Oby Ukadike-oyer: From the campus of Harvard Medical School, this is Think Research, a podcast devoted to the stories behind clinical research. I'm Oby, your host. Think Research is brought to you by Harvard Catalyst, Harvard University's Clinical and Translational Science Center and by NCATS, the National Center for Advancing Translational Sciences.

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Previously, we explored the work of the Community Coalition for Equity and Research, a source of high-quality community input on research proposals and protocols, as well as a trusted communication channel between researchers and community members. Coalition members have provided feedback on dozens of research projects since its initiation in 2021, including a study from Stephen and Ruth-Alma, from Beth Israel Deaconess Medical Center. Tune in as they discuss their efforts to engage with the community through their project, Groceries for Black Residents of Boston to Stop Hypertension or Go Fresh.

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Hi, Ruth-Alma and Stephen. Welcome to the show.

Ruth-alma Turkson-ocran: Thanks for having me.

Stephen Juraschek: Great to be here.

Oby Ukadike-oyer: Let's start with a little background. Can you both talk to us about where you're from, where did you grow up, the career path that you've had as well that led you to the work you're doing now?

Stephen Juraschek: So I'm a general internist, and I also have a PhD in cardiovascular disease epidemiology. I grew up in Dedham, Massachusetts, and I went to Xaverian Brothers High School, in Westwood, then Boston College, in Newton. And then I lived in California for a couple of years doing some volunteering work, then was in Baltimore for about 10 years getting all of my training. So my MD, PhD, and then residency and fellowship.

And my path towards community-engaged research began in medical school. I was involved in a number of service-oriented research projects, and I remember one grant we were working on in the Latino community, in Baltimore, focused on providing occupational health equipment and education around workplace safety. We had submitted a grant to get funding for the equipment and some of the supplies, and we weren't successful. And one of the critiques I got was that we hadn't included a way to evaluate program effectiveness for long-term sustainability, and I remember, after nursing my wounds, I realized this is something I should probably get some more training in.

Because yes, the merits of the program seem quite clear, but if we can't demonstrate benefit, we won't be able to improve upon it or convince others to fund it and keep it going down the road. And so that's where I leaped into public health, to get more training on tools and research, but that side of me that always wanted to do something more community focused never went away. And I think our current work-- and I'm so grateful to be working with Ruth-Alma, focused on food and nutrition security and access in the Boston area-- has resonated for me, about both bringing together rigorous scientific methods but also looking at food as medicine and a way to address inequity and access to healthy groceries to improve health.

Ruth-alma Turkson-ocran: I'm originally from Ghana, West Africa. So I born in Ghana. My parents lived a little bit in the Gambia, so I was there until I was probably maybe like seven years old. Then, we moved back to Ghana, where I did my elementary and high school, and then I came to the US, specifically to Jefferson City, Missouri, to do my undergrad.

After undergrad, I moved to North Carolina, and I worked at one of the Duke hospitals, Duke Raleigh Hospital. After that, I decided I wanted to go back to school. I actually always wanted to do a doctorate degree, but I got the opportunity to do my master's in Public Health and also become a nurse practitioner at the same time. I got a full scholarship to become a nurse practitioner, and I ended up working in a medically-underserved area, in West Texas, about 100 miles from Midland, Texas, in small, tiny town of 3,000 people called Pecos, Texas.

So it was a critical access area, and that actually was where my interest and my passion and drive for health disparities work actually started, because we did see a lot of immigrant populations. I started trying to learn how to speak Spanish-- this is health care Spanish-- and after doing that for a few years, I know I needed to do more. And so I applied for a PhD, and I got the opportunity to do my PhD and postdoctoral fellowship at Johns Hopkins School of Nursing for the PhD and School of Medicine for the postdoctoral fellowship.

So I guess that's one of the places where Stephen and I are paths intersected, at Johns Hopkins, essentially. I met him there. I don't think he knew knew me out there, but I had attended a number of talks that he had given at the Welsh Center, at Hopkins.

So after all of that, I think Stephen pulled me out here. I had some questions about some of the work that he was doing that intersected with mine, and then what do you know, I'm here in the Boston area. In the Baltimore area, I was really involved with community-based work, specifically targeted at or focused on persons of African descent, so African-Americans and then African immigrants. Because there's a large African immigrant population in the BWI area, just working with a few people there, Lisa Cooper, Yvonne Commodore-Mensah, out there is when I started getting more into, I guess, community-engaged work, the health disparities, a health equity space.

Oby Ukadike-oyer: Thank you so much to both of you for giving us a bit about your background and taking us along the journey. And you started to talk a little bit about the research you do now, and what you're doing in Boston. So can you talk to us about your research and tell us, how did your research start? You started to talk about it a little bit. Give us some history about your research and what you're actively working on now. I know that's three questions, but all relate it to your research.

Stephen Juraschek: So interestingly enough, community-based research and engaged research I feel like is so rewarding, but I feel like it's a lot harder than maybe analyses that you're taught about in school. I don't know if, Ruth-Alma, you feel the same way.

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Ruth-alma Turkson-ocran: Yeah.

Stephen Juraschek: It's just a lot more nuance, and I think a big part of that is because of the fundamental recognition that we're working with groups of people, and we're working in a space that they live in. And it might not be our typical space, and so that requires I think first a recognition. And I feel like I'm always learning from Ruth-Alma more and more about this, but recognition of cultural humility and how where we're coming from might be different. And we might not the ways of-- know or identify all those differences when we approach the community.

And I think starting at that point of listening is very, very key. And so I feel like our current studies have really been evolving quite a bit and reflect that in many ways. And so our initial idea, three or four years ago, was to try to see if we could-- we had been doing some work around healthy eating and medically-tailored groceries, to see if we could improve blood pressure, cardiovascular risk factors.

And we had done a pilot study called DIGO down in the Baltimore area, among patients with gout, to see if we gave them a DASH-patterned groceries. Which had been shown in tightly controlled studies, if we gave them groceries, we might reduce their uric acid level, which is a major risk factor for gout, also related to cardiovascular disease. And we learned a lot from that pilot, that yes, the groceries were quite good at helping people adopt healthy patterns of eating, but they didn't exactly have the same effect that we would have expected on blood pressure and cholesterol.

And one of the things we were learning from the participants is that, well, we didn't necessarily provide enough groceries, and the groceries often didn't include the family. And so many folks said, it's a little bit awkward for me. I don't prepare food for the family, but yet you're saying that, here are some groceries that only I can eat, but I need someone else to help me prepare the food. It just put people in a difficult situation, and so we tried to learn from that experience.

And the thought we had was, well, if we use a virtual grocery store and deliver a pattern of healthy groceries to people's homes, at a quantity that can feed the family up to six members at dinnertime, could we really move the needle on blood pressure? And then also looking at cholesterol, blood sugar and body weight. So we had this idea of using technology in the community, and it actually took us several attempts. And one proposal wasn't successful, the next proposal scored really well in peer review, but then the NIH said, we're not going to fund that pathway anymore. So then it was the third try, after I feel like three years, where we started making progress in.

And interestingly, around the same time, the American Heart Association had this Health Equity Research Network focused on hypertension, and we were able to join with other innovative academic faculty members throughout the country to create a network focusing on different strategies to lower blood pressure among Black adults. And so that mechanism started around the same time that we were in the process of our NIH submission, and it turned out that, with coordination with both groups, we were able to have two trials funded. So we went from like nothing, and like what's going on? Like this is so important, but we can't convince anybody it's important to getting these two trials funded.

And the American Heart Association trial focuses on Black families without treated hypertension, and then the NIH trial focuses on Black adults and their families with treated hypertension. And we're looking at impact of groceries on blood pressure over a three-month period. And then we have a period of observation after that, where we then later do some interviewing and focus groups, trying to get into what was a barrier or a facilitator for people maintaining the healthy eating longer term, and so that was the concept.

And we had a community advisory board at the time, that included three members who were very, very helpful in getting us started. But then when Ruth-Alma joined us, I feel like it just was like on steroids. It's just like-- [laughter] we have this amazing dynamic, much larger board. I'll let her talk about that.

And I think this is how I feel like I learned. I learned so much from Ruth-Alma. We have much more robust community voice to learn from. And I think it's really been very positive in terms of how the current study is being conducted and what we've been seeing, in terms of our reception in the community but then also how we're envisioning the next wave of studies really being more community engaged, community driven.

Ruth-alma Turkson-ocran: Stephen is absolutely right in terms of how our study is focused, and I like the fact that we work in a team. So I think Stephen talked about working with dietitians. We just try to make sure, especially because our studies focus on people who identify as Black, so we just try to make a lot of the things that we did community engaged. So whether it was designing our flyers or getting recipes for intervention, we just really try to involve members in the community who identified as Black.

And also the input of a community advisory board, and so the community advisory board, essentially, like Stephen was saying, we grew it from about 3 or 4. I believe we have about at least 13 people in our group now who are really, really passionate about nutrition, who are passionate about heart disease, who are passionate about the health of the community. And without the input of the people in the community, I don't think we would be essentially where we are. They gave input on different aspects of the design, different aspects of the recruitment, like even the materials that we used for recruitment, some of the things that we ask of participants.

And I think through doing that and just other people hearing about the work that we're doing, it's actually brought other people who are here at BI into just-- I'm asking about, hey, is it coming advisory board available to give input on this study or on that study? It's just been I guess rewarding, so to speak, just seeing the community be involved, just as also just having them enrich our study with that.

Oby Ukadike-oyer: That is fantastic. As you both talked about what you're working on now, I had a couple questions. There were some acronyms you were talking about and/or different things that you mentioned that I wanted to get a little more information about.

I may ask first that you talk about DASH. I know what DASH stands for, but I don't know how many people have heard of it, if they know what that stands for. So if you could talk a little bit about that. What does it stand for, what does that look like, as far as the groceries you're delivering, and then I have a couple other questions.

Stephen Juraschek: Thank you so much for asking that question, and in fact, I have a couple slides. Like in a national survey, less than 1% of US adults have heard of DASH diet. So it stands for Dietary Approaches to Stop Hypertension. It was actually a diet that was conceptualized I think at BU and was tested formally through the NHLBI's support and published in 1997.

And what they showed is that this diet was more effective than fruits and vegetables only and like a typical American diet in reducing blood pressure. It also reduced LDL cholesterol, which is the lousy cholesterol that's associated with cardiovascular disease. The DASH diet emphasizes whole grains, low-fat or no-fat dairy, lean meats, like fish and poultry, and then nuts and beans and emphasizes fruits and vegetables. That's a major component, and then it's also restricted in fat, saturated fat, total cholesterol, red meat, sweets, and sugary beverages. And so that's DASH in a nutshell.

And I'll point out that the trial, when it was conducted, the population-- I think the trial was really visionary for its time. This is kind of a regrettable aspect of research history, but the DASH trial enrolled, over half of the participants self-identified as Black. And so they were able to do a very robust look at the effects of the diet by racial identification, so Black and White groups, and also by male and female. And what they found is that the effects were magnified among Black adults and even stronger among Black women, but all groups benefited. And so I think it's-- at least for these two very large racial groups in the United States-- it's strong evidence, compelling evidence that diet can be medicinal and can impact human health.

Ruth-alma Turkson-ocran: And just to add to what Stephen is saying, he just talked about what types of foods are included in DASH. And I also like to think about it not necessarily as a diet but more like an eating pattern. Because when the general public hears diet, it's like, OK, well, it's for weight loss or things like that. But studies have shown that, yes, DASH can have some weight loss, but it's also from eating healthier. So I just like to think about it as an eating pattern, a way of life, and not necessarily like diet, which sounds a little bit more restricted.

Oby Ukadike-oyer: Thank you for clarifying that. That's a great distinction. When you talk about-- you use the words medically-tailored groceries or food as medicine. And you earlier were talking about cultural humility and working in different environments, and sometimes food is culture.

So how do you all think about culture and food and tying that together in the work you're doing? How have you thought about it? How do you think about it moving forward? What does that mean in the work you are doing?

Stephen Juraschek: Yeah. Thank you so much for that question, and this is one of the reasons-- one of the many reasons I love working with Ruth-Alma, because she's a real trailblazer in this regard. It's also fundamental to our philosophy around Go Fresh. So one of the reasons we wanted to get groceries into people's homes is because, first of all, we wanted these to be products that people could buy after the study. But then also, we want to give people enough variety that they could construct a healthy diet with foods that they could enjoy with their family, according to their cultural traditions.

When we think about a lot of these diets that are healthy diets, for example the Mediterranean diet or the DASH diet, there is still a cultural construct of what the meal might look like around those healthy diets. And I hear a lot that people are like, oh, well, I really like the Mediterranean diet. I'm happy that's a healthy one, because it's foods that I like to eat. Right?

But when I start talking to patients about these different diets, you see very, very quickly that, well, what I might find to be palatable or fitting within my cultural experience may not be the case, and often is not the case, with many, many patients. I was reflecting on this, and it's interesting. I was telling Ruth-Alma about this one day. I was like, let's say the healthy diet out there had been a Japanese diet or had been an Indian diet. Right? That's where the trial had been done.

And then people were telling me, a primary care physician, OK, everybody needs to eat the Indian diet. Well, I have a hard enough time trying to get American folks to eat the DASH diet, which is an Americanized diet. I can't-- it would just be crazy to suggest-- to think that I could get folks to completely-- and yet this is what we're doing to everybody.

And the United States is a multicultural country. We have folks from all over. So we need to get away from a monolithic way to eat in a healthy way, down to the basic elements.

And to your point, and one thing that I feel like has been so eye opening to me, as we've been talking to people in the Boston area-- so the Black community in Boston is I feel like one of the most diverse communities that I've encountered. And one of the things that came up is that, even the healthy-- even though we're giving people a list of fruits and vegetables to purchase off of Instacart, which goes to all over the place, well, those groceries, they already lack a lot of diversity. Somebody somewhere has said, well, we're going to sell these 200 or 300 fruits and vegetables.

And we spoke with an owner of a grocery store called Tropical Foods. One of the things that struck me is they went out of their way to get cultural fruits and vegetables that sometimes were very difficult to find. Select farmers in Florida would grow a specific item that people really appreciated, because it reminded them of home.

And one thing that we've been talking about a lot is, how can we get to that level where, yeah, we want you to eat fruits and vegetables, but we don't want to force you to eat vegetables that you've never eaten before. We want to encourage you to eat the fruits and vegetables that remind you of home, that you can enjoy with your family. And I think that's where we're aspiring to get, but you're absolutely right.

I think diet, nutrition, it's at our core as people. Everybody eats. Right? And so if we don't account for culture and how food is prepared in a communal setting, I think our ability to motivate behavior change and sustain behavior change is really going to continue to fall short.

Ruth-alma Turkson-ocran: Absolutely, and going back to what Stephen said, yes, we did talk to I believe it's an owner and manager of Tropical Foods. And we had said, in addition to Amazon Fresh, we're using Instacart to deliver the foods to people's homes, but Tropical Foods was not on Instacart. I think several months into our intervention, one of our dietitians was like, wait a minute, Tropical Foods is on Instacart. And that was a whole game changer, because there might be places that we get groceries for people, but people may request certain groceries that we have to go back to Tropical Foods. So Instacart to help with that delivery, I do believe that that's been a game changer.

When people identify as Black, you have people who are from here, who are African-American. We have people who are Afro-Caribbean. We have people who are African immigrants. We have people who are Afro-Latino.

And so we tried to make sure that the chefs that we've been working with, who have provided recipes and recorded them cooking, we did try to make sure that, OK, they're at least provided a wide range of foods that would cater to the regions where they come from. And so that's one of the things that we're trying to do. But also do believe in the fact that we do need to look at more into tailoring the DASH eating plan for different cultures.

And so that hopefully is going to be-- is where we're moving next, trying to see if we can seek community input on that to figure out, OK, what is the best way to go about this? And then we look more into effectiveness, and do people really stick with it? Do people like that it's tailored based on your region of birth? People are still not monolithic, but just at least trying to do some things that may be more regionally appropriate.

Oby Ukadike-oyer: That is great. This is such an interesting conversation to me, because I grew up in Georgia. And I've lived in Massachusetts for a long time, for 20 plus years, and even some things, when I got here, I was like, where the heck do you find cream of wheat and okra?

And I was like, you can get this everywhere and anywhere in the South. And then I got here, and I was like, why am I searching high and low for okra? Like what's the issue, people? Like what is going on?

Ruth-alma Turkson-ocran: That is true, and that goes back to another of our things that we've looked at, is that even here, in the grocery stores that I hear cater to their small communities. So you would see, whether it's a Costco or whatever it is, they would have more products that are suited to the community around them than providing a wide range of things. And so you might end up having to travel far and wide to get things that fit your culture, and I don't believe that's necessarily right. That's going more into some of food access issues that would be a little bit beyond the scope but severely impact what you're doing also.

Stephen Juraschek: Yeah. I'd like to that. One of our consulting dietitians works, I believe, at-- is it Stop and Shop? Is that right, Ruth-Alma?

Ruth-alma Turkson-ocran: Yes.

Stephen Juraschek: She pointed out to us, there's just not enough diversity among many folks who are in nutrition and dietitian fields. And there's a lot of advocacy around this one amazing group, led by Vivien Morris's a BOND of Color to try to encourage more folks to go into dietitian, nutrition, and training programs and professions. And so when we think about this point that Ruth-Alma was making, it's almost like an invisible thing. Right?

Like if you have someone like me choosing what's to be sold in a store, yeah, I might have maybe hopefully some surveys, population surveys of who my consumers are. But like if I didn't know what a butter bean was or-- right? I think what was-- there was a certain fruit you were telling me about in Ghana, Ruth-Alma.

Ruth-alma Turkson-ocran: I think it was an African star apple or something like that.

Stephen Juraschek: Proving the point right now. If I don't even know that exists-- right? [laughter] You're starting in a pretty rough spot for that to show up in a grocery store. And yet that has implications for people. Right? I think that this is such an important issue that's really in the background but can have profound implications for folks trying to adopt a healthier lifestyle.

Oby Ukadike-oyer: This leads me into another question I was having as you all were talking, and it has to do with the longevity, the sustainability. Like what comes next, and what roles other people have to play in this research? And what I mean by that is I think of the local government. I think of corporate. I think of grocery stores and different people who can engage in this work as well.

Because at some point, the deliveries need to stop. You can't send people groceries forever. They need to be able to do this and think about this on their own. So what does that look like in the research? And who are the other groups maybe you think about, or you are thinking about, or you're already working with when you think about the work you're doing?

Stephen Juraschek: I love the opportunity to talk about Ruth-Alma's leadership roles and what she's doing, because she's leading a project right now. We've been thinking a lot about translation and sustainability. So she's leading, right now, a food security Food is Medicine initiative voucher program, prescribed food voucher program, at our local clinic practice, which has 40,000 folks. And really looking at a way we can do a better job of screening people for nutrition security concerns, and then linking them with benefits that they're entitled to to get a monthly stipend for healthy groceries with a debit card.

And so this is ongoing right now and is actually making a profound difference. Like a lot of times, we don't screen people appropriately, and we think about who's going to pay for this? Well, there are folks that are already entitled to benefits, to monthly stipends, fruits and vegetables. But they're not getting them, because the care teams just don't have a good system for identifying and matching people with those services. And I think that that's one real important area that we're looking at specifically.

I was just talking to someone at United Health Care, and they are tremendously interested in prevention. And I think many of these insurance companies are looking for evidence, for programs that they can pay for, that will send groceries to people's homes in a healthy way, that can reduce their cardiovascular risk factors and improve their longevity, their quality of life, their disease-free years. And so I think we need to do more partnership with insurers and health systems to make sure there's a good referral, but also a payment structure in place that people could have sustainable change in their lifestyle and prevent a lot of these diseases from developing.

So I think there's a lot of alignment actually growing around these issues. I think there's interest from the federal level. I know the National Institutes of Health is adopting a Food is Medicine initiative that they're going to be rolling out. But there's a lot of interest around how we can have more equity in terms of access to healthy foods, making sure people can consume healthier diets. There's just a number of synergies in this regard, and I believe translation is really important in that regard.

Ruth-alma Turkson-ocran: I was going to just add to what Stephen was saying. Yes, we do have these entities that are supporting all of this, but I want to also encourage people, especially in terms of people who do policies, just to also make sure that we do some more advocating for all these things. Because yes, these may be people who are covered by certain health plans, but what about people who are not covered?

The pandemic has taught us a lot of things. People are suffering. People may not be able to afford healthy foods. Even sometimes public assistance programs are not enough. And so just thinking about that and also advocating for a wider range of healthy foods to be covered would be the next steps, the next places that we can go to ensure equitable food access and options for all.

Oby Ukadike-oyer: That's such a great point. I appreciate what you're saying about it goes further when you're thinking about the equity piece and access and what is on the list of items you can get with these different benefits. I think that's a really powerful thing to think about.

How do you hope your research-- and you've talked about this quite a bit, but I will leave it with, how do you hope your research improves health care everyday life? And what do you hope people understand from your research and take away as the individuals participating in your research?

Stephen Juraschek: I think there's a couple areas where we're hoping to have a positive impact. One thing I like about our community initiatives has to do with the immediate impact. We do a lot of health screenings, and we've had over 4,000 people request to be in our study, over this past year, a little over a year now. And we've done over 3,000 pre-screening interviews, and then we've had nearly 900 in-person blood pressure measurements over this time frame.

A number of those folks have gone on to get labs done, and one of the things that excludes people from being in our study is having extremely high blood pressure or having diabetes. Because we emphasize a lot of foods that might be higher in carbohydrates, our groceries. We're hoping to do something specifically for folks with diabetes that are lower in carbohydrates down the road.

I actually just was on the phone with someone the other day. Well, from a study perspective you might say, oh, this is regrettable. You didn't get someone enrolled, and in some sense, that's what we're really focused on trying to do. On the flip side, identifying that someone has diabetes who didn't know it is actually super rewarding.

Two days ago, I called someone up, and I said, listen, we're really sorry that you weren't able to be in our study, but you know your A1C was such and such, and this is what that means. Did you know? Has anyone told you you had high blood sugar? You might have diabetes.

And this gentleman was like, I had no idea. I wasn't going to even talk about it with my primary care doctor. Later this week, I have an appointment. I'm going to definitely bring it up, and I'm so grateful to you all for bringing this to my attention.

We know that many people, they're not getting adequate screening. They don't have access to regular care, and then to present with disease at a very advanced stage-- sometimes, it's in the hospital where they're being told, well, there's already been irreversible damage. And so I think for me, it's been incredibly gratifying to, even for the folks who aren't in the study, to provide them with some knowledge about their health that they might have not gotten otherwise.

Then, for folks in the study, obviously, those who are in our intervention are getting all of those materials that they can learn and apply and we hope will be beneficial to them. We actually have recorded, as Ruth-Alma said, a number of narratives from Black chefs throughout Boston, talking about a dish that they enjoy. So a little bit of narrative-based storytelling there, where you talk about why a dish is important to them, how they prepare it, with a tie-in from a community dietitian. And we're hoping to make those available to the community.

And we were just speaking with another potential partner we're thinking of bringing on board to think about ways we can even take our curriculum. That's a 12-week telehealth session format right now, and make it more publicly available or digitize it in a fashion that anyone, anywhere can participate without necessarily being in our study. Those are some of the areas we're hoping to impact in the short term, but I think we have a lot more to do. And that's where we keep thinking like, how can we make things more personalized, partner with more folks to expand and get the word out, even beyond our brief period?

Ruth-alma Turkson-ocran: Absolutely. At the end of this, we would just love to see people be more engaged with their health, doing things that are going to improve their health. Seek resources, not be intimidated by asking health care providers all over the place questions. I think people have more knowledge and more aware and can do things to prevent or hold off disease. So that's our ultimate goal is to reduce the amount of disease, especially heart-related diseases, in our communities and beyond.

Oby Ukadike-oyer: That's fantastic. We have had such a thorough conversation, and I haven't even gone back to ask how your work is connected to the Harvard Catalyst community-engaged coalition group.

Ruth-alma Turkson-ocran: Throughout this whole process, we have been working very closely with Harvard Catalyst. When we started, we reached out to Becca, and she's been involved in this whole process. If there are any kind of challenges, whether it was with starting out the community advisory board, whether it was with challenges with recruitment and other things like that, we have just been in communication with her and with the Catalyst as a whole. And the resources that we've gotten, the ideas, everything has just been so impactful, and we are so, so grateful to have that opportunity, have that resource available, and know that, in the future, we can continue to collaborate. We can continue to learn from each other.

Stephen Juraschek: We're so grateful to Rebecca Lee and Community Coalition, to the Harvard Catalyst. They've really helped us get started. As I mentioned, we had a very small group at the beginning of great founding members, the Harvard Catalyst. Ruth-Alma said it all. They shared resources, plans, how to bring people together, really gave us a roadmap to grow a community advisory team.

I'll be honest, this has been so wonderful. I feel like Ruth-Alma gets emails all the time about how to set up a community advisory board and engage the community. And this is something that I feel like is so important. People are beginning to recognize it more, and now in our institution, there are talks-- I just can't-- can you believe, Ruth-Alma, like we're only in this for a couple years, but already talks about how we can do something institution-wide, Health Network-wide, as a way to engage the community. Before the projects even get started, at the concept phase, to advise allocation of resources to those projects that really align with patients and communities, also to inform the progress of an evolution of trials the way our board is doing for us.

And so it's just been like a gift that keeps giving. Like we learn so much we still benefit from the Catalyst, and then we're trying to pass it on to build up a more robust ecosystem around community engagement at Beth Israel Lahey Health. It's positive that there's so much discussion and interest and momentum now, which I don't think had been there prior.

Oby Ukadike-oyer: Thank you so much to both of you for having this conversation with us. We sincerely have more to talk to you about. We'll have you back.

Ruth-alma Turkson-ocran: OK, yes.

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Ruth-alma Turkson-ocran: We want to be back. Yeah.

Oby Ukadike-oyer: But it's been a serious pleasure having this conversation with you. So thank you.

Ruth-alma Turkson-ocran: Thank you so much. Thank you.

Stephen Juraschek: Yes. Thank you so much for this opportunity to speak with you all.

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Oby Ukadike-oyer: Thank you for listening. If you enjoyed this episode, please, rate us on iTunes, and help us spread the word about the amazing research taking place across the Harvard community and beyond. We are always looking to connect and collaborate with the research community and would like to hear from you. Please, feel free to email us at onlineeducation.catalyst.harvard.edu to inquire about being a guest on the podcast.

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