It Takes Trust: A Sub-community Health Outreach Strategy in a Pandemic
In early 2021 amidst the frenzy of distributing the COVID-19 vaccine across the country, my husband (Dr. Kweku Hazel) and I were securing doses for the underserved BIPOC and immigrant communities in our home city of Aurora, Colorado. In this reflection, I’ll discuss the work Kweku and I accomplished through our community outreach group The Gyedi Project, providing resources and support to our community to ensure a more equitable rollout of the vaccine in Aurora. I’ll also detail important lessons we learned that can be replicated for successful community outreach in other cities, especially now with surging cases due to the Delta variant.
How Our Journey Began
Kweku and I were both born in Ghana and have dedicated our lives to championing public health for all. I am currently a Research Manager with a focus on public and behavioral health here at OMNI, and Kweku is a General Surgeon and Surgical Fellow at UCHealth University of Colorado Hospital. Kweku moved from Ghana to Texas to finish high school and attend college and medical school. While studying in Texas, he founded the Barbershop BP Program, a community outreach initiative focused on educating communities of color about high blood pressure and diabetes by sending medical student volunteers to barbershops across the city to help with blood pressure checks.
After finishing my Master’s in Public Health Policy from Durham University in the United Kingdom, I returned to Ghana where I interned with the Ghana Health Service working on the national health performance review. It exposed me to the successes and challenges of the healthcare system in Ghana. I went on to be the country’s manager for the evaluation of a mobile health technology program called MOTECH (Mobile Technology for Community Health), which was aimed at improving antenatal care attendance and skilled delivery in rural Ghana. I also volunteered to organize health programs for underserved communities with my church and supported local health projects educating the elderly on chronic health conditions.
Following our marriage in 2014, I joined Kweku in Aurora, where he had discovered a community of African immigrants, including many Ghanaian immigrants. As he was welcomed into the community, Kweku learned about the healthcare challenges immigrant communities faced in the city. Many minority patients:
Did not feel heard by their medical providers
Had limited knowledge of the healthcare system
Felt their culture and lifestyle were not always factored into healthcare recommendations
Sometimes felt blamed for their poor health
Gyedi: Building Lasting Trust and Leveraging the Concept of Self-Belief
With my public health background and community outreach experience, we continued our work in Aurora, frequently organizing health forums with immigrant churches and community groups, as well as one-on-one counseling when people reached out privately.We realized that education and self-efficacy were the key to people taking control of their own health and that of their family’s, so we founded The Gyedi Project. “Gyedi” is a Ghanaian Akan word that means “to believe”. It is also a noun that translates to “self-belief”. The concept of gyedi is fundamental to believing in one’s own capacity to take full control of challenges and the self-assurance to successfully overcome any situation. We leverage the concept of gyedi as well as values of shared humanity such as “ubuntu” (which means ‘I am, because we are’), to build individual ownership of community health, increasing awareness about the importance of supporting one other on our individual and collective journeys to achieving better health. We also emphasize the importance of gathering and sharing accurate and beneficial health knowledge that can better prepare the community to address ongoing health challenges and emerging health threats.
We learned that building community trust requires a holistic approach, which includes acknowledgement of and compassion for everything members of the community consider important in their lives. Building community trust didn’t mean that we could solve all of the problems experienced by the community, and that was never the expectation. But, there is power in listening to people’s truths, sharing yours, encouraging each other through challenges, helping to solve problems when you can, and celebrating successes together.
“Building trust is not seasonal, or when the cameras are rolling, or when you have the funding, or when you feel like it. Building trust with the community is intentional, ongoing, and takes dedication.”
Empathizing and uplifting communities that have been historically marginalized should be done with respect and in recognition of the complex socioeconomic circumstances that exist in these communities, and not in ways that are patronizing or assign blame. We recognize that most BIPOC communities are resilient and have survived without the consistent support of the broader society and will continue to survive. Therefore, any efforts that affect the lives of BIPOC people is an honor and an opportunity to share our skills and talents with our resilient communities -- that is how we have always approached our community work.
Taking Action During COVID-19: The Sub-Community Approach
When COVID-19 hit, Kweku and I effectively became health knowledge brokers for our community. We received requests to help provide information about the COVID-19 virus and how to avoid it at a time when misinformation had created a lot of confusion in our community. We were surprised to learn that even misinformation that looked obviously false to us still gained a lot of traction in the community. To keep abreast with misinformation and counter them with accurate information, we encouraged the community to forward to us any materials about the COVID-19 pandemic they were unsure of. We had to watch lots of videos, listen to audios, and follow threads of discussions online about the COVID-19 virus to understand exactly what was out there and plan how to address questions we got on these materials.
One of the most important learnings was that certain sub-sections of the community had different needs and questions, even on the same materials. For example, the elderly, younger people, faith groups, etc. all had questions that pertained specifically to their sub-communities’ unique circumstances. To ensure the effectiveness of our community education, we re-strategized and changed the outreach approach, prioritizing sub-community forums within the broader community. We met with smaller groups with similar interests and revised our education materials to reflect the priorities of each group we met with. This new sub-community approach solidified the focus of the outreach messages, made discussions richer, and further enhanced our community relationships.
Hosting Vaccine Equity Clinics
Our most ambitious undertaking was to host our own community COVID-19 vaccination clinics following requests from the community and numerous questions on where to get vaccinated. The purpose of the clinic was to supply vaccines to those members of the community who had historically experienced challenges accessing the health system.
We reached out to the Colorado Vaccine Equity Taskforce, of which we are both members and serve on the community outreach and policy committees, to seek guidance from members who had hosted community clinics. Julia Ellington and Mary Etta Curtis of the Montbello Organizing Committee and United Church of Montbello, respectively (who are both retired nurses and had vaccinated hundreds of community members through their drive-through vaccination clinics), offered to share their experience and provide guidance and mentorship to us during our planning stages. We also received support from the Rocky Mountain Ghana Council, OMNI Institute, and over 70 volunteers from the community. We also partnered with RISE Colorado, a nonprofit that works with low-income families and families of color to promote equity in our public school system, on hosting the COVID-19 clinics to expand our outreach to multiple immigrant and minority groups in Aurora.
We wanted to create a process that felt comfortable and accessible, and so we held the clinics at the Solid Rock Baptist Church in Aurora, a familiar location close to the communities we were focused on. We staffed the event with volunteers who represented the diversity of the community, and we made sign-up accessible to those without computer skills or internet connection.
Clinics were held monthly from February through May at the Solid Rock Baptist Church site, where we administered over 2,500 vaccines (80% of the recipients identified as BIPOC). With over 50% of adults now fully vaccinated, Colorado and the United States have yet to reach herd immunity and remove all public health mandates that were instituted due to the pandemic. The Delta variant has extended the timeline of this goal, and made vaccination even more important as the number of COVID-19 cases are on the rise in all 50 states. The race for booster shots for the elderly and immunocompromised has begun another chapter in the conversation about vaccine inequities at a time when many BIPOC communities still face limited access to the vaccine. Notably, the Hispanic community which make up 20.2% of Colorado’s population only constitute 11.6% of vaccinated people as of September 2021.
Lessons Learned: Hosting COVID-19 Vaccine Equity Clinics in Colorado’s BIPOC Community
History, community perceptions and culture all play an important role in healthcare, as well as the type of health risk that is considered acceptable to individuals and their community. It is for these reasons that community health outreach cannot only be a science but should also involve intentional relationship building and trust that could vary from community to community.
Listening and learning alone are not sufficient to build trust with communities that have historically been marginalized and still consistently face challenges with the healthcare system.
Listening and learning about a community are an important step to engagement. However, listening and learning alone are insufficient to build trust with communities that have historically been marginalized and consistently face challenges with the healthcare system. The COVID-19 pandemic revealed that both large healthcare systems and marginalized communities were ill-prepared to engage collaboratively in community health protection efforts. While mistrust and vaccine hesitancy were initially exacerbated by the fear from a growing pandemic and lockdown mandates across the country, large healthcare systems were faced with the responsibility of revamping services to accommodate digital health solutions in the face of dwindling in-person care, leaving little time and resources for effective community engagement efforts. All the while, COVID-19 misinformation added another layer of challenge, further complicating the relationship between marginalized communities and the healthcare system.
To get the full attention of the community, there was a need to address layers of challenges clouding accurate communication channels about the COVID-19 virus and vaccines. Community health education was the first step to rebuilding community trust, which included:
Seeking out hesitant groups
Listening and validating historical and current concerns about health and vaccinations
Countering misinformation directly
Providing accurate information, and
Answering questions
Lesson 1: Planning with the Community is Critical
Engaging the community early on in the clinic planning process is a critical aspect to securing community buy-in and engagement. This includes conversations around who might be hesitant, what questions the community has about the vaccines, what are the best ways to reach and persuade people, what would be the community’s expectations of the COVID-19 clinic, what barriers can we anticipate and eliminate, which location would be the most convenient, etc. Obtaining insight from the community and planning together also builds community ownership of the clinic and can establish community ambassadors who can repackage COVID-19 vaccination messaging in ways that are highly effective in persuading community members. Another key element is to recruit medical personnel and volunteers from the community to ensure that the public-facing organizers of the COVID-19 clinic are representative of the community. This key point was articulated by a patient in the recent satisfaction survey we issued after the fourth COVID-19 clinic.
“As a Black woman, I was so pleased to be treated by Black health care practitioners. I felt welcomed, seen, and heard. Moreover, the environment was so comfortable. I knew I would be well taken care of.”
Lesson 2: Prioritize Cultural Competency Training
Cultural competency in a COVID-19 clinic focused on BIPOC communities cannot be emphasized enough. Even when the majority of providers, personnel, and volunteers are representative of the community they are serving, the BIPOC community has varied lived experiences and cultural attributes that requires acknowledgement for effective engagement. These include linguistic and communication characteristics, history, religious practices, community norms, etc., that should be accounted for to allow for more effective vaccine recipient navigation and triaging when necessary. Creating an atmosphere where patients, regardless of demographic background, feel welcomed and respected is important for increasing patient satisfaction, and more importantly, turning patients into future ambassadors who could spread information and their positive experiences about COVID-19 vaccination to their family and friends. From our recent survey, a patient clearly articulated their experience at the COVID-19 clinic:
“Although not a member of your church community, I received the info from a friend. The level of organization was amazing, and I was in and out in 20 minutes. What stood out most to me was the absolute friendliness of all involved, particularly one physician who was acting almost like the host of a party wanting to make sure everyone was doing well... thank you for that.”
Lesson 3: Community Feedback is Important, Funding is Key
Given that the Moderna and Pfizer vaccines require two doses for full vaccination, the initial patient experience with the first dose is critical to ensuring vaccination completion. As a result, community feedback is important for addressing gaps, creating a welcoming atmosphere, and ensuring continuous quality improvement throughout the entire experience of the clinic and follow-up. Patients who are satisfied with their first dose experience are less likely to postpone or forego their second dose. For COVID-19 clinics focused on BIPOC communities, accommodations should be made for language, varying tech experience, health literacy gaps, ability status, transportation challenges, follow-up communication, etc., which requires considerable planning, and resources of time and energy. Therefore, adequate funding is needed to ensure effective logistical planning, medical supplies, and compensation for staff time. Many community-based organizations, grassroots groups, and charismatic leaders have stepped up to fill the gaps in community health outreach to reduce the disproportionate burden of COVID-19 on underserved communities. During the pandemic and beyond, it’s important for funders to prioritize direct funding to these localized efforts in the community and terminate the “gate-keeper” model of funding which often overlooks the race and power dynamics that have so long plagued philanthropy and funder-grantee relationships to the detriment of minority-led groups. Innovative ways to make funding available to grassroots efforts include simplifying and streamlining grant applications, increasing transparency in the grant application process, prioritizing place-based funding, and creating a sustained funding mechanism for long-term funding support instead of operating on a project-to-project basis.
Lesson 4: Partner with Other Community Stakeholders and Community-Based Organizations (CBOs)
Partnering with other community stakeholders and community-based organizations maximizes resources and expands community outreach capacities to inform a broader section of community members. In addition, collaborating with other entities ensures a balance of perspectives that are more representatives of diverse communities. The Gyedi Project partnered with multiple community stakeholders including the Colorado Vaccine Equity Taskforce, OMNI Institute, Rocky Mountain Ghana Council, RISE Colorado, faith groups, and diverse grassroots groups, which enhanced our cultural competency, created new relationships while improving existing ones, and created sustained channels for future health outreach and engagement.
As we continue through and past the COVID-19 pandemic, The Gyedi Project will continue educating, counseling, advocating for Colorado’s BIPOC communities, and bridging health service access gaps. Learn more about The Gyedi Project and connect with us at omni.org/gyediproject.