Through the eyes of community health workers: what was needed to increase COVID-19 vaccine uptake in the Missouri Southeast region

Front Public Health. 2024 Mar 27:12:1286177. doi: 10.3389/fpubh.2024.1286177. eCollection 2024.

Abstract

Public health emergencies, such as the COVID-19 pandemic, elucidate the strengths, weaknesses, and significant gaps in infrastructure, compatibility and consistency in communication systems, as well as the quality of collaborative relationships, and provider and workforce capacity. They also expose longstanding patterns of mistrust in the government and healthcare systems, and inadequacy in socio-economic infrastructures. These issues resulted in higher COVID-19 infection and mortality rates, and lower vaccination rates in many rural counties across the nation, including Missouri. In response to these challenges, the COVID-19 Response Network was formed in the Southeast corner of the state. The Network was a community-academic partnership that brought together community and faith-based leaders, academicians, healthcare providers and administrators, public health practitioners, and pharmacists to facilitate collaboration on education and outreach efforts aimed at reducing vaccine inequity in the 16-county project area. Importantly, the Network also included Community Health Workers (CHWs) who worked with these different agencies and organizations and were at the heart of implementing Network activities. The intent of this study was to assess their perspectives on the factors that influenced community engagement and communication strategies, and increased vaccine uptake in rural Missouri. Qualitative methods, including in-depth interviews, were used to explore the professional and personal experiences of CHWs working at the grassroots level during an ongoing pandemic. Narrative analysis revealed effective communication and engagement strategies for increasing vaccine uptake in rural communities. For instance, fear-based messaging was perceived as coercive and met with resistance. In contrast, messages that shared personal experiences and catered to the human need to protect their loved ones were more effective. Trust in the source of information was critical. This study highlights the significance of exploring and leveraging the capacities of trusted community members like CHWs to increase the effectiveness of public health interventions in rural communities.

Keywords: COVID-19; community engagement; community health workers; rural health; vaccine equity.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19 Vaccines*
  • COVID-19* / prevention & control
  • Community Health Workers
  • Humans
  • Missouri
  • Pandemics

Substances

  • COVID-19 Vaccines

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. Support for this project was provided by a grant from the Robert Wood Johnson Foundation Interdisciplinary Research Leaders program. Interdisciplinary Research Leaders is a national program of the Robert Wood Johnson Foundation led by the University of Minnesota. The views expressed here do not necessarily reflect those of the Foundation or the University of Minnesota. This project was also supported by the Health Resources and Services Administration (HRSA: U3SHS42192‐01‐00) of the U.S. Department of Health and Human Services (HHS) and Saint Louis University (SLU) Drs. Mary Susan and Robert Heaney Primary Care Research Fund. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by SLU, HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.