Partnering with Latino Communities for Dementia Research: A Mixed-Methods Study of Engagement

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Masoud, Byeong Yeob Choi, Juana Escareño, Belinda Flores, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7458959/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Latinos are disproportionately affected by dementia but remain underrepresented in dementia research. Culturally responsive strategies are needed to engage Latino communities as research partners. This study examined engagement with a community council of Latino partners in South Texas, convened to co-lead culturally-specific engagement activities ( community pláticas ) and identify dementia care research priorities. Methods An explanatory sequential mixed-methods design study was implemented to assess engagement with council for this project. The Research Engagement Survey Tool (REST) was administered at three time points over two years. Repeated measures ANOVA and pairwise t -tests assessed changes in engagement quality and quantity across eight engagement principles. Descriptive statistics examined changes across five levels of engagement. Semi-structured interviews with council members (n = 10) were conducted and analyzed using content analysis. Quantitative and qualitative findings were integrated to provide a comprehensive assessment of engagement. Results Thirteen council members—representing caregivers, persons living with dementia, community health workers, organizations, clinicians, and researchers—completed surveys at all time points. Overall quality scores increased from baseline to study end (mean 4.18 to 4.77, p = .003). Increases were observed within several areas of engagement, including focusing on community perspectives (p = .008), valuing partner input (p = .015), co-learning and capacity building (.017), fostering collaborative partnerships (p = .015), involving partners in dissemination (p = .013), and building trust (p = .022). When examined by levels of engagement, collaboration remained the highest across all time points, while the largest increases occurred in partnership (quality + 6.9; quantity + 6.8). Qualitative findings reinforced survey results, highlighting three categories: establishing partnerships through diversity, shared experiences, and leadership; building capacity through co-learning, trust, and being heard; and sustaining the work. Together, the survey and interview results illustrate a trajectory in which structural diversity and inclusive processes produced outcomes of stronger trust, partnership, and sustained community leadership. Conclusion This study demonstrates that community councils can effectively engage Latinos in dementia research when structured around cultural values and community-centered methods. By aligning structural diversity, relational processes, and shared leadership, engagement strategies strengthened trust and fostered sustained partnership. These findings contribute evidence to the science of engagement and provide a model for reducing underrepresentation of Latinos in dementia research. Research engagement Dementia research Community council Latino communities Persons living with dementia Family caregivers Translational science Mixed-methods design Community-based participatory research Figures Figure 1 Figure 2 Plain English Summary Latino families are more likely to be affected by dementia, yet they are often left out of dementia research. When communities are not represented in research, the results do not always reflect their needs or experiences, and treatments may be less effective. To address this problem, our team worked with a group of community members in South Texas called the Community Council. The council included people living with dementia, family caregivers, community health workers, researchers, and professionals from health and community organizations. Together, we held regular meetings to plan and carry out community conversations, known as pláticas, where community members in South Texas could talk about dementia and share what mattered most to them. The council led the design of the activities, guided how they were carried out, and worked with the study team to make sense of the results. We measured how engaged council members felt over time and also interviewed them about their experiences. We found that members felt more involved and connected as the project went on. They described gaining trust, learning together, and building stronger partnerships with one another and with the research team. This study shows that when community members are included as equal partners in research, especially through culturally familiar approaches like pláticas, trust and collaboration grow over time. In turn, this helps ensure that dementia research reflects the real needs of Latino families. Our work provides a model for how researchers and communities can work together to create more meaningful and inclusive research. Background Latinos are 50% more likely to develop Alzheimer’s disease than non-Latino whites, with numbers expected to increase more than nine-fold from 379,000 in 2012 to 3.5 million by 2060 [ 1 , 2 ]. Despite the growing and significant impact of Alzheimer’s disease and related dementias on the Latino community, health care disparities around access to care and quality of care persist. Latinos are reported to have a younger onset of dementia which adds to disability-adjusted life years and overall disease burden [ 3 , 4 ]. Clark et al.[ 3 ] examined age of onset among participants across five Alzheimer’s Disease Research Centers and reported the mean age at onset for the first dementia symptom was 6.8 years (95% confidence interval [CI], 3.5–10.3 years) earlier in Latino compared with Anglo patients. Despite a younger age of symptom onset, time to diagnosis is often delayed among Latinos, with greater severity of cognitive impairment at time of diagnosis [ 5 , 6 ]. These stark disparities underscore the urgent need to develop effective strategies to reduce inequities in dementia and dementia care for Latinos, particularly given the growing number of affected individuals and the wide-ranging health, social, and economic consequences for families, communities, and society. Yet despite their well-established greater risk for Alzheimer’s disease and other types of dementia, Latinos are substantially underrepresented in dementia research [ 2 , 7 ]. Although Latinos make up nearly one-fifth of the U.S. population and face disproportionate dementia risk, they account for as low as ~ 3% of participants in federally-funded Alzheimer’s and related dementias research [ 8 , 9 ]. This underrepresentation perpetuates gaps in prevention, diagnosis, and care, contributing to later detection, reduced access to culturally appropriate services, and worse outcomes [ 10 , 11 ]. The Dementia Care Summit in 2020 underscored the need to include persons living with dementia and their family caregivers as research participants and as engaged research partners. We have not adequately included the voices of persons with lived experiences in setting the dementia research agenda, learning about the questions and outcomes that directly affect them. A community-engaged approach, wherein community members are able to share their voice, values, beliefs, and histories is fundamental to addressing these inequities [ 12 , 13 ]. Engaging patients, families, and caregivers in setting research agendas, conducting studies, and disseminating findings has been shown to improve the quality, impact, and relevance of scientific work [ 14 – 16 ]. Translational science frameworks have integrated relational approaches to research (e.g., community-based participatory research) to address the structural exclusion of disproportionately impacted populations from dementia research [ 11 , 17 , 18 ]. A patient- and family-centered approach to research is particularly needed to overcome barriers that contribute to low involvement in research among Latino communities. There have, however, been few coordinated approaches to engage families impacted by dementia as partners in research, particularly among the Latino community [ 19 – 21 ]. To address these gaps, a project was conducted to build capacity among representatives of communities highly impacted by dementia to co-lead and participate in patient-centered outcomes research, expanding outreach and engagement to their wider networks. Utilizing a CBPR approach, the project centered co-directional learning about patient- and family-centered outcomes research, dementia and its impact among Latino communities, and what research questions and outcomes matter to Latino families impacted by dementia. Individuals from South Texas were engaged as members of a community council (CC) to oversee the activities of the project. A mixed methods study assessed their experiences being engaged for the project to determine whether engagement strategies were effective in strengthening the partnership over time. Methods The CC was established to connect with families and communities impacted by dementia in South Texas. The overarching goal of the project was to engage CC partners to identify community-driven dementia care research priorities and outcomes. CC membership included Latino family caregivers, individuals impacted by dementia, community health workers (CHWs), representatives of community-based organizations, researchers, and a geriatrics and palliative care physician. CC members represented different geographic regions of the South Texas area including the Rio Grande Valley, Laredo, South Coastal region, and San Antonio. Many CC members and the study team identify with multiple roles (e.g., family caregiver and researcher or CHW impacted by early-stage dementia). Monthly CC meetings were held online to support the participation and collaboration of members across different regions of South Texas. Activities of the CC included but were not limited to: (a) establishing “community agreements” to achieve mutually agreed upon approaches for decision-making and collaboration; (b) planning and engaging in capacity building activities both internally for the CC and with the wider community; (c) outreach and engagement activities with wider networks in South Texas; and (d) partnership with the project team to coordinate the identification of research priorities among Latinos impacted by dementia and the research outcomes that matter to them. The project team supported the CC to determine the logistics of the planned activities and to work through any challenges related to the successful accomplishment of their shared goals. The key activity of the CC was to plan and implement community pláticas (conversations) to connect with families impacted by dementia and others in their communities to identify patient- and family-centered research priorities. Pláticas are an informal, semi-structured form of conversation in groups or one-to-one that rely on a dynamic of “reciprocity, vulnerability, and reflexivity” [ 22 ] about personal experiences and perspectives around a particular theme or topic [ 23 – 25 ]. During these community conversations, participants can share rich, nuanced cultural knowledge and information through a process of storytelling about their perceptions, memories, and experiences [ 22 , 26 ]. Pláticas are recognized as a culturally relevant methodology for research engagement among Latinos and other communities [ 22 ]. The engagement processes of pláticas were modeled in CC meetings, where each gathering operated on a semi-structured framework (conversation guides) that could be adapted as needed in response to CC priorities. Six community pláticas in different regions of South Texas were planned and implemented by the CC and project team. The community conversations provided opportunities for the council to put into practice the decision-making and collaborative frameworks established through their shared community agreements. As needed, monthly CC meetings were supplemented with additional sub-group meetings to plan the pláticas. The CC was engaged by the study team to determine plática logistics, including the selected dates, locations, and overall structure of the gatherings. Members of the CC who lived in the regions where pláticas were held served as designated local leaders in the planning, outreach, and implementation of the pláticas. The CC and project team co-developed conversation guides to learn from community members about their experiences around dementia. Notes taken during plática conversations were analyzed by the study team and CC to identify community-driven dementia research priorities and outcomes. Following the implementation of each plática, the CC and project team would debrief and reflect on the successes and challenges of each session. Subsequent plática(s) would be adapted based on feedback from the debriefing sessions. Study design To examine engagement overtime with the CC, a participatory explanatory sequential mixed-methods design study was conducted (Fig. 1 ). Reporting of patient and public involvement in this study follows the GRIPP2 Short Form checklist (see Supplementary Table 1). The initial phase of the study involved the collection of quantitative data using the Research Engagement Survey Tool (REST) [ 15 , 27 ] administered at three time points to identify any potential differences in levels of engagement with the CC prior to and following the implementation of pláticas. The project team examined quantitative findings to inform the creation of interview guides used for the subsequent qualitative assessment phase. Interviews with members of the CC were conducted and analyzed to further examine their experiences of engagement. Upon completion of all analyses, quantitative and qualitative findings were interpreted together to elucidate a more nuanced assessment of engagement with the CC. Sample The community-academic partnership that oversaw this project had extensive experience providing community resources and research for family caregivers of persons living with dementia, and thus brought with them a robust network of key individuals and partnering organizations with whom they collaborated in the South Texas region. The South Texas Area Health Education Centers Program (ST-AHEC) had partnered with the study team for prior initiatives, including the development of a CHW-focused training to promote brain health, address dementia, and advocate for patient-centered research [ 28 ]. The ST-AHEC has an extensive geographic catchment area and a wide-ranging network of promotoras and CHWs. Initial invitations to participate in the project as CC members were extended through the study team’s networks and ST-AHEC networks at the start of the project period. Recruited CHWs, caregivers, persons living with dementia, and other partners were asked if they could identify additional members to join the CC. Members of the CC were invited if they were located in a region of South Texas or surrounding areas, had a personal or professional connection to dementia, and were able to commit to attending all or most of the monthly meetings. Being Latino/Latina or Hispanic was not a requirement to join the CC, though all members of the CC and project team shared a commitment to centering the Latino community in the project. Data collection During phase 1 of the study, the validated REST was used to quantitatively examine engagement among the CC [ 15 , 27 ]. The REST is designed to assess how engagement occurs among all partners involved in engagement activities for research. It is comprised of 32 items that align with eight engagement principles (EPs). Each EP corresponds with survey items that are assessed using Likert-type scales to rate the quality of engagement (how well: poor, fair, good, very good, excellent, and not applicable) and quantity of engagement (how often: never, rarely, sometimes, often, always, and not applicable). The REST generates quality and quantity scores for each of the eight EPs as well as quality and quantity scores for the overall measure ranging from 0–5 for each score. This measure has strong internal consistency for each of the eight EPs measured for both quality (Cronbach’s alpha range: 0.83–0.92) and quantity (Cronbach’s alpha range: 0.79–0.91) and the overall measure for quality (Cronbach’s alpha = 0.98) and quantity Cronbach’s alpha = 0.97). The pláticas served as critical structures in the project period during which the CC could leverage their capacity to implement collaborative research activities in partnership with the project team. As such, the quantitative phase of this study was anchored around the pláticas, with three data collection timepoints: T1 took place prior to planning and implementing the pláticas; T2 followed the implementation and debrief of the first three pláticas, and; T3, the final administration, took place upon completion of three more pláticas. The REST was administered to CC members via REDCap [ 29 , 30 ]. After conducting a preliminary analysis of the quantitative data, the project team discussed the findings to inform the development of a semi-structured interview guide. Interviews were conducted online using Zoom, audio recorded and transcribed. One participant who was living with dementia was provided the opportunity to participate in the interview alongside their family caregiver who was also a member of the CC. Analysis Quantitative data were analyzed using STATA 16 [ 31 ]. After screening missing data, descriptive statistics including means and standard deviations were calculated for each EP and the overall measure. The mean of the 3–5 items within each EP was calculated for EP-specific scores, then the overall means of the EP-specific scores were calculated to determine the overall REST scores for quality and quantity. Our primary hypothesis is that both the quality and quantity of engagement, as measured by REST, will be improved following pláticas. Repeated measures analysis of variance (ANOVA) was employed to examine whether REST scores for each EP and the overall measure were different across three consecutive timepoints. In cases where Mauchley’s test indicated a violation of the assumption of sphericity ( p < 0.05), and the Greenhouse-Geisser epsilon values less than 0.75, the Greenhouse-Geisser correction was applied. Following, ANOVA, pairwise comparisons with Bonferroni correction were used to compare mean scores at T1-T2, T2-T3, and T1-T3. The threshold for statistical significance was a 2-sided p-value of 0.05. Scores were also examined in alignment with five levels of engagement identified during the Delphi process to develop the REST: 1) outreach and education, 2) consultation, 3) cooperation, 4) collaboration, and 5) partnership. Scoring in alignment with levels of engagement involves calculating a percentage score for REST items by each level of engagement, determined by classifications assigned by the REST development team. Scoring instructions and codes for performing analyses using statistical software is publicly accessible [ 32 ]. Qualitative content analysis of individual interviews was conducted. All transcripts were reviewed for accuracy prior to analysis. Using line-by-line coding in Microsoft Word, relevant sections were identified and summarized for applicability to study aims. Relevant segments of data were grouped based on similarities in content. The grouped data were sorted into categories with sub-categories used to cluster similar content within each category. Coding decisions and categorization were reviewed in collaboration between study team members until consensus was achieved. Following the principles of explanatory mixed-methods design, data collected from the qualitative and quantitative phases of the study were reviewed by members of the project team [ 33 ]. Findings from the REST data were connected with and compared to categories identified through qualitative analysis, bringing to light any convergence or divergence across datasets. This integration phase allowed for a more nuanced, richer assessment of the CC’s engagement experiences. Results Quantitative data A total of 16 CC members participated in the study. Of the 16 CC members, 13 completed the REST at all time points. One member had resigned prior to the second data collection time point (T2), and another had joined after the first data collection time point (T1) had already been completed. Except for the intentionally limited representation of providers on the CC, representation was evenly distributed between persons living with dementia, caregivers, community organization, and researchers. Most CC members were women and identified as Hispanic or Latino. Half of CC members represented the San Antonio region, six CC members represented the Rio Grande Valley and surrounding areas, and the remainder represented the South Coastal region of Corpus Christi and surrounding areas (Table 1 ). Table 1 Demographics of CC members (N = 16) Characteristics n % Primary partner group Person living with dementia 3 18.8 Caregiver 3 18.8 Community Health Worker 3 18.8 Community Organization 3 18.8 Geriatrics and Palliative Care Provider 1 6.3 Researcher 3 18.8 Gender : Women 13 81.3 Men 3 18.8 Hispanic or Latino : Yes 14 87.5 No 2 12.5 Region : San Antonio 8 50 Rio Grande Valley and surrounding area 6 37.5 South Coastal Texas 2 12.5 Results of repeated measures ANOVA tests and pairwise t -tests are presented in Table 2 . Overall, engagement quality total scores increased significantly across the three time points ( F (2,24) = 7.67, p = .003), with mean scores reflecting a statistically significant rise from T1 (M = 4.18, SD = .69) to T3 (M = 4.77, SD = .24), ( t (12) = -3.35, p = .006). Engagement quantity total scores showed an upward trend ( F (2,24) = 3.47, p = .047), though pairwise differences did not remain significant after correction. Mean scores for quality of engagement were seen for EP6 ( Facilitate collaborative, equitable partnerships ) over time ( F (2,24) = 6.97, p = .004), with T1 scores (M = 4.02, SD = .93) increasing at T2 (M = 4.6, SD = .6), t (12) = -3.34, p = .007. Similar changes were observed for EP7 quality scores ( Involve all partners in the dissemination process ) across time ( F (2,24) = 5.02, p = 0.015), with a statistically significant increase from T1 (M = 3.95, SD = 1.06) to T3 (M = 4.79, SD = 0.4), t (12) = -3.27, p = .013. Quality of engagement within EP1 ( Focus on community perspectives and determinants of health ) increased over the study period ( F (2,24) = 5.67, p = 0.010), with a statistically significant increase identified from T1 (M = 4.17, SD = .64) to T3 (M = 4.77, SD = .24), t (12), =-3.19, p = .008. EP8 ( Build and maintain trust in the partnership ) quality scores also increased significantly ( F (2,24) = 6.45, p = .006) from T1 (M = 4.37, SD = .69) to T2 (M = 4.85, SD = .25), t (12) = -3.11, p = .011). An additional notable increase was identified in EP2 ( Partner input is vital ) across time ( F (2,24) = 5.57, p = .010), and between T1 (M = 4.33, SD = .70) and T3 (M = 4.88, SD = .24). Average quantity of engagement scores within most EPs showed upward but non-significant patterns. Statistically significant changes in quantity scores over time were observed for EP6 ( F (2,24) = 4.83, p = .017) and EP7 ( F (2,24) = 4.14, p = .029), though no statistically significant changes across between time points were identified. EP5 ( Build on strengths and resources within the community or patient population ) remained stable across the three time points. Results suggest that while CC perspectives of quantity of engagement did not change significantly, their perceived quality of engagement strengthened over time. Table 2 Research engagement scores across three timepoints Engagement Principles (EPs) a ANOVA (N = 13) Pairwise t -tests (N = 13) T1 T2 T3 T1-T2 T2-T3 T1-T3 M (SD) M (SD) M (SD) p -value Unadjusted p -value Total Quality 4.18 (0.69) 4.59 (0.44) 4.77 (0.24) 0.003 ** 0.039 0.086 0.006 * Quantity 4.45 (0.65) 4.59 (0.48) 4.85 (0.19) 0.047 * 0.335 0.081 0.051 EP1 Quality 4.17 (0.64) 4.63 (0.53) 4.77 (0.24) 0.010 * 0.053 0.383 0.008 * Quantity 4.5 (0.52) 4.67 (0.43) 4.87 (0.19) 0.057 0.211 0.156 0.051 EP2 Quality 4.33 (0.70) 4.79 (0.29) 4.88 (0.24) 0.010 * 0.048 0.410 0.015 * Quantity 4.54 (0.71) 4.81 (0.27) 4.92 (0.16) 0.096 0.226 0.235 0.070 EP3 Quality 3.86 (1.06) 4.58 (0.6) 4.6 (0.48) 0.006 ** 0.028 0.837 0.022 Quantity 4.15 (1.04) 4.54 (0.55) 4.63 (0.47) 0.164 0.202 0.577 0.137 EP4 Quality 4.4 (0.55) 4.73 (0.51) 4.83 (0.28) 0.031 * 0.116 0.406 0.017 * Quantity 4.63 (0.44) 4.71 (0.44) 4.88 (0.19) 0.189 0.570 0.248 0.084 EP5 Quality 4.33 (0.65) 4.69 (0.58) 4.69 (0.44) 0.085 0.136 1.000 0.084 Quantity 4.72 (0.43) 4.82 (0.29) 4.77 (0.39) 0.771 0.472 0.721 0.731 EP6 Quality 4.02 (0.93) 4.6 (0.6) 4.73 (0.39) 0.004 ** 0.007 * 0.421 0.015 * Quantity 4.17 (0.91) 4.56 (0.67) 4.85 (0.36) 0.017 * 0.062 0.198 0.019 EP7 Quality 3.95 (1.06) 3.87 (1.27) 4.79 (0.4) 0.015 * 0.818 0.021 0.013 * Quantity 4.21 (1.36) 3.82 (1.58) 4.95 (0.18) 0.029 * 0.293 0.028 0.079 EP8 Quality 4.37 (0.69) 4.85 (0.25) 4.88 (0.29) 0.006 ** 0.011 * 0.790 0.022 Quantity 4.67 (0.53) 4.75 (0.45) 4.94 (0.13) 0.144 0.482 0.172 0.102 Note. For repeated measures ANOVA, unadjusted p-values are reported (Greenhouse–Geisser epsilon values were examined, but adjusted values are not presented). For paired-samples t-tests, unadjusted p-values are presented; significance is interpreted relative to the Bonferroni-corrected alpha level of .017. Engagement Principles (EPs) are as follows: EP1, “Focus on community perspectives and determinants of health”; EP2, “Partner input is vital”; EP3, “Partnership sustainability to meet goals and objectives”; EP4, “Foster co-learning, capacity building, and co-benefit for all partners”; EP5, “Build on strengths and resources within the community or patient population”; EP6, “Facilitate collaborative, equitable partnerships”; EP7, “Involve all partners in the dissemination process”; EP8, “Build and maintain trust in the partnership.” p < .05. p < .01. When examined by levels of engagement, REST data showed the highest scores in the collaboration category for both quality and quantity across all time points (Table 3 ). Over the course of the project period, the greatest increases occurred in the partnership category, where quality scores rose from 9.8 to 16.7 (+ 6.9 points) and quantity scores from 14.4 to 21.2 (+ 6.8 points). Scores in lower engagement categories (outreach, consultation, and cooperation) declined modestly over time, whereas higher engagement categories (collaboration and partnership) showed trends toward increased scores. Table 3 REST scores by levels of engagement T1 T2 T3 Level of engagement M (SD) M (SD) M (SD) Outreach & education Quality 4.2 (1.9) 4.8 (3.5) 3.1 (0) Quantity 3.6 (2.4) 3.5 (1.1) 3.1 (0) Consultation Quality 6.0 (4.9) 5 (4.5) 4.5 (2.7) Quantity 5.8 (1.6) 7.1 (4.2) 6.3 (0) Cooperation Quality 24.4 (10.3) 19.6 (3.4) 18.8 (1.7) Quantity 17.3 (4.1) 17.1 (3.3) 15.8 (0.8) Collaboration Quality 52.1 (12.0) 53.6 (6.9) 56 (3.8) Quantity 54.6 (10.9) 52.7 (6.7) 52.7 (3.6) Partnership Quality 9.8 (8.5) 14.6 (6.7) 16.7 (6.2) Quantity 14.4 (9.0) 16.9 (8.3) 21.2 (4.9) Qualitative data Three categories were identified through analysis of the qualitative data: 1) establishing partnerships, 2) building capacity together, and 3) sustaining the work. Subcategories of similar content were grouped together to depict nuanced findings within each category. The qualitative data reflect a cyclical process, from the structure of the CC to the application and sustainment of the work, showing an ongoing progression of engagement. This process is depicted in Fig. 1 . Category 1: Establishing partnerships Participants tied their engagement to structural features of the CC, including diversity in perspectives and regional representation, shared experiences with dementia, and the supportive approach to leadership from the project team. Diversity of the CC. Participants emphasized the importance of diverse community perspectives, including current and former family caregivers, persons living with dementia, community organizations, health workers, and researchers. The inclusion of those directly impacted by dementia was described as especially valuable to members of the CC: “… Having those special individuals in the group made it more interesting because we’re getting firsthand experience from somebody actually living with dementia and somebody caring for someone living with dementia ” Hearing the personal experiences of CC members who were living with dementia and caring for family members supported the development of trust and formed a shared motivation to address the needs of communities. “ Some of our council members have really gone through very difficult situations. So, for them to open up... I think it showed us that, hey, you know, people hurt, there's people that are hurting… And so, I think that really helped build the trust that people are just people, and all people need help .” Regional representation across South Texas was also critical, as members recognized cultural and resource differences while working toward shared goals: “ San Antonio versus Laredo versus Corpus Christi versus the Rio Grande Valley — we’re all different in so many ways… For me, my community is my priority… But yet, I still respect, and I want to also support other areas. ” Shared experiences with dementia. While diversity was valued, participants stressed the importance of shared experiences with dementia. All CC members had some personal connection—living with dementia, caregiving, or working professionally in the field. As one member shared, “ Everybody in some form or fashion has been touched by Alzheimer’s… parent, grandparent, sibling, spouse. So, everybody understands what’s going on or what’s at stake .” This shared experience was seen as a defining feature of the CC’s engagement. Supportive leadership . Participants highlighted the role of leadership in supporting the CC to provide guidance over project activities. “ What really jumped at me, and I think this is the most powerful aspect of it, is the variety of people on this council, experiences, backgrounds, I guess, locations… and that kind of variety really needs a ringleader… that will allow everyone to participate .” Supportive leadership was described as central to members’ willingness and confidence to share feedback: “ All the members are encouraged to really provide feedback… it’s an open forum where we feel safe, and know that whatever we bring about is going to be taken constructively .” Category 2: Building capacity together From the foundation provided by the partnership structure, participants shared their engagement experiences related to the process of capacity building to implement the community pláticas together. They described the CC as a learning experience, in which they were able to adapt and grow through the engagement process. Participants spoke of a shared purpose in hosting the community pláticas among the group formed through the CC experience and the importance of cultivating trust to facilitate meaningful collaboration. A key part of this process was the importance of being heard by one another and the project team when shaping how the pláticas were approached. A learning experience. Regardless of prior experience on councils or boards, participants described the CC as a unique learning opportunity. “ For me, it was the first time being considered a member of something…it gave me a different sense of cohesiveness and a sense of unity than I had experienced before ”. The CC created space to exchange information and resources: “ I've learned being on this council that… if I come up with, with something or somebody tells me something, I know where to go to get more resources. You know, that's been awesome ”. Activities with the project team also built members’ own experiences and capacities: “ I have (previously) hosted what they call ‘community pláticas’, but… it was not the same… Now I can make comparisons .” Uniting through shared goals . Participants described developing camaraderie through shared goals in planning and implementing the pláticas. “ I’ve learned to appreciate everybody’s input… we all have different roles, but we share that commonality of trying to help others .” Collaboration was supported by a sense of unity and shared mission: “ Everybody understood that we all had a purpose and a mission… we each took our role within the group and that’s how we all did the work .” Some described the CC as an extension of themselves: “ They’re just another part of me, an extension of what I do, but maybe in a different capacity .” Cultivating trust for collaboration . Trust was cited as essential for collaboration despite differences in perspective or region: “ All of us are different… and continuing to build on that trust… I think the outcomes have been wonderful, and it stems from the trust. ” Those directly impacted by dementia emphasized respect as key to building trust: “ I like the way I’m treated. And if you can treat me like that, I know you can treat other people that way .” Others described trust through openness to share personal experiences: “ For me to share some personal experiences about my family, you just don’t do that with everybody, especially in the Hispanic community… but everybody felt comfortable… truly, you could feel the love of the council members .” Being heard . A commonly shared experience among participants was a feeling of being listened to by the other members of the CC and the project team. This was a vital component of their engagement experiences, often cited as a facilitator of trust and a key aspect of the SC’s ability to achieve consensus for decision-making for the pláticas as a group. “I feel like being part of this council, yes, we have very opinionated people, but never spoke over each other. We all allow each other time to, you know, to voice our opinions or our thoughts”. Being heard was sufficient for CC members who expressed that as long as they felt listened to, they understood if their input was not ultimately the direction taken, “ we may not go with what some of us recommend, but at least we were heard and were given that opportunity to be heard and listened. And that's important” . Feeling listened to was an important experience for persons living with dementia to be included in providing oversight and input in project activities, “ They listen to me, specifically, specially. And I really appreciate that ”. Another person living with dementia shared, “ sometimes I don't (give input), because I feel like, like, everybody's much more educated and I don't know how to, to express myself. But my daughter… she's always saying, ‘Mom, even if it's simple, you bring you bring your point across’… I try to reach out to, you know, and remember that at least I'm talking, some people don't even talk… It's getting easier because I'm getting to know them .” Category 3: Sustaining the work Participants reflected on outcomes of their collaboration, noting that the CC built capacity to implement pláticas across South Texas and engage wider communities. The pláticas were described as responsive to community needs, providing opportunities for those impacted by dementia to share and connect. Looking ahead, participants emphasized the importance of sustaining the work by following through on what was learned from these conversations. Engaging communities (pláticas) . Participants described the pláticas as successful in connecting with wider communities and providing insight into how experiences with dementia could inform research: “ We want to report that input to someone at the research level… to say, this is what the community is asking for .” Facilitating the pláticas also allowed the CC to model their own engagement strategies: “ The way the pláticas were coordinated… you heard every single individual speak… there was a lot of active listening and clarifications .” Participants described the culturally tailored approach for each plática as contributing to the communities’ willingness to share in the plática setting: “ We bring out the food, we bring out the music… the plática right away opens up, because we’ve used that for years and years… We get in a circle, you know, so that everybody can see each other and hear each other, you know… that’s the Latino culture right there .” Members emphasized that this approach created safety for vulnerability about experiences and challenges: “ At each session, people really let their hair down… there was crying… and I don’t think people will do that if they don’t feel comfortable. I feel like we did that .” Responsiveness to communities . Participants emphasized that the pláticas were directly responsive to community needs, particularly for Latino families impacted by dementia. In many South Texas regions, few opportunities exist to support persons with dementia and their families. “ There is such a need for the Latino community… they live in the shadows… and when they do come out, they’re kind of hesitant .” Providing a platform for open communities to talk through their experiences, alongside professionals and community organizations, raised awareness of resources and reduced isolation: “ It makes the people feel a bit better… they weren’t alone… having a few physicians and healthcare personnel there made them feel like what they were going through was being heard .” Following through . A strong motivation was shared among CC members that the work needed to continue, especially in following up the pláticas with action to address the needs addressed through the conversations. “ How do we become sustainable beyond the project? … there has to be a conversation about sustainability of these programs .” Recognizing that change takes time, they saw continued community engagement as the next step: “ It’s not like from one day to another… it takes a lot of effort… from here, from the community, that’s the first step .” The participants felt the framework of the CC and their role in planning the pláticas is a model that can be replicated to continue engaging and learning from Latino communities impacted by dementia: “ Its simplicity was what served it best… however that could be replicated is very powerful. ” Mixed-methods interpretation Engagement with the CC was facilitated through partnering to plan, implement, and evaluate the pláticas. CC perspectives on engagement are best understood by interpreting the quantitative and qualitative findings together. At baseline, T1 REST scores reflected high engagement (quality = 4.18, quantity = 4.45). Interviews with the CC explained these high scores in describing the structural components of the CC that were present at the onset of the study, diversity, shared experiences and familiarity with dementia, and supportive leadership. Repeated measures ANOVA tests demonstrated that strategies used to engage the CC in the pláticas nonetheless resulted in statistically significant changes over time in overall REST scores for both quality and quantity of engagement, despite already high baseline levels. Increases were observed across most EPs, with significant improvements in quality scores within EP1, EP2, EP4, EP6, EP7, and EP8. EP5 ( Build on strengths and resources within the community or patient population ) showed little change, explained through interviews as a result of a strong emphasis at the project onset on community strengths and resources, a value that remained consistent over the study period. Pairwise comparisons reflected significant changes in quality of engagement for EP1 ( focus on community perspectives and determinants of health ) and EP2 ( partner input is vital ) from T1–T3. Qualitative findings reflect that the inclusion of diverse groups on the CC, including persons living with dementia and family caregivers alongside CHWs, enabled the focus to remain on the community. Further, the use of pláticas as the culturally-specific approach to engagement with the CC and wider community most likely contributed to the noted increase in scores for EP1. Capacity building activities and consistent meetings between the study team and CC that intentionally sought partner input to shape plática content and processes likely contributed to the observed increase in EP2 scores. EP6 ( facilitate collaborative, equitable partnerships ) improved from T1–T2 and T1–T3, supported by qualitative accounts that prolonged involvement in the project fostered stronger relationships between community and academic partners. EP7 ( involve all partners in the dissemination process ) improved only at T1–T3, reflecting that longer participation created opportunities to present work and co-author publications. EP8 ( build and maintain trust in the partnership ) also increased significantly from T1–T2, consistent with member accounts that sustained involvement cultivated trust and confidence in the CC’s collaborative work. When quantitative data were assessed within levels of engagement, REST scores were consistently highest in the collaboration category, explained by leadership’s role in guiding discussions and consensus. Over time, CC members described becoming more comfortable to take leadership in planning and implementing the pláticas. The greatest increases were from T1–T3 in the partnership category (quality + 6.9, quantity + 6.8), explained by interviews describing more opportunities for CC input, decision-making, and trust-building through the plática process as the project progressed. Discussion Including communities as partners in research, where their perspectives and experiences are centered is key to addressing the persistent underrepresentation of Latinos in dementia care research. This study assessed engagement with a community council (CC) convened to conduct culturally-specific outreach and engagement with Latinos in South Texas. Despite the growing urgency to address dementia research gaps among communities of color, this study is one of few to assess community partner engagement for dementia research using a council model [ 34 , 35 ]. Findings can be interpreted through a Donabedian-type framework of structure, process, and outcome [ 36 ]. Structural components of the CC influenced engagement processes and outcomes, helping explain high baseline REST scores. Similar to findings from other studies assessing the council structure for research partnerships [ 34 , 35 , 37 ], the establishment of a diverse council to oversee the project was an effective facilitator of engagement at the onset of the project. Participants stressed that representation from different regions of South Texas and varied lived or professional dementia experiences strengthened the shared knowledge and capacity of partners. While increases were observed across most EPs, no statistically significant difference was identified for EP5 ( Builds on strengths and resources within the community or patient population ). This may be explained by the study’s grounding in key community-based participatory research (CBPR) principles, as the project was designed from the outset around the needs and experiences of the target population [ 38 ]. Past community-engaged research identified a need for culturally specific approaches to engage Latinos in dementia research [ 20 , 39 , 40 ]. To address this, CHWs were integrated as a critical component of the CC structure. CHWs strengthened the overall project through their deep connections to community members in their areas and their ability to bring the perspectives of highly impacted and underserved communities to the project. While CHWs have been leveraged as key partners in health research broadly [ 41 ], they remain mostly excluded as co-leaders in dementia care research [ 42 , 43 ]. By partnering with CHW leaders, the pláticas were ultimately better aligned with the needs and experiences of South Texas communities. Processes of engagement applied during the study period included monthly meetings, capacity building workshops, and the development and implementation of community pláticas. Through these activities, partnership with the CC evolved as the study progressed, as reflected in the increasing REST scores within EP6, ' Facilitate collaborative, equitable partnerships ”. This study demonstrates that trust-building activities facilitated over time were central to cultivating equitable partnerships with the study team. This is consistent with community-engaged research methodology that relies on mutually beneficial long-term relationships of rapport-building and trust [ 17 , 44 , 45 ]. As the project progressed, CC members gained new skills, developed shared goals with a mutual sense of purpose, and enacted decision-making and co-learning while tailoring engagement to their communities. With each opportunity to listen and be listened to, the CC was able to build and maintain trust in each other and in the project team. The CC’s structure and processes supported successful outcomes from the partnership, most notably the implementation of six community pláticas in South Texas. As a reciprocal, bi-directional storytelling practice rooted in Latino culture, pláticas have been described by community researchers as an effective qualitative method [ 24 ]. Yet this approach had not been formally examined as a strategy for strengthening community-academic partnerships for research. Interviews with members of the CC highlighted the personal impact of their role in planning and implementing pláticas that were tailored to their respective regional communities. This approach built on their lived experiences, knowledges, and connections, emphasizing the importance of their role as leaders in the planning and implementation process. When assessed for the five levels of engagement, the REST data reflected the greatest increase in scores within “partnership,” the highest category of engagement. CC members’ growing sense of ownership and leadership over time as they implemented the community pláticas explains these increases and their expressed commitment to sustain and expand the work. This study demonstrates that aligning partnership structures with key principles of community-centered engagement generates outcomes of strengthened trust, partnership, and sustained leadership. Together, these findings point to a pathway for transforming dementia research to more fully share power and leadership with highly impacted communities. Limitations Few statistically significant findings from the comparative analysis of REST scores for quantity of engagement are likely due to the study being underpowered by the small sample size. Quantitatively measuring engagement is inherently challenging, as meaningful engagement typically requires small councils. While the recommended size of a community advisory board or council varies, most guidance suggests staying below 10–15 members [ 44 , 46 ]. Engaging more partners on the CC may have added some power to the analysis but would have potentially come at a cost to the quality of engagement possible. Although this study was conducted with Latino communities in South Texas, which may limit generalizability, the approach and methods warrant further study to determine their applicability to other populations. Conclusion There is a critical need for evidence on effective strategies to recruit and retain underrepresented populations in research. Engagement and recruitment science is a developing discipline and research is needed to identify effective strategies for community partner engagement, especially among communities of color [ 11 , 15 ]. This study contributes to the science of engagement by reflecting on outcomes from the implementation of culturally-specific engagement strategies among Latino communities of South Texas. Results from this study provide evidence that can support researchers and communities to meaningfully partner with each other for research around dementia care. Findings provide evidence that researchers and communities can draw on to build equitable partnerships and address the persistent underrepresentation of highly impacted populations in dementia research. Declarations Ethics approval and consent to participate . All study procedures were performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. This project was submitted to the Institutional Review Board for ethical review and deemed to be exempt (HSC22-0277E). All participants were provided an information sheet which was reviewed prior to attaining consent to participate. Consent for publication . Not applicable. Availability of data and materials . All quantitative and qualitative data generated and analyzed during the current study are not publicly available to protect participant confidentiality. De-identified survey data and qualitative coding summaries that support the findings of this study may be obtained from the corresponding author upon reasonable request. Competing interests . The authors declare that they have no competing interests. Funding . The work was funded by a Patient Centered Outcomes Research Institute (PCORI) Eugene Washington Engagement Award (EACB-23031). Authors' contributions . SM conceived and led the study, conducted the analysis, and was the primary contributor to writing the manuscript. BYC supported SM in the statistical analysis. JE, BF, and KDLL contributed to study coordination, data collection, and interpretation. CW provided senior mentorship and guidance throughout the study. All authors reviewed and approved the final manuscript. Acknowledgements . The authors extend their deepest gratitude to the members of the Community Council who generously contributed their time, experience, and insight to this study. We also honor the memory of Dr. Janna Lesser, whose vision and commitment were instrumental to this work and whose loss is deeply felt. We are grateful to the communities of South Texas for their continued engagement and dedication to improving the lives of families impacted by dementia. Finally, we acknowledge the Patient-Centered Outcomes Research Institute (PCORI) for their support and guidance in making this project possible. Authors' information (optional). All research partners for this study were researchers who also cared for family members impacted by dementia, with most actively serving as caregivers during the study period. Co-authors include community health workers (CHWs) who partnered in the study and contributed to the overall project. All authors lived in South Texas or surrounding areas at the time of the study. The professional expertise and lived experiences of both community and academic partners were integral to shaping the study, and their intersectionality strengthened the depth and relevance of our collaborative efforts. Additional community partners were invited to participate in the manuscript process but respectfully declined; however, they actively supported the study and the dissemination of its findings in many other ways, for which we are deeply grateful. References Wu S, Vega WA, Resendez J, Jin H. 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1","display":"","copyAsset":false,"role":"figure","size":89914,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMixed-methods study design\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7458959/v1/e3e03b1aa14b2259a0487464.png"},{"id":92581544,"identity":"3456cc4d-aca0-47b7-9f77-8d106735385b","added_by":"auto","created_at":"2025-10-01 09:31:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":163238,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 1. Qualitative findings depicted as a cyclical engagement process.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7458959/v1/a1610165e5776e6554212eec.png"},{"id":92582093,"identity":"0b765885-06cb-4a87-bf65-62e6f90bd070","added_by":"auto","created_at":"2025-10-01 09:39:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1211567,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7458959/v1/4e1f4cbe-96f1-41f9-a952-1e863bbd75fc.pdf"},{"id":92581075,"identity":"f7c677ce-0eba-4d15-b542-3901becf217c","added_by":"auto","created_at":"2025-10-01 09:23:00","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":28297,"visible":true,"origin":"","legend":"","description":"","filename":"Gripp2Checklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7458959/v1/f284290b7968e13c485254da.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Partnering with Latino Communities for Dementia Research: A Mixed-Methods Study of Engagement","fulltext":[{"header":"Plain English Summary","content":"\u003cp\u003eLatino families are more likely to be affected by dementia, yet they are often left out of dementia research. When communities are not represented in research, the results do not always reflect their needs or experiences, and treatments may be less effective. To address this problem, our team worked with a group of community members in South Texas called the Community Council. The council included people living with dementia, family caregivers, community health workers, researchers, and professionals from health and community organizations.\u003c/p\u003e\n\u003cp\u003eTogether, we held regular meetings to plan and carry out community conversations, known as pl\u0026aacute;ticas, where community members in South Texas could talk about dementia and share what mattered most to them. The council led the design of the activities, guided how they were carried out, and worked with the study team to make sense of the results.\u003c/p\u003e\n\u003cp\u003eWe measured how engaged council members felt over time and also interviewed them about their experiences. We found that members felt more involved and connected as the project went on. They described gaining trust, learning together, and building stronger partnerships with one another and with the research team.\u003c/p\u003e\n\u003cp\u003eThis study shows that when community members are included as equal partners in research, especially through culturally familiar approaches like pl\u0026aacute;ticas, trust and collaboration grow over time. In turn, this helps ensure that dementia research reflects the real needs of Latino families. Our work provides a model for how researchers and communities can work together to create more meaningful and inclusive research.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eLatinos are 50% more likely to develop Alzheimer\u0026rsquo;s disease than non-Latino whites, with numbers expected to increase more than nine-fold from 379,000 in 2012 to 3.5\u0026nbsp;million by 2060 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Despite the growing and significant impact of Alzheimer\u0026rsquo;s disease and related dementias on the Latino community, health care disparities around access to care and quality of care persist. Latinos are reported to have a younger onset of dementia which adds to disability-adjusted life years and overall disease burden [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Clark et al.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] examined age of onset among participants across five Alzheimer\u0026rsquo;s Disease Research Centers and reported the mean age at onset for the first dementia symptom was 6.8 years (95% confidence interval [CI], 3.5\u0026ndash;10.3 years) earlier in Latino compared with Anglo patients. Despite a younger age of symptom onset, time to diagnosis is often delayed among Latinos, with greater severity of cognitive impairment at time of diagnosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These stark disparities underscore the urgent need to develop effective strategies to reduce inequities in dementia and dementia care for Latinos, particularly given the growing number of affected individuals and the wide-ranging health, social, and economic consequences for families, communities, and society.\u003c/p\u003e\u003cp\u003eYet despite their well-established greater risk for Alzheimer\u0026rsquo;s disease and other types of dementia, Latinos are substantially underrepresented in dementia research [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Although Latinos make up nearly one-fifth of the U.S. population and face disproportionate dementia risk, they account for as low as ~\u0026thinsp;3% of participants in federally-funded Alzheimer\u0026rsquo;s and related dementias research [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This underrepresentation perpetuates gaps in prevention, diagnosis, and care, contributing to later detection, reduced access to culturally appropriate services, and worse outcomes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Dementia Care Summit in 2020 underscored the need to include persons living with dementia and their family caregivers as research participants and as engaged research partners. We have not adequately included the voices of persons with lived experiences in setting the dementia research agenda, learning about the questions and outcomes that directly affect them. A community-engaged approach, wherein community members are able to share their voice, values, beliefs, and histories is fundamental to addressing these inequities [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Engaging patients, families, and caregivers in setting research agendas, conducting studies, and disseminating findings has been shown to improve the quality, impact, and relevance of scientific work [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Translational science frameworks have integrated relational approaches to research (e.g., community-based participatory research) to address the structural exclusion of disproportionately impacted populations from dementia research [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A patient- and family-centered approach to research is particularly needed to overcome barriers that contribute to low involvement in research among Latino communities. There have, however, been few coordinated approaches to engage families impacted by dementia as partners in research, particularly among the Latino community [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo address these gaps, a project was conducted to build capacity among representatives of communities highly impacted by dementia to co-lead and participate in patient-centered outcomes research, expanding outreach and engagement to their wider networks. Utilizing a CBPR approach, the project centered co-directional learning about patient- and family-centered outcomes research, dementia and its impact among Latino communities, and what research questions and outcomes matter to Latino families impacted by dementia. Individuals from South Texas were engaged as members of a community council (CC) to oversee the activities of the project. A mixed methods study assessed their experiences being engaged for the project to determine whether engagement strategies were effective in strengthening the partnership over time.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe CC was established to connect with families and communities impacted by dementia in South Texas. The overarching goal of the project was to engage CC partners to identify community-driven dementia care research priorities and outcomes. CC membership included Latino family caregivers, individuals impacted by dementia, community health workers (CHWs), representatives of community-based organizations, researchers, and a geriatrics and palliative care physician. CC members represented different geographic regions of the South Texas area including the Rio Grande Valley, Laredo, South Coastal region, and San Antonio. Many CC members and the study team identify with multiple roles (e.g., family caregiver and researcher or CHW impacted by early-stage dementia).\u003c/p\u003e\u003cp\u003eMonthly CC meetings were held online to support the participation and collaboration of members across different regions of South Texas. Activities of the CC included but were not limited to: (a) establishing \u0026ldquo;community agreements\u0026rdquo; to achieve mutually agreed upon approaches for decision-making and collaboration; (b) planning and engaging in capacity building activities both internally for the CC and with the wider community; (c) outreach and engagement activities with wider networks in South Texas; and (d) partnership with the project team to coordinate the identification of research priorities among Latinos impacted by dementia and the research outcomes that matter to them. The project team supported the CC to determine the logistics of the planned activities and to work through any challenges related to the successful accomplishment of their shared goals.\u003c/p\u003e\u003cp\u003eThe key activity of the CC was to plan and implement community \u003cem\u003epl\u0026aacute;ticas\u003c/em\u003e (conversations) to connect with families impacted by dementia and others in their communities to identify patient- and family-centered research priorities. Pl\u0026aacute;ticas are an informal, semi-structured form of conversation in groups or one-to-one that rely on a dynamic of \u0026ldquo;reciprocity, vulnerability, and reflexivity\u0026rdquo; [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] about personal experiences and perspectives around a particular theme or topic [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. During these community conversations, participants can share rich, nuanced cultural knowledge and information through a process of storytelling about their perceptions, memories, and experiences [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Pl\u0026aacute;ticas are recognized as a culturally relevant methodology for research engagement among Latinos and other communities [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The engagement processes of pl\u0026aacute;ticas were modeled in CC meetings, where each gathering operated on a semi-structured framework (conversation guides) that could be adapted as needed in response to CC priorities.\u003c/p\u003e\u003cp\u003eSix community pl\u0026aacute;ticas in different regions of South Texas were planned and implemented by the CC and project team. The community conversations provided opportunities for the council to put into practice the decision-making and collaborative frameworks established through their shared community agreements. As needed, monthly CC meetings were supplemented with additional sub-group meetings to plan the pl\u0026aacute;ticas. The CC was engaged by the study team to determine pl\u0026aacute;tica logistics, including the selected dates, locations, and overall structure of the gatherings. Members of the CC who lived in the regions where pl\u0026aacute;ticas were held served as designated local leaders in the planning, outreach, and implementation of the pl\u0026aacute;ticas. The CC and project team co-developed conversation guides to learn from community members about their experiences around dementia. Notes taken during pl\u0026aacute;tica conversations were analyzed by the study team and CC to identify community-driven dementia research priorities and outcomes. Following the implementation of each pl\u0026aacute;tica, the CC and project team would debrief and reflect on the successes and challenges of each session. Subsequent pl\u0026aacute;tica(s) would be adapted based on feedback from the debriefing sessions.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eTo examine engagement overtime with the CC, a participatory explanatory sequential mixed-methods design study was conducted (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Reporting of patient and public involvement in this study follows the GRIPP2 Short Form checklist (see Supplementary Table\u0026nbsp;1). The initial phase of the study involved the collection of quantitative data using the Research Engagement Survey Tool (REST) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] administered at three time points to identify any potential differences in levels of engagement with the CC prior to and following the implementation of pl\u0026aacute;ticas. The project team examined quantitative findings to inform the creation of interview guides used for the subsequent qualitative assessment phase. Interviews with members of the CC were conducted and analyzed to further examine their experiences of engagement. Upon completion of all analyses, quantitative and qualitative findings were interpreted together to elucidate a more nuanced assessment of engagement with the CC.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSample\u003c/h3\u003e\n\u003cp\u003eThe community-academic partnership that oversaw this project had extensive experience providing community resources and research for family caregivers of persons living with dementia, and thus brought with them a robust network of key individuals and partnering organizations with whom they collaborated in the South Texas region. The South Texas Area Health Education Centers Program (ST-AHEC) had partnered with the study team for prior initiatives, including the development of a CHW-focused training to promote brain health, address dementia, and advocate for patient-centered research [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The ST-AHEC has an extensive geographic catchment area and a wide-ranging network of promotoras and CHWs. Initial invitations to participate in the project as CC members were extended through the study team\u0026rsquo;s networks and ST-AHEC networks at the start of the project period. Recruited CHWs, caregivers, persons living with dementia, and other partners were asked if they could identify additional members to join the CC. Members of the CC were invited if they were located in a region of South Texas or surrounding areas, had a personal or professional connection to dementia, and were able to commit to attending all or most of the monthly meetings. Being Latino/Latina or Hispanic was not a requirement to join the CC, though all members of the CC and project team shared a commitment to centering the Latino community in the project.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eDuring phase 1 of the study, the validated REST was used to quantitatively examine engagement among the CC [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The REST is designed to assess how engagement occurs among all partners involved in engagement activities for research. It is comprised of 32 items that align with eight engagement principles (EPs). Each EP corresponds with survey items that are assessed using Likert-type scales to rate the quality of engagement (how well: poor, fair, good, very good, excellent, and not applicable) and quantity of engagement (how often: never, rarely, sometimes, often, always, and not applicable). The REST generates quality and quantity scores for each of the eight EPs as well as quality and quantity scores for the overall measure ranging from 0\u0026ndash;5 for each score. This measure has strong internal consistency for each of the eight EPs measured for both quality (Cronbach\u0026rsquo;s alpha range: 0.83\u0026ndash;0.92) and quantity (Cronbach\u0026rsquo;s alpha range: 0.79\u0026ndash;0.91) and the overall measure for quality (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.98) and quantity Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.97). The pl\u0026aacute;ticas served as critical structures in the project period during which the CC could leverage their capacity to implement collaborative research activities in partnership with the project team. As such, the quantitative phase of this study was anchored around the pl\u0026aacute;ticas, with three data collection timepoints: T1 took place prior to planning and implementing the pl\u0026aacute;ticas; T2 followed the implementation and debrief of the first three pl\u0026aacute;ticas, and; T3, the final administration, took place upon completion of three more pl\u0026aacute;ticas. The REST was administered to CC members via REDCap [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAfter conducting a preliminary analysis of the quantitative data, the project team discussed the findings to inform the development of a semi-structured interview guide. Interviews were conducted online using Zoom, audio recorded and transcribed. One participant who was living with dementia was provided the opportunity to participate in the interview alongside their family caregiver who was also a member of the CC.\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eQuantitative data were analyzed using STATA 16 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. After screening missing data, descriptive statistics including means and standard deviations were calculated for each EP and the overall measure. The mean of the 3\u0026ndash;5 items within each EP was calculated for EP-specific scores, then the overall means of the EP-specific scores were calculated to determine the overall REST scores for quality and quantity. Our primary hypothesis is that both the quality and quantity of engagement, as measured by REST, will be improved following pl\u0026aacute;ticas. Repeated measures analysis of variance (ANOVA) was employed to examine whether REST scores for each EP and the overall measure were different across three consecutive timepoints. In cases where Mauchley\u0026rsquo;s test indicated a violation of the assumption of sphericity (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the Greenhouse-Geisser epsilon values less than 0.75, the Greenhouse-Geisser correction was applied. Following, ANOVA, pairwise comparisons with Bonferroni correction were used to compare mean scores at T1-T2, T2-T3, and T1-T3. The threshold for statistical significance was a 2-sided p-value of 0.05.\u003c/p\u003e\u003cp\u003eScores were also examined in alignment with five levels of engagement identified during the Delphi process to develop the REST: 1) outreach and education, 2) consultation, 3) cooperation, 4) collaboration, and 5) partnership. Scoring in alignment with levels of engagement involves calculating a percentage score for REST items by each level of engagement, determined by classifications assigned by the REST development team. Scoring instructions and codes for performing analyses using statistical software is publicly accessible [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eQualitative content analysis of individual interviews was conducted. All transcripts were reviewed for accuracy prior to analysis. Using line-by-line coding in Microsoft Word, relevant sections were identified and summarized for applicability to study aims. Relevant segments of data were grouped based on similarities in content. The grouped data were sorted into categories with sub-categories used to cluster similar content within each category. Coding decisions and categorization were reviewed in collaboration between study team members until consensus was achieved.\u003c/p\u003e\u003cp\u003eFollowing the principles of explanatory mixed-methods design, data collected from the qualitative and quantitative phases of the study were reviewed by members of the project team [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Findings from the REST data were connected with and compared to categories identified through qualitative analysis, bringing to light any convergence or divergence across datasets. This integration phase allowed for a more nuanced, richer assessment of the CC\u0026rsquo;s engagement experiences.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eQuantitative data\u003c/h2\u003e\u003cp\u003eA total of 16 CC members participated in the study. Of the 16 CC members, 13 completed the REST at all time points. One member had resigned prior to the second data collection time point (T2), and another had joined after the first data collection time point (T1) had already been completed. Except for the intentionally limited representation of providers on the CC, representation was evenly distributed between persons living with dementia, caregivers, community organization, and researchers. Most CC members were women and identified as Hispanic or Latino. Half of CC members represented the San Antonio region, six CC members represented the Rio Grande Valley and surrounding areas, and the remainder represented the South Coastal region of Corpus Christi and surrounding areas (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographics of CC members (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrimary partner group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerson living with dementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity Health Worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity Organization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeriatrics and Palliative Care Provider\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResearcher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHispanic or Latino\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRegion\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSan Antonio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRio Grande Valley and surrounding area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth Coastal Texas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eResults of repeated measures ANOVA tests and pairwise \u003cem\u003et\u003c/em\u003e-tests are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Overall, engagement quality total scores increased significantly across the three time points (\u003cem\u003eF\u003c/em\u003e(2,24)\u0026thinsp;=\u0026thinsp;7.67, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003), with mean scores reflecting a statistically significant rise from T1 (M\u0026thinsp;=\u0026thinsp;4.18, SD\u0026thinsp;=\u0026thinsp;.69) to T3 (M\u0026thinsp;=\u0026thinsp;4.77, SD\u0026thinsp;=\u0026thinsp;.24), (\u003cem\u003et\u003c/em\u003e(12) = -3.35, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.006). Engagement quantity total scores showed an upward trend (\u003cem\u003eF\u003c/em\u003e(2,24)\u0026thinsp;=\u0026thinsp;3.47, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.047), though pairwise differences did not remain significant after correction.\u003c/p\u003e\u003cp\u003eMean scores for quality of engagement were seen for EP6 (\u003cem\u003eFacilitate collaborative, equitable partnerships\u003c/em\u003e) over time (\u003cem\u003eF\u003c/em\u003e(2,24)\u0026thinsp;=\u0026thinsp;6.97, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.004), with T1 scores (M\u0026thinsp;=\u0026thinsp;4.02, SD\u0026thinsp;=\u0026thinsp;.93) increasing at T2 (M\u0026thinsp;=\u0026thinsp;4.6, SD\u0026thinsp;=\u0026thinsp;.6), \u003cem\u003et\u003c/em\u003e(12) = -3.34, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.007. Similar changes were observed for EP7 quality scores (\u003cem\u003eInvolve all partners in the dissemination process\u003c/em\u003e) across time (\u003cem\u003eF\u003c/em\u003e(2,24)\u0026thinsp;=\u0026thinsp;5.02, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015), with a statistically significant increase from T1 (M\u0026thinsp;=\u0026thinsp;3.95, SD\u0026thinsp;=\u0026thinsp;1.06) to T3 (M\u0026thinsp;=\u0026thinsp;4.79, SD\u0026thinsp;=\u0026thinsp;0.4), \u003cem\u003et\u003c/em\u003e(12) = -3.27, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.013. Quality of engagement within EP1 (\u003cem\u003eFocus on community perspectives and determinants of health\u003c/em\u003e) increased over the study period (\u003cem\u003eF\u003c/em\u003e(2,24)\u0026thinsp;=\u0026thinsp;5.67, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010), with a statistically significant increase identified from T1 (M\u0026thinsp;=\u0026thinsp;4.17, SD\u0026thinsp;=\u0026thinsp;.64) to T3 (M\u0026thinsp;=\u0026thinsp;4.77, SD\u0026thinsp;=\u0026thinsp;.24), \u003cem\u003et\u003c/em\u003e(12), =-3.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.008. EP8 (\u003cem\u003eBuild and maintain trust in the partnership\u003c/em\u003e) quality scores also increased significantly (\u003cem\u003eF\u003c/em\u003e(2,24)\u0026thinsp;=\u0026thinsp;6.45, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.006) from T1 (M\u0026thinsp;=\u0026thinsp;4.37, SD\u0026thinsp;=\u0026thinsp;.69) to T2 (M\u0026thinsp;=\u0026thinsp;4.85, SD\u0026thinsp;=\u0026thinsp;.25), \u003cem\u003et\u003c/em\u003e(12) = -3.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.011). An additional notable increase was identified in EP2 (\u003cem\u003ePartner input is vital\u003c/em\u003e) across time (\u003cem\u003eF\u003c/em\u003e(2,24)\u0026thinsp;=\u0026thinsp;5.57, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.010), and between T1 (M\u0026thinsp;=\u0026thinsp;4.33, SD\u0026thinsp;=\u0026thinsp;.70) and T3 (M\u0026thinsp;=\u0026thinsp;4.88, SD\u0026thinsp;=\u0026thinsp;.24).\u003c/p\u003e\u003cp\u003eAverage quantity of engagement scores within most EPs showed upward but non-significant patterns. Statistically significant changes in quantity scores over time were observed for EP6 (\u003cem\u003eF\u003c/em\u003e(2,24)\u0026thinsp;=\u0026thinsp;4.83, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.017) and EP7 (\u003cem\u003eF\u003c/em\u003e(2,24)\u0026thinsp;=\u0026thinsp;4.14, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.029), though no statistically significant changes across between time points were identified. EP5 (\u003cem\u003eBuild on strengths and resources within the community or patient population\u003c/em\u003e) remained stable across the three time points. Results suggest that while CC perspectives of \u003cem\u003equantity\u003c/em\u003e of engagement did not change significantly, their perceived quality of engagement strengthened over time.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResearch engagement scores across three timepoints\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEngagement\u003c/p\u003e\u003cp\u003ePrinciples (EPs)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eANOVA (N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003ePairwise \u003cem\u003et\u003c/em\u003e-tests (N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT1-T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eT2-T3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eT1-T3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eM (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eUnadjusted \u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.18 (0.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.59 (0.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.77 (0.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.006\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.45 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colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.17 (0.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.63 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.77 (0.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.010\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.383\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.008\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.5 (0.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.67 (0.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.87 (0.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" 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colname=\"c5\"\u003e\u003cp\u003e0.010\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.410\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.015\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.54 (0.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.81 (0.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.92 (0.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.096\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" 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align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.86 (1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.58 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.6 (0.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.006\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.837\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.022\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.15 (1.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.54 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align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.084\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.72 (0.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.82 (0.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.77 (0.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.771\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.472\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.721\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.731\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.02 (0.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.6 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.73 (0.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.007\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.421\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.015\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.17 (0.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.56 (0.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.85 (0.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.017\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEP7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.95 (1.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.87 (1.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.79 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.015\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.818\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.013\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.21 (1.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.82 (1.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.95 (0.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.029\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.293\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.079\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEP8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.37 (0.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.85 (0.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.88 (0.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.006\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.011\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.790\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.022\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.67 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.75 (0.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.94 (0.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.482\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.102\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cb\u003eNote.\u003c/b\u003e \u003cem\u003eFor repeated measures ANOVA, unadjusted p-values are reported (Greenhouse\u0026ndash;Geisser epsilon values were examined, but adjusted values are not presented). For paired-samples t-tests, unadjusted p-values are presented; significance is interpreted relative to the Bonferroni-corrected alpha level of .017. Engagement Principles (EPs) are as follows: EP1, \u0026ldquo;Focus on community perspectives and determinants of health\u0026rdquo;; EP2, \u0026ldquo;Partner input is vital\u0026rdquo;; EP3, \u0026ldquo;Partnership sustainability to meet goals and objectives\u0026rdquo;; EP4, \u0026ldquo;Foster co-learning, capacity building, and co-benefit for all partners\u0026rdquo;; EP5, \u0026ldquo;Build on strengths and resources within the community or patient population\u0026rdquo;; EP6, \u0026ldquo;Facilitate collaborative, equitable partnerships\u0026rdquo;; EP7, \u0026ldquo;Involve all partners in the dissemination process\u0026rdquo;; EP8, \u0026ldquo;Build and maintain trust in the partnership.\u0026rdquo; p\u0026thinsp;\u0026lt;\u0026thinsp;.05. p\u0026thinsp;\u0026lt;\u0026thinsp;.01.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhen examined by levels of engagement, REST data showed the highest scores in the collaboration category for both quality and quantity across all time points (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Over the course of the project period, the greatest increases occurred in the partnership category, where quality scores rose from 9.8 to 16.7 (+\u0026thinsp;6.9 points) and quantity scores from 14.4 to 21.2 (+\u0026thinsp;6.8 points). Scores in lower engagement categories (outreach, consultation, and cooperation) declined modestly over time, whereas higher engagement categories (collaboration and partnership) showed trends toward increased scores.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eREST scores by levels of engagement\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel of engagement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eM (SD)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eOutreach \u0026amp; education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.2 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.8 (3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.1 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.5 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.1 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eConsultation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.0 (4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.5 (2.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.8 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.1 (4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.3 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eCooperation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24.4 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.6 (3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.8 (1.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.3 (4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.1 (3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.8 (0.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eCollaboration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52.1 (12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.6 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56 (3.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54.6 (10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.7 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52.7 (3.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003ePartnership\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9.8 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.6 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.7 (6.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.4 (9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.9 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.2 (4.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eQualitative data\u003c/h3\u003e\n\u003cp\u003eThree categories were identified through analysis of the qualitative data: 1) establishing partnerships, 2) building capacity together, and 3) sustaining the work. Subcategories of similar content were grouped together to depict nuanced findings within each category. The qualitative data reflect a cyclical process, from the structure of the CC to the application and sustainment of the work, showing an ongoing progression of engagement. This process is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eCategory 1: Establishing partnerships\u003c/h3\u003e\n\u003cp\u003eParticipants tied their engagement to structural features of the CC, including diversity in perspectives and regional representation, shared experiences with dementia, and the supportive approach to leadership from the project team.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003eDiversity of the CC.\u003c/span\u003e Participants emphasized the importance of diverse community perspectives, including current and former family caregivers, persons living with dementia, community organizations, health workers, and researchers. The inclusion of those directly impacted by dementia was described as especially valuable to members of the CC: \u0026ldquo;\u0026hellip;\u003cem\u003eHaving those special individuals in the group made it more interesting because we\u0026rsquo;re getting firsthand experience from somebody actually living with dementia and somebody caring for someone living with dementia\u003c/em\u003e\u0026rdquo; Hearing the personal experiences of CC members who were living with dementia and caring for family members supported the development of trust and formed a shared motivation to address the needs of communities. \u0026ldquo;\u003cem\u003eSome of our council members have really gone through very difficult situations. So, for them to open up... I think it showed us that, hey, you know, people hurt, there's people that are hurting\u0026hellip; And so, I think that really helped build the trust that people are just people, and all people need help\u003c/em\u003e.\u0026rdquo; Regional representation across South Texas was also critical, as members recognized cultural and resource differences while working toward shared goals: \u0026ldquo;\u003cem\u003eSan Antonio versus Laredo versus Corpus Christi versus the Rio Grande Valley \u0026mdash; we\u0026rsquo;re all different in so many ways\u0026hellip; For me, my community is my priority\u0026hellip; But yet, I still respect, and I want to also support other areas.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eShared experiences with dementia.\u003c/span\u003e While diversity was valued, participants stressed the importance of shared experiences with dementia. All CC members had some personal connection\u0026mdash;living with dementia, caregiving, or working professionally in the field. As one member shared, \u0026ldquo;\u003cem\u003eEverybody in some form or fashion has been touched by Alzheimer\u0026rsquo;s\u0026hellip; parent, grandparent, sibling, spouse. So, everybody understands what\u0026rsquo;s going on or what\u0026rsquo;s at stake\u003c/em\u003e.\u0026rdquo; This shared experience was seen as a defining feature of the CC\u0026rsquo;s engagement.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSupportive leadership\u003c/span\u003e. Participants highlighted the role of leadership in supporting the CC to provide guidance over project activities. \u0026ldquo;\u003cem\u003eWhat really jumped at me, and I think this is the most powerful aspect of it, is the variety of people on this council, experiences, backgrounds, I guess, locations\u0026hellip; and that kind of variety really needs a ringleader\u0026hellip; that will allow everyone to participate\u003c/em\u003e.\u0026rdquo; Supportive leadership was described as central to members\u0026rsquo; willingness and confidence to share feedback: \u0026ldquo;\u003cem\u003eAll the members are encouraged to really provide feedback\u0026hellip; it\u0026rsquo;s an open forum where we feel safe, and know that whatever we bring about is going to be taken constructively\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eCategory 2: Building capacity together\u003c/h2\u003e\u003cp\u003eFrom the foundation provided by the partnership structure, participants shared their engagement experiences related to the process of capacity building to implement the community pl\u0026aacute;ticas together. They described the CC as a learning experience, in which they were able to adapt and grow through the engagement process. Participants spoke of a shared purpose in hosting the community pl\u0026aacute;ticas among the group formed through the CC experience and the importance of cultivating trust to facilitate meaningful collaboration. A key part of this process was the importance of being heard by one another and the project team when shaping how the pl\u0026aacute;ticas were approached.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eA learning experience.\u003c/span\u003e Regardless of prior experience on councils or boards, participants described the CC as a unique learning opportunity. \u0026ldquo;\u003cem\u003eFor me, it was the first time being considered a member of something\u0026hellip;it gave me a different sense of cohesiveness and a sense of unity than I had experienced before\u003c/em\u003e\u0026rdquo;. The CC created space to exchange information and resources: \u0026ldquo;\u003cem\u003eI've learned being on this council that\u0026hellip; if I come up with, with something or somebody tells me something, I know where to go to get more resources. You know, that's been awesome\u003c/em\u003e\u0026rdquo;. Activities with the project team also built members\u0026rsquo; own experiences and capacities: \u0026ldquo;\u003cem\u003eI have (previously) hosted what they call \u0026lsquo;community pl\u0026aacute;ticas\u0026rsquo;, but\u0026hellip; it was not the same\u0026hellip; Now I can make comparisons\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eUniting through shared goals\u003c/span\u003e. Participants described developing camaraderie through shared goals in planning and implementing the pl\u0026aacute;ticas. \u0026ldquo;\u003cem\u003eI\u0026rsquo;ve learned to appreciate everybody\u0026rsquo;s input\u0026hellip; we all have different roles, but we share that commonality of trying to help others\u003c/em\u003e.\u0026rdquo; Collaboration was supported by a sense of unity and shared mission: \u0026ldquo;\u003cem\u003eEverybody understood that we all had a purpose and a mission\u0026hellip; we each took our role within the group and that\u0026rsquo;s how we all did the work\u003c/em\u003e.\u0026rdquo; Some described the CC as an extension of themselves: \u0026ldquo;\u003cem\u003eThey\u0026rsquo;re just another part of me, an extension of what I do, but maybe in a different capacity\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCultivating trust for collaboration\u003c/span\u003e. Trust was cited as essential for collaboration despite differences in perspective or region: \u0026ldquo;\u003cem\u003eAll of us are different\u0026hellip; and continuing to build on that trust\u0026hellip; I think the outcomes have been wonderful, and it stems from the trust.\u003c/em\u003e\u0026rdquo; Those directly impacted by dementia emphasized respect as key to building trust: \u0026ldquo;\u003cem\u003eI like the way I\u0026rsquo;m treated. And if you can treat me like that, I know you can treat other people that way\u003c/em\u003e.\u0026rdquo; Others described trust through openness to share personal experiences: \u0026ldquo;\u003cem\u003eFor me to share some personal experiences about my family, you just don\u0026rsquo;t do that with everybody, especially in the Hispanic community\u0026hellip; but everybody felt comfortable\u0026hellip; truly, you could feel the love of the council members\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eBeing heard\u003c/span\u003e. A commonly shared experience among participants was a feeling of being listened to by the other members of the CC and the project team. This was a vital component of their engagement experiences, often cited as a facilitator of trust and a key aspect of the SC\u0026rsquo;s ability to achieve consensus for decision-making for the pl\u0026aacute;ticas as a group. \u003cem\u003e\u0026ldquo;I feel like being part of this council, yes, we have very opinionated people, but never spoke over each other. We all allow each other time to, you know, to voice our opinions or our thoughts\u0026rdquo;.\u003c/em\u003e Being heard was sufficient for CC members who expressed that as long as they felt listened to, they understood if their input was not ultimately the direction taken, \u0026ldquo;\u003cem\u003ewe may not go with what some of us recommend, but at least we were heard and were given that opportunity to be heard and listened. And that's important\u0026rdquo;\u003c/em\u003e. Feeling listened to was an important experience for persons living with dementia to be included in providing oversight and input in project activities, \u0026ldquo;\u003cem\u003eThey listen to me, specifically, specially. And I really appreciate that\u003c/em\u003e\u0026rdquo;. Another person living with dementia shared, \u0026ldquo;\u003cem\u003esometimes I don't (give input), because I feel like, like, everybody's much more educated and I don't know how to, to express myself. But my daughter\u0026hellip; she's always saying, \u0026lsquo;Mom, even if it's simple, you bring you bring your point across\u0026rsquo;\u0026hellip; I try to reach out to, you know, and remember that at least I'm talking, some people don't even talk\u0026hellip; It's getting easier because I'm getting to know them\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eCategory 3: Sustaining the work\u003c/h2\u003e\u003cp\u003eParticipants reflected on outcomes of their collaboration, noting that the CC built capacity to implement pl\u0026aacute;ticas across South Texas and engage wider communities. The pl\u0026aacute;ticas were described as responsive to community needs, providing opportunities for those impacted by dementia to share and connect. Looking ahead, participants emphasized the importance of sustaining the work by following through on what was learned from these conversations.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEngaging communities (pl\u0026aacute;ticas)\u003c/span\u003e. Participants described the pl\u0026aacute;ticas as successful in connecting with wider communities and providing insight into how experiences with dementia could inform research: \u0026ldquo;\u003cem\u003eWe want to report that input to someone at the research level\u0026hellip; to say, this is what the community is asking for\u003c/em\u003e.\u0026rdquo; Facilitating the pl\u0026aacute;ticas also allowed the CC to model their own engagement strategies: \u0026ldquo;\u003cem\u003eThe way the pl\u0026aacute;ticas were coordinated\u0026hellip; you heard every single individual speak\u0026hellip; there was a lot of active listening and clarifications\u003c/em\u003e.\u0026rdquo; Participants described the culturally tailored approach for each pl\u0026aacute;tica as contributing to the communities\u0026rsquo; willingness to share in the pl\u0026aacute;tica setting: \u0026ldquo;\u003cem\u003eWe bring out the food, we bring out the music\u0026hellip; the pl\u0026aacute;tica right away opens up, because we\u0026rsquo;ve used that for years and years\u0026hellip; We get in a circle, you know, so that everybody can see each other and hear each other, you know\u0026hellip; that\u0026rsquo;s the Latino culture right there\u003c/em\u003e.\u0026rdquo; Members emphasized that this approach created safety for vulnerability about experiences and challenges: \u0026ldquo;\u003cem\u003eAt each session, people really let their hair down\u0026hellip; there was crying\u0026hellip; and I don\u0026rsquo;t think people will do that if they don\u0026rsquo;t feel comfortable. I feel like we did that\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eResponsiveness to communities\u003c/span\u003e. Participants emphasized that the pl\u0026aacute;ticas were directly responsive to community needs, particularly for Latino families impacted by dementia. In many South Texas regions, few opportunities exist to support persons with dementia and their families. \u0026ldquo;\u003cem\u003eThere is such a need for the Latino community\u0026hellip; they live in the shadows\u0026hellip; and when they do come out, they\u0026rsquo;re kind of hesitant\u003c/em\u003e.\u0026rdquo; Providing a platform for open communities to talk through their experiences, alongside professionals and community organizations, raised awareness of resources and reduced isolation: \u0026ldquo;\u003cem\u003eIt makes the people feel a bit better\u0026hellip; they weren\u0026rsquo;t alone\u0026hellip; having a few physicians and healthcare personnel there made them feel like what they were going through was being heard\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eFollowing through\u003c/span\u003e. A strong motivation was shared among CC members that the work needed to continue, especially in following up the pl\u0026aacute;ticas with action to address the needs addressed through the conversations. \u0026ldquo;\u003cem\u003eHow do we become sustainable beyond the project? \u0026hellip; there has to be a conversation about sustainability of these programs\u003c/em\u003e.\u0026rdquo; Recognizing that change takes time, they saw continued community engagement as the next step: \u0026ldquo;\u003cem\u003eIt\u0026rsquo;s not like from one day to another\u0026hellip; it takes a lot of effort\u0026hellip; from here, from the community, that\u0026rsquo;s the first step\u003c/em\u003e.\u0026rdquo; The participants felt the framework of the CC and their role in planning the pl\u0026aacute;ticas is a model that can be replicated to continue engaging and learning from Latino communities impacted by dementia: \u0026ldquo;\u003cem\u003eIts simplicity was what served it best\u0026hellip; however that could be replicated is very powerful.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eMixed-methods interpretation\u003c/h2\u003e\u003cp\u003eEngagement with the CC was facilitated through partnering to plan, implement, and evaluate the pl\u0026aacute;ticas. CC perspectives on engagement are best understood by interpreting the quantitative and qualitative findings together. At baseline, T1 REST scores reflected high engagement (quality\u0026thinsp;=\u0026thinsp;4.18, quantity\u0026thinsp;=\u0026thinsp;4.45). Interviews with the CC explained these high scores in describing the structural components of the CC that were present at the onset of the study, diversity, shared experiences and familiarity with dementia, and supportive leadership.\u003c/p\u003e\u003cp\u003eRepeated measures ANOVA tests demonstrated that strategies used to engage the CC in the pl\u0026aacute;ticas nonetheless resulted in statistically significant changes over time in overall REST scores for both quality and quantity of engagement, despite already high baseline levels. Increases were observed across most EPs, with significant improvements in quality scores within EP1, EP2, EP4, EP6, EP7, and EP8. EP5 (\u003cem\u003eBuild on strengths and resources within the community or patient population\u003c/em\u003e) showed little change, explained through interviews as a result of a strong emphasis at the project onset on community strengths and resources, a value that remained consistent over the study period.\u003c/p\u003e\u003cp\u003ePairwise comparisons reflected significant changes in quality of engagement for EP1 (\u003cem\u003efocus on community perspectives and determinants of health\u003c/em\u003e) and EP2 (\u003cem\u003epartner input is vital\u003c/em\u003e) from T1\u0026ndash;T3. Qualitative findings reflect that the inclusion of diverse groups on the CC, including persons living with dementia and family caregivers alongside CHWs, enabled the focus to remain on the community. Further, the use of pl\u0026aacute;ticas as the culturally-specific approach to engagement with the CC and wider community most likely contributed to the noted increase in scores for EP1. Capacity building activities and consistent meetings between the study team and CC that intentionally sought partner input to shape pl\u0026aacute;tica content and processes likely contributed to the observed increase in EP2 scores.\u003c/p\u003e\u003cp\u003eEP6 (\u003cem\u003efacilitate collaborative, equitable partnerships\u003c/em\u003e) improved from T1\u0026ndash;T2 and T1\u0026ndash;T3, supported by qualitative accounts that prolonged involvement in the project fostered stronger relationships between community and academic partners. EP7 (\u003cem\u003einvolve all partners in the dissemination process\u003c/em\u003e) improved only at T1\u0026ndash;T3, reflecting that longer participation created opportunities to present work and co-author publications. EP8 (\u003cem\u003ebuild and maintain trust in the partnership\u003c/em\u003e) also increased significantly from T1\u0026ndash;T2, consistent with member accounts that sustained involvement cultivated trust and confidence in the CC\u0026rsquo;s collaborative work.\u003c/p\u003e\u003cp\u003eWhen quantitative data were assessed within levels of engagement, REST scores were consistently highest in the collaboration category, explained by leadership\u0026rsquo;s role in guiding discussions and consensus. Over time, CC members described becoming more comfortable to take leadership in planning and implementing the pl\u0026aacute;ticas. The greatest increases were from T1\u0026ndash;T3 in the partnership category (quality\u0026thinsp;+\u0026thinsp;6.9, quantity\u0026thinsp;+\u0026thinsp;6.8), explained by interviews describing more opportunities for CC input, decision-making, and trust-building through the pl\u0026aacute;tica process as the project progressed.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIncluding communities as partners in research, where their perspectives and experiences are centered is key to addressing the persistent underrepresentation of Latinos in dementia care research. This study assessed engagement with a community council (CC) convened to conduct culturally-specific outreach and engagement with Latinos in South Texas. Despite the growing urgency to address dementia research gaps among communities of color, this study is one of few to assess community partner engagement for dementia research using a council model [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFindings can be interpreted through a Donabedian-type framework of structure, process, and outcome [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Structural components of the CC influenced engagement processes and outcomes, helping explain high baseline REST scores. Similar to findings from other studies assessing the council structure for research partnerships [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], the establishment of a diverse council to oversee the project was an effective facilitator of engagement at the onset of the project. Participants stressed that representation from different regions of South Texas and varied lived or professional dementia experiences strengthened the shared knowledge and capacity of partners. While increases were observed across most EPs, no statistically significant difference was identified for EP5 (\u003cem\u003eBuilds on strengths and resources within the community or patient population\u003c/em\u003e). This may be explained by the study\u0026rsquo;s grounding in key community-based participatory research (CBPR) principles, as the project was designed from the outset around the needs and experiences of the target population [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePast community-engaged research identified a need for culturally specific approaches to engage Latinos in dementia research [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. To address this, CHWs were integrated as a critical component of the CC structure. CHWs strengthened the overall project through their deep connections to community members in their areas and their ability to bring the perspectives of highly impacted and underserved communities to the project. While CHWs have been leveraged as key partners in health research broadly [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], they remain mostly excluded as co-leaders in dementia care research [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. By partnering with CHW leaders, the pl\u0026aacute;ticas were ultimately better aligned with the needs and experiences of South Texas communities.\u003c/p\u003e\u003cp\u003eProcesses of engagement applied during the study period included monthly meetings, capacity building workshops, and the development and implementation of community pl\u0026aacute;ticas. Through these activities, partnership with the CC evolved as the study progressed, as reflected in the increasing REST scores within EP6, '\u003cem\u003eFacilitate collaborative, equitable partnerships\u003c/em\u003e\u0026rdquo;. This study demonstrates that trust-building activities facilitated over time were central to cultivating equitable partnerships with the study team. This is consistent with community-engaged research methodology that relies on mutually beneficial long-term relationships of rapport-building and trust [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. As the project progressed, CC members gained new skills, developed shared goals with a mutual sense of purpose, and enacted decision-making and co-learning while tailoring engagement to their communities. With each opportunity to listen and be listened to, the CC was able to build and maintain trust in each other and in the project team.\u003c/p\u003e\u003cp\u003eThe CC\u0026rsquo;s structure and processes supported successful outcomes from the partnership, most notably the implementation of six community pl\u0026aacute;ticas in South Texas. As a reciprocal, bi-directional storytelling practice rooted in Latino culture, pl\u0026aacute;ticas have been described by community researchers as an effective qualitative method [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Yet this approach had not been formally examined as a strategy for strengthening community-academic partnerships for research. Interviews with members of the CC highlighted the personal impact of their role in planning and implementing pl\u0026aacute;ticas that were tailored to their respective regional communities. This approach built on their lived experiences, knowledges, and connections, emphasizing the importance of their role as leaders in the planning and implementation process. When assessed for the five levels of engagement, the REST data reflected the greatest increase in scores within \u0026ldquo;partnership,\u0026rdquo; the highest category of engagement. CC members\u0026rsquo; growing sense of ownership and leadership over time as they implemented the community pl\u0026aacute;ticas explains these increases and their expressed commitment to sustain and expand the work.\u003c/p\u003e\u003cp\u003eThis study demonstrates that aligning partnership structures with key principles of community-centered engagement generates outcomes of strengthened trust, partnership, and sustained leadership. Together, these findings point to a pathway for transforming dementia research to more fully share power and leadership with highly impacted communities.\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eFew statistically significant findings from the comparative analysis of REST scores for quantity of engagement are likely due to the study being underpowered by the small sample size. Quantitatively measuring engagement is inherently challenging, as meaningful engagement typically requires small councils. While the recommended size of a community advisory board or council varies, most guidance suggests staying below 10\u0026ndash;15 members [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Engaging more partners on the CC may have added some power to the analysis but would have potentially come at a cost to the quality of engagement possible. Although this study was conducted with Latino communities in South Texas, which may limit generalizability, the approach and methods warrant further study to determine their applicability to other populations.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere is a critical need for evidence on effective strategies to recruit and retain underrepresented populations in research. Engagement and recruitment science is a developing discipline and research is needed to identify effective strategies for community partner engagement, especially among communities of color [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This study contributes to the science of engagement by reflecting on outcomes from the implementation of culturally-specific engagement strategies among Latino communities of South Texas. Results from this study provide evidence that can support researchers and communities to meaningfully partner with each other for research around dementia care. Findings provide evidence that researchers and communities can draw on to build equitable partnerships and address the persistent underrepresentation of highly impacted populations in dementia research.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics approval and consent to participate\u003c/u\u003e. All study procedures were performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. This project was submitted to the Institutional Review Board for ethical review and deemed to be exempt (HSC22-0277E). All participants were provided an information sheet which was reviewed prior to attaining consent to participate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication\u003c/u\u003e. Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of data and materials\u003c/u\u003e. All quantitative and qualitative data generated and analyzed during the current study are not publicly available to protect participant confidentiality. De-identified survey data and qualitative coding summaries that support the findings of this study may be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests\u003c/u\u003e. The authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding\u003c/u\u003e. The work was funded by a Patient Centered Outcomes Research Institute (PCORI) Eugene Washington Engagement Award (EACB-23031).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthors\u0026apos; contributions\u003c/u\u003e. SM conceived and led the study, conducted the analysis, and was the primary contributor to writing the manuscript. BYC supported SM in the statistical analysis. JE, BF, and KDLL contributed to study coordination, data collection, and interpretation. CW provided senior mentorship and guidance throughout the study. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcknowledgements\u003c/u\u003e. The authors extend their deepest gratitude to the members of the Community Council who generously contributed their time, experience, and insight to this study. We also honor the memory of Dr. Janna Lesser, whose vision and commitment were instrumental to this work and whose loss is deeply felt. We are grateful to the communities of South Texas for their continued engagement and dedication to improving the lives of families impacted by dementia. Finally, we acknowledge the Patient-Centered Outcomes Research Institute (PCORI) for their support and guidance in making this project possible.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthors\u0026apos; information (optional).\u003c/u\u003e All research partners for this study were researchers who also cared for family members impacted by dementia, with most actively serving as caregivers during the study period. Co-authors include community health workers (CHWs) who partnered in the study and contributed to the overall project. All authors lived in South Texas or surrounding areas at the time of the study. The professional expertise and lived experiences of both community and academic partners were integral to shaping the study, and their intersectionality strengthened the depth and relevance of our collaborative efforts. Additional community partners were invited to participate in the manuscript process but respectfully declined; however, they actively supported the study and the dissemination of its findings in many other ways, for which we are deeply grateful.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWu S, Vega WA, Resendez J, Jin H. Latinos \u0026amp; Alzheimer\u0026rsquo;s disease: new numbers behind the crisis. 2016. https://www.usagainstalzheimers.org/sites/default/files/2016-06/Latinos-and-AD_USA2-Impact-Report.pdf. Accessed 04 November 2024. \u003c/li\u003e\n\u003cli\u003eAlzheimer\u0026rsquo;s Association. 2025 Alzheimer\u0026rsquo;s disease facts and figures. Alzheimers Dement. 2025;21(4):e70235.\u003c/li\u003e\n\u003cli\u003eClark CM, DeCarli C, Mungas D, Chui HI, Higdon R, Nu\u0026ntilde;ez J, et al. Earlier onset of Alzheimer disease symptoms in Latino individuals compared with Anglo individuals. 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Am J Geriatr Psychiatry. 2011;19(5):430\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eMassett HA, Mitchell AK, Alley L, Simoneau E, Burke P, Han SH, et al. Facilitators, challenges, and messaging strategies for Hispanic/Latino populations participating in Alzheimer\u0026rsquo;s disease and related dementias clinical research: a literature review. J Alzheimers Dis. 2021;82(1):107\u0026ndash;27.\u003c/li\u003e\n\u003cli\u003eCanevelli M, Bruno G, Grande G, Quarata F, Raganato R, Remiddi F, et al. Race reporting and disparities in clinical trials on Alzheimer\u0026rsquo;s disease: a systematic review. Neurosci Biobehav Rev. 2019;101:122\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eNational Institutes of Health. Inclusion statistics report: Alzheimer\u0026rsquo;s disease related dementias (ADRD). 2023. https://report.nih.gov. Accessed 20 December 2023.\u003c/li\u003e\n\u003cli\u003eOrtiz K, Nash J, Shea L, Oetzel J, Garoutte J, Sanchez-Youngman S, et al. 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San Francisco: Jossey-Bass; 2018.\u003c/li\u003e\n\u003cli\u003eIsrael B, Schulz A, Parker E, Becker A, Allen A, Guzman JR, et al. Community-based participatory research for health: from process to outcomes. In: Minkler M, Wallerstein N, editors. Critical issues in developing and following community-based participatory research principles. San Francisco: Jossey-Bass; 2008. p. 47\u0026ndash;66.\u003c/li\u003e\n\u003cli\u003eJennings LA, Palimaru A, Corona MG, Cagigas XE, Ramirez KD, Zhao T, et al. Patient and caregiver goals for dementia care. Qual Life Res. 2017;26(3):685\u0026ndash;93.\u003c/li\u003e\n\u003cli\u003ePatel NK, Masoud SS, Meyer K, Davila AV, Rivette S, Glassner AA, et al. Engaging multi-stakeholder perspectives to identify dementia care research priorities. J Patient Rep Outcomes. 2021;5(1):46.\u003c/li\u003e\n\u003cli\u003eReuben DB, Gill TM, Stevens A, Williamson J, Volpi E, Lichtenstein M, et al. D-CARE: the dementia care study: design of a pragmatic trial of the effectiveness and cost effectiveness of health system-based versus community-based dementia care versus usual dementia care. J Am Geriatr Soc. 2020;68(11):2492\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eFierros CO, Delgado Bernal D. VAMOS A PLATICAR: the contours of pl\u0026aacute;ticas as Chicana/Latina feminist methodology. Chicana/Latina Stud. 2016;15(2):98\u0026ndash;121.\u003c/li\u003e\n\u003cli\u003eBernal D. Using a Chicana feminist epistemology in educational research. Harv Educ Rev. 1998;68(4):555\u0026ndash;83.\u003c/li\u003e\n\u003cli\u003eFlores Carmona J, Hamzeh M, Delgado Bernal D, Hassan Zareer I. Theorizing knowledge with pl\u0026aacute;ticas: moving toward transformative qualitative inquiries. Qual Inq. 2021;27(1):3\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eGuajardo F, Guajardo M. The power of pl\u0026aacute;tica. Reflections. 2013;13(1):159\u0026ndash;64.\u003c/li\u003e\n\u003cli\u003eHuante-Tzintzun N. The problematics of method: decolonial strategies in education and Chicana/Latina testimonio/pl\u0026aacute;tica [dissertation]. Salt Lake City: University of Utah; 2018.\u003c/li\u003e\n\u003cli\u003eGoodman MS, Ackermann N, Haskell-Craig Z, Jackson S, Bowen DJ, Sanders Thompson VL. Construct validation of the Research Engagement Survey Tool (REST). Res Involv Engagem. 2022;8(1):26.\u003c/li\u003e\n\u003cli\u003eMasoud SS, Escare\u0026ntilde;o JT, Flores B, Lesser J, White CL. Project ECHO Brain Health: assessing the impact of a pilot program to promote self-efficacy among community health workers. Fam Community Health. 2024;47(1):64\u0026ndash;71.\u003c/li\u003e\n\u003cli\u003eHarris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. 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Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities. Am J Public Health. 2010;100(11):2094\u0026ndash;102.\u003c/li\u003e\n\u003cli\u003eMasoud SS, Glassner AA, Patel N, Mendoza M, James D, Rivette S, et al. Engagement with a diverse stakeholder advisory council for research in dementia care. Res Involv Engagem. 2021;7(1):54.\u003c/li\u003e\n\u003cli\u003eDabiri S, Raman R, Grooms J, Molina-Henry D. Examining the role of community engagement in enhancing the participation of racial and ethnic minoritized communities in Alzheimer\u0026rsquo;s disease clinical trials: a rapid review. J Prev Alzheimers Dis. 2024;11(6):1647\u0026ndash;72.\u003c/li\u003e\n\u003cli\u003eCoulter K, Ingram M, McClelland DJ, Lohr A. Positionality of community health workers on health intervention research teams: a scoping review. Front Public Health. 2020;8:208.\u003c/li\u003e\n\u003cli\u003eAskari N, Bilbrey AC, Garcia Ruiz I, Humber MB, Gallagher-Thompson D. Dementia awareness campaign in the Latino community: a novel community engagement pilot training program with promotoras. Clin Gerontol. 2018;41(3):200\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eGarza N, Uscamayta-Ayvar M, Maestre G. Addressing neurocognitive disorders, dementias, and Alzheimer\u0026rsquo;s disease in colonias of the Lower Rio Grande Valley: establishing a research foundation using promotores. Ethn Dis. 2020;30(4):775\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003eMatthews AK, Anderson EE, Willis M, Castillo A, Choure W. A community engagement advisory board as a strategy to improve research engagement and build institutional capacity for community-engaged research. J Clin Transl Sci. 2018;2(2):66\u0026ndash;72.\u003c/li\u003e\n\u003cli\u003eWallerstein N, Oetzel JG, Sanchez-Youngman S, Boursaw B, Dickson E, Kastelic S, et al. Engage for equity: a long-term study of community-based participatory research and community-engaged research practices and outcomes. Health Educ Behav. 2020;47(3):380\u0026ndash;90.\u003c/li\u003e\n\u003cli\u003eKubicek K, Robles M. Resource for integrating community voices into a research study: community advisory board toolkit. Los Angeles: Southern California Clinical and Translational Science Institute; 2016.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"research-involvement-and-engagement","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"riae","sideBox":"Learn more about [Research Involvement and Engagement](http://researchinvolvement.biomedcentral.com/)","snPcode":"40900","submissionUrl":"https://submission.nature.com/new-submission/40900/3","title":"Research Involvement and Engagement","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Research engagement, Dementia research, Community council, Latino communities, Persons living with dementia, Family caregivers, Translational science, Mixed-methods design, Community-based participatory research","lastPublishedDoi":"10.21203/rs.3.rs-7458959/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7458959/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eLatinos are disproportionately affected by dementia but remain underrepresented in dementia research. Culturally responsive strategies are needed to engage Latino communities as research partners. This study examined engagement with a community council of Latino partners in South Texas, convened to co-lead culturally-specific engagement activities (\u003cem\u003ecommunity pl\u0026aacute;ticas\u003c/em\u003e) and identify dementia care research priorities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eAn explanatory sequential mixed-methods design study was implemented to assess engagement with council for this project. The Research Engagement Survey Tool (REST) was administered at three time points over two years. Repeated measures ANOVA and pairwise \u003cem\u003et\u003c/em\u003e-tests assessed changes in engagement quality and quantity across eight engagement principles. Descriptive statistics examined changes across five levels of engagement. Semi-structured interviews with council members (n\u0026thinsp;=\u0026thinsp;10) were conducted and analyzed using content analysis. Quantitative and qualitative findings were integrated to provide a comprehensive assessment of engagement.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThirteen council members\u0026mdash;representing caregivers, persons living with dementia, community health workers, organizations, clinicians, and researchers\u0026mdash;completed surveys at all time points. Overall quality scores increased from baseline to study end (mean 4.18 to 4.77, p\u0026thinsp;=\u0026thinsp;.003). Increases were observed within several areas of engagement, including focusing on community perspectives (p\u0026thinsp;=\u0026thinsp;.008), valuing partner input (p\u0026thinsp;=\u0026thinsp;.015), co-learning and capacity building (.017), fostering collaborative partnerships (p\u0026thinsp;=\u0026thinsp;.015), involving partners in dissemination (p\u0026thinsp;=\u0026thinsp;.013), and building trust (p\u0026thinsp;=\u0026thinsp;.022). When examined by levels of engagement, collaboration remained the highest across all time points, while the largest increases occurred in partnership (quality\u0026thinsp;+\u0026thinsp;6.9; quantity\u0026thinsp;+\u0026thinsp;6.8). Qualitative findings reinforced survey results, highlighting three categories: establishing partnerships through diversity, shared experiences, and leadership; building capacity through co-learning, trust, and being heard; and sustaining the work. Together, the survey and interview results illustrate a trajectory in which structural diversity and inclusive processes produced outcomes of stronger trust, partnership, and sustained community leadership.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study demonstrates that community councils can effectively engage Latinos in dementia research when structured around cultural values and community-centered methods. By aligning structural diversity, relational processes, and shared leadership, engagement strategies strengthened trust and fostered sustained partnership. These findings contribute evidence to the science of engagement and provide a model for reducing underrepresentation of Latinos in dementia research.\u003c/p\u003e","manuscriptTitle":"Partnering with Latino Communities for Dementia Research: A Mixed-Methods Study of Engagement","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-01 09:06:55","doi":"10.21203/rs.3.rs-7458959/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-25T03:05:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-25T01:19:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-14T21:09:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"131703878216310180598651282195116724714","date":"2026-01-29T22:35:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325901959132817697023053601179513007899","date":"2026-01-26T08:39:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116509214628687837105614283611309327435","date":"2026-01-21T15:27:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-07T11:15:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6206734499781474169566021140959731768","date":"2025-10-23T10:07:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-20T22:18:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T09:07:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-29T08:57:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"Research Involvement and Engagement","date":"2025-08-26T05:23:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"research-involvement-and-engagement","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"riae","sideBox":"Learn more about [Research Involvement and Engagement](http://researchinvolvement.biomedcentral.com/)","snPcode":"40900","submissionUrl":"https://submission.nature.com/new-submission/40900/3","title":"Research Involvement and Engagement","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cde18ec8-02f7-4fd2-87cb-73455cbfa3f5","owner":[],"postedDate":"October 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-26T16:38:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-01 09:06:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7458959","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7458959","identity":"rs-7458959","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}