COVID-19 Multicultural Communications: Embracing Health Center Patients’ Diverse Demographic Differences to Meet People Where They Are

Community health centers play a key role in vaccinating millions of the nation’s most vulnerable, highly marginalized communities, including those who speak a language other than English. To help with COVID-19 vaccination, many health centers are employing a multicultural communications approach to engage their diverse populations with a respectful and authentic manner, using a language they understand and scenarios that resonate with them, and through a channel(s) available to them.   “To address a lot of misinformation about the vaccines' fast-paced development, safety concerns, and confidential access to the vaccines (an issue for many migrant workers and non-citizens), we developed a multilingual “myth versus facts” sheet and clear and concise, multilingual FAQs around each of the available vaccines,” says Laura Miller, M.D., Chief Medical Officer, Community Health Center Network (CHCN), a non-profit Medi-Cal managed care organization providing business administrative support for community health center members of the Alameda Health Consortium. To download these materials, visit CHCN's COVID-19 Resources page. As part of its multicultural communications campaigns, health centers are also working with their community partners who are respected as “trusted messengers” to help communicate specific vaccine messages and information. “What we know and understand is that it is going to take a lot of communication across different platforms before enough trust can be built to accept the vaccine,” says Dr. Miller. “It may not always be health care providers that are the best messengers for all people… Having a variety of approaches that can be tailored to a person’s or a community’s needs is vital.”

Multicultural Communications Tips Consider these tips to strengthen your health center’s efforts to build COVID-19 vaccine confidence among your diverse patient population:   • Tailor messages and communications products to each population to ensure they resonate • Use simple language that can be easily translated and accurately understood • Aim to produce content at a 4th- 6th grade reading level • Test messages and materials with the audience • Use imagery and photos that mirror your patient population and their surroundings • If budget is limited, consider using graphically designed faceless, yet comforting, images of people from various backgrounds • Work with trusted community leader messengers to share and disseminate materials • Communicate through multiple channels including social media, patient newsletters, website, and patient text messages Special thanks to Jody Sahota, Advocacy and Communications Manager, Alameda Health Consortium and Clare Gunther, Chief Advancement & Communications Officer, Lowell Community Health Center for sharing their insights from leading multicultural COVID-19 vaccine communications efforts for their health centers.

COMMUNITY HEALTH CENTERS IN ACTION

COVID-19 CONVERSATIONS   This month, NACHC talks with Jody Sahota, Advocacy and Communications Manager, Alameda Health Consortium. The health consortium is a regional association of eight community health centers that together serve 300,000 patients in Alameda County, California. These health centers serve a highly diverse patient population where 27 languages are spoken. Sahota shares with NACHC how the consortium developed and disseminated audience-informed, multicultural and multilingual communication to help build vaccine confidence, clarify misinformation, and build public acceptance of mask wearing in the East Bay California area with its campaign Mask On to Move On.

Lowell Community Health Center Leverages New Technology to Increase Equitable Access to COVID-19 Vaccinations Among its Multilingual Patient Community

On any given day, up to 60 different languages can be heard in the halls and clinic rooms at the Lowell Community Health Center (Lowell CHC) in Lowell, Massachusetts. With about 40 percent of its 31,000 clients speaking in a primary language other than English, the health center is dedicated to health equity and providing culturally appropriate care, communication, and patient access to information.  Lowell CHC recently launched a new COVID-19 vaccine registration system using intelligent automated technology, with a focus on assuring language access. It is the first health center to partner with Notable Health, a digital health company that provides intelligent automation to health care organizations. “At Lowell CHC, one of our top commitments is to improve patient access,” said Brenda Rodriguez, the health center’s chief strategist and finance officer. “By leveraging technology like Notable, we can improve the patient experience to be more proactive and culturally proficient and set up simple processes that allow our providers and staff to better serve our community.”   Launching Notable Health Technology The Notable technology trains bots or “digital assistants” to scan the EHR for unvaccinated patients who meet federal CDC and state eligibility recommendations. For eligible patients, Notable initiates a digital pre-screening, collects informed consent, and schedules an appointment in the patient’s preferred language.  After training staff on how to use Notable, the health center launched its new COVID-19 vaccine registration platform in early April. The initial rollout is focused on reaching patients who speak one of the health center’s 4 most spoken languages  English, Spanish, Brazilian, and Português  via their cell phones. More languages will come online soon.  “With Notable, we can reach patients in their own language, in the safety of their homes, allowing them to feel heard, comforted, and secure in their interactions,” said Susan West Levine, CEO at Lowell CHC. After rolling out this technology for COVID-19 vaccine distribution, the health center plans to use Notable to automate workflows for a variety of other health services including automated patient outreach, appointment scheduling and reminders, check-in, and registration.  A Commitment to Health Equity and Patient Access to Care During COVID-19 Lowell CHC’s leadership team knew it needed to embrace, invest in, and better leverage technology to best serve its patient community, ensure health equity, and reduce stress and demands placed on staff the past year. In addition to its partnership with Notable Health, the health center made these investments in language access: • Launched a new, bi-weekly patient newsletter in five languages • Enhanced language translation capacity on its website that enables visitors to read content in their preferred language • Regularly assesses its website analytics to better understand what information patients are seeking and the pages they search • Publishes a COVID-19 Vaccination Equity Report, updated weekly and available on its website • Ensures all content is created at a 4th to 6th grade reading level to assure accessibility, and is culturally and linguistically relevant

COVID-19 Vaccinations for Agricultural Workers – Building Their Vaccine Confidence and Meeting Them Where They Are

Ensuring frontline migrant and seasonal agricultural workers receive the vaccine from a trusted source who understands this community's cultural, linguistic, and logistical challenges is a priority at Clinicas del Camino Real, Inc. Clinicas del Camino Real, Inc. serves 52,000 agricultural worker families at its 15 health centers in Ventura County, California. Since the health center began its vaccination efforts in March,12,404 people have been vaccinated including approximately 3,896 agricultural workers. Its COVID-19 vaccination outreach efforts are informed by the health center’s deep understanding of several key logistical challenges the agricultural worker community experiences, including lack of transportation and limited Internet access, as well as some unique cultural beliefs, and experiences, such as: • A highly transient, primarily Mexican, very low-income population  • For many, the COVID-19 vaccine will be their first shot • Many misconceptions exist such as the belief that the vaccination process is a government ploy to track them down and deport them and COVID-19 is similar to the flu  • Very tight-knit community in which word-of-mouth communication is influential The outreach team utilizes a multi-channel marketing approach to build vaccine confidence and promote vaccination events including: • Airing ads on and participating in local Spanish radio and TV stations • Using an automated text messaging system to communicate with patients • Utilizing Facebook so the migrant community can easily stay connected when on the move Creating Welcoming, Trusted Vaccination Clinic Sites Clinicas del Camino Real, Inc. makes the vaccination process as easy and effortless as possible according to Anna Monroy, Chief Operations Officer. “One negative experience can rapidly spread misinformation and create greater vaccine hesitation among the larger community that will be very hard to undo. We must get our outreach and vaccination events right every time.” The health center partners with neighborhood schools to hold vaccination clinics that are easily accessible without transportation and are open in the evenings when needed. Walk-ins are always welcome as many people cannot, or do not want to, register in advance or hear about the experience from a neighbor or family member and walk in to learn more. The Second Dose Challenge As the crops are harvested, migrant agricultural workers leave Ventura County looking for their next farming opportunity. “Many will leave without receiving their second vaccine dose,” explains Monroy. “However, we make sure everyone who receives their first vaccine from Clinicas del Camino Real, Inc. is given vaccination cards and information on how to find where the vaccine is available in California, and where they can go to get their second vaccine dose in the next community that they find work.” In addition, Clinicas del Camino Real, Inc. shares their vaccine administration information on the California Immunization Registry to ensure other health centers and providers can access it.

Are dentists and pharmacists working at community health centers covered under FTCA to administer COVID-19 vaccines? Dentists and pharmacists can be protected under the FTCA program to administer vaccines if all requirements of the Federally Supported Health Centers Assistance Act are met. First, the dentist or pharmacist must be an employee or full time contractor of a deemed health center. Second, the administration of vaccines must be within the scope of the dentist's or pharmacist's license. Third, the administration of vaccines must be within the privileges granted to the dentist or pharmacist by the deemed health center. For more information see HRSA’s COVID-19 FTCA FAQs.

MONTHLY RESOURCES

Six New COVID-19 Vaccine Education Toolkits Now Available The Ad Council and COVID Collaborative's COVID-19 Vaccine Education Initiative has released six COVID-19 vaccine education toolkits to help build COVID-19 vaccine confidence. These toolkits include messaging tips about language and tone that best resonate with difference audiences, audience insights to better understand low vaccine confidence among diverse communities, and CDC approved digital and downloadable print communication materials.

Creating a Business Continuity Plan for Your Health Center This new manual provides community health centers and Primary Care Associations with an easy-to-use-tool to create and/or improve their business continuity plan (BCP) and program. The manual guides users through the nine key components of a BCP with dozens of templates and sample tools that can be adapted through each step of the BCP process. Want to learn more? Register here for the two free remaining virtual Business Continuity Institute sessions.

COVID-19 Educational Resources for Agricultural Workers The National Center for Farmworker Health has literacy-sensitive resources including print, video, audio and radio files, social media content, and images. They are available in Spanish, Haitian Creole, and indigenous languages such as Triqui, Mam, and Mixteco. Click here to learn more.  Also, CDC's COVID-19 Communication Toolkits for Migrants, Refugees and Other Limited-English-Proficient Populations has materials in more than a dozen languages.

We are listening! CDC and NACHC heard your stories and recent struggles around vaccines in your communities. We will be conducting listening sessions with care team members across the country to develop an animated web-based application to build vaccine confidence. Stay tuned for more information on findings. 

This publication is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,000,000, with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.

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