Community Engagement

​The goals of the community engagement component of the CHNA are to:

  • Identify San Franciscan’s health priorities, especially those of
    vulnerable populations
  • Obtain data on populations and issues for which we have little
    quantitative data
  • Build relationships between the community and SFHIP
  • Meet the regulatory requirements including the IRS rules for Charitable
    501(c)(3) Charitable Hospitals, Public Health Accreditation Board
    requirements for the San Francisco Health Department, and the San
    Francisco’s Planning Code requirements for a Health Care Services
    Master Plan

The 2019 CHNA includes 4 categories of focus groups: SFHIP key informant
group interview, Equity Coalition focus groups, food insecure pregnant
women focus groups, and Kaiser focus groups.

SFHIP Key Informant Group Interview.
On September 20, 2018 one focus group comprised of SFHIP members who are
all subject matter experts was held. The groups represented by SFHIP are:

  • San Francisco Department of Public Health
  • Metta Fund
  • Kaiser Permanente
  • African American Community Health Equity Council/Rafiki
  • San Francisco Community Clinic Consortium
  • Chicano, Latino, Indigena Health Equity Coalition/ Instituto
    Familiar de la Raza
  • St. Mary’s Medical Center
  • API Health Parity Coalition/APA Family Support Services
  • California Pacific Medical Center
  • Chinese Hospital
  • SF Interfaith Council
  • St. Francis Memorial
  • University of California San Francisco

Two series of questions were asked, “What are the healthiest
characteristics of this community? What supports people to live healthier
lives?” and “What are the biggest health issues and/or conditions your
community struggles with? What do you think creates those issues?”.

The SFHIP Steering Committee members’ responses to and discussion of the 2
key questions were entered into a google word cloud generator. The
following words were articulated most frequently and, by extension, the
themes that emerged for each area are:

  • Healthy Characteristics: CBOs, culture, access/care and space/parks
  • Health Issues: mental health, housing, access, trauma/violence and

Click here to see presentation slides on the SFHIP Key Informants Interview.

Equity Coalition focus groups. Focus groups were conducted with each of the three health equity coalitions in San Francisco: The Chicano / Latino / Indigena Health Equity Coalition, The Asian Pacific Islander Healthy Parity Coalition, and The African American Health Equity Coalition. The Asian Pacific Islander Healthy Parity Coalition focus group was comprised of care providers and executive directors of community based organizations that provided services to their community. The African American Health Equity Coalition hosted approximately 40 diverse and mostly Black / African American community members to attend their focus group. The Chicano / Latino / Indigena Health Equity Coalition invited Indigena promotoras, many of whom spoke Mayan as their first language, to participate in their focus group.

​Using the Technology of Participation (ToP) Consensus Method, the question posed to each focus group was, “What actions can we take to improve health?”.While each focus group came up with their own particular themes, the broad cross-cutting themes from all three equity coalition focus groups covered education, safety, care, community, environment, and funding.

Cross-cutting Themes from Equity Coalition Focus Groups

Hage clic aquí para ver los resultados del grupo Chicano/Latino/Indigena Health Equity Coalition en español.

Food Insecure Pregnant Women. Four focus groups were conducted with women who experienced food insecurity while pregnant. Each focus group focused on a different group of women: Spanish, Chinese, multi-ethnic English speakers, and African American. The question to respond to was, “What actions can we take to improve your food needs?”.

Click here to see presentation slides on the Presentation slides for focus groups of Food Insecure Pregnant Women.

Kaiser. Kaiser conducted four focus groups, one each with Kaiser Permanente leadership, Kaiser Permanente staff, Spanish-speaking parents on youth healthy eating and active living, and homeless and/or HIV positive youth.

  • Access to coordinated, culturally and linguistically appropriate care: Participants cited a need for more culturally appropriate care and a trauma-informed approach that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in people’s lives. They also discussed the need for a more flexible and adaptable health care system that could provide equitable and inclusive services. Service providers also noted that low pay and a high-stress working environment has created a shortage of providers, including case workers, who can serve as a connection between the community and crucial services. Finally, community members discussed the location of services, affordability, and not feeling respected by providers as barriers to accessing care.
  • HIV/AIDS/STDs: In general, participants reported that San Francisco has done a good job of responding to the HIV/AIDs epidemic over the last 30 years. Participants noted that equity issues still exist in the treatment and care of those living with HIV, including knowledge of prevention options in communities of color, and services for the homeless, including homeless youth.
  • Homelessness: Participants  reported that homelessness has a cascading effect on other health issues including access to care, HIV/AIDs, mental health, overall health, substance abuse, and healthy eating/active living. The instability and trauma of homelessness is a significant barrier to addressing other acute and chronic health needs.
  • Mental Health: Participants discussed mental health issues relating to trauma, especially amongst veterans, youth, and the homeless. They also pointed to isolation amongst the elderly as a mental health issue. Often, participants discussed mental health in connection with other health areas, including substance abuse and anxiety related to overall health issues.
  • Obesity/Health Eating – Active Living/Diabetes: The affordability of food was the number one concern in this category cited both by providers and community members. While community members reported that they understand basic healthy eating, they struggle to find affordable fresh foods. This, in turn, has resulted in diabetes and childhood obesity for their family members. While some programs in the city exist to provide healthy food to low-income communities, providers acknowledged that there could be more.
  • Overall health: Providers discussed the need for holistic care to improve overall health. They recognized the challenges of addressing a multitude of health issues to improve overall health, including homelessness, mental health issues, substance abuse, and lack of access to healthy foods.
  • Substance Abuse/Tobacco: Participants identified substance abuse as an exacerbating factor to other health needs. Some discussed the importance of safe injection sites for supporting those with substance abuse issues and as a place for providing connections to other services.

​​As part of the focus groups, service providers and community members were also asked about community assets that contribute toward health. Participants recognized strong social networks, connections to friends and family, and resilience as contributing factors to health. They also named systems and providers, such as school districts, local champions, government funding, and community-based programs that have had a positive impact.