Study: Community health clubs adapt to improve vaccine hesitancy among South Texas Latino community during COVID-19

During the COVID-19 pandemic, community health clubs in the South Texas area quickly adapted to virtual programs to address misperceptions about the virus and vaccines and provide timely, scientifically accurate information.

A study led by Jason Rosenfeld, DrPh, MPH, associate professor in the Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, director of Global Health Education at the Charles E. Cheever Jr. Center for Medical Humanities and Ethics, The University of Texas Health Science Center at San Antonio (UT Health San Antonio), published recently in Progress in Community Health Partnerships: Research, Education and Action, found that programs using the community health club model were effective in improving confidence about the COVID-19 vaccine. Additionally, participants were more likely to receive the vaccine and tell others about it.

Model for collective change

The community health club model was designed to create collective change in a group. These clubs were first introduced in Zimbabwe in the late 1990s to promote clean water and hygiene behaviors. A pilot program came to South Texas in 2017 to address Zika virus. Since then, clubs have evolved to cover a variety of health topics, including nutrition, physical activity and mental wellness.

"The idea was to engage the community in a conversation around these issues, to build consensus around what both the problems are, what potential solutions could be and create a system and opportunity for social support as you engage in the behavioral change process," Rosenfeld said.

In 2017, Rosenfeld facilitated a pilot community health club program in the Brownsville area to address the emergence of Zika virus. The goal was to provide a model for community health workers (called promotore/as) to provide health information by using principles of community-based participatory research to build relationships and encourage collective action to address the drivers of health.

In the wake of the COVID-19 pandemic, Latino communities experienced disproportionately higher rates of infection, hospitalization and death due to the virus. The lower Rio Grande Valley region is about 90% Latino and had one of the highest per capita rates of COVID-19 infection in the United States. In addition, vaccine confidence was lower among Latinos, with 30% expressing hesitancy compared to the national average of 22%.

Pandemic pivot to virtual learning

During the early days of the pandemic, Garrett Kneese, a medical graduate student working with Rosenfeld at the time, helped the clubs in Brownville to quickly pivot their program to a virtual learning environment to provide a COVID-centered learning module. Students working with Rosenfeld began with a COVID-19 "myth-busting" series that met online biweekly for three months. Program facilitators listened to the members' questions and concerns, took a week to develop content, and then delivered a program the following week. Rosenfeld said the desire to learn was evident as 15 participants soon turned into 130 participants meeting virtually.

"Our membership grew exponentially from week three of implementation. Part of that was because of technology, but also because the process had been ingrained in people that this is where you go to get good information. It reflected the reality at the time that there were so many questions," he said.

As vaccines became available, the clubs decided to dedicate a portion of sessions specifically to COVID-19 vaccine promotion. They designed a four-session, two-month module using content previously created through Health Confianza, a sister program based in San Antonio. The 62 participants were compared to a control group in a quasi-experimental design. They found that club participants were more than twice as likely to receive at least one dose of a COVID-19 vaccine.

At the end of the module, 97% percent of participants said they were confident or very confident in their ability to share information with others about COVID-19 vaccines and about 90% said they had shared information with friends or family members.

"We ultimately found that through this virtual engagement, members were more likely to get vaccinated after the four-week session than a comparison control in the community," Rosenfeld said.

Cohesive learning unit

After COVID-19 subsided, the Brownsville clubs went back to meeting in person. Since their inception, more than 600 unique individuals have attended, with a core group of about 50 women attending nearly every module, session and activity provided by the clubs.

"The idea is that you want to build a cohesive unit of people who are dedicated to learning. No matter where you live in the world, we all have a desire to be together, to share time and space," Rosenfeld said.

Shortly after the launch of the Brownsville location, a community health club also began in San Antonio with a different approach. Rosenfeld said rather than starting with a preset idea, they talk with the community first and find out what pressing health issues are important to them.

"We'll go in and just listen to our community and have them tell us what is on their mind. Through those assessments, we identify some health topics that we can bring to bear," he said.

Rosenfeld said they continue to refine the community health club model and training sessions for use in a variety of communities and for a range of health needs. This study shows the power of working with the community to create tailored programs for meaningful change.

Public link

Please use the above public link if you want to share this noodl on another website.