No abstract

Varying dimensions of social, environmental, and economic vulnerability can lead to drastically different health outcomes. The novel coronavirus (SARS-CoV-19) pandemic exposes how the intersection of these vulnerabilities with individual behavior, healthcare access, and pre-existing conditions can lead to disproportionate risks of morbidity and mortality from the virus-induced illness, COVID-19. The available data shows that those who are black, indigenous, and people of color (BIPOC) bear the brunt of this risk; however, missing data on race/ethnicity from federal, state, and local agencies impedes nuanced understanding of health disparities. In this commentary, we summarize the link between racism and COVID-19 disparities and the extent of missing data on race/ethnicity in critical COVID-19 reporting. In addition, we provide an overview of the current literature on missing demographic data in the US and hypothesize how racism contributes to nonresponse in health reporting broadly. Finally, we argue that health departments and healthcare systems must engage communities of color to co-develop race/ethnicity data collection processes as part of a comprehensive strategy for achieving health equity.

This Viewpoint discusses the importance of accurately categorizing and collecting race and ethnicity data, matching self-identity with race and ethnicity labels, in an effort to quantify the extent of health disparities.

Background COVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities, but are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital health care services. Dialogue-based health literacy interventions may mitigate mistrust and increase access to health services and information, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk. Objective To improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community- and faith-based organizations, and the Westchester County Department of Correction, co-developed a health education program for community members, correctional officers, and incarcerated jail residents in Westchester, New York. Specific objectives are to increase preventative health behaviors, positive attitudes toward use of public health protocols, full vaccination or intentions to vaccinate, health care information understanding, health provider care access, clear communication with health care providers, and personal health care decision-making. Methods Grounded in dialogic learning, the program entails training community-based “trusted messengers” and correctional officers to lead health information sessions in community and correctional settings. During the grant period, the program intends for 80 community-based trusted messengers to receive training from the Department of Health and will be expected to reach a goal of 100 members (N=8000) of their communities. Correctional staff with experience delivering educational programs will be trained to facilitate sessions among 400 correctional facility residents and 600 correctional staff. Results Pre-post surveys will assess changes in health behaviors, attitudes, and perceptions. The program has been administered in the correctional facility since February 2022, with information sessions expected to cease for correctional staff and residents in June 2022 and November 2022, respectively. An initial cohort of community-based trusted messengers began training in February 2022, and information sessions have been scheduled in various virtual and community settings since March 2022. As of April 2022, the two-pronged health education program has reached 439 correctional officers, 98 jail residents, and 201 community members countywide. Program evaluation findings will be released in future publications after study implementation is complete. Conclusions Few studies have evaluated the combined effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first known COVID-19–specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in current knowledge about health literacy and health behavior in marginalized populations. Thus, this evidence-based framework can remedy COVID-19 disparities while also addressing risks for a host of health-related issues at the community level, potentially serving as a best-practice model for future health programs. International Registered Report Identifier (IRRID) PRR1-10.2196/37713

UNSTRUCTURED COVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus that causes COVID-19. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities. Yet, they are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital healthcare services. Additionally, issues such as language barriers and the complexity of the healthcare system are among many structural challenges that impede access to health information and services. Dialogue-based, participatory health literacy interventions may help mitigate mistrust and increase access to health information and services, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk. To improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community and faith-based organizations, and the Westchester County Department of Correction will co-develop a health education program for community members, correctional officers, and incarcerated jail residents in the county of Westchester, NY. Grounded in dialogic learning, the program entails training Trusted Messengers to lead culturally sensitive and linguistically appropriate COVID-19 focused information sessions with a healthcare professional’s support. Over a 2-year period, 160 community-based Trusted Messengers will be trained to reach 16,000 community members in the county’s high-risk zip codes. Correctional staff with experience delivering educational programs will be trained as Trusted Messengers in the correctional facility setting, reaching 400 correctional facility resident inmates and 800 correctional staff, respectively. Pre- and post-surveys will assess changes in health behaviors, attitudes, and perceptions. Few studies evaluate the effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first COVID-19-specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in the current knowledge about how to address health literacy among marginalized populations and motivate healthy behaviors. This evidence-based framework can remedy COVID-19 disparities and address health literacy among populations at high risk for a host of health-related issues, potentially serving as a best practice model for future health programs.