Posted on February 21, 2023

RADx-UP project spotlights essential workers too often overlooked in health care

02.21.2023

The RADx-UP consortium gathers each month to hear program updates and presentations about community-engaged research activities across the United States, its territories, and Tribal Nations. This article recaps a recent project presentation by Shawna Hudson, Diane Hill, Emily Barrett, and Manuel Costañeda.

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In 2020, New Jersey was among the states hit hardest by the COVID-19 pandemic, with a high case incidence and death rate, especially among communities with high social vulnerability.

The New Jersey Healthcare Essential Worker Outreach and Education Study – Testing Overlooked Occupations (NJ HEROES TOO) project stemmed from conversations with community partners that many essential occupations were being overlooked in healthcare worker advocacy and resources.

“In our healthcare settings, everyone was concerned about COVID-19, but the conversations were really focused on our nurses and our doctors and weren’t getting to other populations – folks that are working every day, like nursing assistants, dietary staff, custodial staff, community health workers,” researcher Shawna Hudson said.

These workers tend to be Black (or) Latino, as well as female, she added.

In Aim 1, the project partnered with 22 community-based organizations (CBO) and healthcare organizations (HCO) to understand community perspectives, establish trust, and co-develop COVID-19 testing education materials for medically underserved, Black, and Latino populations in New Jersey.

“The community partners and researchers were combined into one team,” researcher Diane Hill explained. “Community partners are treated as valued experts in their own rights working alongside researchers and serving as trusted arms to the residents and populations they serve.”

For Aim 2 of the implementation science study, they then compared the impact of the healthcare worker-focused strategy through HCOs using materials developed in Aim 1 compared to traditional community outreach through CBOs using standard materials.

Study Aims and Methods

Aim 1 of the study focused on exploring Black and Latino community perceptions about COVID-19 testing, treatment, and vaccination and included designing culturally tailored COVID-19 testing materials and messages based on the learnings.

Researchers developed these materials based on conversations with 111 community members. Conversations focused on the profound impact of the pandemic on job responsibilities, fears and uncertainty among HCWs, mitigation behaviors, and more.

In Aim 2, the project measured the impact of those materials by comparing the uptake of screening participating and then testing among underrepresented minorities, through two different routes. The two alternative strategies were to recruit healthcare workers as ambassadors who lead engagement of their “spheres of influence” using the materials developed in Aim 1 or recruitment through traditional CBO outreach.

The two arms were compared in terms of the accrual rate of study participants; success in testing vulnerable sub-populations of interest; the proportion of participants testing positive; and the costs of implementing NJ HEROES TOO for HCOs and CBOs.

Aim 2 implemented a health worker-focused strategy using the newly developed materials. They also conducted community outreach through community-based organizations using standard materials and methods.

Results

Of the 1110 participants that were recruited, 94% came through the traditional, CBO arm of the study. However, the likelihood of a participant to complete a COVID-19 test was higher for participants recruited through the HCO arm of the study.

There was substantial loss in both arms at every step of the path to a completed COVID-19 test.

The odds of completing a test were higher among participants who were older, female, have public health insurance or participated in Spanish. The resources were not effective for those who did not want to be vaccinated and who had never been tested for COVID-19 before.

“Our results reinforced the importance of the social determinants of health, as participants who faced more pandemic-related challenges were ultimately less likely to order tests and complete the process,” researcher Emily Barrett said.

Reflections and Lessons Learned

Manuel Castañeda, New Brunswick Tomorrow’s director of community health, applauded the project for involving community partners at all stages, from development to implementation.

“It’s that real sense of collaboration,” Castañeda said. “The healthcare team as well as the leadership can say that we were very vocal as community-based organizations on things that we felt were working or not working. We were listened to, and overall, the project benefited from it.”

Hudson said that the major takeaway from the project is that researchers need to be engaged with community storytelling. The project disseminated the results through an in-person celebratory event, publishing in academic journals as well as enduring online materials.

“It’s not enough for us to collect their data, we need to actually disseminate that information in ways that are meaningful,” Hudson said.

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