Filling the Gap: Community Organizations’ Role during a Health Crisis in California Rural Unincorporated Communities

Background and Purpose: Governmental and nonprofit organizations are pivotal structures in underserved communities. Organizations provide essential services, resources, knowledge and support that communities depend on to support a population’s health and well being in a limited opportunity environment.

Many small, underserved communities are unincorporated communities, where approximately one third of the U.S. population lives. These communities generally do not have local representation and rely on county government. Organizations in these areas often play roles in the community beyond their scope of work and are one of the only local providers with a presence in the community. During a crisis, there may be pressure to play a larger role in helping communities address health threats such as during the COVID-19 pandemic or a climate or environmental disaster. Greater understanding is needed to inform how organizations can support residents during a community health crisis.

Method: We employed purposive sampling to recruit participants who lived or worked in unincorporated communities in California’s Central Valley to explore challenges residents face when addressing a health crisis. Through semi-structured in-depth interviews, we examined the role government and community organizations played during two health threats -a birth defect crisis and COVID-19 Pandemic. Participants included unincorporated community residents (n = 16; representing 8 organizations) and non-resident organizational participants that provided direct or indirect services, resources, governance, and technical assistance (n = 8; representing 5 organizations). Organizational sectors included government, social services, health, education, community development, grass roots organizations, and nonprofits. Using deductive content analysis, we incorporated a coding framework adapting Giddens’ structuration theory. We contribute to an understanding of how organizations operate to fill in the gaps in communities with little infrastructure and no local government to address health threats.

Results:

Participants conveyed that organizations acted as 1) informational and resource intermediaries; 2) advocates 3) trusted mediators with country government and 4) leadership substitutes that helped residents receive some allocation of necessary resources to address the health threats faced by the community. Participants highlighted the benefits of long term and short term organizational actions on behalf of residents. Notably, participants spoke about the outsized importance of having champions within government and community organizations for smaller unincorporated communities during a health crisis.The majority of organizations were seen as trusted entities. However, some organizational actors that sought to fill the leadership vacuum in the community were seen as illegitimate by a portion of residents. Divergent community perceptions on organizations in the communities revealed community divisions on potential causes and solutions to addressing the birth defect cluster.

Conclusions and Implications:

Government and community organizations can reduce challenges residents face when seeking to access resources to address a health threat. However, not all organizational partners and responses are considered equal especially when an external environmental threat is perceived to be at play. Addressing needs in communities without local government representation requires greater understanding and nuance for those seeking to serve and assist community residents.