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Article

Toward a Sustainable Future: Advancing Health Promotion in Underserved Populations Through Collaborative Engagement

by
Yok-Fong Paat
1,*,
Angela V. Dorado
1,
Diego Garcia Tovar
1,
Nathan W. Myers
2,
Sarah L. Ruiz
3,
David A. Perez
3,
Brenda L. Ramirez Vara
1,
Elizabeth Camacho
1,
Guillermina Gina Núñez-Mchiri
4,
Hector Zamora, Jr.
5,
Karim C. Singh
1 and
Rosa A. Polanco
6
1
The University of Texas at El Paso, El Paso, TX 79968, USA
2
New Mexico State University, Las Cruces, NM 88003, USA
3
Sun City Dietitians, El Paso, TX 79905, USA
4
San Diego State University, San Diego, CA 92182, USA
5
Dismas Charities, El Paso, TX 79915, USA
6
Texas Health and Human Services, El Paso, TX 79901, USA
*
Author to whom correspondence should be addressed.
Sustainability 2025, 17(16), 7507; https://doi.org/10.3390/su17167507
Submission received: 27 June 2025 / Revised: 29 July 2025 / Accepted: 2 August 2025 / Published: 20 August 2025
(This article belongs to the Section Health, Well-Being and Sustainability)
Versions Notes

Abstract

Effective community health initiatives are grounded in strategic collaboration among community-based organizations and local residents to ensure the interventions are responsive to the community’s unique needs. Drawing on insights from community partners and project participants, this study explored key factors that facilitated, hindered, and strengthened community engagement, collaboration, and sustainability in health promotion efforts for underserved populations on the U.S.-Mexico border. This study utilized semi-structured interviews to gather the perspectives and insights of community partners and participants regarding effective health promotion strategies developed through our collaborative project. Data were collected from 15 community partners who have collaborated with our project and 15 participants who had attended our project events (n = 30). Our study identified four major themes: (1) key attributes and perceived value of effective health promotion activities, (2) tailored approaches for engaging underserved populations, (3) strategies for successful partnerships, and (4) ways to enhance health promotion and barriers to overcome. Practice implications are discussed.

1. Introduction

Community health promotion involves collaborative efforts that apply public health science and evidence-based strategies to engage communities, with the goal to promote health, reduce risks, and alleviate the burden of chronic diseases within defined geographic areas [1,2]. Healthy People 2030 emphasizes the importance of addressing the social determinants of health, recognizing them as core factors that shape health outcomes. These include the conditions in which individuals are born, raised, learn, work, play, worship, live, and age—all of which can influence daily functioning and contribute to health disparities [3,4]. Consistent evidence suggests that community health is shaped by a complex interplay of factors that encompass social and political systems, cultural norms, structural conditions, environmental contexts, and non-medical elements such as healthcare access [5,6,7].
Effective community health initiatives are grounded in strategic collaboration among public health professionals, community-based organizations, social service agencies, and local residents to ensure the interventions are responsive to the community’s unique needs [8,9]. Traditionally, the academic model has positioned university researchers as the primary experts guiding and leading health promotion efforts in communities. However, in recent decades, there has been a shift in ideology to recognize the value of community-university partnerships as essential to community engagement efforts [10,11,12]. Despite this, many health researchers and community partners continue to face barriers and struggle to identify effective strategies for fostering successful collaboration [13,14]. Underserved populations, in particular, are disproportionately affected by this outcome. As such, to ensure the successful development of community health initiatives, it is critical to establish community partnerships that foster collaboration among institutions (e.g., academic institutions, nonprofit and community-based organizations, and healthcare systems) to support and optimize the effective use of limited resources [15,16].
This study explored the perspectives of community partners and participants on key factors that supported and enhanced health promotion efforts in underserved populations on the U.S.–Mexico border, with the goal to identify barriers and facilitators, improve efficiency of implementation, and strengthen collaboration and sustainability. Building on our health promotion efforts through our community-based project, the Healthy Families Healthy Kids Initiative (HFHKI), this study offers preliminary insights into strategies for sustaining partnerships between universities and communities. The lessons learned may be used to inform efforts that support better health outcomes and address health inequities in marginalized and medically underserved communities.

2. Literature Review

2.1. Conceptualizing Community Engagement

Community engagement is the process of working collaboratively with individuals in a geographic area who share common interests to promote collective well-being [11,15,17]. This process involves the active participation and consultation of community members in decision-making in the planning, design, and delivery of services [18,19,20]. Additionally, this approach fosters collaboration and partnership between researchers and community members, ensuring that the goals align with local values and address the specific needs and concerns identified by the community [21,22]. Interest in community partnerships has grown significantly over the past two decades, accompanied by an increasing focus on the search for effective strategies to address implementation challenges. Despite many obstacles, community engagement through partnerships is becoming a widely accepted practice in community-based interventions [23,24]. Evidence from community-based health promotion in disadvantaged areas highlights that implementation is more effective when activities are delivered in trusted and accessible spaces [25].
Indeed, empirical studies have postulated that community engagement is a practical approach for harnessing potential and driving population-level change. In particular, it empowers marginalized groups by offering a voice to the voiceless and is prevalently perceived as a valuable tool for addressing shared challenges [15,22,26]. Community engagement embedded within university settings provides additional benefits to students, faculty, and community partners involved. These experiences contribute to “high-impact practices” that yield opportunities for research engagement, foster empathy, and strengthen social networks across academic disciplines and community settings [27]. Actively engaged community partnerships also play a crucial role in jointly developing the infrastructure needed for implementation and translating it into practical, real-world applications [28]. Levin et al. (2021) [29] highlight best practices that support a collective approach to improving community health, recognizing that complex health issues cannot be solved by a single entity alone. This underscores the rationale for establishing community health partnerships, which stems from the fact that no single entity has the capacity to address all the determinants influencing population health [16,30]. Hence, bringing together resources and expertise from various stakeholders can effectively address these challenges. Additionally, understanding the roles of partnerships in health promotion initiatives can provide insights for researchers, practitioners, and policymakers, informing effective strategies for improving health [31,32].

2.2. Community Engagement in Health Promotion

In the realm of health promotion, community engagement is a practical approach to enhancing health outcomes and helping others regain control of their lives, which ultimately leads to better health [33]. While building community partnerships between universities and local organizations holds promise for reducing health disparities in underserved populations, these efforts are currently facing unprecedented challenges across the United States. Beginning in 2025, a shift in administrative priorities has led to proposed significant funding cuts across various sectors, including education, social services, healthcare, environmental protection, and other areas [34,35], raising concerns about the long-term and disproportionate impacts on marginalized populations and underserved communities. A decrease in funding necessitates stronger collaborative and grassroots efforts to drive impactful change within communities [36]. A number of factors can motivate community members to participate in health promotion efforts and/or interventions. Specifically, community partners may engage in health promotion activities for a range of personal, communal, and societal reasons. These motivations include, but are not limited to, betterment of personal well-being, improvements in community health, reductions in crime, and advancement of the public good [15,33,37,38]. In fact, the benefits may be more salient for economically disadvantaged and financially constrained communities [33].
Effective partnership relies on mutual trust, respect, collaboration, and clear communication among stakeholders who may be unfamiliar with one another or have limited prior experience working together [25,39]. Additionally, these partners often vary in their resources, skills, competence, knowledge of the issue, experience, status, or influence, and may have varying expectations and interests [40]. Partnerships in community-based health promotion are most successful when there is a clear goal and shared vision among stakeholders [32,41]. High-quality, consistent communication is critical for ensuring successful partnerships [22] and has been linked to increased satisfaction, effectiveness, and sustainability [40,42]. In addition to offering in-depth knowledge of local cultural norms and socio-political factors that can help inform and advance the research process [10], effective collaboration can empower stakeholders to foster a stronger sense of collective ownership over health issues within the community, which can further strengthen engagement and the long-term sustainability of initiatives [20]. From a resource-dependence perspective [43], partnerships can offer institutions opportunities to access complementary skills, foster interdependence, and minimize risks. Hence, organizations may achieve more effective outcomes by pooling their skills and capabilities [13].
Nonetheless, attaining and maintaining authentic partnerships can prove challenging due to the existing inequalities between academic researchers, community partners, and participants [10,44]. Launching an effective health intervention requires scientific background knowledge on the targeted health issue that community members may not have or be able to develop during the project period. The significance of having requisite knowledge and sufficient orientation to a community’s priorities cannot be overstated [29]. Yet, community partners and researchers may not share common ground on many issues [45]. In funded projects, funding agencies may focus more on research knowledge and skills rather than local knowledge and priorities [10]. Furthermore, funding agencies and university protocols may also have procedures for allocating grant money that are not in congruence with community expectations [10,39]. Many researchers struggle to access and engage with socially disadvantaged participants, also termed hard-to-reach or hidden populations, who often encounter a disproportionate burden of diseases due to structural, social, and cultural barriers [15,46,47,48]. Yet, empirical evidence suggests that disadvantaged populations frequently face increased risks of disease and may be unaware of available health resources. In addition, many lack health insurance, encounter barriers to accessing culturally appropriate care and services, have limited health literacy, and experience language challenges, all of which can hinder their effective use of health services [15,49]. Yet, evidence shows that disadvantaged populations are not being adequately approached or effectively engaged in health interventions [15]. Barriers to recruiting vulnerable populations often include cultural beliefs, low literacy levels, lack of awareness of health research, distrust of institutions, and challenges related to obtaining informed consent [46].

2.3. The Importance of Health Promotion in Underserved U.S.-Mexico Border Communities

Historically, the U.S.-Mexico border region is medically underserved and economically marginalized, making targeted health promotion efforts especially critical [50]. Health disparities along the U.S.-Mexico border are rooted in the structural and economic disadvantages that perpetuate health inequities [51]. The significant resource limitations faced by the U.S.-Mexico border region have contributed to elevated risks for a range of health challenges, including food insecurity and other related adversities [52]. Residents on the U.S.-Mexico border experience many health needs and healthcare challenges, such as having lower health insurance coverage, higher rates of mortality and morbidity, and other social concerns associated with poor health [53,54]. Many residents also face cultural and language barriers in seeking care and have limited access to healthy food, preventive care, and recreational spaces [53,55,56]. As a result of systemic inequities, residents in the border region experience disproportionately high rates of chronic diseases, including obesity, hypertension, type 2 diabetes, cancer, and heart diseases, and are susceptible to infectious diseases such as tuberculosis, hepatitis, and other environmental health risks such as inadequate sanitation [50,57]. The border region also experiences maternal and child health concerns, including high teen pregnancies and low prenatal care utilization [58]. Ingram et al. (2024) presented a collaborative approach for applying the sociocultural resilience model across three U.S.-Mexico border communities, guiding community-based participatory research partners in selecting and utilizing health behavior models to design and evaluate health promotion interventions [59]. Their findings emphasize the importance of community–academic partnerships in enhancing the relevance and effectiveness of these interventions, especially given the complexities of the cross-border context. These dynamics pose significant challenges to public health coordination and highlight the need for collaborative efforts among universities and community stakeholders—including culturally tailored, community-based interventions and health promotion—to enhance access and equity throughout the region.

3. Methods

3.1. Project Description

The Healthy Families Healthy Kids Initiative (HFHKI), housed at The University of Texas at El Paso (UTEP), is a community-based project developed in El Paso County, Texas, in 2021. The County of El Paso is situated where the borders of the three states (Texas and New Mexico in the U.S. and Chihuahua in Mexico) intersect. The county has over 870,000 residents, with a median income of USD 58,859. There is a high proportion of Hispanics of Mexican origin and monolingual Spanish speakers, with more than half of the county population speaking a language other than English (68.3%). The county also has lower educational attainment compared to its respective state and national estimates [60]. Some areas in El Paso County are predominantly rural (e.g., Vinton, Westway, Canutillo). In contrast, others are a mix of suburban and rural (e.g., Socorro), small towns (e.g., Anthony), and unincorporated communities (e.g., Canutillo). The high prevalence of poverty is partly due to the high unemployment rate and the lack of livable wages and infrastructure necessary to curb poverty [61]. The social and geographic isolation of residents in rural border communities may contribute to “out of sight, out of mind” perceptions, shaping rural-urban dynamics and contributing to underinvestment in infrastructure and healthcare services.
The HFHKI, supported by a small group of UTEP faculty members and students in collaboration with a few community partners, was developed with the goal to increase access to health education (in healthy and active living, physical and mental health, life skills, parenting and child development), hands-on learning, and connections to ongoing care and health promotion [62]. The project aims to educate families and school-age children about health risks (via tailored health presentations, workshops, and activities), increase access to free educational materials and preventive health screenings, and ensure all individuals, regardless of their race, gender, age, and background, have an equitable opportunity to achieve optimal health. Prioritizing cultural and linguistic responsiveness, the project is grounded in the principle that everyone deserves good health and that no child should be left behind. Our project believes that ensuring healthy families is fundamental in family-oriented Hispanic communities such as El Paso, as their well-being directly influences the quality of life for their children. What sets our project apart from other health promotion initiatives is its mobility—our project delivers health education and services directly to underserved communities, particularly those facing barriers to travel due to a lack of transportation. Our partnership with shelters and schools in underserved areas has expanded our reach and support for those who are most in need and have limited access to transportation. At the time of writing this article, our project is in its fifth year of implementation and has delivered over 450 health promotion and educational work-shops/presentations, as well as nearly 40 health screening events/health fairs in varied community locations.

3.2. Data Collection

This study employed semi-structured interviews to explore the perspectives and insights of community partners and participants pertinent to the successful health promotion strategies developed through our project collaboration, with the goal to assess the project’s effectiveness and overall impact. In this study, the research team interviewed 15 community partners (from shelters providing services to individuals experiencing homelessness and/or intimate partner violence, schools, and an after-school program) who have collaborated with our project, and 15 participants who had attended at least three events offered by our project on the shelter premises. Community partners, in this study, were representatives of community-based organizations that coordinated efforts with our project in planning and implementing health promotion events/activities. While we acknowledge the limitation of interviewing participants from a single source (i.e., shelters), many of our public events held outside the shelters (e.g., in schools and public venues) are one-time engagements, which makes it challenging to track attendees over time for follow-up interviews. The study received approval from the Institutional Review Board of The University of Texas at El Paso (IRB#: 2146881). The interviews took place between May and October 2024, with the average interview time for community partners and participants being 14.7 min and 17.1 min, respectively. After obtaining informed consent, community partners were asked about their experiences in collaborating with our project, the strategies employed throughout the project that had been successful or beneficial, and the aspects of the project they felt needed to be enhanced. The participants, on the other hand, were asked about the project’s relevance to their daily lives, the barriers they faced in health promotion, ways to promote health in their community, and suggestions for improving our project’s future activities. As a token of appreciation for their contributions, all community partners and participants were provided with a USD 15 gift card.

3.3. Sample Characteristics

The average age of our community partners was 52.7 years, while the participants had a slightly younger average age of 51.5 years. About 80% of the community partners were female, whereas 60% of the participants identified as female. Approximately 80% of the community partners self-identified as Hispanic, Mexican, or Latina, while the remaining 20% identified as White/Caucasian. Among the participants, 46.7% identified as Hispanic or Mexican, 40% identified as White/Caucasian, 6.7% identified as Native American, and 6.7% identified as multiracial. Additionally, an estimated 73.3% of the community partners held a college degree, compared to only 13.3% of the participants who had earned a college degree. To protect the privacy of the interviewees, they are identified by an interviewee ID in this article, starting with the letter “C” representing community partners and “P” indicating project participants.

3.4. Data Analysis

All the interviews were audio-recorded and transcribed verbatim. The transcripts were systematically reviewed line by line to identify commonalities, differences, and key patterns and to generate initial codes. Three members of the research team independently analyzed the data to enhance reliability and minimize bias. Recurring ideas and patterns were assigned specific codes, which were iteratively refined and organized into broader thematic categories based on conceptual similarities [63,64]. NVivo 14, qualitative data analysis software, was used to organize the data, support the coding process, and facilitate the systematic development of themes, enabling deeper insights into the phenomena of interest. Data were analyzed using both inductive and deductive approaches. The inductive approach involved identifying themes that emerged directly from the interview data, allowing patterns to arise naturally without preconceived assumptions. In contrast, the deductive approach was guided by interview questions and informed by a set of predetermined themes based on the study’s theoretical framework and research objectives [65]. Any discrepancies in data analysis were discussed among the research team members until a consensus was reached.

4. Findings

Overall, our study identified four major themes: (1) key attributes and perceived value of effective health promotion activities, (2) tailored approaches for engaging underserved populations, (3) strategies for successful partnerships, and (4) ways to enhance health promotion and barriers to overcome. Table 1 shows the themes, sub-themes, illustrative texts, and direct quotes from the interviews.

4.1. Key Attributes and Perceived Value of Effective Health Promotion Activities

In general, the community partners agreed that the health promotional agenda, such as educational presentations/workshops and interactive activities, offered a wide range of physical and mental health benefits, particularly for economically marginalized populations (e.g., shelter residents and single-mother families experiencing homelessness) who often lack access to reliable health education and resources. These events not only bridged critical information gaps but also empowered individuals and families to make informed decisions about their well-being, as well as that of their families. Both community partners and participants acknowledged that health promotion initiatives are most effective when they are dynamic, engaging, and informative rather than repetitive or lacking engagement. Participants reported that active engagement fostered meaningful learning and motivated them to apply their knowledge in everyday practice. Below, the community partners provided insights and reflections describing the benefits they perceived from the activities:
Everything has been very beneficial to them. … Some of these ladies (shelter residents) … they had to re-learn how to cook, how to do stuff because some of them had been in jail for a long time. … The instructors that come and do the class [sic] with them are very engaging. And I guess, that’s why … they really enjoy it as well.
(C6)
I feel like [project team member’s] class, … specifically, has touched on so many things that are very important. … I feel like she brings a lot of awareness to a lot of really interesting topics. … I really think that … the ladies have gained a lot of knowledge. They really like the class. … I think that [project team member’s] class really is helping the community. … They (the classes) are able to grasp the attention of every single resident, which is really, really awesome. … [Project team member’s] class is one of the very few that is not an issue. … They (the residents) really do enjoy the class.
(C8)
Along with supporting well-being and expanding knowledge, these activities also helped boost social connectedness, increase social integration, and reduce social isolation among shelter residents. Some of our community partners noted that shelter residents who had previously isolated themselves had begun to step out and interact with other residents more frequently, particularly in settings where the instructors’ presence actively promoted dialogues and interaction, as well as after the events concluded. These educational group sessions encouraged residents to share personal stories, fostering openness and mutual support. While not therapy sessions, sharing challenges in a supportive group helped build community and enhance mental health, as the sessions provided residents with tools for emotional regulation. The activities offered also provided residents with a constructive and meaningful way to spend their time—time they might otherwise have spent alone. The community partners shared some of the social benefits of the health promotion events they witnessed among the residents in the homeless shelters:
Most of the guys here … they basically don’t want to do anything. … It (the class) keeps their minds occupied. It keeps their minds going.
(C2)
We had Zumba … that was the highlight of the day. … If you walk in here on a Saturday morning, everybody in this building is participating, and they love it. So is the art, the music … that you have provided. … We didn’t have that before. … I pray it continues. … It’s uplifting for these women … otherwise, they sit here all day and do nothing.
(C1)
I think it has been very positive. You can walk through our shelter, and you can see all the things that the ladies have been doing, crafts, things like that. … It’s a positive experience for them to be able to sit down and just have a community here within. … They are more active. They get up. They do things that they are excited about. … They are able to connect with each other.
(C13)
Sometimes, they just come in, eat, and leave for the rest of the day, and then come back. But when you guys are here, they are actually talking to each other. So, when you leave, they do end up talking to each other about what they just experienced with you guys, cause [sic] they talked about nutrition and about hygiene and stuff (topics covered in class). … I think that’s a good aspect cause [sic] they didn’t have communication before.
(C3)
Application was a critical part of the learning process. It allowed the participants to move beyond the information they received, build confidence, and apply the newly gained knowledge in real-world situations. The hands-on activities made learning engaging and memorable while also providing the residents with an opportunity to relax and unwind after a long day, as many shared with the research team. In the long run, it also promoted behavioral change and supported evidence-based decision-making in health promotion. For instance, several participants have used the knowledge gained to make healthier dietary choices and embrace more physically active lifestyles. Below are some quotes from the community partners who exemplified these behavioral shifts:
Parents got out a lot of information that they were able to apply in their everyday lives. That was very beneficial. It was an eye-opener for some of them that they were doing things that it’s very “common thinking” that is healthy [sic], and they figured out it was not. So … it was pretty beneficial.
(C9)
I think the ones (topics) that are most beneficial are the money management, … the food allergies, … nutrition. Because some of the ladies here, since they don’t have a lot of funds to eat, they don’t eat very well. And so, their diets are really out of control, so those (classes) are very helpful to us.
(C12)
I think it’s wonderful. … Women (shelter residents) learn to eat healthier, … deal with a lot of mental issues, … and spiritual issues. And I think that makes an impact not only in [the shelter] but in the whole community. … Helping a woman to recover is helping an entire community because … we are helping the family, their kids, the mom, the sister, the brother, the father, … so it impacts [the shelter] in a very positive way, as in the way that it impacts outside [the shelter].
(C7)
Some of the women here have lost their children through CPS (Child Protective Services). And it helped them kind of open their eyes on how to be able to rekindle that family bond back with their children and … learning healthy ways and be able to provide care … after they reunite with their families.
(C8)
We have … been able to help the kids eat better and be more healthy [sic] … and more active.
(C15)

4.2. Tailored Approaches for Engaging Underserved Populations

Successful health promotion initiatives must tailor their approaches to meet the specific needs of underserved populations, who are often economically disadvantaged and under-resourced. These include being mindful of the unique challenges that these disadvantaged populations face, such as time and economic constraints, limited transportation, childcare issues, and irregular work schedules. Flexibility and cultural sensitivity appeared as two critical elements to ensure the accessibility of the project activities. The community partners detailed the challenges that their shelter residents faced and the importance of scheduling the project events at times and days convenient for the participants to maximize attendance and engagement:
We try to adjust the classes based on our schedules here in the house (shelter). And many of the women are either out at work, … looking for employment, have appointments, so it’s mainly just participation that we have personally had trouble with.
(C11)
Most of the clients, like I said, don’t have much education. … Since they have children, it’s very hard for them to access any other type of … classes or anything like that because they don’t have childcare. They don’t have … a place where they leave the children, so … it (offering the classes on-site) really makes it very … beneficial for our clients.
(C10)
  • Equally important was addressing language barriers that could significantly impact access to information and participation. A significant proportion of the participants our project worked with spoke Spanish as their primary language, with their English proficiency levels varying significantly. Hence, most of the project’s presentations and workshops were offered in both English and Spanish, as culturally and linguistically appropriate communication was crucial to ensuring inclusivity and the effectiveness of health promotion activities. Additionally, participants were more likely to attend the events, ask questions, and engage in discussions when instruction was offered in their preferred language, as illustrated by one of our community partners:
I feel like she … and all her team connect to the residents in a way where they’re gonna [sic] be … talking to them in Spanish or English, explaining to them, going over, asking questions.
(C8)
Next, health promotion activities should be thoughtfully tailored to the needs of economically disadvantaged individuals and aligned with participants’ educational backgrounds and levels of comprehension. This includes adapting the content of the educational activities to be consistent with the realities of the population served in order to improve delivery effectiveness, as depicted by the following quotes from the community partners:
I feel like the cooking … the … health … class that she held … was really good for them because a lot of the women are used to not eating too well and … cause [sic] they are on the streets and … they don’t have that option. But [project team member] coming in and showing them … just being … efficient with … a lot of items (food) has really helped them. … A lot of the women coming in … they feel really alone, and they don’t know how to reach out back to the community … and I feel like this class also showed them different ways of how to approach it and … how to maybe be able to handle situations that they … obviously weren’t able to do by themselves before.
(C8)
I love the … kind of support … people that [sic] are coming in like [project team member]. … They can relate to the clients … and the clients feel understood. … This population has a lot of challenges. … They have a job, they don’t have a job, they don’t have childcare, so sometimes we get a lot of attendance, sometimes we don’t. But having them (the HFHKI project) come here constantly, it provides stability, and it provides a resource that most 90% of the time we don’t have a way to provide for our clients.
(C10)
  • The educational activities also helped provide a strong foundation, enabling participants who are parents to be “better parental figures” to their children, supporting families in a way that strengthens the dynamics of the household. Further, this knowledge proved beneficial for staff members working with marginalized populations, equipping them with the necessary skills and sensitivity to provide meaningful support to the clients they serve. Although our project does not offer educational classes directly to our community partners, they are welcome to join or visit the classes at any time. One of the community partners shared her view of the educational classes our project offered:
We do have a lot of clients here that [sic] have anxiety, depression. And sometimes … we as staff [sic], we don’t understand those kinds of stuff, and it’s really hard sometimes to even communicate with a couple of the residents. And that’s where it becomes an issue. … So, if there could be a way that maybe she (project team member) could give us … a little training … or if she even has the resources that can help.
(C6)
From the participants’ perspective, consistent programming not only provided them with a sense of stability but also helped the project team build rapport and trust over time. Making participants feel comfortable was essential to supporting their full engagement in our activities, as illustrated in the following quotes from the participants:
The topics of discussion are really interesting. And I think … the presenter kind of makes it better, you know? Cause [sic] she’s just very … in tune with. … I think she really wants everybody to feel comfortable and … if you have any questions, … she is really good at answering all of that.
(P3)
Knowing who you guys are makes us feel more comfortable and opens up. Like, I’m not a person that [sic] opens up. … Seeing familiar faces is just like, “Okay, I can ask you something!”
(P5)
  • In addition to bilingual support, other criteria that the participants valued from the project facilitators included the diverse range of content the project presented, recognition of different learning styles (such as visual, auditory, kinesthetic), practical relevance to their daily lives, and a wide variety of engaging activities, all of which ensured accessible, effective, and meaningful participation. Below, the participants shared their experiences and suggestions:
Help us apply what we learned. … For example, if we’re talking about … how to deal with anxiety and stuff like that, just kind of helping us implement those things in our day-to-day life, … not just … absorb the information, but actually teaching us how to actually implement it in our own lives.
(P3)
The information has to be curious and possibly well presented. The information has to be taught later on, through repetitive learning. … And of course … attention to things that are changing in the environment.
(P10)

4.3. Strategies for Successful Partnerships

As part of the efforts to improve project outcomes, the research team asked the community partners to share their experiences collaborating with the project and identify the components they found most successful and valuable to the partnership. Good communication was consistently recognized as a critical strategy for building successful partnerships, as our community partners greatly valued being consulted in the planning and execution of health promotion activities and events. The quotes below offered insights into the perceptions of our community partners:
[Project team member] is always either emailing me or I’m with her. The communication has been terrific. There has been no problem at all!
(C1)
[Project team member] … is so sweet. … She asked, “Is it okay that we talk about this or do this? Like “What do you think?” I mean, there are so many things that she comes up with that we are like “Yeah! That would be good, and sometimes we don’t even think about it!
(C4)
  • In general, community partners appreciated that the project team took the time to listen attentively and respond promptly, often describing the team as being “on top of everything.” Community partners also valued the project’s consistency in following up and the team members’ ability to remain organized throughout the process, from scheduling to project implementation.
The fact that … [team member] has always tried to listen to what they (shelter residents) want to do or what they want to talk about, so it’s not just one thing. And I think it’s amazing that the [project] talks about so many things. … I think it touches a lot of bases that are really, really important. … I think they love the class.
(C8)
Just the fact … that [project team member] is doing all of these for reaching out to the community is beneficial and worthwhile. And everything, the communication was superb. … Everything was pretty good!
(C5)
I really like the way that … how she has her classes and how she’s always like “very on top of all that”!
(C6)
Flexibility was essential not only for effective project delivery but also for sustaining successful partnerships. In general, the community partners regarded the project’s ability to adapt and switch between activities to meet the evolving needs of the client populations they serve as a positive strength of the project. To ensure a manageable schedule, some community partners preferred to plan in advance and acknowledged the project’s willingness to adapt to their pace. Balancing these approaches helped create responsive partnerships. Persistence in service delivery, characterized by consistent effort over time to achieve the desired outcomes, was another key criterion. Most community partners believed that the collaboration exceeded their expectations in part due to the team members’ consistent presence, responsiveness, and availability, as illustrated by the following quotes:
Well, in the beginning, we didn’t know exactly. … We thought it was only gonna [sic] be like … a couple of months and then … it was gonna [sic] end. … It has already been almost two years since [project team member] has been coming in, and it’s always something different. … It does help a lot of our residents.
(C6)
It’s something that I had hoped would happen. And it’s not always some organizations would come and stay a while, and then they just disappear. … But with [the HFHKI project], it has been consistent and … it’s ongoing. Other programs you might have them come in, and they are really not relevant to what the needs of these ladies are, but this [project] has certainly addressed and helped them.
(C1)
  • Successful collaboration was also dependent on the project’s ability to align with and support the missions of the organizations involved. This, in turn, helped these organizations maintain their focus and ensure that the resources were used and allocated efficiently, as reflected in the following quotes by the community partners:
It’s (organization’s mission) supported 100% because our goal is to try to help those that [sic] are able to improve their life, and their emotions, and their physical health, and your [project] has certainly enhanced that goal.
(C1)
I believe that the goals and the mission are to help these gentlemen stop being homeless by teaching them how to break those habits and get new habits that when they do get housing, they do stay there and not go back to their old habits. You guys have taught them a lot to where I feel some of them, when they leave, aren’t coming back.
(C3)
I was very fond of it, mainly because most of our activities here are for the women. … We do try to incorporate activities for the children. … It was just nice to see the women and children being able to have that fun time together. … I feel like the topics covered very much go … hand in hand with our mission. … And most of the women really don’t have the background of the topics covered … so I feel like it’s a really good way to enhance their knowledge.
(C11)
It has supported us 100%, I can tell you that. … Seeing the children grow, understand, communicate, and coordinate with their parents … is a success. … I wish we could have more, more collaborations like that.
(C12)

4.4. Ways to Enhance Health Promotion and Barriers to Overcome

The research team also invited both community partners and participants to share the challenges or barriers they encountered in health promotion, as well as their recommendations for strengthening the community-university health promotion partnership or other relevant health promotion efforts. Some participants recommended involving individuals with lived experience to enhance the project’s relatability. Additionally, scheduling classes at optimal times was noted as a key factor in maximizing engagement. One of the community partners shared her idea:
I believe that … probably … having … the cooking classes being more often, so we create community in the kitchen. … That’s what I believe would help them more because they really like attending the classes.
(C7)
  • Additionally, lack of resources was commonly cited as a major barrier to health promotion initiatives by our community partners, as exemplified by the following quotes:
Maybe offer more services or provide resources outside of school so parents can go. I know that some of them had questions, but … maybe bringing more agencies that can service our population (students and their parents).
(C9)
It would be the availability of more programs. But I know it’s hard. You don’t have the staff, you don’t always have the money … but anything that can provide diversion for them (shelter residents) throughout the day is really helpful.
(C1)
I really think it’s a great resource because we don’t have the budget, we don’t have the resources to provide this kind of … educational and support groups … that the university is providing for us.
(C11)
We don’t have the resources to do what you guys have been doing for our clients, and this is something very needed. We sometimes provide only a basic level of services. We try to do more, but only with partnerships like this we can [sic] do that.
(C10)
  • The research team also asked participants to share the challenges they encountered while engaging with other health promotion initiatives. Some participants identified a range of ecological barriers to maintaining good health, including the widespread availability of fast food, limited access to affordable healthy food options, and a lack of readily available parks and recreational opportunities in their neighborhoods. They also acknowledged several necessary changes, including making greater use of local parks, developing and practicing stronger self-discipline, participating in community clean-ups, and making healthier food choices, such as reducing consumption of unhealthy snacks, including chips. According to our participants, the community would benefit from more engaging and interactive activities integrated into varied health promotion efforts. They also emphasized the importance of increased publicity of health promotion interventions to help normalize healthy behaviors and integrate them into everyday life. Below are some suggestions offered by the participants who recommended diverse formats and media for communicating with the public:
Have a fair or something … a health fair where you know you have music and balloons. … Have … a little booth setup, … give out … flyers and just maybe do free blood pressure checks, free … diabetes checks, or … weight checks and stuff like that.
(P1)
Have such programs presented where applicable and allowable in more public spaces, that is, more [open] to the general public.
(P3)
Try to invite people or give them pamphlets or something so they can know … more information about that.
(P4)
In my community, you gotta [sic] go through social media. … I think seeing posters of it would get my attention. Every poster I see, I have to read it.
(P5)
  • It is also important to provide the audience with evidence-based facts to educate them in an engaging and relatable way, as illustrated by the following participants’ quotes:
Give them a scientific study that has statistics and can be validated.
(P12)
Aside from making it more, better well-known, … make it a little more engaging … especially if you’ve got somebody with young children. Make it more engaging for the children. … And the parents to also participate with their children.
(P13)
  • Because many organizations were located in areas with limited access to affordable produce, practical adaptations were necessary to keep nutritional education realistic. Ingram et al. (2024) reported similar challenges along the U.S.-Mexico border, where limited infrastructure and food access require tailored, community-specific health strategies [59]. Cross-sector collaboration could be beneficial in addressing health challenges, as it brings together diverse expertise and perspectives to create more sustainable solutions, as noted by one of the participants.
Maybe working through food banks or … farmers markets. See what could be done about getting fresher materials, healthier materials (food options) in. Help … with their own snacking or maybe their own food preparation, or maybe communal food preparation. Maybe bringing in fresher materials (food items), donating them here.
(P9)

5. Discussion

Drawing on insights from community partners and project participants, this study explored key factors that facilitated, hindered, and strengthened community engagement, collaboration, and sustainability in health promotion efforts among underserved populations on the U.S.-Mexico border. Findings from this study may provide practical guidance for community-based health initiatives aiming to translate community partnerships into impactful and lasting outcomes. Findings from this study indicated that consistent and accessible community-based health promotion initiatives can yield significant returns on investment, particularly among underserved populations, when all parties prioritize the partnerships equally. While this study was not able to examine the long-term effect of our collaboration, empirical studies noted that such collaborative efforts can contribute to enduring public health benefits and systemic well-being and have the potential to mitigate future health risks by fostering a sustainable environment that enhances both individual and collective well-being over time [8,66].
Effective implementation of health promotion initiatives requires stable partnerships and active community engagement to support sustained collaboration and long-term commitment. Fostering a climate of trust and confidence among community partners and university faculty throughout the project’s development and implementation is essential for its success and sustainability [22,23]. Hudson et al. (2023) emphasize that authentic academic–community engagement rooted in trust and shared responsibility is critical to advancing health equity and ensuring the long-term success of the partnership [47]. Although community-university collaborations value mutual commitment and project continuity, a number of factors can hinder successful partnerships. We noted that resource shortages are a common challenge faced by our project and other community partners. The lack of resources—such as funding, staff, and time—often increases staff workload and hinders effective partnership. Additionally, high staff turnover and the absence of key personnel can disrupt collaboration [13], as relationships often need to be reestablished each time a new staff member joins the partnership. By contrast, the mutual benefits of university-community partnerships exemplify the advantages of collaboration, including increased access to resources, cost-sharing, and the exchange of knowledge [23]. These positive outcomes are often facilitated by staff members known as “boundary spanners,” who work across organizational and professional boundaries to sustain the success of collaborative efforts [67]. Throughout this project, we learned that staff members our project collaborated with also gained insights from the diverse themes and topics presented by our project team members to community participants and actively offered valuable input. This contributed to shared knowledge building, which fostered both personal and professional growth and development of both the project team members and community partners. To support these efforts, staff training on collaborative processes and joint inter-agency training can serve as an effective strategy for strengthening cross-sector collaboration and fostering mutual understanding among partners [13].
Building on lessons learned from this study, future research could investigate how cross-sector partnerships facilitate the navigation and resolution of complex social challenges associated with resource shortages. This form of partnerships is increasingly recognized as vital for improving health outcomes and addressing health equity, particularly by leveraging shared resources and coordinated efforts across sectors [5,32]. The socio-ecological model offers a valuable framework for promoting community engagement by identifying systemic barriers and enablers, as well as examining individual behaviors and the social and cultural influences that shape them. This framework can inform the development of comprehensive, coordinated strategies to strengthen community involvement in health promotion [36,68]. This entails collaboration among healthcare, social services, public health, and a community coalition of diverse stakeholders [13]. Another effective approach to collaboration involves actively engaging partners throughout the implementation process—jointly defining the problem, co-developing solutions, supporting organizational efforts, and sharing responsibility and ownership to promote more impactful and lasting outcomes [28]. We also learned that soliciting feedback from participants throughout the experiences and process of developing and delivering workshops is essential for ensuring that collaborative efforts remain responsive and inclusive. Indeed, the “top-down” approach to community engagement—in which authorities make decisions with minimal community input—can undermine the effectiveness of health promotion efforts compared to “bottom-up” participatory methods that actively involve communities in decision-making [2,15]. Critical to these efforts is the need to explore practices and actions that can be sustained beyond grant funding periods. Partnerships that invite the co-creation of ideas and practical solutions from a horizontal perspective, as opposed to a top-down institutional approach that overlooks community stakeholders as equally valuable contributors, are likely to yield valuable experiences and lessons learned for future applications and initiatives.
To address a broader range of health needs, our project sought input on diversifying health promotion topics. It enhanced overall impact by incorporating expertise from multiple fields, including social work, public health, nutrition, nursing, social sciences, kinesiology, and clinical laboratory science. Multidisciplinary collaboration offers numerous benefits, as promoting health often requires complex solutions that involve the expertise of professionals from various fields [69,70]. Our findings suggest that for health promotion to be genuinely effective, health promotion initiatives must be coordinated and shared within an inclusive community-wide effort. Effectively promoting health involves addressing the broader social, economic, cultural, and environmental factors that influence it [32]. Collaborative efforts aimed at developing systemic approaches to enhance community health promotion, whether through policy reforms or health initiatives, can help unite the various organizations working toward a shared goal [68]. Some shared traits and values, such as trust and shared objectives between organizations and leaders, can promote effective partnerships [13]. Collective efficacy—the shared belief that group action can shape the future and the willingness to intervene for the common good—has also been linked to positive community health outcomes and effective health promotion by fostering connections and building social support networks that bring disconnected groups together [36,71]. Sharing collective responsibility strengthens communities by empowering them to make decisions and implement changes that lead to their desired outcomes [72].
Following the emergence of social media as a highly effective platform for raising health awareness, it could be used as a cost-effective way to educate the general public and help them make more informed decisions about their health and well-being. We also acknowledge that seeing materials in print, such as posters and flyers, can engage people in spaces where there is limited access to information and public health education. Smith and Denali (2014) highlight how targeted social media strategies can effectively reach rural populations along the U.S.-Mexico border—who face health disparities due to poor socioeconomic conditions—and overcome the limitations of traditional media campaigns [73]. Health promotion efforts that are culturally and linguistically inclusive and delivered in the preferred languages spoken by participants, whether in-person or online, can drive change through warnings, recommendations, and legal regulations, thereby helping to build community resilience and enhance public safety [74]. Overall, we learned that health promotion efforts inspire action, encouraging individuals and communities to take control of their health and the factors that influence it. Collaboration, solidarity, and mutual support can unite communities to work toward the common good and safeguard everyone’s health. These collective efforts not only address immediate health challenges but also strengthen the community’s long-term well-being [75,76].

6. Limitations

This study has several limitations, including limited generalizability due to its small sample size of community partners and participants. Therefore, the findings may not be generalizable to the broader population. Like any study that relies on primary data collection, the findings of this study are subject to selection bias, as community partners and participants who agreed to be interviewed may have had a more cordial relationship with the research team and were, therefore, more likely to accept the interview request. Additionally, the findings might be influenced by potential selection bias due to prior programmatic benefits and the provision of participation incentives. Like many other research studies, this study is subject to social desirability bias, where participants might provide responses that they believed were expected or favorable. Additionally, our project interviewed only community partners and participants who could speak English, and it was limited in its capacity to engage a large number of community partners and participants due to funding, staffing, and time constraints, which naturally restrict our study sample size. Future studies are encouraged to incorporate external evaluations and expand the scope of their interviewee pool by including community partners and participants from diverse settings and geographical locations to improve the applicability of their outcomes across different populations. We note that our study is exploratory and does not aim to establish causation. We hope that our community-based initiative inspires others to develop diverse health promotion initiatives that consistently and effectively support underserved populations.

7. Conclusions

Our project offered valuable insights into implementing sustainable, community-based health promotion in underserved settings. Actively involving community partners and participants in selecting health promotion topics and activities helped ensure relevance and improved engagement. Tailoring content to community needs fostered deeper connections and rapport in disadvantaged populations [25]. Flexible session delivery that accommodated schedules, preferred languages, and cultural contexts made education more accessible and inclusive. Storytelling and participant-driven content enhanced relatability and fostered a collaborative learning environment. In addition, involving facility staff early in planning fostered buy-in and a supportive environment. These collaborative practices promoted continuity and trust, highlighting the value of relationship-building and shared ownership [47,59]. We learned that implementing the project across community sites highlighted the importance of tailoring approaches to meet population needs and address site-specific constraints. This was particularly crucial in environments that were transient or highly unstructured. In sum, these lessons highlighted that successful community engagement necessitates responsiveness to cultural, logistical, and environmental realities, particularly when working with resource-limited populations facing complex challenges.

Author Contributions

Conceptualization, Y.-F.P.; methodology, Y.-F.P.; funding acquisition, Y.-F.P.; project administration, Y.-F.P.; supervision, Y.-F.P.; writing—original draft, Y.-F.P.; data curation, Y.-F.P., A.V.D., D.G.T. and N.W.M.; formal analysis, Y.-F.P., D.G.T. and N.W.M.; investigation, Y.-F.P., A.V.D., D.G.T., N.W.M., S.L.R., D.A.P., B.L.R.V., E.C., G.G.N.-M., H.Z.J., K.C.S. and R.A.P.; writing—review and editing, Y.-F.P., A.V.D., D.G.T., N.W.M., S.L.R., D.A.P., B.L.R.V., E.C., G.G.N.-M., H.Z.J., K.C.S. and R.A.P. Y.-F.P. is the first and senior author of this article. All authors have read and agreed to the published version of the manuscript.

Funding

The Healthy Families Healthy Kids Initiative is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling USD 250,000. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by HRSA, HHS, or the U.S. Government.

Institutional Review Board Statement

This study has been reviewed by the Institutional Review Board at The University of Texas at El Paso (IRB #: 2146881, approval date 8 January 2024) and qualifies as exempt from review under the following federal guidelines: 45 CFR 46.104(d)(2)(ii).

Informed Consent Statement

Informed consent was obtained from all interviewees involved in the study.

Data Availability Statement

Data are not available for public dissemination to protect the privacy of the interviewees.

Acknowledgments

The research team thanks the interviewees for their insights and the collaborators and community partners for their contributions and support throughout this project.

Conflicts of Interest

Authors Sarah L. Ruiz and David A. Perez were employed by Sun City Dietitians. Author Hector Zamora, Jr. was employed by Dismas Charities. All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Table 1. Themes, sub-themes, illustrative texts, and direct quotes from the interviews.
Table 1. Themes, sub-themes, illustrative texts, and direct quotes from the interviews.
ThemesSub-ThemesIllustrative Texts or Direct Quotes
Key attributes and
perceived value of
effective health promotion
activities 		Physical and mental health benefits, health knowledge, social
benefits, and
application in daily lives
▪
The classes addressed key information gaps and empowered participants to make informed decisions about their well-being.
▪
“The parents really enjoyed that. … They got lots of good tips.”
▪
Active engagement increased motivation and participation.
▪
“With people coming in, they’re more active. They get up. They do things that they are excited about. … They are able to connect with each other.”
▪
Participation helped promote social connectedness and integration.
▪
Participants put their newly learned knowledge into practice in real-life contexts.
▪
“Parents got out a lot of information that they were able to apply in their everyday lives. That was very beneficial.”
Tailored
approaches for engaging underserved populations		Convenient
scheduling, culturally responsive
programming,
cultural sensitivity, flexibility, and
language support
▪
Culturally and linguistically appropriate communication ensured inclusivity.
▪
Classes were aligned with participants’ educational backgrounds and levels of comprehension.
▪
The project content was adapted to match the practical realities of the community.
▪
“They brought the knowledge that our parents needed, and it was pretty beneficial.”
▪
A diverse range of content supported parenting and different learning styles.
▪
“They can relate to the clients more, and they can talk … and understand. And the clients feel understood.”
▪
Consistent programming offered participants a sense of stability and helped foster trust.
Strategies for successful partnershipsEffective
communication,
organization,
consistency,
accessibility,
convenience, and
mutually supportive goals
▪
Community partners valued being involved in health promotion efforts.
▪
The project team was attentive and timely in their responses.
▪
Effective organization by team members ensured smooth project planning and implementation.
▪
Community partners were pleased with the project’s capacity to address the evolving needs of the collaboration.
▪
“I feel like the topics covered very much go … hand in hand with our mission.”
▪
The team members’ consistent presence and collaboration ensured steady progress toward shared goals.
Ways to
enhance health
promotion and barriers to overcome		Relevance and
relatability, lack of
resources, and other ecological barriers
▪
Including those with firsthand experience could enhance the project’s relevance.
▪
There is a need for more health promotion programs to be available in the community.
▪
“It’s a great resource because we don’t have the budget.”
▪
Fast food prevalence, scarce healthy options, and limited recreation are ecological barriers to health promotion.
▪
Varied formats and channels are needed to reach the public more effectively.
▪
Providing the audience with scientifically supported data helps guide informed decision-making.
▪
Partnerships between different sectors could help address challenges more effectively.
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Paat, Y.-F.; Dorado, A.V.; Garcia Tovar, D.; Myers, N.W.; Ruiz, S.L.; Perez, D.A.; Ramirez Vara, B.L.; Camacho, E.; Núñez-Mchiri, G.G.; Zamora, H., Jr.; et al. Toward a Sustainable Future: Advancing Health Promotion in Underserved Populations Through Collaborative Engagement. Sustainability 2025, 17, 7507. https://doi.org/10.3390/su17167507

AMA Style

Paat Y-F, Dorado AV, Garcia Tovar D, Myers NW, Ruiz SL, Perez DA, Ramirez Vara BL, Camacho E, Núñez-Mchiri GG, Zamora H Jr., et al. Toward a Sustainable Future: Advancing Health Promotion in Underserved Populations Through Collaborative Engagement. Sustainability. 2025; 17(16):7507. https://doi.org/10.3390/su17167507

Chicago/Turabian Style

Paat, Yok-Fong, Angela V. Dorado, Diego Garcia Tovar, Nathan W. Myers, Sarah L. Ruiz, David A. Perez, Brenda L. Ramirez Vara, Elizabeth Camacho, Guillermina Gina Núñez-Mchiri, Hector Zamora, Jr., and et al. 2025. "Toward a Sustainable Future: Advancing Health Promotion in Underserved Populations Through Collaborative Engagement" Sustainability 17, no. 16: 7507. https://doi.org/10.3390/su17167507

APA Style

Paat, Y.-F., Dorado, A. V., Garcia Tovar, D., Myers, N. W., Ruiz, S. L., Perez, D. A., Ramirez Vara, B. L., Camacho, E., Núñez-Mchiri, G. G., Zamora, H., Jr., Singh, K. C., & Polanco, R. A. (2025). Toward a Sustainable Future: Advancing Health Promotion in Underserved Populations Through Collaborative Engagement. Sustainability, 17(16), 7507. https://doi.org/10.3390/su17167507

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