Written by Sarah Goldring, Health and Well-being Agent, Gina Crist, Community Health Specialist - Health & Well-being Program Leader and Alyssa Whitaker, Health and Well-being Agent

View as an infographic >

RELEVANCE

COVID-19 has disproportionately impacted many low-income, rural, and underserved communities. However, these populations still face barriers to vaccine education and access. The University of Delaware and the University of Maryland Cooperative Extension Systems partnered to research this issue in 2022 and 2023. Needs assessments from this research project included interviews and surveys of key informants and community members from the agricultural industry, healthcare, education, faith-based, and social assistance within targeted underserved areas.

Findings from the data were reported into themes:

Trusted and untrusted sources
Barriers to accessing information
Sources of misinformation
Barriers to accessing the vaccine

These findings highlighted the need for community-based programming through trusted organizations, programs to assist with navigating the healthcare system, and culturally tailored messaging and materials.

RESPONSE

UD continued working on adult vaccine hesitancy and education through the Extension Collaborative on Immunization and Teaching Engagement (EXCITE) Implementation grant. Due to findings from past research, Cooperative Extension focused on building health literacy and vaccine education through partnering with the State of Delaware Division of Public Health's Community Health Workers (CHW). Educational presentations were developed to provide the CHWs with professional development to build skills in communicating with underserved populations regarding vaccine hesitancy.

Practice-based training to promote the use of these skills is being organized as the next phase of training. The practice-based training will utilize UD's Healthcare Theatre actors. This will allow a comfortable space for CHWs to practice their skills with actors portraying common scenarios they may typically face. Cooperative Extension combines didactic and practice-based learning for this project to enhance communication skills around vaccine uptake in vulnerable populations that CHWs work with.

Throughout the grant, Cooperative Extension offers four trainings (two didactic and two practice-based) for CHWs. The four trainings will cover various topics, including vaccine hesitancy, vaccine access, barriers and motivations to getting vaccinated, building community trust and rapport, cultural awareness and competency, motivational interviewing and other communication techniques.

RESULTS

Cooperative Extension adapted a previously developed EXCITE presentation to fit the specific needs of CHWs. During one of their monthly roundtable meetings, this session was virtually presented to CHWs (n= 79). From this session, participants learned about addressing vaccine hesitancy, gaining trust within a community, cultural competency, and basic health literacy components. They identified open-ended questions that they would use in their work. Examples are, "What brings you here today?" "Please tell me more about that," and "What are your biggest concerns."

The group of CHWs also shared some things they can control to ensure their programs, resources, and work are more culturally inclusive. Some of these examples were research and training to educate and identify the community's cultural needs, translation of written materials or spoken word, and hiring staff from diverse backgrounds.

After the presentation, participants (n=18) were surveyed on what topics they would be interested in practicing during Healthcare Theatre training, with the choice of marking all that apply. Results showed further interest in cultural awareness (10), open-ended questions (8), teach-backs (7), motivational interviewing (7), active listening (4), and empathetic listening (4). These responses will aid us in further developing educational training and materials for the CHWs.

RECOGNITION

The Extension Collaborative on Immunization and Teaching Engagement (EXCITE) initiative is funded through the Extension Foundation, the Extension Committee on Organization and Policy, the USDA National Institute of Food and Agriculture, and the Centers for Disease Control and Prevention.

Partnerships for this project include the Delaware Division of Public Health and the Community Health Workers Association of Delaware.