CEAL research team supports community health workers during COVID-19
The COVID-19 pandemic highlighted the importance of community health workers (CHWs)—including Hispanic/Latinx promotores de salud and Indigenous community health representatives (CHRs)—in getting valuable and trusted scientific information to community members, preventing COVID-19 spread, and linking individuals to essential health and social services and resources.
In a community case study titled, “Community Engagement Alliance (CEAL) Against COVID-19 Disparities: Academic-Community Partnership to Support Workforce Capacity Building Among Arizona Community Health Workers,” researchers from Northern Arizona University partnered with the Arizona Community Health Workers Association (AzCHOW) to detail their work in creating community-grounded tools and resources to support the CHW workforce during the COVID-19 pandemic.
The team conducted a series of focus groups with CHWs from throughout Arizona at two different times in 2021 to discover the priority concerns, needs, and challenges that CHWs were working to address in their communities as well as CHW strategies to overcome these. From the results, the team developed culturally and linguistically relevant health education messages, materials, and training for the CHW workforce. By building capacity within the workforce, CHWs are better equipped to serve their communities.
The researchers included Dulce J. Jiménez and Omar Gomez, research coordinators, NAU Center for Health Equity Research (CHER); Ruby Meraz, director of specialized trainings, AzCHOW; Amanda M. Pollitt, assistant professor, CHER and NAU Department Health Sciences; Linnea Evans, assistant professor, Community Health Equity, University of Massachusetts Amherst; Naomi Lee, associate professor, NAU Department of Chemistry and Biochemistry; Matt Ignacio, assistant professor, ASU School of Social Work; Katherine Garcia, CHW, coordinator of CHW specialized trainings, AzCHOW; Richard Redondo, research coordinator, AzCHOW; Floribella Redondo, CHW, cofounder and chief executive officer, AzCHOW; Heather J. Williamson, associate professor, CHER and NAU Department of Occupational Therapy; Sabrina Oesterle, associate professor, Arizona State University, School of Social Work, and director, Southwest Interdisciplinary Research Center; Sairam Parthasarathy, professor of medicine, University of Arizona, Department of Health Sciences, chief, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, and medical director, Center for Sleep Disorders, Banner–University Medical Center, Tucson; and Samantha Sabo, associate professor, CHER and NAU Department of Health Sciences.
The team is part of the Arizona Community Engagement Alliance Against COVID-19 Disparities (CEAL), a collaboration between Northern Arizona University, University of Arizona, Arizona State University, Mayo Clinic, and the Arizona Community Health Workers Association, funded by the National Institutes of Health Community Engagement Alliance.
“This publication, led by NAU MPH graduate Dulce Jiménez, is testimony of a strong partnership between academia and the not-for-profit sector representing the CHW profession,” Sabo said. “The demonstrated success of this collaborative work reinforces the importance of continued support for the CHW workforce by NIH to continue to assist Arizona communities hit hardest by COVID-19.”.
Why are CHWs so valuable to their community and to health equity?
CHWs are frontline public health workers who are trusted members of the communities they serve. As such, they have a unique understanding, sharing their culture, language, and lived experiences of their clients.
As valuable members of public health and care teams who are effective in reducing health disparities and improving health outcomes, CHWs play a vital role in addressing medical and social determinants of health among underserved populations.
According to the researchers, CHWs serve as a bridge between community members and fragmented systems of care and can support efforts to ease fear and correct false information in disadvantaged communities by leveraging their cultural connectedness and shared lived experiences to offer trusted advice and education.
Examples of how CHWs mobilized during the pandemic include connecting clients to basic services such as food pantries and food distribution sites, rent assistance, primary care providers, mental health resources and unemployment filing systems.
They have also assisted with finding resources for undocumented immigrants, facilitating the delivery of medications, creating and disseminating culturally and linguistically relevant health education materials, and providing social support to isolated older adults via phone.
Translating research findings to action to support the CHW workforce
The information CHWs shared with researchers during focus groups was used to develop and adapt COVID-19 educational materials and health education messages, and to identify knowledge gaps and training priorities for CHWs.
“Community health workers are experts in their communities. They are boots on the ground, providing trusted education, social support, and connection to vital health and social services,” Jiménez said. “This collaboration between researchers, a statewide CHW association, and CHWs themselves facilitated rapid decision-making and knowledge sharing to support an effective community-grounded pandemic response.”
According to the publication, the most important priority area among both CHWs serving Latinx communities and CHRs serving American Indian communities was COVID-19 vaccines, including topics such as vaccine contents, safety and side effects, efficacy, and benefits.
Since COVID-19 information was rapidly evolving, CHWs said they needed accurate and up-to-date information on the COVID-19 vaccines to enable them to answer their client’s questions, respond to their concerns, address misinformation, and help them make informed decisions about vaccination.
Another priority training area for CHW participants was mental health, including such topics as anxiety and depression, isolation, grief, and loss for both their clients and themselves.
CHWs also reported challenges with their clients managing chronic diseases, especially during periods of isolation. To support their clients, CHWs recommended incorporating nutrition, physical activity, and chronic disease management topics into COVID-19 prevention training to further develop their own knowledge and skills in these areas.
As a result of the focus group conversations, AzCHOW developed and offered topic-specific training in English and Spanish to the CHW workforce in Arizona, focusing on COVID-19 vaccines and spanning topics such as vaccine content, safety, and effectiveness, vaccine hesitancy, and addressing misinformation.
Training style and delivery format were also driven by CHW input. For example, to address safety concerns and reach as many CHWs as possible, synchronous training on vaccine topics and COVID-19 misinformation were offered virtually via Zoom during a time in the pandemic when vaccines were not widely accessible to all communities and vaccine uptake was low.
AzCHOW adapted and expanded the synchronous virtual training on vaccines to an asynchronous online format, consisting of a seven-part series of training videos that included:
- Introduction to the COVID-19 vaccine video series
- COVID-19 vaccines available
- The development of COVID-19 vaccines
- Deciding to get vaccinated
- Speaking with clients about the vaccines
- COVID-19 vaccine myths or facts
- Educational resources
The seven-part series was created with short, concise videos segmented by topics so that CHWs could learn at their own pace and use the videos with their clients to provide education. The series was made available in both English and Spanish.
AzCHOW also developed and offered an online synchronous training focused on mental health support for CHWs that included topics of grief, isolation, and loss in the context of COVID-19.
CEAL is funded by the National Institutes of Health Community Engagement Alliance.