Strategies to Engage Underserved Communities in Southern California in COVID-19 Testing, Vaccinations and Trials

Summary

The STOP COVID-19 CA UC San Diego-Global ARC project team, comprised of researchers from UC San Diego and members of the Global Action Research Center (Global ARC), aimed to identify strategies and create solutions to overcome barriers to COVID-19 testing, vaccination uptake, and participation in clinical trials, among Latino/a/x, African American, East African, Syrian, Afghan, Pacific Islanders, and South East Asian communities in San Diego County.

The Challenge

Limited health literacy (including knowledge of the US healthcare system), lower English proficiency, and discrimination are contributing factors to poorer health outcomes, as well as barriers to accessing and receiving healthcare services, which disproportionately impact immigrant and refugee communities in the United States. The COVID-19 pandemic dramatically illustrates widening health disparities impacting immigrant, refugee, Black, Indigenous, and Communities of Color communities nationally in the United States and within specific geographic regions. These communities are significantly more likely to experience mortality and morbidity from COVID-19, along with delayed and lower testing and vaccination rates compared to white individuals in the United States.

The Approach

The primary goal of the multisite STOP COVID-19 CA Project was to increase participation in COVID-19 Preventive, Vaccine, and Therapeutic Clinical Trials, as well as to increase COVID-19 vaccine uptake particularly in underserved communities who were disproportionally affected by COVID-19. The UC San Diego and Global Action Research Center (Global ARC) site’s main objective was to identify and co-create solutions to overcome barriers to COVID-19 testing, vaccination uptake, and participation in clinical trials, by engaging with and learning from Latino/a/x African American, East African, Syrian, Afghan, Pacific Islanders, and Southeast Asian communities in San Diego. The San Diego site recruited representative members of these key groups to serve on a Community Advisory Board (CAB), which met on multiple occasions to share their communities’ concerns. Led by the Global ARC team, the CAB created a Theory of Change to inform and guide best practices and approaches for eliminating barriers to COVID-19 testing, vaccinations, and participation in research. Members of the CAB also completed surveys to document their needs, assets, and values, and a subset also participated in listening sessions, to elicit more detailed information regarding determinants to obtaining COVID-19 related services.

The Impact

The San Diego STOP COVID-19 CA UC San Diego-Global ARC team has made significant strides in increasing awareness and understanding of factors that contribute to health disparities, focusing on improving COVID-19 testing and vaccination access for various communities. Their research has led to better ways of reaching and helping these groups, with local collaborators and health providers using the findings to direct resources and staff effectively. The team created a Theory of Change, a guide that helps others expand their services to similarly underserved populations, using methods like ethnographic documentation to understand and engage communities better. This work is crucial for providers to understand the challenges and needs of different communities, building trust and paving the way for more equitable healthcare. The San Diego team's efforts have especially illuminated the experiences of diverse groups, including Latino/a/x, African American, East African, and Asian communities, among others, who speak a wide range of languages. By focusing on these previously less understood groups, the project has contributed to broader health equity goals, ensuring that all communities have a voice and are prioritized in health initiatives.

Key Benefits

	Investigative Procedures - *Demonstrated* Ethnographic approaches used in the STOP COVID-19 CA UC San Diego-Global ARC project have practical research and investigational applications, especially for populations whose needs, barriers to care and other social determinants of health are not well understood.
	Public Health Practices - *Potential* The STOP COVID-19 CA UC San Diego-Global ARC project findings, including information gained through the Theory of Change process, have the potential to inform best practices for preventive health measures directly related to COVID-19 prevention, as well as other disease prevention.
	Healthcare Accessibility - *Potential* The STOP COVID-19 CA UC San Diego-Global ARC project findings from the Theory of Change, surveys, and listening sessions inform health care providers about barriers and facilitators to access to care for immigrant and refugee communities which, if applied, can lead to improved health care practices and strategies to reach these and other underserved communities.
	Cost-Effectiveness - *Demonstrated* Information gained from the STOP COVID-19 CA UC San Diego-Global ARC project helps health service providers determine cost-effective approaches to health promotion and disease prevention efforts. For example, from the surveys and listening sessions, information was gained regarding the type of messenger who is most trusted with health advice. Utilizing this information, providers can rely on trusted spokespersons, and not waste funds for less trusted sources.
	Societal & Financial Cost of Illness - *Potential* It is anticipated that information gained from the STOP COVID-19 CA UC San Diego-Global ARC project will improve the quality of life of local immigrant, refugee, and other underserved populations, reducing the financial and social cost of disease by contributing to the delivery of more informed, thus more effective disease prevention efforts.
	Policies - *Potential* The STOP COVID-19 CA UC San Diego-Global ARC team led the development and delivery of a five-session training for ethnically-based, immigrant and refugee community leaders to advocate for policy-level changes. Findings will inform efforts to help others increase capacity to impact policy changes and methods utilized will also inform the efforts of others with similar goals.