Table 2.

Assessment of potentially most relevant processes in relation to reflective questions.

First Author(s) [date(s)]*–article type	Process	Includes diverse patient life trajectories, mobility, vulnerabilities and assets?	Indicators tapping eco-social contexts for health?	State of application?†	Aspects applicable to practices-communities in diverse rural, resource development regions?	Challenges uncovered/addressed for operationalizing?
Leonhardt et al. (46)—case study	Community-based patient advisory council	Focus was medication use safety, not patient distinguished	Not included	Promising approach	Rural county with multiple health centers, so likely applicable.	Health provider involvement, creating trust and respect, time-intensive for personnel involved.
Tisnado et al. (47)—case study	Community-partnered research—CBPR	Of participating community researchers	Not focus	Demonstration project process documentation	Cultural group rather than geographically defined. Working through different values, establishing mechanisms for interaction between community members and providers- researchers all instructive.	Time availability, preferred communication modes, data sharing issues, limited funding for community partners.
Joosten et al. (48, 49)—multiple case study	Community engagement studios	Yes	Not focus	Demonstration project evaluation	Potential for adapting already developed research ideas. Could be done virtually in rural areas, depending on connectivity.	Core funding support and adequate information to stakeholders needed. Reasonable cost.
Etchegary et al. (50)—case study	Town halls on health research	Not directly, though some shared	Not clear	Promising approach	Rural communities included, could tap health research interests.	Time for planning and use of appropriate language.
Marcus et al. (51) [and Moosa et al. (52)]—multiple case study	(ward-based) Primary care outreach	Vulnerabilities and assets yes	Yes, rurally including water and sanitation	Demonstration project evaluation	Yes, complementary responsibilities in communities with travel to households.	Organizational independence as part of regional health services, with separate staffing and resources.
Kaufman et al. (53)—multiple case study	Health Extension broadly, though distinct models in five different states	In some practices, in some states	Not explicit	Demonstration project evaluations	Several explicitly rural efforts. Experience of building sustained relationships with practices and community coalitions; documenting success in broad terms as well as diverse outcomes of meaning to different stakeholders; understanding that health extension can be carried out by an individual or group depending on resources.	Challenge in USA of market-based health care corporations buying up primary care practices. Need for long-term, sustained fundraising beyond grants.
Shahzad et al. (43)—systematic review	Use clinical opportunities to address underlying causes of health problems	Yes	Built environment—housing in the city (54)	Some empirical evaluation around other kinds of information	Issues addressed in encounter EHR could be eco-social relevant ones e.g., exacerbation of asthma or COPD by wildfires (55).	Generic
	Use clinical encounters and share data (e.g., Electronic Health Records) to build community databases (54, 56)	Potential	Not generally	Some demonstra- tion project evaluation around other kinds of information	Sharing of anonymous, aggregate patient utilization and population information example Bruckner and Barr (57) specifically noted collaborative work in rural county.	Generic
Johnston et al. (58)—case study	Community-engaged health services planning	Subsumed	Only indirectly in effects on transportation	Demonstration project evaluation	All, with a focus on health providers, authorities, systems.	Potential power differential between health providers and other engaged partners.

^*Chronological.

^†State of Application categories: interesting idea, promising approach, empirical evaluation, decades of institutionalization.