Adapting Citizens’ Panels for Under-Resourced Rural Settings: A Community-Based Participatory Approach to Identify Feasible Health Policy

Community-based participatory strategies can help academics and practitioners identify and prioritize health policies that are timely and responsive to local public health needs. These approaches may need to be adapted when used in rural or under-resourced communities due to contextual factors, resource availability, and communication needs that shape local health issues. In this article, we describe how we modified the citizens’ panels approach to engage rural communities in policy formulation and feasibility in a rural region in California. We adapted a deliberative citizen panel approach to present viable policy options that were contextually feasible, considering local socio-political and demographic factors (i.e., predominantly Latino, rural population), to address key public health concerns identified by participants. Key adaptations included: (1) partnering with an established community network; (2) presenting culturally relevant policy options to address participant concerns; and (3) making it optional to rank-order policy options. We partnered with a group of promotoras (Community Health Workers or CHWs) from a local nonprofit organization in an under-resourced rural setting. Participants selected housing insecurity and behavioral health services as top public health priorities. In April and August 2024, we conducted two citizens’ panel sessions with promotoras and presented three policy options for each public health priority, followed by small group discussions. Materials were created and presented in Spanish as this was the participants’ dominant and preferred language. Regarding housing affordability, all presented policies were positively received by promotoras , although some expressed a preference for the right to legal representation. Participants noted that community members are frequently unaware of this right or of landlord regulations due to language barriers. Regarding mental health service shortages, Project Cal-Well and the Community Mental Health Equity Project received the most support—especially among mothers and grandmothers—with several stating that these initiatives complemented each other and could reduce disparities, promote cultural humility through more responsive and community-informed care, and improve access to mental health services. Adapting citizens’ panels for rural communities demonstrates the portability and flexibility of deliberative approaches and highlights the need to adjust these approaches to local contexts and resource landscapes.