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Table 2 Identified challenges and strengths across the habits, Community Advisory Board member counts, and exemplary quotes

From: Advancing engagement and capacity for rural cancer control: a mixed-methods case study of a Community-Academic Advisory Board in the Appalachia region of Southwest Virginia

Habit Challenges and strengths T2a T3b Exemplar quotes
Effective communication Challenges    “I don’t really know that we have made a really solid effort to build awareness outside of our group in terms of what we do and who we are and what we’re about. …it might be in the future that we have a communications action team who could concentrate on that a little bit more.” (Challenge, T2, Academic)
“…the elephant in the room is COVID. That…is a huge challenge in terms of how…to facilitate… communication…while being able to…social distance and keep everyone safe.” (Challenge, T2, Community)
“I think the leaders do a great job of explaining things and also explaining them more than one time to make sure that you understand. And…create that culture of feel[ing] free to ask if you lack understanding of something.” (Strength, T2, Community)
“There’s definitely been a larger push to meeting…more regularly through virtual channels in the last year. And that was…a very good…thing because…there were gaps in between meetings and … recap that was needed…to get everybody back into the swing of things.” (Strength, T3, Academic)
• Members have limited time to communicate with one another 54% 43%
• Lack of strategies for external communication 35% 39%
• COVID-19 hindered communication n/a 43%
Strengths   
• Communication uses multiple channels 81% 86%
• Communication mirrors the CPPE processes 65% 43%
• Communication keeps CAB informed 46% 64%
• Communication promotes understanding 43% 46%
• Communication is purposeful and keeps momentum 46% 21%
• Communication promotes an open and respectful environment 38% 29%
• CAB website shares information internally and externally 38% 14%
• Communication promotes CAB efforts to the community 32% 32%
• Communication from leaders fosters engagement 11% 32%
Priority work plans Challenges    “… [A]ll the board is volunteer. I think that is a positive and also a challenge. ..[T]hey’re very much committed to participating, but there could be limitations in their time and/or commitment, I guess if they’re pulled in another direction or their organization is. (Challenge, T2, Community)
“I think [the CPPE process]…is moving us in a structured environment which we need to be in… For instance, in the last meeting we sat around the table and truly defined what our priorities were and what action steps we would take to implement those different things. [The CAB]… isn’t just a meet and greet and see you again at the next quarter. There’s a lot of action involved and time is well spent.” (Strength, T2, Community)
“Well, I like how it’s from the roots up. It’s not you know, we get directed that this is what needs to be done and then we say, well OK, well this is how it works in southwest Virginia. No, we we’re starting from the bottom and working up. And I think, you know, the setting of priorities is coming from the community members.” (Strength, T3, Community)
• Difficulty using member expertise and resources 11% 36%
• Members have limited time to participate in the work plans 14% 25%
Strengths   
• Works plans reflect the stage of the CPPE Process 68% 64%
• Community stakeholders inform the priorities that drive the work 51% 36%
• Priorities are set through shared decision making 41% 25%
• Data informs priorities 30% 43%
• Work plan roles are informed by member expertise and resources 38% 18%
22% 36%
Clear roles and accountability Challenges    “The only thing that I could think of that might be a challenge would be just being able to consistently get the group together like we need to. You know we need to come together as a group as often as we do. And I guess that maybe that could be a challenge just with other people in their responsibilities pulling them in different directions.” (Challenge, T1, Community)
“But for the most part people that are in there individuals that are on the CAB that have their certain specialties I think they tend to stay very similar with those roles the roles stay similar.” (Strength, T2, Community)
“Well, I think people are asked to do things that either they’ve expressed an interest in or that they may have a good knowledge base or be able to contribute.” (Strength, T3, Academic)
• Members have limited time to carry out roles 30% 39%
• Unclear accountability processes 8% 25%
Strengths   
• Accountability is communicated formally and informally 59% 57%
• Roles are determined through interest and opportunity 19% 50%
• Member knowledge, expertise, and resources influences roles 32% 36%
(Academic) Leaders identify roles and members to fill them 22% 36%
• Role flexibility and adaptability 27% 32%
• Tangible tasks and processes guides roles 30% 29%
Shared decision making Challenges    “So we have our in-person meetings quarterly and we’ll have these calls in between sometimes. And so, yes, do I sometimes wish things could move a little quicker? It’d be great, but it’s not feasible. It’s not feasible to do that because we make these decisions within the structure that we have and we have the structure for a reason.” (Challenge, T3, Academic)
“There is [a formal structure] when we have a decision to make it. If it’s a big decision it is brought to the entire group and then at that point that’s all we have. Both the auditory discussion and the visual things that go up on the board so we can all see what we’re looking at to decide what those priorities are and say okay who votes for this and who votes for that. So there is a formalized process that is taking place there.” (Strength, T2, Community)
• Decision making process is time consuming 27% 7%
Strengths   
• Formal structure for decision-making process 62% 68%
• External factors and events integrated into decision processes 49% 54%
• Flexibility and adaptability in decision making 51% 32%
Value-added collaboration Challenges    “And then there’s probably I would think for some of the community members maybe sometimes some tension in like you are a member of the CAB then you’re also from your organization so you’re kind of wearing like multiple hats like you’re sort of part of a bigger organization with a broader mandate but then you’re still like an individual from this particular organization. So trying to balance that might be kind of tricky sometimes.” (Challenge, T2, Academic)
“The folks coming there have you know they have resources at their disposal. If within the case of cancer survivors they’re a very valuable resource. And I think you have we have the hospital system there. We have a representative we have home health. We have cancer centers. We have educational institutions. And I think all of them have something to bring to the table. And you know you just to the whole is greater than its parts added paths. So you know I think that’s the value of bringing all those people together.” (Strength, T2, Community)
• Limited time to devote to collaboration 30% 36%
• Narrowed focus may lead to drop out or drop off 30% 29%
• Bureaucracy of partner organizations 27% 4%
Strengths   
• Pooling resources and expertise of the CAB 62% 93%
• Provides learning and networking that is useful and beneficial 62% 54%
• Expands reach and influence of the CAB efforts 19% 57%
• Provides an inspirational vision 49% 50%
• Contributing to research is important 30% 29%
• Advancement on the collaboration continuum 3% 29%
Empowering leadership Challenges    “So my sense is that there’s shared leadership within, you know, the sort of local partners and organizations and on the academic side. And so I definitely have that sense. I mean, I think that’s one thing that’s been really good is that I’ve never had the sense that it’s like UVA’s CAB which would be unfortunate. So it definitely feels like a shared endeavor.” (Strength, T3, Academic)
“I think in the same way that they’ve been doing just that by being facilitators and by being leaders and keeping up. … the facilitator has the work laid out for us when we come. … having the work laid out for us so that we know what you know we’ve got we need to get this done to keep this thing moving in the right direction. We’ve got to get this done today or we’ve got to think about this and we’ve got to have a call about this and I’m going to reach out to this or that person and that’s how I see the leadership.” (Strength, T2, Community)
• Limited time discourages taking on leadership roles 14% 25%
Strengths   
• Leaders work to facilitate engagement 51% 61%
• CPPE processes open up leadership opportunities 38% 36%
• Leadership roles are linked to expertise 24% 36%
• Leadership is dispersed and representative of the CAB 27% 25%
• Leaders inspire others 22% 25%
• Leaders guide, but don’t direct the CAB 16% 25%
Diversified funding Challenges    “I would like to see more of the budget and the financial breakdown of it. Not just the grant but the entire [CAB] program in general what’s funding it what’s supported and think things like that.” (Challenge, T2, Community)
“I think there will be a lot of opportunities. I think right now with Covid that makes it tough because I know a lot of funding is going for that. But I definitely think there’s funding out there for opportunities for obviously cancer related things, especially for rural areas.” (Challenge, T3, Community)
“They were pretty upfront with the [budget] especially the PCORI funding. This money was gonna go towards this and this would go towards this. You know how all it was going to work.” (Strength, T2, Community)
“Well, of course, all these agencies allowing their people to attend the meetings. That’s a very big in-kind because they could say, well, we’re paying you and you can’t, you know, devote 4 h to that sort of thing. So I think that’s huge right there for those of us that... I don’t have to put in personal time to attend meetings. I think, you know, that’s a biggie.” (Strength, T3, Community)
• Grant writing is time consuming without guaranteed success 65% 46%
• The COVID-19 pandemic has impacted funding opportunities n/a% 50%
• Challenging funding climate 0% 32%
• Budget is not transparent 27% 29%
Strengths   
• Member expertise in grant writing 78% 64%
• Output of CAB used in leveraging grant opportunities 38% 11%
• Budget is transparent 32% 29%
• In-kind donations by members and organizations 27% 21%
  1. aTime 2: 37 (23 community, 14 academic)
  2. bTime 3: 28 (15 community, 13 academic)