3/27/2023

Engaging Minority Populations With Health Education

Healthwise Communications Team

April is National Minority Health Month, which highlights the importance of supporting minority communities who face health inequities. For example, during the COVID-19 pandemic, Asian Americans experienced stigma, misinformation campaigns, and a staggering rise in anti-Asian hate crimes. Asian Americans are the fastest-growing population in the United States by immigration, but the group represents a diverse range of cultures and languages. This means there’s not a one-size-fits-all solution for sharing health information and addressing the group’s health disparities. So, how can we make sure culturally sensitive health information is accessible to all individuals? One study is finding out.

Here we speak with researchers Joyce Cheng, Executive Director of the Chinese Community Health Resource Center, and Dr. Janice Tsoh, professor at the University of California San Francisco, about their recent work providing culturally appropriate COVID-19 information to Chinese, Hmong, and Vietnamese people in California. Healthwise is proud to support the work for this study by providing the COVID-19 education in all the languages represented by the participating communities.

Q: Thank you for meeting with us, Joyce and Janice. Tell us how the study came to be.

A: For many years, our team has been doing community-based education. We use patient education to support our community members in making well-informed decisions and staying healthy. But we wanted to find out how to do that better. The COVID-19 pandemic created disproportionate burdens for Asian Americans, and we wanted to see how we could help.

Q: At a high level, how does the study work and what are you measuring?

A: This is a community-engaged research project with Chinese, Hmong, and Vietnamese communities in California. The project is called INFORMED, which stands for Individual and Family Oriented Responsive Messaging and Education. Responsive messaging means developing messages that respond specifically to the community’s needs and the constantly changing nature of the pandemic. Providing tailored information is meant to promote better individual health, but also better health for families and the community at large.

We were most interested in learning about how to best engage our community. We measured participants’ attitudes toward COVID-19 testing—whether they got tested, vaccinated, and boosted—but those stats were not our main objectives. Our main objective was learning about the participants’ decision processes and whether they felt confident and well-informed when they needed to make decisions about their health.

This study is part of the national NIH RADx Underserved Populations (RADx-UP). We also worked with longtime partners in our community. In addition to CCHRC serving the Chinese immigrant community, our community partners include the Fresno Center (serving Hmong community), and the Immigrant Resettlement Cultural Center (Vietnamese).  Our research team also include colleagues at other University of California campuses (Davis and Merced), so we have expertise in science, community engagement, and culturally competent, linguistically appropriate education materials. We also worked with community health messengers. They’re lay health workers who know how to make the messages relevant and digestible to their community members.

This study has two parts:

1. The first part is the trial specifically using Healthwise education. We recruited 240 participants—80 people from each of the Chinese, Vietnamese, and Hmong communities. We followed them over 16 weeks. Everyone in the study received a 12-week-long text messaging sequence set to deliver the core messages around COVID-19. If they clicked the link in the text, they got more information on our Project INFORMED website. Additionally, half of them were randomly assigned to work with a lay health worker for two group Zoom meetings and two follow-up phone calls to check in. During those meetings, the lay health workers provided more information and served as a bridge to bring back questions from participants.
   
   To measure the impact, all participants filled out a baseline survey at the beginning of the study so we could get a sense of who they are, their attitudes and barriers around COVID-19 testing and vaccination, how well-informed they felt, and how confident they felt about making decisions. Participants completed surveys again at weeks 4, 8, 12, and 16. We finished all survey data collection in December 2022.
2. We also interviewed a separate group of 18 people (six from each Asian ethnic group) who weren’t participating in the trial. We interviewed them three times over 12 months to learn how they viewed and understood COVID-19 and how their actions changed over time. For this group, we didn’t provide education because we wanted to learn more about their understanding of what was going on without the extra educational context.

Q: What role does Healthwise education play, and why did you choose it?

A: Healthwise serves an important role. One of Healthwise’s board members, Dr. Evelyn Ho, is also our colleague through the Asian American Research Center on Health (ARCH). Early in the pandemic, Evelyn brought up the importance of language and cultural competency in Healthwise education, and through Evelyn, we connected with Healthwise to discuss collaboration. When we first got in touch, we were so excited about your openness and willingness to take part—it’s so hard to find education in modern languages and Healthwise could provide it!

As we developed the study materials, we got input from our community advisors about which Healthwise articles to use. We sent the first article in September of 2022—I think it was “What to do when I get COVID-19.” From September to December, we texted previews of six articles in the group’s language with links to learn more on our website. These links gave us data on whether people engaged and what people were most interested in learning. Our most viewed article was “9 Things to Do if You Have Been Exposed to COVID-19.” Other popular articles covered coping with stress and caring for someone who is sick with COVID-19. During the study, Healthwise articles on various topics across languages have been viewed more than 2,000 times.

Participants received text messages in their language with links to the full article on the COVID Informed website

Q: Is there a story you can share about a specific success or early findings from the study?

A: We were most surprised that people shared so much in the comments on the study’s website. The first post on the website was about how COVID-19 particularly impacted the Asian American community, and it was the most responded-to message. Our participants shared all kinds of things, including feeling unsafe and how they didn’t want to leave home because there was a lot of anti-Asian crime. People were so open and engaged and even encouraged each other. We were caught off guard and pleasantly surprised that participants used the study as a forum to express what they might find difficult to express elsewhere.

Q: Health equity and social determinants of health (SDOH) are hot topics in the industry. What lessons can healthcare systems take from the data you’re gathering about providing culturally relevant health education?

A: This study shows it’s so important to learn about the community you’re working with and understand the community stigmas. We learned you need to work with people’s readiness and be flexible. Throughout the study, our community’s needs were constantly evolving, and that made input from our community advisors really helpful.

To successfully engage Asian Americans, we determined three areas of focus, or the three Cs: culture, capacity, and convenience.

• Culture. First, embrace cultural facilitators like our lay health workers when engaging with communities. They serve as trusted messengers and help navigate culturally appropriate communication channels.
• Capacity. Second, use intervention strategies to build capacity when engaging with communities. Identify the community’s evolving needs, and craft messages in preferred languages while also considering the cultural context.
• Convenience. Finally, use methods that are convenient for community members to engage with.

Hopefully, other companies, institutions, and health systems can intentionally modify and adapt these steps to better serve and better deliver messages to the communities they work with.

To read more about this research, see Joyce and Janice’s article in the American Journal of Public Health titled, “Engaging Asian American Communities During the COVID-19 Era Tainted With Anti-Asian Hate and Distrust.”

Because of the overwhelmingly positive response to this study, the research team is continuing to provide participants with COVID-19 information even beyond the study’s run time. Researchers are currently crunching the numbers to understand how their outreach impacted the communities. We’ll share that information when it becomes available!