Table 2.

Themes.

COVID pandemic impact negative
Information dissemination and public education lacking There is a need to educate the public and translate current research for lay audiences to inform their health decisions.	“I think the entire academic community, and that includes health and medical centers, have not been good, at the translation of academic information to the general public. . . How do we get the messages out there? How do we use evidence-based strategies? How do we disseminate that, even to other people in research and academic institutions, other than by publishing in a journal?” IV14
Unfair and inaccessible testing and vaccine roll-out strategy The rollout strategy for the COVID-19 vaccines was perceived to be unfair. Community frontline workers were not prioritized. Testing was inaccessible and impractical at times.	“I do think . . . the vaccine rollout could have been better as far as equity and who was getting them. I’m just gonna say that the nonprofits were pissed when we heard about Mayo office workers getting vaccines before our front-line people. I know that Mayo Clinic says they were following CDC and state health guidelines, but it felt pretty unfair when our client facing staff and our drivers could not get a vaccine, but Mayo Clinic IT people were getting them.” IV4 “Initially, it was a little challenging for the population to get their COVID testing done at Mayo. . . there wasn’t anyone who could communicate with them in Spanish. That was a little challenging. Then even just to try to keep people safe and separated, their process was you set up your appointment online or over the phone with someone, and then our interpreters would try to call and help them, and then they were told ‘You have to be in the same room’—the interpreter and the patient have to be in the same room in order to make that appointment. Well, interpreters aren’t gonna wanna be in the same room as someone who thinks they have COVID” IV5
COVID pandemic impact positive
Outreach and Education COVID catalyzed stronger relationships and partnerships through improved mutual awareness of community organizations.	On the COVID community team: “What we have experienced with the team is a coming together of members throughout the community from all organizations. Number one, educating us about the disease. Educating us about the whole concept of what this pandemic was all about and the impact that it could have and what we needed to do to prepare ourselves, to keep ourselves safe, and to keep ourselves healthy. . .I thought Mayo Clinic had done a wonderful job. . .I think Mayo Clinic has really been on the forefront. In my opinion they’ve been out front in guiding the leadership and I would say really coordinating the efforts to educate the community.” IV13 “I just had a meeting yesterday with our local health and human service office, Public Health, and they said one thing that’s been good about this is—we’ve really been working with them on vaccine efforts as well as Mayo Clinic, all three of us. It has been so good to work together, and particularly with this higher risk immigrant population. They just realized that there’s a whole group of people that they didn’t even realize were a part of our community. . .” IV5
Infrastructure and Resources Many local organizations received support and funding from MCHS to support COVID-19 testing efforts. MCHS provided the necessary infrastructure and support to establish testing sites in collaboration with the community.	“The grants for my church—we had one $50,000 grant from Mayo that . . .we (used for) COVID testing.” IV16 “We did a large scale COVID testing contract with Mayo this year. We don’t have those abilities here on our campus, so that was a great opportunity to even build additional relationships with Mayo.” IV10
Accessible Relationships for getting COVID-19 advice Relationships between MCHS and community leaders helped inform decision making during COVID-19 pandemic.	“What was helpful for us, and I keep coming back to our relationship, obviously, with Mayo, but I had a couple Mayo members on speed dial. That’s who I went to when I had to ask a question about safety. Should we be open? Should we be offering this athletic program? What should we be requiring for visitors or parents?” IV9
General comments negative
Perceived Lack of Access MCHS was perceived as elite and exclusive and inaccessible institution among local communities.	“I don’t know if that’s a misconception, but when people think of Mayo Clinic, they think of this top echelon type of medical facility. You need money or good insurance to go there.” IV12 “The biggest issue we have found in the past has been the idea that Mayo’s for rich people or whatever” IV18 “Quite honestly, I’m happy to hear that Mayo is interested in our community ’cause, for years, I didn’t think Mayo was—I thought they were just physically housed in x, not really having an interest in x” IV22
Insurance Barriers Financial burdens of upfront payments and insurance deter the local community from seeking and obtaining medical care.	“That’s also one of the big barriers for the community because they’re—so many of our patients are so responsible. If they know that they can’t afford something, they’re not gonna go and have the procedure or whatever done. It’s a little scary to say, ‘Go have this multi-thousand-dollar visit, and then we’ll let you know what your portion of it is.” IV5
	“I’ve had so many clients who come to me and tell me certain things about Mayo refusing services or asking for certain things before they can have services. That really just taints your view and kind of makes it hard to work with Mayo or want to work with Mayo, even though . . . we want to. Just like yesterday, I had someone whose mom needed an MRI. Mayo was like, ‘No, we have to have a deposit of so many thousands of dollars before you can do that.’” IV1
Collaboration Challenges and Unsustained Partnerships Lack of continuity with relationships and poor communication suggesting poor of appreciation for the work of the organization.	“I think [collaboration] just kind of gets lost. You would start having a conversation, and then it just doesn’t continue. . . . my supervisor feels like Mayo doesn’t understand the role that we would play in terms of helping their patients or that maybe it’s not something that’s important, . . . to Mayo.” IV1 “To be honest, our region is a little bit behind because Mayo has not jumped on board. . . I’m not saying that Mayo doesn’t want to be involved. We’ve had conversations, but it hasn’t really—it has not taken off.” IV4
Lack of Transparency Aggressive billing practices and unaffordable upfront payments make referrals challenging.	“It’s really hard. It’s been difficult to really get in with Mayo. . . I think my supervisor especially was really pushing a really close relationship with Mayo in terms of having a really close referral process. Anyone who comes in the door, we can check their insurance. We can make sure it’s okay. We can help them apply, whatever. We haven’t been very successful with that.” IV1 “X has always been tricky to refer—it used to be very slow, and now they want either up-front payments or people are left with a bill that, well, they’re not sure what the bill could be. Is that correct? Yeah. Now you’re findin’ that even locally it’s a little bit less easy to refer.” IV5 “Even a little more challenging than that is if the patient needs a specialty, let’s say rheumatology, and we don’t have that locally here in X. They have to go to y Mayo for that. . . requires that you pay like $5,000 up front before they’ll even give you that appointment. Obviously, that’s a pretty big barrier that our patients can’t afford to do that.” IV5
General comments positive
Good Education and Information Outreach Effort MCHS proactive in educating the community and local organizations. Outreach efforts are viewed as instrumental sources of support.	“I do see Mayo Clinic as a major educator in the community. I think that they have taken their role quite seriously in making it a point to be active participants. . .Here’s what I felt was very instrumental about Mayo Clinic. Other organizations have their outreach, and Mayo Clinic has been very supportive in being a participant in the outreach of other organizations.” IV13 “Mayo’s outstanding at coming back and sending in people to support us and present. We need the people to present on health day. All of those hospitals, they rotate where we go, so 1 year, we’ll meet at Mayo for health day, the next year” IV21
Open Communication and Trust	“I think we have a very open line of communication and there’s a lot of trust both ways. I think that relationship with community engagement is great.” IV14
Suggested improvements
Increase information sharing and presentation opportunities Improvements needed regarding information sharing and educating the community including for those with poor computer and health literacy.	“I think conversations, information sharing, I think, would be useful. We often bring people to speak before the village board, and I can’t really remember the last time there was someone from the Mayo Clinic that we brought to speak to us about an informational issue or something as meaningful as that” IV3 “I would love to collaborate [with Mayo]. . . to be more in contact with providers that have a diverse background. Then they can help to educate our community in their own language, and also to empower our young people, to help to motivate them to explore some of those professional careers.” IV6 “It was the same thing with the COVID shots. You almost had to be a very computer literate, investigative sleuth to figure out where you could go, when you could go, how you made your appointment to get a COVID vaccination. It shouldn’t’ve been that hard. There should’ve been readily available charts. If you have this, you go here. If you have this, you go there. I think the education is lacking community wide on what’s available.” IV21
Increase Connection Opportunities More collaborations with MCHS are desired.	“I think we used to a little better job of connecting twice a year usually in a meeting just to share notes and areas of potential partnership. It’s been a little while since we’ve done that” IV5
Mental Health The prevalence of mental health issues in the pandemic landscape for all age groups was a concern.	“. . .We know. . . our kids suffered alone. We did interview some kids and their main concern was isolation and mental health and not having their peers. They did not have any access to mental health (support). Their parents were already laid off or furloughed or very stressed having kids at home. Without access to any mental health (support), it was very tough.” IV3 “Through everything, I think—when you ask, what else could be done? The whole mental health piece. [The pandemic] has impacted people in so many different ways. Everybody, whether we actually acknowledge it, we were all impacted on a mental health level with whatever it was. People were afraid” IV11 “Lately, a lot of mental health issues. I think mental health has always been an issue or concern for some of our [Hispanic] families. I think, also, it has been seen as a taboo, and so many of ‘em have not asked too much about it.” IV15