process and produce recommen- rather than with a specific disease or condition. This pro-
dations to PHUs. It was imperative to tailor our approach ject demonstrated that it is not simply a matter of trans-
to community engagement, carefully considering fac- lating the ‘tried and tested’ patient engagement strategies
tors such as the specific partnerships researchers estab- to public health community engagement. In the public
lish within each community, the cultural and linguistic health sphere, there remains a need for agile and tailored
nuances of the community (e.g., language skills and pref- community engagement strategies, and the current study
erences, communication styles), the historical and social fills a key knowledge gap in linking behavioural science
context surrounding the issue at hand, the accessibility approaches to iKT and CBPR [65–67].
of resources for community members, and the support Presenting complex findings from behavioural science
systems and organizations within the community. Over- was pivotal in engaging CAGs in effective discussions
all, this approach requires researchers to adopt a more in the OPTimise Platform. The use of ‘personas’ crafted
flexible, empathetic, and community-centric perspec- as fictional individuals, each embodying the diverse
tive, moving away from a one-size-fits-all methodology themes and perspectives unearthed from the qualita-
and pre-established protocols. Although the urgency of a tive interviews, was deemed effective by CAG members.
public health crisis can result in projects being conducted They not only recognized these personas as reflective
more quickly, it remains possible to build trusting rela- of their community’s diverse viewpoints but also found
tionships if meetings and feedback occur regularly and them relatable, akin to familiar neighbours and peers.
consistently while respecting the overall project timeline This familiarity was crucial—it transformed our findings
[41, 42, 55, 57]. Community members were understand- from abstract concepts into tangible, relatable narra-
ing of the urgency surrounding the situation and agreed tives, fostering a deeper understanding among the CAGs.
to shorter timelines when approached transparently. The personas served as a bridge, linking the theoretical
Trust can be established and maintained even in the face aspects of our research with the practical, lived experi-
of time constraints by maintaining open lines of commu- ences of the community members. This, in turn, sparked
nication, and consistently involving community members rich discussions, enabling the CAGs to provide insightful
in the decision-making process. observations and suggestions on potential strategies that
Approaches such as iKT and CBPR have enormous could effectively resonate with the personas represented.
value in informing public health authorities, especially Translating data into narratives that CAGs can connect
when working with historically excluded groups [42, 43, with, we not only enhance their ability to engage with the
45]. Building on the expertise of community members, findings but also empower them to contribute meaning-
gained through lived experience, is essential for design- fully to the discussion.
ing public health strategies and policies that reflect the This study has some limitations that should be consid-
realities of those communities. Effective partnerships ered when interpreting the findings and considering the
are founded on mutual respect for each other’s exper- applicability of our approach to other contexts. First, our
tise, with researchers and community members work- methodology was relatively resource-intensive, requir-
ing collaboratively [41, 45]. Before embarking on any ing significant time (around a year from the prioritiza-
research involving equity-denied groups, researchers tion of key behaviours and populations by PHUs to the
need to be aware of the barriers to participation based production of tailored recommendations) and effort from
on past history, potential harms, pre-conceived notions the research team and community partners. For many
about research and uneasiness with the roles of research- PHUs, this level of resource commitment may not be
ers within society (past and present) [64]. We have to feasible, especially those with limited funding or staff-
change the widely held (and often justified) belief that ing. However, we hope this approach also demonstrates
Fontaine et al. BMC Public Health (2024) 24:784 Page 16 of 19

the complementary–and at times, bridging–role that perceptions, should be responded to by researchers

research teams can have in partnering with PHUs and with active engagement efforts. As researchers, we have
communities, whereby research teams can provide an opportunity to highlight the value of community
complementary resources and expertise to PHUs. Fur- engagement and bring community members together
thermore, leveraging the methods and lessons from this to tackle complex public health issues such as climate
process might improve efficiency in future applications. change, environmental destruction and food insecurity.
For future studies in low-resource settings, the use of Combining community engagement and behavioural
existing and adaptable interview guides from this project science approaches can result in public health poli-
could expedite data collection, as could partnering with cies and recommendations that are truly relevant and
research teams. Second, our recruitment strategy, which meaningful to diverse communities.
relied heavily on the existing networks of our commu-
nity partners, may have introduced biases in the sample,
Abbreviations
study activities and outputs. While we made efforts to CAG​ Community Advisory Group
include diverse community members, there is a possibil- CBPR Community-Based Participatory Research
ity that we missed individuals who are not connected to CHC Community Health Centre
COVID-19 Coronavirus disease 2019
these networks or who face specific barriers related to CRC​ Community Resource Centre
trust, access to healthcare, and information. This could iKT Integrated Knowledge Translation
limit the generalizability of our findings to the broader KU Knowledge User
PEIR Patient Engagement in Research Framework
community. Lastly, while we employed a variety of data PHU Public Health Unit
sources to understand community-level perspectives
including CAGs, we relied primarily on individual inter- Supplementary Information
views and this can result in gaps in our understanding of The online version contains supplementary material available at https://​doi.​
the broader community context and concerns. Overall, org/​10.​1186/​s12889-​024-​18270-x.
while our approach provided valuable insights into com-
munity engagement and attitudes towards COVID-19 Supplementary Material 1.
vaccination, readers should consider these limitations
when adapting similar approaches to their own contexts. Acknowledgements
We wish to acknowledge the members of the Ottawa, Peel, and Toronto
community advisory groups for their invaluable contributions and insights
Conclusion which greatly enriched our research. Their dedication, diverse perspectives,
and active participation were instrumental in shaping our approach to com-
When community engagement results in a posi- munity engagement and understanding the unique challenges and needs of
tive, rewarding experience, community members are each region. We extend our heartfelt thanks to each member for their tireless
more willing and capable of advocating for inclusion in efforts, collaborative spirit, and unwavering support throughout this study.
research that concerns them, as well as communicat- Authors’ contributions
ing to researchers which factors contribute to effective GF & MS: Conceptualization, Methodology, Data acquisition and analysis,
participation in the research process. At various points Manuscript Draft, Review. JP: Study lead, Conceptualization, Methodology,
Data acquisition and analysis, Review, Supervision. TL, MS & EG: Data acquisi-
throughout the study, community members shared posi- tion and analysis, Project administration, Review. KM, EEN, JB, VD, AMP, NM, KT,
tive feedback on their engagement experiences. Many JC, JMG, TA, JB, SM & MB: Conceptualization, Methodology, Review. HG, AA, KZ:
community partners from all three geographical regions Data acquisition and analysis, Review. All authors reviewed and approved the
manuscript.
elected to be notified of future opportunities to collabo-
rate with research teams. The findings from a formal Authors’ information
third-party evaluation of the project’s citizen and knowl- Not applicable.
edge user engagement will be published. Funding
As citizen engagement in health research becomes This study was funded by the Canadian Institutes of Health Research
more common, best practices need to reflect the diver- (#202109EG3-477211-ERG-ADYP-179079; Nominated Principal Applicant: Dr.
Justin Presseau).
sity of communities and how the engagement approach
must not be conceived as ‘one size fits all.’ The COVID- Availability of data and materials
19 pandemic has put a spotlight on public health and All data generated or analysed during this study are included in this published
article. This paper focuses on methodological reflections derived from com-
the role of PHUs as key actors in keeping our communi- munity engagement in the OPTimise Platform. Given the nature of this work,
ties safe. Moreover, increased public interest in science which revolves around conceptual and methodological discourse, our empha-
and public health since the outbreak of the COVID- sis was on the qualitative reflection and synthesis of community engagement
practices. Results from the qualitative interviews conducted in the OPTimise
19 pandemic, including both positive and negative Platform will be reported in a separate paper.
Fontaine et al. BMC Public Health (2024) 24:784 Page 17 of 19

Declarations CD, Sattar N, Shaw CA, Sheikh A, Sinha IP, Swann O, Taylor-Robinson D,
Thomas D, Turtle L, Openshaw PJM, Baillie JK, Semple MG, Investigators,
Ethics approval and consent to participate ISARIC4C. Ethnicity and outcomes from COVID-19: the ISARIC CCP-UK
The OPTimise Platform was approved by the Ottawa Health Sciences Network prospective observational cohort study of hospitalised patients. SSRN.
Research Ethics Board (#20200285-01H). Informed consent was obtained for Preprint posted online June 17, 2020. https://​doi.​org/​10.​2139/​ssrn.​36182​
all participants recruited for qualitative interviews. 15.
10. Sze S, Pan D, Nevill CR, Gray LJ, Martin CA, Nazareth J, Pareek M. Ethnicity
Consent for publication and clinical outcomes in COVID-19: a systematic review and meta-analy-
Not applicable. sis. Lancet. 2020;19:100630. https://​doi.​org/​10.​1016/j.​eclinm.​2020.​100630.
11. Mathur R, Rentsch CT, Morton CE, Hulme WJ, Schultze A, MacKenna B,
Competing interests Eggo RM, Bhaskaran K, Wong AY, Williamson EJ, Forbes H. Ethnic differ-
The authors declare no competing interests. ences in SARS-CoV-2 infection and COVID-19-related hospitalisation,
intensive care unit admission, and death in 17 million adults in England:
Author details an observational cohort study using the OpenSAFELY platform. Lancet.
1
Centre for Implementation Research, Clinical Epidemiology Program, Ottawa 2021;397(10286):1711–24.
Hospital Research Institute, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. 12. WHO. Considerations for implementing and adjusting public health and
2
Department of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON social measures in the context of COVID-19. 2023. https://​iris.​who.​int/​
K1H 8M5, Canada. 3 Citizen Partner, Ottawa, ON, Canada. 4 Ottawa Public bitst​ream/​handle/​10665/​366669/​WHO-​2019-​nCoV-​Adjus​ting-​PH-​measu​
Health, 100 Constellation Dr, Nepean, ON K2G 6J8, Canada. 5 Peel Public Health, res-​2023.1-​eng.​pdf?​seque​nce=1. Accessed 11 Mar 2024.
7120 Hurontario St, Mississauga, ON L5W 1N4, Canada. 6 Toronto Public Health, 13. Ayouni I, Maatoug J, Dhouib W, Zammit N, Fredj SB, Ghammam R, Ghan-
City Hall, 100 Queen St W, Toronto, ON M5H 2N2, Canada. 7 School of Epide- nem H. Effective public health measures to mitigate the spread of COVID-
miology and Public Health, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, 19: a systematic review. BMC Public Health. 2021;21(1):1–4.
Canada. 8 School of Rehabilitation Therapy, Queen’s University, Louise D Acton 14. Talic S, Shah S, Wild H, Gasevic D, Maharaj A, Ademi Z, Ilic D. Effective-
Building, 31 George St, Kingston, ON K7L 3N6, Canada. 9 University of Ottawa, ness of public health measures in reducing the incidence of covid-19,
Ottawa, ON, Canada. 10 Citizen Partner, Mississauga, ON, Canada. 11 The Hospital SARS-CoV-2 transmission, and covid-19 mortality: systematic review
for Sick Children (SickKids), Toronto, ON, Canada. 12 McMaster University, 1280 and meta-analysis. BMJ. 2021;375:e068302. https://​doi.​org/​10.​1136/​
Main St W, Hamilton, ON L8S 4L8, Canada. 13 Centre for Behaviour Change, bmj-​2021-​068302.
University College London, Gower St, London WC1E 6BT, UK. 14 School of Psy- 15. Hartley DMPE. Public health interventions for COVID-19: emerging
chology, University of Ottawa, 136 Jean‑Jacques Lussier Vanier Hall, Ottawa, evidence and implications for an evolving public health crisis. JAMA.
ON K1N 6N5, Canada. 2020;323(19):1908–9.
16. Abbas AH. Politicizing COVID-19 vaccines in the press: a critical discourse
Received: 11 December 2023 Accepted: 4 March 2024 analysis. Int J Semiot Law. 2022;35(3):1167–85. https://​doi.​org/​10.​1007/​
s11196-​021-​09857-3.
17. Hart PS, Chinn S, Soroka S. Politicization and polarization in COVID-19
news coverage. Sci Commun. 2020;42(5):679–97. https://​doi.​org/​10.​1177/​
10755​47020​950735.
References 18. Stroebe W, vanDellen MR, Abakoumkin G, et al. Politicization of COVID-19
1. WHO. COVID-19 weekly epidemiological update: edition 155 published health-protective behaviors in the United States: longitudinal and cross-
10 August 2023. 2023. https://​www.​who.​int/​publi​catio​ns/m/​item/​ national evidence. PLoS One. 2021;16(10):e0256740. https://​doi.​org/​10.​
weekly-​epide​miolo​gical-​update-​on-​covid-​19---​10-​august-​2023. Accessed 1371/​journ​al.​pone.​02567​40.
11 Mar 2024. 19. World Health Organization. Behavioural and social drivers of vaccination:
2. Delardas OKK, Pontikos PN, Giannos P. Socio-economic impacts and tools and practical guidance for achieving high uptake. Geneva: World
challenges of the Coronavirus Pandemic (COVID-19): an updated review. Health Organization; 2022. https://​www.​who.​int/​publi​catio​ns/i/​item/​
Sustainability. 2022;14(15):9699. 97892​40049​680. Accessed 11 Mar 2024.
3. Verschuur JKE, Hall JW. Global economic impacts of COVID-19 lockdown 20. Ike N, Burns KE, Nascimento H, et al. Examining factors impacting accept-
measures stand out in high-frequency shipping data. PLoS One. ance of COVID-19 countermeasures among structurally marginalised
2021;16(4):e0248818. Canadians. Glob Public Health. 2023;18(1):2263525. https://​doi.​org/​10.​
4. Osterrieder ACG, Pan-Ngum W, Cheah PK, Cheah PK, Peerawaranun P, 1080/​17441​692.​2023.​22635​25.
Silan M, Orazem M, Perkovic K, Groselj U, Schneiders ML. Economic and 21. Wallerstein N, Oetzel JG, Sanchez-Youngman S, et al. Engage for equity:
social impacts of COVID-19 and public health measures: results from an a long-term study of community-based participatory research and
anonymous online survey in Thailand, Malaysia, the UK, Italy and Slovenia. community-engaged research practices and outcomes. Health Educ
BMJ Open. 2021;11(7):e046863. Behav. 2020;47(3):380–90. https://​doi.​org/​10.​1177/​10901​98119​897075.
5. Yates TSA, Razieh C, Banerjee A, Chudasama Y, Davies MJ, Gillies C, Islam 22. Wallerstein NB, Duran B. Using community-based participatory research
N, Lawson C, Mirkes E, Zaccardi F. A population-based cohort study of to address health disparities. Health Promot Pract. 2006;7(3):312–23.
obesity, ethnicity and COVID-19 mortality in 12.6 million adults in Eng- 23. Farina M, Lavazza A. Advocating for greater inclusion of marginalized and
land. Nat Commun. 2022;13(1):624. forgotten populations in COVID19 vaccine rollouts. Int J Public Health.
6. Bilal UJJ, Schnake-Mahl A, Murphy K, Momplaisir F. Racial/ethnic and 2021;66:1604036. https://​doi.​org/​10.​3389/​ijph.​2021.​16040​36.
neighbourhood social vulnerability disparities in COVID-19 testing posi- 24. Holder-Dixon AR, Adams OR, Cobb TL, et al. Medical avoidance among
tivity, hospitalization, and in-hospital mortality in a large hospital system marginalized groups: the impact of the COVID-19 pandemic. J Behav
in Pennsylvania: a prospective study of electronic health records. Lancet Med. 2022;45(5):760–70. https://​doi.​org/​10.​1007/​s10865-​022-​00332-3.
Reg Health Am. 2022;10:100220. 25. Heymann DLSN. COVID-19: what is next for public health? Lancet.
7. Robinson PCYJ. Racial and ethnic differences in COVID-19 outcomes: a 2020;395(10224):542–5.
call to action. Lancet Rheumatol. 2022;4(7):e455-7. 26. Smith RW JT, Sandhu HS, Pinto AD, O’Neill M, Di Ruggiero E, Pawa J,
8. Alcendor DJ. Racial disparities-associated COVID-19 mortality among Rosella L, Allin S. Centralization and integration of public health systems:
minority populations in the US. J Clin Med. 2020;9(8):2442. perspectives of public health leaders on factors facilitating and imped-
9. Harrison EM, Docherty AB, Barr B, Buchan I, Carson G, Drake TM, Dunning ing COVID-19 responses in three Canadian provinces. Health Policy.
J, Fairfield CJ, Gamble C, Green CA, Griffiths C, Halpin S, Hardwick HE, Ho 2022;127:9-28. https://​doi.​org/​10.​1016/j.​healt​hpol.​2022.​11.​011.
A, Holden KA, Hollinghurst J, Horby PW, Jackson C, Katikireddi SV, Knight 27. Norheim OF, Abi-Rached JM, Bright LK, Bærøe K, Ferraz OL, Gloppen S,
S, Lyons RA, MacMahon J, Mclean KA, Merson L, Murphy D, Nguyen-Van- Voorhoeve A. Difficult trade-offs in response to COVID-19: the case for
Tam JS, Norman L, Olliaro PL, Pareek M, Piroddi R, Pius R, Read JM, Russell open and inclusive decision making. Nat Med. 2021;27(1):10–3.
Fontaine et al. BMC Public Health (2024) 24:784 Page 18 of 19

28. McGuire ALAM, Davis FD, Erwin C, Harter TD, Jagsi R, Klitzman R, Macauley 46. Graham ID, Kothari A, McCutcheon C. Moving knowledge into action for
R, Racine E, Wolf SM, Wynia M. Ethical challenges arising in the COVID-19 more effective practice, programmes and policy: protocol for a research
pandemic: an overview from the Association of Bioethics Program Direc- programme on integrated knowledge translation. Implement Sci.
tors (ABPD) task force. Am J Bioeth. 2020;20(7):15–27. 2018;13(1):1–15.
29. Canadian Public Health Association (CPHA). Strengthening public health 47. Viswanathan M, Ammerman A, Eng E, Garlehner G, Lohr KN, Griffith D,
systems in Canada. 2022. https://​www.​cpha.​ca/​sites/​defau​lt/​files/​uploa​ Whitener L. Community‐based participatory research: assessing the
ds/​advoc​acy/​stren​gthen/​stren​gthen​ing-​ph-​syste​ms-​brief-e.​pdf. Accessed evidence: summary. Evid Rep Technol Assess (Summ). 2004;99:1-8.
11 Mar 2024. 48. Wilson E, Kenny A, Dickson-Swift V. Ethical challenges in community-
30. Escandón KRA, Bogoch II, Murray EJ, Escandón K, Popescu SV, Kindra- based participatory research: a scoping review. Qual Health Res.
chuk J. COVID-19 false dichotomies and a comprehensive review of 2018;28(2):189–99.
the evidence regarding public health, COVID-19 symptomatology, 49 Nguyen T, Graham ID, Mrklas KJ, et al. How does integrated knowledge
SARS-CoV-2 transmission, mask wearing, and reinfection. BMC Infect Dis. translation (IKT) compare to other collaborative research approaches
2021;21(1):710. to generating and translating knowledge? Learning from experts in
31. Sachs JDKS, Aknin L, et al. The Lancet Commission on les- the field. Health Res Policy Syst. 2020;18(1):35. https://​doi.​org/​10.​1186/​
sons for the future from the COVID-19 pandemic. The Lancet. s12961-​020-​0539-6.
2022;400(10359):1224–80. 50. Jagosh J, Macaulay AC, Pluye P, Salsberg JON, Bush PL, Henderson JIM,
32. Hallsworth M. A manifesto for applying behavioural science. Nat Hum Greenhalgh T. Uncovering the benefits of participatory research: implica-
Behav. 2023;7:310–22. https://​doi.​org/​10.​1038/​s41562-​023-​01555-3. tions of a realist review for health research and practice. Milbank Q.
33. Noone C, Warner N, Byrne M, Durand H, Lavoie KL, McGuire BE, McSharry 2012;90(2):311-46. https://​doi.​org/​10.​1111/j.​1468-​0009.​2012.​00665.x.
J, Meade O, Morrissey E, Molloy G, O’Connor L, Toomey E. Investigating 51. NICE. Community engagement to increase childhood immunisations.
and evaluating evidence of the behavioural determinants of adherence London; 2012.
to social distancing measures: a protocol for a scoping review of COVID- 52. Habib MA, Soofi S, Cousens S, Anwar S, ul Haque N, Ahmed I, Bhutta ZA.
19 research. HRB Open Res. 2020;3:46. Community engagement and integrated health and polio immunisation
34. Stojanovic J, Boucher VG, Gagné M, Gupta S, Joyal-Desmarais K, Paduano campaigns in conflict-affected areas of Pakistan: a cluster randomised
S, Aburub A, Sheinfeld Gorin SN, Kassianos AP, Ribeiro PAB, Bacon SL, controlled trial. Lancet Global Health. 2017;5(6):e593-603. https://​doi.​org/​
Lavoie KL. Global trends and correlates of covid-19 vaccination hesitancy: 10.​1016/​s2214-​109x(17)​30184-5.
findings from the iCARE study. Vaccines. 2021;661:1–13. 53. Jain M, Shisler S, Lane C, Bagai A, Brown E, Engelbert M, Parsekar SS. Use
35. Michie S, Johnston M, Abraham C, et al. Making psychological theory of community engagement interventions to improve child immunisation
useful for implementing evidence based practice: a consensus approach. in low‐and middle‐income countries: a systematic review and meta‐
Qual Saf Health Care. 2005;14(1):26–33. https://​doi.​org/​10.​1136/​qshc.​ analysis. Campbell Syst Rev. 2022;18(3):e1253. https://​doi.​org/​10.​1002/​cl2.​
2004.​011155. 1253.
36. Michie S, Richardson M, Johnston M, et al. The behavior change 54. Capurro G, Maier R, Tustin J, Jardine CG, Driedger SM. The spokesper-
technique taxonomy (v1) of 93 hierarchically clustered techniques: son matters: evaluating the crisis communication styles of primary
building an international consensus for the reporting of behavior change spokespersons when presenting COVID-19 modeling data across three
interventions. Ann Behav Med. 2013;46(1):81–95. https://​doi.​org/​10.​1007/​ jurisdictions in Canada. J Risk Res. 2022;25(11–12):1395–412.
s12160-​013-​9486-6. 55. Jennings W, Stoker G, Bunting H, et al. Lack of trust, conspiracy beliefs,
37. OECD. Behavioural insights and public policy: lessons from around the and social media use predict COVID-19 vaccine hesitancy. Vaccines.
world. Paris: 2017. 2021;9(6):593.
38. Crawshaw J, Konnyu K, Castillo G, et al. Factors affecting COVID-19 56. McMillan G, van Allen Z, Presseau J. Understanding the role of personal
vaccination acceptance and uptake among the general public: a living risk perceptions during the COVID-19 pandemic: a rapid behavioural
behavioural science evidence synthesis (v5, Aug 31st, 2021). McMaster science evidence synthesis. McMaster Health Forum. 2022. https://​www.​
Health Forum. 2021. https://​www.​mcmas​terfo​rum.​org/​docs/​defau​lt-​ mcmas​terfo​rum.​org/​docs/​defau​lt-​source/​produ​ct-​docum​ents/​rapid-​
source/​produ​ct-​docum​ents/​living-​evide​nce-​synth​eses/​covid-​19-​living-​ respo​nses/​riskp​ercep​tions​aross​covid-​19pan​demic.​pdf?​sfvrsn=​7da9d​
evide​nce-​synth​esis-4.​5---​facto​rs-​affec​ting-​covid-​19-​vacci​nation-​accep​ d7f_5. Accessed 11 Mar 2024.
tance-​and-​uptake-​among-​the-​gener​al-​public.​pdf?​sfvrsn=​33dc4​261_5. 57. Castillo G, Wilson M, Smith M, Grimshaw JM, Presseau J. COVID-19 vaccine
Accessed 11 Mar 2024. mandates and their relationship with vaccination intention, psychologi-
39. Gilmore BNR, Tchetchia A, De Claro V, Mago E, Lopes C, Bhattacharyya S. cal reactance, and trust: a rapid behavioural evidence synthesis. McMas-
Community engagement for COVID-19 prevention and control: a rapid ter Health Forum. 2022. https://​www.​mcmas​terfo​rum.​org/​docs/​defau​
evidence synthesis. BMJ Glob Health. 2020;5(10):e003188. lt-​source/​produ​ct-​docum​ents/​rapid-​respo​nses/​covid-​19-​vacci​ne-​manda​
40. National Collaborating Centre for Methods and Tools. Rapid review: what tes-​and-​their-​relat​ionsh​ip-​with-​vacci​nation-​inten​tion-​psych​ologi​cal-​react​
were the public’s experiences accessing and interacting with public ance-​and-​trust.​pdf?​sfvrsn=​5eb9d​7e5_5. Accessed 11 Mar 2024.
health information during the COVID-19 pandemic? 2023. https://​www.​ 58. Langmuir T, Wilson M, McCleary N, et al. Strategies and resources used by
nccmt.​ca/​pdfs/​res/​health-​infor​mation. Accessed 11 Mar 2024. public health units to encourage COVID-19 vaccination among priority
41 Jagosh J, Bush PL, Salsberg J, et al. A realist evaluation of community- groups: a behavioural science-informed review of three urban centres
based participatory research: partnership synergy, trust building and in Canada. ResearchSquare. Preprint posted online September 14, 2023.
related ripple effects. BMC Public Health. 2015;15:725. https://​doi.​org/​10.​ https://​doi.​org/​10.​21203/​rs.3.​rs-​32637​14/​v1.
1186/​s12889-​015-​1949-1. 59. Hamilton CB, Hoens AM, Backman CL, McKinnon AM, McQuitty S, English
42. Lucero JE, Wright KW, Reese A. Trust development in CBPR partnerships. K, Li LC. An empirically based conceptual framework for fostering mean-
In: Wallerstein NB, Duran B, Oetzel J, Mikler M, editors. Community-based ingful patient engagement in research. Health Expect. 2018;21(1):396–
participatory research in health: advancing social and health equity. San 406. https://​doi.​org/​10.​1111/​hex.​12635.
Francisco: Jossey-Bass; 2017. 60. De Weger E, Van Vooren N, Luijkx KG, Baan CA, Drewes HW. Achieving
43. Shalowitz MU, Isacco A, Barquin N, Clark-Kauffman E, Delger P, Nelson D, successful community engagement: a rapid realist review. BMC Health
Wagenaar KA. Community-based participatory research: a review of the Serv Res. 2018;18(1):1–8. https://​doi.​org/​10.​1186/​s12913-​018-​3090-1.
literature with strategies for community engagement. J Dev Behav Pedi- 61 Cane J, O’Connor D, Michie S. Validation of the theoretical domains
atr. 2009;30(4):350–61. https://​doi.​org/​10.​1097/​dbp.​0b013​e3181​b0ef14. framework for use in behaviour change and implementation research.
44. Schiavo R. What is true community engagement and why it matters (now Implement Sci. 2012;7:37. https://​doi.​org/​10.​1186/​1748-​5908-7-​37.
more than ever). J Commun Healthc. 2021;14(2):91–2. https://​doi.​org/​10.​ 62. Francis JJ, Johnston M, Robertson C, et al. What is an adequate sample
1080/​17538​068.​2021.​19355​69. size? Operationalising data saturation for theory-based interview studies.
45 Jull J, Giles A, Graham ID. Community-based participatory research and Psychol Health. 2010;25(10):1229–45. https://​doi.​org/​10.​1080/​08870​
integrated knowledge translation: advancing the co-creation of knowl- 44090​31940​15.
edge. Implement Sci. 2017;12:1–9.
Fontaine et al. BMC Public Health (2024) 24:784 Page 19 of 19

63. Weijer C, Emanuel EJ. Ethics. Protecting communities in biomedical

research. Science. 2000;289(5482):1142–4. https://​doi.​org/​10.​1126/​scien​
ce.​289.​5482.​1142.
64. Minkler M. Ethical challenges for the “outside” researcher in community-
based participatory research. Health Educ Behav. 2004;31(6):684–97.
65 Teresa RM, Valentina P, Marcello DP, et al. Community-based participatory
research to engage disadvantaged communities: Levels of engage-
ment reached and how to increase it. A systematic review. Health Policy.
2023;137:104905. https://​doi.​org/​10.​1016/j.​healt​hpol.​2023.​104905.
66. Rodriguez Espinosa P, Verney SP. The Underutilization of Community-
based participatory research in psychology: a systematic review. Am J
Community Psychol. 2021;67(3–4):312–26. https://​doi.​org/​10.​1002/​ajcp.​
12469.
67. Duea SR, Zimmerman EB, Vaughn LM, Dias S, Harris J. A guide to selecting
participatory research methods based on project and partnership goals. J
Particip Res Methods. 2022;3(1). https://​doi.​org/​10.​35844/​001c.​32605.

Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub-
lished maps and institutional affiliations.