Using Meaningful Community Engagement Methods to Advance COVID-19 Testing and Vaccine Uptake in Underserved Communities

NICOLE STADNICK
University of California San Diego

In response to the alarming health disparities experienced by underserved communities related to the COVID-19 pandemic, the National Institutes of Health (NIH) heavily invested in community engagement research efforts to eliminate disparities in testing, clinical trial participation, access to care, and vaccination. We describe the use of a Theory of Change process to meaningfully engage community members from or supporting underserved communities in two NIH-funded implementation science projects aimed at promoting equitable access to COVID-19 prevention and care services.

Both projects focused on underserved Latinx, Black, and immigrant and refugee communities in South/Central San Diego and/or individuals accessing care at a federally qualified health center (FQHC) near the US/Mexico border.

A Community Advisory Board (CAB) was established for each project with 11 and 22 members. CAB members included community organizers, promotores, FQHC providers and administrators, and public health researchers. The Global Action Research Center (ARC) led the recruitment of CAB members and facilitated each meeting. The Global ARC is a non-profit social change organization committed to bridging academic and community conversations to support community-driven solutions to public health priorities. The CABs were guided through a six-session Theory of Change, focused on identifying necessary conditions that must exist for a community-identified issues of concern along with specified actions to create those conditions and a blueprint for assessing the efficacy of those actions. Each session lasted two hours hosted over Zoom and was augmented by interactive web-based activities. Each CAB member was offered $100 for their participation in each meeting. There was a live interpreter who facilitated participation of Spanish-speaking CAB members.

A Theory of Change for each project was completed in approximately four months. A total of nine necessary conditions were identified across both projects. Cross-cutting conditions related to 1) accessible and available resources and services, 2) culturally and linguistically competent programming and materials, 3) investment in trusted community and faith leaders to convey accurate information, 4) social safety net to provide ancillary resources/services to support families. Corresponding actions to create these conditions were operationalized by the CAB members along with measures to indicate success in creating these necessary conditions.

We used a CAB-led Theory of Change process facilitated by our community partner, the Global ARC, to comprehensively assess and co-create necessary conditions, actions, and measures to eliminate disparities in COVID-19 prevention and intervention. While resource-intensive, these methods yielded a rich opportunity to equitably engage diverse groups that typically are not invited to inform these processes.