Table 2.

Definitions of LHCC and key barriers and enablers as identified in included articles

	First author (year)	Definition of LHCC	Community participation process	Type of rural health service development	Enablers	Barriers
1	Arcia (2016) [16]	LHCC implementation involves patient participation in the development of robust data utility, use of new clinical communication tools, and knowledge building through patient reported outcomes. Opportunities for patients and families to be engaged at all levels is an essential component to an LHCC	Participatory design sessions were held to elicit participants’ perceptions of the meaning of each design, whether the infographics would motivate them to change their health behaviors, their design preferences, and feedback for improvement	Development of tailored infographics that support comprehension of health information	Prolonged engagement with stakeholders and check-ins with members, peer debriefings, regular consultations with groups, carefully designed infographics to help patients engage with their own health data	Low levels of health literacy, agreement bias in group settings, financial constraints, difficulty in recruitment
2	Kunz (2017) [17]	Community resources and policies, in combination with coordinated health system functions, enable productive interactions between informed, activated patients and prepared, proactive practice teams. Productive interactions lead to better outcomes by improving clinicians’ treatment decisions, and patients’ understanding of their health and adherence to recommended treatment regimens or behavioral modifications for better health	Community health worker roles were designed to reach and support distinct populations. Multisector partnerships were made to support engagement through continuing education workshops and digital story screening to encourage referrals to the program	Vivir Mejor! (Live Better!), a diabetes prevention and management program tailored for the rural, Mexican American population	Funding, strong leadership, open communication	Lack of understanding of how to operationalize multi-sector partnerships Evaluation of how partnerships impact diabetes management, prevention, and the broader community
3	Carpenter (2018) [18]	An LHCC involves a collaborative environment that supports the adoption of health care innovations and motivates organizational change	LHCCs focused on adopting innovations in 3 high priority areas: (1) advancing the practice of patient- and family-centered care in hospitals, (2) promoting medication therapy management for at-risk populations, and (3) reducing non-urgent emergency services	The practice of patient and family-centered care in hospitals ; (2) Medication therapy management for at-risk populations; (3) Reducing non-urgent emergency services	Adoption of a learning community model, establishing a patient advisory council, maintaining partnerships, making incremental changes, strong communication, and achieving effective stakeholder engagement	Obtaining enough staffing resources, maintaining stakeholder commitment, and recruiting and training individuals
4	Chhabra (2018) [19]	A community health worker can conduct outreach to at-risk individuals in the community, provide needed education, and make linkages to care. Community members can act as health promotion catalysts, provide community education, encourage health promotion, and service navigation. They should have the opportunity to focus on issues that are important to them and can serve as leaders, influence health decisions, and have the skills to know how the community can instill change	Women referred their friends, family, and peers to attend a cervical cancer prevention workshop. Four focus group sessions with them were completed that involved the completion of a questionnaire	The Cervical Health Action and Intervention (CHAI)	Peers were educated as health advocates on how they could better promote healthy change in their communities, small, hands-on environment	Enrollment failure due to a lack of power to demonstrate efficacy and feasibility, lack of funding, limited in-person reach of rural populations and health care facilities
5	Fung-Kee-Fung (2018) [20]	Individual competence, systems thinking, cohesive vision, team learning, and the integration of different perspectives are elements of an LHCC. Also, there is a common goal of learning, a collective of multiple stakeholders with individuals outside of the hierarchy institution, that are considered equals is essential to LHCC development	A sample of health care professionals, patients, and caregivers were selected to represent the greatest variety of organizational and individual perspectives. This group was engaged through semi-structured interviews and stakeholder mapping	Application of an LHS paradigm to lung cancer care	A system open to ongoing innovation, dynamism of an LHS, continuous improvement in response to new evidence and information	Resistance to change, conflicting goals and priorities
6	Key (2018) [21]	Engagement of community at the organizational and institutional levels is a key element of an LHCC. Community was defined by identifying stakeholders one intends to engage and those working within and utilizing services of the LHS. Stakeholders within the LHS are critical to the knowledge that the health system produces and may include researchers, clinicians, insurance providers, and other key staff embedded in the system	-	-	Community/patient advisory boards participatory approach, stakeholder access to data, incremental improvements	Effectively engaging the community, funding, maintaining stakeholder engagement
7	Myers (2018) [22]	Multi Stakeholder engagement, shared value and mission, identification of the problem, evidence-based solutions commitment, and a sound operational approach are key elements of an LHCC	A coordinating team, a steering committee, and patient and stakeholder advisory committees were formed to address cancer screening and disparities in health systems	Colorectal Cancer Screening	Strong relationships with partners, having a shared mission	Maintaining long-term commitment from stakeholders
8	Gierisch (2019) [23]	An LHCC requires continuous stakeholder involvement and involves patient input throughout all levels of project implementation, training to ensure meaningful patient engagement, collaboration between patient populations and scientists, and the adoption of findings into practice	Qualitative interviews with researchers with different roles across 4 hubs and the coordinating center, and focus groups with veteran patients and caregivers were conducted. Patient informants were through ESP affiliated VA research centers	The Veteran Affairs Evidence Synthesis Program (ESP)	Shared goals, adequate training, obtaining appropriate resources, meaningful engagement use of time constraints	Patient representativeness, patient engagement, scientific complexity of evidence synthesis
9	Murray (2019) [24]	A Learning Network applies rigorous QI science methodology to identify gaps in services to be targeted for improvement and identify successful practices to replicate across the network site. LNs endeavor to achieve population health outcomes at scale. An LN platform does this by aligning clinical care, informatics, and culture to focus on continuous improvements, innovation, and research. Active partnering with patients and families in all aspects is essential	Various stakeholders, a part of the Anderson Center team, parents, clinicians, researchers, and data analysts/biostaticians met for an in-person, two-day design session followed by weekly collaborative leadership calls	The Autism Learning Health Network	Access to large data collection, Evidence-based solutions knowledge sharing	Effectively engaging participants, maintaining stakeholder engagement, funding, effective collaboration between stakeholders
10	Baba (2020) [25]	A participatory approach through a workshop methodology involves engagement of different stakeholders, builds on available data, reflection on evidence and real-world experience, promotion of LHSs and development of pragmatic strategies for the retention and attraction of health workers in rural settings	A workshop methodology was used in this study. Participatory workshops were held for community members and stakeholders. Discussions took place on the distribution and experiences of midwives	Recruitment and retention of health workers	Participatory/collaborative approach, strong communication between stakeholders, integration of workshops	Financial constraints, and poor financial planning, inequitable policy implementation
11	Curtis (2021) [26]	Collaborative efforts and meaningful engagement with patients, communities, and local health care stakeholders is essential to LHCC implementation as it allows for voices to be heard and incorporated into the project in a way that promotes shared decision-making and sustainability. Culturally safe clinical practices were identified as an essential component of the LHCC. All parties must share in the development and implementation of the project in a process that upholds mutual respect, learning, and dialogue	An engagement event on Kidney Check took place with a meal and presentations were completed to stakeholders. Community members shared their experiences managing kidney disease, their role within the networks, and insight on how to best use engagement strategies and local resources	Kidney Check Point-of-Care Testing	A patient-oriented approach, a multidisciplinary team, meaningful engagement with communities, collaboration	Lack of literature on recruitment in rural African American communities, low levels of health literacy, some participants were resistant to change
12	Donahue (2021) [27]	Using continuous Quality Improvement (QI) strategies to improve care over time is essential to LHCC implementation. Real-time data collection at the point of care, continuous measurement of outcomes essential to patients, patient engagement, evidence-based care, and standardization and improvement of care processes are components of the LHCC	A design session was completed to bring together clinical and community partners to refine the vision and mission for the network from a variety of perspectives	Establishing an LHS framework to improve health outcomes for individuals with epilepsy	Institutional Support, stakeholder engagement, shared experiences, incremental improvements, culture of respect, stakeholder collaboration	Obtaining appropriate resources, engaging participants in a hands-on manner, funding
13	Golden (2021) [28]	Interaction, collaboration, and synergies among researchers, clinicians, and educators, generating a mutually reinforcing relationship between research, practice, and policy are key elements of an LHCC. Real-time access to knowledge, engaged, and empowered patients are also important	Stakeholders were involved in the project development, implementation, data analysis and dissemination phases. Women completed patient feedback forms presenting for appointments in primary care clinics	Women’s Health Practice-Based Research Network embedded within Veterans Health Administration	Good communication with partners, continuous feedback, engagement, strong stakeholder collaboration, and broad dissemination of findings	Competing demands stakeholders, timelines
14	Irby (2021) [10]	Community is defined as any group affiliated by geographic proximity, special interest, health condition, or similar categories of shared identity. In an LHCC, community members and representatives from community organizations collaborate and share research roles with academic investigators and research teams. Relationship building, trust, open communication, co-learning, shared power, resources, and decision-making, mutual ownership of the processes and products of research, and community engagement are essential components	Professors and research associates of varied academic backgrounds and departments were identified and completed semi-structured interviews	-	Institutional support (e.g., funding, protected time, and respect), research resources (e.g., research centers), shared mission, strong partnerships, having an institutional review board	Potential for burnout and strain, time commitment, competing community and academic goals/priorities, community mistrust, sustaining partnership, lack of funding
15	Keck (2021) [29]	Collaborative Learning Health Systems (CLHSs) are communities of patients, families, clinicians, and researchers who can all act as improvers by collaborating to improve health care and health outcomes. CLHSs facilitate collaboration by supporting effective communication between patient advocates and providers, shared goal development, mutual responsibility, and accountability for the production and sharing of resources and information	Patients and families were asked to opt in to the CIRCLE eNewsletter that links patients and caregivers to resources, and learning sessions. One-on-one meetings were conducted to establish a relationship and aid in co-producing training materials	ImproveCareNow, a collaborative Learning Health System for pediatric inflammatory bowel disease	Demonstrating value of stakeholder engagement, collaboration, organization into affinity groups, engagement using a systematic approach	Participant recruitment, resistance to change, creating stakeholder connections, knowledge/resource sharing with community
16	Beks (2022) [30]	Establishing partnerships that can inform steps of the research project, based on epistemological rationale where community members can lead and guide the research. Using participatory and culturally appropriate approaches to engage participants and for them to lead the discussion on health	Community-based System Dynamics Method and the Indigenous research method of Yarning (Story-telling)	-	Community partnerships and involvement, using culturally appropriate research methods, and community-based participatory approaches, sharing the use and value of the research with participants, strong relationships and communication	A need for flexibility in the research plan, meeting timelines, maintaining commitment and engagement with partners
17	Lindeman (2022) [31]	The LHCC can be adapted to different culturally diverse contexts, to enable genuine intercultural learning, and draws on Aboriginal and non-Aboriginal knowledge. This LHCC recognises the potential to work with communities to support reinvigoration of kinship-centred protective relationships and the potential to develop language-based resources to support this strengths-based work	The LHCC used a participatory Action research process to support Aboriginal and non-Aboriginal participants to take part in the research. The iterative action learning cycles involved a series of four two-day workshops over almost two years	Enhanced Domestic and Family Violence Services	Knowledge of community, language, strong communication skills, strong relationships, trust, sharing of cultural knowledge and practices, participatory action research, collaboration, meaningful engagement, recognizing the value of participant feedback	Lack of knowledge and discomfort by non-Aboriginal participants, flexibility of researchers and research process
18	Marsh (2022) [32]	The LHCC involves evidence-based interventions to improve health outcomes, aims to increase accessibility to quality care for underserved communities and address challenges related to the social determinants of health. The LHCC involves community interventions integrated into the primary care setting, patient-centered programs, and strong communication between patients and health care providers	A Community Health Worker (CHW) visited every other week to participants' homes for 12 weeks. Patients were visited in tandem or individually. During their home visits, the CHWs performed their routine assessment and provided diabetes education. The CHW also facilitated the patient's video conference with a health care provider	Diabetes Care of Older Adults through Community Health Worker (CHW) and Telemedicine Access Model (Diabetes COACH TeAM)	Telemedicine, and community health worker involvement, collaboration, patient-centered approach, strong communication and relationships	Lack of resources
19	Mishra (2022) [33]	The LHCC is a ‘people driven’ activity, involving participation and planning at each level of governance, involving multiple stakeholders. The LHCC involves participatory learning action (PLA) that can build local capacity to work toward a healthier community. Communities instead of outsiders analyze their situations to ensure that any learning is translated into action	A team of resident doctors and medical social workers visited all the selected 10 villages and held discussions with key community members as well as health care workers. A facilitator led PLA exercises (i.e. chart making, resource map development) in 10 villages	A conceptual framework for community participation in rural health care	Community participation, active dialogue from political and administrative stakeholders, participatory learning action approach, needs assessment, leadership	Lack of clarity of the role of community participation, poor supervision, lack of resources, health illiteracy, pessimism among participants
20	Oser (2022) [34]	The LHCC involves partnerships with community members, academic researchers, and health professionals. Having a multidisciplinary team, strong communication, engaging community members and patients, and community-specific knowledge is vital to the LHCC	10 virtual meetings over a six-month period with Community Advisory Council members including 15 diverse community stakeholders took place. Ad hoc members were added to round out expertise and perspectives	Enhanced Diabetes Self-Management Education and Support program called ‘Diabetes One Day (D1D)’	Community-based participatory research approach, one-day LHCC structure, virtual education, inclusive recruitment strategies, adaptability, strong communication, development of educational materials	Lack of resources
21	Pitchalard (2022) [35]	The LHCC involves creating links between the health care system and the community, co-learning, collaboration, strong communication skills, and knowledge sharing. The LHCC promotes interpersonal support, and seeks to improve health management and performance of health care workers	Village health workers were recruited by nurses at meetings. Diverse stakeholders were engaged and they participated in focus group discussions and completed research questionnaires. They completed the peer-training program for three days per week for three weeks	Peer-training Program to improve chronic disease management among eldrly	Participatory approach, supportive environment, communication, stakeholder feedback, group discussions, strong relationships, stakeholder engagement, training based on community needs, noting the value of participants	Identifying core program activities
22	Pullyblank (2022) [36]	Multi-sector collaboration between a rural health care system and community-based organizations are essential to the LHCC. It involves continuous capacity-building efforts with community partners, the use of health care system assets, and a cycle of quality improvement. The LHCC aims to improve health and health outcomes	Caregivers, as well as adults with a chronic condition were invited to participate in the program. Also clinicians made referrals to patients who were eligible. Workshops consisted of 8 to 16 participants and took 2.5 h each	Living Well Program	Strong community-clinic linkages, leveraging health care system assets, strong communication, community partners, and engaged stakeholders, adaptability, buy-in from partners, dissemination of outcomes, collaboration, multi-disciplinary team, multi-sector approach	Recruitment, lack of coordination between community-based organisations, low health care system engagement and lack of funding, and limited staff
23	Quraishi (2022) [37]	The LHCC engages communities using a participatory approach with the aim to increase health knowledge. The LHCC involves collaboration between community members, health care providers, and heath experts. Also, community knowledge and experiences are used to create educational messages that can address knowledge gaps	Individuals visiting TB centers in Punhana block, local leaders, women’s self-help groups, local community health workers, and other local health workers were invited to voluntarily partake in the Story Labs. The Story Labs sessions included 20–25 individuals and were facilitated by staff using a discussion guide	Story Labs: Digital TB awareness- raising storytelling	Using a systematic process, collaboration, participatory approach, digital storytelling, communication, engaged participants	The systematic process is human resource- intensive
24	Gregg (2023) [38]	The LHCC can allow for sharing of theoretical and practical knowledge through social experiences with community members. Using a Care Group Approach can increase participation from the community and empower people to make positive health behavior changes for themselves and for their children and families. The LHCC can increase engagement in community activities for improved health and beyond, thereby enhancing social capital in the community	A Care Group composed of 5–12 women Care Group Volunteers met together every 2 weeks with a Promoter to learn one or a small number of health messages that they each shared with their neighbors. Volunteers would meet with the mothers of assigned households, either as a group or individually during a visit to the woman's home to share and discuss the message(s)	Curamericas Maternal and Child Health Project	Group interview approach, group learning, collaboration, strong communication, strong relationships, participatory approach, knowledge sharing	Lack of resources, time, and literacy and knowledge of volunteers
25	Niranjan (2023) [39]	The LHCC aims to collaborate with community health advisors to increase community health service knowledge and uptake of preventative health services. Strong relationships with community health workers, community involvement, trust and partnerships are vital to the LHCC	Local county coordinators and community health advisors recruited participants. Participants completed questionnaires and then underwent a single CHA delivered educational session that took about 30 minutes. Then, they completed the posteducation survey	Community Health Advisor Educational Initiative to Increases Lung Cancer Screening and Knowledge	Trusting relationships, structured educational intervention, collaboration, strong relationships, using existing infrastructure, partnerships, understanding of culture	Lack of knowledge of health guidelines, medical mistrust,