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Drs Anita Makkenchery and Brandy Farrar: Vaccine Hesitancy and the Role of Community Health Workers


Anita Makkenchery, MD, MPH, and Brandy Farrar, PhD, discuss how community health workers can address COVID-19 vaccine hesitancy.

Anita Makkenchery, MD, MPH, a research associate in the Quality Improvement and Innovation Division at IMPAQ International, and Brandy Farrar, PhD, a principal research associate in IMPAQ’s Health division, presented results from their study on community health workers in a poster at the Academy Health 2021 National Health Policy Conference.


What, realistically, does it take for community health workers to address vaccine resistance in populations that historically have not had a reason to trust the health care establishment?

Farrar: And that's the loaded question. It's difficult. I think we just have to acknowledge that. I think the mistrust is deep rooted and long standing. Community health workers can serve as trusted messengers for accurate information about the vaccine. I have heard and seen characterizations of vaccines that you just wouldn't even believe. You wouldn't believe that this is what people actually think that they do. So, I think helping to serve as trusted messengers of accurate information is one thing.

This is something that I've seen more and more and I'm starting to get really interested in. Think about a community health worker who's a lay person. They're most effective, typically, if they're a lay person. They are working with people who are representative of minority groups, but are experts, physicians, clinicians, nurses, researchers, and other kinds of scientists who do understand all of the science of what's happening and can digest and translate that into an easy-to-understand way of explaining. You can partner someone like that with the lay person who's actually from the community and maybe hesitant and experiencing mistrust. That is a growing strategy that we're seeing this gaining some traction. So, I think there are some things that they can do. Anita, do you have other thoughts? I definitely think it's an uphill climb.

Makkenchery: I agree with you that it's definitely an uphill climb. The way I look at it is that in the hospital, we provide lots of different services so patients can understand their care well. We have care coordinators, interpreters, nurses that specialize in different areas, male providers, and female providers. There are many different specialties, that are used to help translate information to patients at a facility. It's about bringing it out that same information out into the community where people in the community can understand in their language. And this doesn't even really reference a English as second language, but it references more of just that either an education level, demographics, or even where they're getting their current information from may not be the right information. It may be word of mouth. So, I think the community health worker really plays a role in providing the factual information to the community, and busting different myths that are out there, in terms of myths and concerns related to vaccine hesitancy, other treatment areas, things like cost of care and how they might be treated within in the clinic. There's so many different types of hesitancy when it comes to treatment that the community health worker can kind of say, "No, I've experienced it from this. I'm from the community, and here's here's an approach we can take."

What aspects should designers keep in mind when developing community health programs? What would ensure a program’s effectiveness and sustainability?

Farrar: They need to be supported. They need to be trained. They need that upfront training and ongoing support. I think that's very vital. They need clear definitions about what their roles and responsibilities are, particularly relative to other members of the care team. Something like a contact tracing program, it's a range of individuals who will be on that team, and the community health worker would be one. So, understanding what their responsibility is vs, for example, the epidemiologist vs the clinician. They may be screening for physical or mental health conditions. I think just being very clear about what they are responsible for is also really important.

And providing some emotional support for them as well. We're hearing a lot that community health workers, as they're out in the community, are really seeing some very difficult situations that people are facing during this pandemic. I think training them and supporting them on how to effectively debrief those situations as they're occurring so that they can support their own mental and emotional well being is also really important because, again, they are not clinicians, so they don't have the expertise of how to manage in those situations or how to engage in self care, for example, to mitigate that impact on their own psychological health. We have to recognize that these things are skills and they are expertises that can be built and need to be encouraged instead of assuming that because they're from the community and because they really that this work that they'll automatically know how to deal with these kinds of difficult situations.

Makkenchery: Yeah, I think Brandy covered most of that response, but I think I would also add in terms of their compensation and giving them a livable wage to treat them very respectfully, because their role is vital. It is important. It's communication within the community and between key members of the committee So, I think that is another piece because funding is a very gray area when it comes to community health workers.

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