Lessons Learned from Culturally Tailored Community-Based Health

Much has been made of the potential for community-based health to close racial health disparities, but new research in JAMA Network Open says those community programs are most effective when they are culturally tailored.

Particularly, the research detailed an Oregon-based program that tapped Promotores de Salud—Spanish for community health promoters—that helped close the gap in the number of Hispanic individuals getting a COVID-19 test out in the community. That success may be translated to future community-based health initiatives focused on closing racial health disparities in other health services, the researchers from various departments at the University of Oregon said.

Hispanic people have long faced steep racial health disparities across a number of disease states, but in 2020 when COVID-19 came ashore in the US, those disparities garnered significant media attention.

During the fall of 2020, the Centers for Disease Control & Prevention reported that Hispanic people represented a disproportionate share of COVID-19 deaths. Separate data published in March 2021 showed that the pandemic was characterized by work, care access, and cost inequities affecting Hispanic people.

Medical industry leaders leaned significantly on community-based health options to try and close some of those gaps. Community-based care includes testing and other services delivered within a community setting and not necessarily in a clinic. Typically, a healthcare provider will partner with a community leader or institution to deliver on-site care, making it easier for certain populations to access healthcare.

For example, a healthcare organization might set up a testing site in a church parking lot, working to increase testing as a means to contain virus spread and ideally cut mortality rates, the researchers said.

These kinds of community-based care programs can be made even more effective when they incorporate actual people from within the community and emphasized cultural responsiveness, as the researchers showed through their program, Oregon Saludable: Juntos Podemos (Healthy Oregon: Together We Can) (OSJP).

The program used promotores de salud, which translates to community health promoters, to build strong relationships with the Hispanic community for whom racial health disparities remain salient.

The program’s 19 promoteres, all of whom were bilingual and bicultural, were in charge of community outreach to ensure parts of Oregon’s Hispanic population knew about the community-based COVID-19 testing available. Particularly, promotores used their standing in the Hispanic community to deliver patient education, dispel misinformation, and establish patient trust.

Promotores did this both on an in-person basis and by using public health messaging through radio, print, and social media advertising. Text messaging patient outreach was also a key tool, the researchers said.

The program was largely effective, the researchers said. Community COVID-19 testing sites that employed promotores saw nearly four times the number of Latinx people get tested than sites without. The promotores program was also linked to testing a greater proportion of the Latinx populace at each community-based testing event, something at amounts to medium to high success rates, the researchers said.

That success is likely due to the involvement of promotores, the team added. Good community health acknowledges historical barriers to care and meets them with cultural expertise, they asserted.

“Effective participatory community engagement required building and maintaining key partner relationships across the duration of research and testing activities,” they wrote. “Such approaches work with the Latinx community instead of developing interventions for the Latinx community and are shown to be effective for mitigating other health disparities.”

Said otherwise, the program was effective because it worked with the Latinx community and wasn’t just developed and applied to the Latinx community.

There were some challenges, the researchers added, mainly with regards to ethics and recruitment of promotores. Before a COVID-19 vaccine became widely available, some prospective promotores said they were uncomfortable with being randomly assigned to a community test site; they suggested all people deserved a right to access high-quality, culturally tailored community health.

“Responsivity to concerns with county officials and CBOs helped establish trust to complete the primary aim of experimentally evaluating the outreach program before releasing all sites to Promotores de Salud,” the researchers wrote. “Through relationship maintenance with stakeholders, we were also able to establish sustainability through state-requested contracted services for ongoing testing sites, independent of the experimental trial.”

Notably, this model can and should be replicated for other health crises or disease states. Racial health disparities are not new and have long impacted Hispanic people. Across all races, utilization of preventive screenings has dropped since the pandemic broke out, but that limited access is more common among Hispanic people and other racial minorities.

Culturally tailored community health and outreach programs may be effective for closing gaps in preventive care access.

“Findings suggest that culturally tailored outreach can be implemented or adapted to serve future needs for community engagement during a health crisis or to address ongoing health disparities,” the researchers concluded.