Takeaway
Introduction
St. David’s Foundation (SDF) is committed to listening to the communities we serve, learning from them, and evolving our work in response to the needs of our region. In 2024, the Foundation partnered with Texas Health Institute (THI) to conduct a community-led approach to respectfully and authentically lift up the experiences of those impacted by health disparities and more deeply explore the systems and conditions impacting health and well-being in Central Texas. The efforts by THI and many community partners who served as advisors, co-designers, and facilitators are summarized in the report available for download. The quotes and stories gathered, the theme analysis, and the report will be incorporated and serve as the qualitative component for the next Community Health Needs Assessment (CHNA) and will also inform St. David’s Foundation strategies for continued community engagement. We are committed to initiatives like the Community Voices Project as one of many methods of engaging communities to learn from, build trust, and inform our work as a funder.
A Unique Approach
Both THI and SDF share a common value and viewpoint to conduct evaluations and community engagement activities in a way that is respectful, flexible, and is not extractive from the communities providing the information. Through this lens, we partnered with five community-centered organizations to design and implement methods that were welcoming and culturally relevant. In addition, we tested our approaches and assumptions with a Community Advisory Committee consisting of community leaders, to ensure we were appropriately acknowledging the role of inequitable systems and conditions on community member experiences throughout both process design and sensemaking. Altogether, 15 interviews with community and regional leaders were conducted by THI, and 135 participant viewpoints were collected through various community events led by our nonprofit research partners including focus groups, pláticas, story circles, youth photovoice, and a public art project.
Findings
The full qualitative report, “Community Voices on Health and Well-Being: Amplifying Perspectives for Action in Central Texas,” includes sections on each of the five counties (Bastrop, Caldwell, Hays, Travis, and Williamson) that make up the Central Texas region. It also reflects insights we heard from communities throughout the region. While each county may have a unique take on the main themes observed, three common themes emerged across counties and various communities within counties.
1. Put the ‘human’ back in human services
Complicated eligibility requirements, confusing enrollment processes, and accessibility limitations make community members feel like support systems are designed to make it more difficult to access them. The emotional and time-consuming toll of navigating complex systems deters people from accessing the support they need for themselves and their family regarding health, education, employment, and housing.
Additionally, economic pressures like missing work or cost of childcare discourages people from seeking support, particularly for healthcare that often requires multiple appointments. When care is sought, community members report negative experiences such as not feeling respected or not feeling culturally safe or understood, which causes people to avoid those services in the future. What this may suggest to us as a funder is that while more service availability in a community is of course needed, those resources may still be underutilized if they are not culturally responsive.
2. Hungry to be heard and have agency to solve problems
A sense of community through neighborhood gatherings, affinity groups, and other informal networks can help buffer the impacts of everyday stressors and/or discrimination experienced. Family and friends often provide help when formal systems fail or are unable to do so. When this community support is not present or available, social isolation and a feeling of not being valued is experienced, particularly reported by older adults in our region. Formal and informal caregivers such as single parents and those caring for both children and aging parents are also impacted by isolation. People of color reported a sense of lost community due to gentrification and lack of representation in new neighborhoods, schools, and businesses.
An additional theme revealed is a feeling that those who control resource allocation, including city officials, school boards, and importantly us as a funder, are not trusting and investing with those who are closest to and are knowledgeable of their communities. Community members shared that solutions to existing issues should not be created without them and are best implemented by them. There is a hunger for mobilization and organized advocacy to express both the needs and the potential solutions.
3. More is needed to move from surviving to thriving
It is hard to focus on a brighter future when one is struggling to meet all the basic needs for themselves, family, and loved ones. Parents are juggling multiple priorities and jobs while also ensuring their children receive a good education, nourishing meals, and enriching experiences. Those in our community who are employed as caregivers or in human services struggle with burnout and compassion fatigue. As one community member expressed: “poverty isn’t just about money, there is also poverty of time and poverty of spirit.” Community members are exhausted with the constant need to fight and advocate for the resources they need and deserve within schools, healthcare, and communities.
To move from surviving to thriving, community members identified that safe spaces are needed for joy, healing, family, and community. Representation matters across all aspects of life including clinics, schools, and decision makers for a community. For people of color, spaces with representation and diversity create a sense of safety and normalcy. The intersections of race, ethnicity, urbanicity, ability, age, legal status, and LGBTQIA+ identity increases the difficulty of finding accessible and timely care. In order to meet communities where they are, healthcare and other services need to be designed to be local, accessible, affordable, and culturally appropriate.
To read more insights and powerful quotes from community members, we encourage you to download the full report below.
Conclusion
Findings from the Community Voices Project will guide the quantitative analysis for the 2025 Community Health Needs Assessment (CHNA), which the Foundation conducts every three years. A summary of the 2022 CHNA can be found here. This is the first time since we began conducting CHNAs in 2012 that we have separated the qualitative and quantitative aspects into sequential steps. By leading with what we heard from communities and letting the qualitative frame the indicators we choose to include, this approach provides a method to prioritize core indicators and ensures that community drives the data that is most important to describing health in their community.
The 2025 CHNA will be available in Fall of 2025 and will be an important tool to deepen our understanding of the communities we serve and guide the development of a three-year implementation plan that moves from insights to actions and future investments.
