A University of Oregon (UO) team developed a culturally-informed outreach program to triple the number of Latinx people being tested for COVID-19 at a randomized trial of 33 testing sites in 9 Oregon counties from Feb. 1, 2021, to Aug. 31, 2021.
The outreach program utilized community health promoters to help increase Latinx testing. They focused on mitigating misinformation, increasing trust, and disseminating information on testing events in English and Spanish. Intervention by community health promoters was associated with 3.84 times more Latinx people tested per event than control sites.
Latinx people have been disproportionately affected during the COVID-19 pandemic and researchers felt it was imperative to develop preventive interventions to assess their effect on health disparities. UO Professor Leslie Leve is the associate director of the UO’s Prevention Science Institute. Along with Research Associate Professor Dave DeGarmo and Professor William Cresko, Leve was one of the directors of the project responsible for this research. She discusses the research in this Q&A.
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State of Reform: The UO team was able to get 3.84 times as many Latinx individuals tested per event than control sites by utilizing community health promoters. Why was this outreach method so successful?
Leslie Leve: “Our success was largely driven by our regionally based “promotores” outreach approach. Specifically, our project team included community health workers, or promotores, who worked in community-based organizations that served Latinx people in the same counties where we were providing testing.
The promotores were bilingual and bicultural, and they had established connections with members of the community. They knew the community and they were seen as trusted individuals. I do not think we would have seen such a positive effect in our study if individuals without the local knowledge and relationships had been doing the outreach.
Further, some of the outreach activities the promotores used included talking to people at local businesses (grocery stores, restaurants) that were frequented by Latinx people to inform them about free testing. Our project materials and website were all available in Spanish and English, and project staff at the testing events were also bilingual and bicultural. All these aspects made the testing feel safe and more accessible.”
SOR: Did the community health promoters encounter significant barriers that had been keeping Latinx individuals from being tested in the form of language or misinformation barriers? If so, could you give me an example of some misinformation they might have been confused by?
LL: “Certainly, one common barrier was language, as it does not feel welcoming or safe to seek health services when health providers don’t speak the same language as you do.
Misinformation was also an issue, but our data suggest that it was no more of a barrier for the Latinx population than it was for non-Latinx community members.
Another barrier was a lack of trust in the process. Helping people understand that their information would not be shared with immigration services was an effective strategy to overcome this barrier.
Finally, some community members did not want to receive testing because if they learned they had COVID, it might affect their ability to work and earn a paycheck. The potential loss of income was a major barrier to seeking testing.”
SOR: What were some of the most effective outreach methods utilized by community health promoters?
LL: “Our study wasn’t designed to test whether one specific outreach strategy was more effective than others, but some of the more common methods that seemed to be effective were approaching people at venues they regularly frequented to tell them about the testing, Spanish radio advertisements, social media posts, having signage near the testing venue that was in Spanish, and direct outreach by promotores to the clients of community-based organizations.
Promotores also reached out to their family and friends to share information they were learning about the importance of COVID-19 testing and to empower family and friends to get tested, but to also mobilize family and friends to share this information with others in their network and community. In this process, promotores shared their own personal experiences related to COVID and motivations for testing.
The research team also worked closely with community partners to select testing locations and tailor the outreach approach to fit the specific local community culture. In other words, we did something a little different in each community, because the community needs, cultures, and preferences vary across the state.”
SOR: Could this type of outreach model be effective in addressing other health-related scenarios? If so, what types of scenarios could benefit from this type of outreach model?
LL: “We are not the first to use promotores or community health workers with Latinx communities. However, our findings were the first to apply it to COVID-19 prevention that we know of.
Across the literature there is now sufficient evidence to suggest that this is an effective method for public health promotion in underserved communities for a variety of community health objectives. This could range from preventive care, such as routine pediatric vaccinations or dental examinations, to healthy behavior promotion, such as encouraging exercise and healthy eating, to chronic disease management such as treatment and care for diabetes or heart disease.
A key ingredient is that effective community health outreach strategies be provided by a trusted individual or agency, who understands the cultural and community values and concerns of the individual seeking or needing care.”
This Q&A was edited for clarity and length.