How does community engagement through CETAC help improve health equity?

Challenge

Racial and ethnic minority groups throughout the U.S. experience higher rates of illness and death across a wide range of health conditions, including diabetes, hypertension, asthma, heart disease, and maternal morbidity and mortality when compared to their White, non-Hispanic counterparts. So when COVID-19 swept across the U.S., its impact on this population was also disproportionate. To address the effect of the virus and other health inequities on these medically underserved groups, the National Heart, Lung, and Blood Institute (NHLBI) tapped Westat to support what has grown to 23 awardees of the Community Engagement Alliance (CEAL) Against COVID-19. CEALS—made up of academic institutions partnering with community members and/or organizations—were tasked with providing trustworthy and scientific-based information about COVID-19 testing and vaccines and to use rapid research approaches to find effective ways to deliver information to communities hardest hit by the pandemic. Their outreach strategies were to be consistent with the strengths and needs of the communities with which they work and achieved through community engagement.

But developing community partnerships for support and exchange of information would likely be stymied by the speed of trust—the time needed to form trustworthy relationships. The speed of trust was at odds with the immediacy of the pandemic. Westat would provide resources to help academic institutions connect with the community. In addition, we would develop communication activities and materials, track the CEAL teams’ milestones and successes, help them develop evaluation plans to assess their interventions, and conduct systematic evaluations of the initiatives and their impact on the communities. Our expertise in technical assistance (TA), communications, and evaluations would not only be applied to this initiative but also to additional NHLBI initiatives focused on climate and health, maternal health and pregnancy outcomes, and the creation of a network for community-engaged primary care research.

Solution

Westat’s core activities for these initiatives include communication and outreach support; alliance-wide data coordination and management; program evaluation; and sub-award administration and monitoring. Our communications support includes guidance related to media engagements and outreach events; assistance with social media campaigns; development of factual, trustworthy COVID-19 resources that community leaders can share to address information gaps, misinformation, and mistrust. We also spotlight the successes the CEALS are achieving to correct misinformation and improve knowledge among marginalized communities.

Further, we ensure the communications we develop are culturally and linguistically appropriate and that despite language and reading skills, affected communities will be able to understand the information in diverse ways. We also develop educational tools to guide community leaders on topics, such as building trust, assessing needs, and encouraging inclusion in health research. Hosting roundtables, town halls, and other events open the door to discussions about COVID-19 treatments, vaccines, and mistrust.

To assist CEALS with their progress, we have installed a liaison model—linking each awardee with a CETAC team member so that if the awardee needs guidance or TA, our team member is easily accessible. This has allowed Westat to not only ensure their continued forward movement but also keep a pulse on their activities.

Because all initiatives conduct community-engaged research, Westat developed a brief set of common measures of community engagement best practices and outcomes. In addition to the overall evaluation of community engagement, Westat conducts initiative-level evaluations to gain information from awardees working on similar health topics. For example, we engaged stakeholders to design a Common Survey to measure COVID-related knowledge, attitudes, and behaviors across all CEAL awardees. We also measured impact by comparing COVID-19 vaccination rates in communities served by CEAL awardees and similar communities not in CEAL. Finally, at the local level, awardees evaluate their own projects and share results in peer-reviewed publications and for community stakeholders.

To collect and store the data used for performance measurement, evaluation, and broader research, the Westat team built an online data portal. Awardees can upload Common Survey data to the data portal using standardized formats and secure processes. We then analyze these data to evaluate the CEAL initiatives, but other researchers can also request these data to deepen their understanding of the problems and solutions related to the impact of COVID-19 on marginalized communities. Awardees also track project milestones, and report progress and challenges in the data portal, making that information readily available to help Westat support awardees in sharing successes and addressing challenges. Additionally, the data portal allows awardees to share resources with each other to increase efficiency and effectiveness.

Through sub-award administration, Westat guarantees that the awardees are complying with National Institutes of Health (NIH) regulations; spending their money responsibly; tracking deliverables, milestones, and successes; and identifying potential problems or risks.

Another innovation we have brought to this work is a dashboard containing a map and the progress of the CEALS. This allows NHLBI and Westat to track CEALS’ work and advances. The map shows where the TEAMS are conducting their research. The dashboard will later be made available to the public.

Results

While the results are preliminary, it appears that the CEALS are increasing marginalized communities’ trust in scientific information about COVID-19 testing and vaccination and that more members of this community are getting vaccinated. More analysis is forthcoming.