Difficulties of Trust: Embedded Community Health Workers and COVID-19 Vaccination
Main Article Content
Abstract
The authors recount the ways in which a COVID-19 vaccination campaign that explicitly embraced strengths-based community engagement moved further away from implicitly deficit-based data and assessment strategies. The conceptual framework was developed over several years in explicit confrontation with difficulties in implementation of various earlier projects, and the vaccination campaign was an important but not final step. The paper explains the driving philosophical commitments of the project and its expanding commitment to a vision of embedded community health workers (CHWs) as the mechanism for creating visibility into the dynamics of communities as they develop in terms of their own strengths and confront barriers to better health outcomes. This paper is written from the perspective of the management team and describes how the CHWs were supported and how they facilitated engagement with community members as a precursor to the vaccination decision. Some examples of CHW interactions within their communities are provided, as still preliminary steps toward a fully strengths-based approach to community data, but the authors recognize serious shortcomings in the highly individualized approach to data collection and interpretation, especially as researchers will require more sophisticated ways to model community dynamics at larger scales.
Article Details
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References
2. Allen JD, Fu Q, Shrestha S, et al. Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults. SSM - Population Health. 2022;20:101278. doi:https://doi.org/10.1016/j.ssmph.2022.101278.
3. Community-Based Outreach to Build COVID-19 Vaccine Confidence | HRSA. www.hrsa.gov. https://www.hrsa.gov/coronavirus/community-based-outreach. Accessed February 27, 2024.
4. Affairs (ASPA) AS for P. HHS Announces $226.5 Million to Launch Community Health Worker Training Program. HHS.gov. Published April 15, 2022. https://www.hhs.gov/about/news/2022/04/15/hhs-announces-226-million-launch-community-health-worker-training-program.html.
5. Shen AK, Browne S, Srivastava T, Kornides ML, Tan ASL. Trusted messengers and trusted messages: The role for community-based organizations in promoting COVID-19 and routine immunizations. Vaccine. Published online February 2023. doi:https://doi.org/10.1016/j.vaccine.2023.02.045.
6. Anderson KF, Ray-Warren D. Racial-Ethnic Residential Clustering and Early COVID-19 Vaccine Allocations in Five Urban Texas Counties. Journal of Health and Social Behavior. Published online February 14, 2022:002214652210749. doi:https://doi.org/10.1177/00221465221074915.
7. Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103:126-133. doi:10.1016/j.socscimed.2013.06.032.
8. Krieger N. Epidemiology and the web of causation: Has anyone seen the spider? Social Science & Medicine. 1994;39(7):887-903. doi:https://doi.org/10.1016/0277-9536(94)90202-x.
9. Schulz AJ, Mehdipanah R, Chatters LM, Reyes AG, Neblett EW, Israel BA. Moving Health Education and Behavior Upstream: Lessons From COVID-19 for Addressing Structural Drivers of Health Inequities. Health Education & Behavior. 2020;47(4):109019812092998. doi:https://doi.org/10.1177/1090198120929985.
10. Morgan A, Ziglio E. Revitalising the Public Health Evidence Base: An Asset Model. Health Assets in a Global Context. Published online 2010:3-16. doi:https://doi.org/10.1007/978-1-4419-5921-81
11. Martin-Kerry J, McLean J, Hopkins T, et al. Characterizing asset-based studies in public health: development of a framework. Health Promotion International. 2023;38(2). doi:https://doi.org/10.1093/heapro/daad015
12. Wilkins CH. Effective Engagement Requires Trust and Being Trustworthy. Medical Care. 2018;56(10):S6-S8. doi:https://doi.org/10.1097/mlr.0000000000000953.
13. Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 — Addressing Social Determinants of Health in Times of Crisis and Beyond. New England Journal of Medicine. 2020;383(19). doi:https://doi.org/10.1056/nejmp2022641.
14. Yearby R, Clark B, Figueroa JF. Structural racism in historical and modern US health care policy. Health Affairs. 2022;41(2):187-194. doi:https://doi.org/10.1377/hlthaff.2021.01466.
15. 2021 National Healthcare Quality and Disparities Report. Agency for Healthcare Research and Quality (US); 2021 . https://www.ncbi.nlm.nih.gov/books/NBK578529/.
16. Schulz AJ, Mehdipanah R, Chatters LM, Reyes AG, Neblett EW, Israel BA. Moving Health Education and Behavior Upstream: Lessons From COVID-19 for Addressing Structural Drivers of Health Inequities. Health Education & Behavior. 2020;47(4):109019812092998. doi:https://doi.org/10.1177/1090198120929985.
17. Schumaker E. Vaccination rates lag in communities of color, but it’s not only due to hesitancy, experts say. ABC News. Published May 8, 2021. https://abcnews.go.com/Health/vaccination-rates-lag-communities-color-due-hesitancy-experts/story?id=77272753. Accessed February 20, 2024.
18. VaxMap 2.0: West Health Policy Center and University of Pittsburgh School of Pharmacy Develop County-Level Map of Potential COVID-19 Vaccine Locations | West Health. West Health. Published August 12, 2024. Accessed February 12, 2024. https://westhealth.org/resources/vaxmap-2-0-west-health-policy-center-and-university-of-pittsburgh-school-of-pharmacy-develop-county-level-map-of-potential-covid-19-vaccine-locations/
19. Bureau UC. Males and the Hispanic, American Indian and Alaska Native Populations Experienced Disproportionate Increases in Deaths During Pandemic. Census.gov. Published June 22, 2023. https://www.census.gov/library/stories/2023/06/covid-19-impacts-on-mortality-by-race-ethnicity-and-sex.html.
20. Ingram M, Sabo S, Rothers J, Wennerstrom A, de Zapien JG. Community Health Workers and Community Advocacy: Addressing Health Disparities. Journal of Community Health. 2008;33(6):417-424. doi:https://doi.org/10.1007/s10900-008-9111-y.
21. May ML, Contreras RB. Promotor(a)s, the organizations in which they work, and an emerging paradox: How organizational structure and scope impact promotor(a)s’ work. Health Policy. 2007;82(2):153-166. doi:https://doi.org/10.1016/j.healthpol.2006.09.002.