Adapting a Health Impact Assessment Tool for Community-Engaged Research to Improve Health Equity Measurements for NIH RADx-UP Pilot Projects

The National Institutes of Health (NIH) supported the Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) program, which aims to ensure that all Americans have access to COVID-19 testing and promotes health equity, especially in underserved communities. Under RADx-UP, there are two pilot programs - Community Collaboration Grants (C2G) and Rapid Research Pilot Program (RP2) - that fund projects to conduct community-engaged outreach and research to address COVID-19 testing disparities. As such, we sought to assess projects' health equity impacts within their priority populations. Our evaluation team used cognitive interviews with C2G and RP2 project representatives to revise health equity metrics within an existing Health Impact Assessment (HIA) tool to measure health equity impacts within these community-engaged research projects. During interviews, participants indicated that we needed to improve the clarity and readability of key terms and phrases related to health equity, and they provided suggestions for how to tailor metrics to community partners. In this paper, we highlight our process of adapting the original metrics and share lessons learned that other evaluators may apply to their work. Our project highlights the importance of cognitive interviewing as a critical methodology to tailor an existing pilot-tested HIA to a community-based audience; however, it also sheds light on the difficulties of measuring health equity within community-engaged research initiatives and future recommendations.