COVID-19 disparities and health literacy: a study protocol for community-based settings and correctional facilities (Preprint)

Abstract

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.