Education and Outreach to Improve Health Disparities
This article for developing awareness surrounding racial and ethnic disparities in care was funded by GSK.
Dr DeLawnia Comer-HaGans is contracted by GSK and is compensated for the development of this article.
Inequities exist in the quality of healthcare received by minoritized communities, such as African American and Latinx populations, and therefore vaccine uptake remains low in minoritized groups. Individualized and community-based interventions such as outreach, educational interventions, and technological strategies are explored to improve vaccination rates.
Adult vaccination rates are far below national target goals, and this issue is particularly pronounced in minoritized groups, such as African American and Latinx populations. As members of the healthcare community, we are aware of the potential serious impacts that arise from rapidly spreading infectious diseases. Most recently, we have witnessed the effects of the COVID-19 pandemic, which led to heavy burdens on the healthcare system. Once the SARS-CoV-2 vaccine was available, coordinated vaccination efforts led to a sharp decrease in morbidity and mortality. Nonetheless, racial and ethnic differences persist for recommended adult vaccinations, with lower coverage among non-White populations for almost all available adult vaccinations. These trends can be observed in recurring vaccinations such as influenza, as well as in nonrecurrent vaccinations such as pneumococcal and herpes zoster. By identifying and addressing these inequities, we can improve health outcomes on both an individual and societal level.
As a researcher studying health equity, I sometimes observe an overall lack of awareness and knowledge around vaccinations in minoritized populations. Traditionally, preventive health education on topics such as the importance of vaccinations happens during a routine exam or wellness encounter between provider and patient. There are very few systematic measures in place to ensure proper education on vaccinations is given to the public. What we see is that those patients already receiving consistent, high-quality healthcare may be more likely to be aware of the preventive measures they can be taking, and thus, are more likely to receive critical vaccinations. Whereas those populations that are either underserved or underrepresented in our current healthcare system are less likely to receive the education, touchpoints, and support to understand the importance of—and ultimately agree to—these important adult vaccinations.
When looking specifically at the African American community, there are various factors to acknowledge when observing lower comparative vaccination rates. Some African American populations prefer seeing African American doctors, who constitute just 5% of all US physicians. More importantly, studies find that African American populations feel discriminated against in healthcare settings, and this can lead to avoidance of receiving care for themselves and their family members. There are data to suggest many healthcare providers display a lack of engagement and poor communication during encounters with minorities. Unfortunately, all of this can create a sense of mistrust towards the healthcare community amongst African American and other minoritized populations. Based on these factors, I feel there are opportunities for improving education with both providers and the communities they serve.
Healthcare institutions and medical schools have cultural competency training modules and workshops in place to help address health inequities. Multiple studies conducted to assess the efficacy of these training sessions have found they are generally ineffective in improving patient outcomes due to the limited time spent training. Personally, I feel a longitudinal curriculum based on developing cultural humility could potentially be more effective. I find that for a healthcare provider to appreciate sociocultural differences and incorporate unbiased care, they must do some introspection focused on identifying and addressing their own personal conscious or unconscious biases.
Direct interventions can improve knowledge around vaccinations for underrepresented and underserved populations. With improved technology, we have an opportunity to reach more of the population. A recent study demonstrated text message vaccine reminders have the ability to increase vaccine uptake. In particular, another recent study showed that this technique of behavioral nudges through text messaging can significantly improve flu vaccine uptake, with the goal of being implemented for other adult vaccinations. Text messaging may help overcome language barriers encountered with other minoritized groups by presenting reminders in their language of preference. Furthermore, we know that in cancer screening research, a communication to patients that is a culturally sensitive, targeted narrative intervention can be particularly successful in the African American community. We as the healthcare community can implement the learnings from these research findings and develop a strategy of targeted and culturally relevant education to improve overall patient care.
Community outreach and vaccine education given in non-traditional settings are being explored as potential strategies to help reduce vaccine disparities. Results of an influenza vaccine outreach program conducted by Vanderbilt University yearly between September and January from 2015-2019 showed promising results. Funding for the program was provided through a local grant. Vaccine outreach program coordinators were tasked with creating community partnerships, managing volunteer staff, and obtaining supplies. The vaccines were administered by medical and nursing students under the supervision of a physician, doctors of pharmacy, or registered nurses. Overall, through community partnerships, the program was able to vaccinate more than 1700 people. The outreach program provided vaccination for unemployed, uninsured/underinsured, disabled, and homeless populations across all races and ethnicities. Most importantly, 21.8% of individuals vaccinated were first-time influenza vaccine recipients.
Reducing racial and ethnic disparities in vaccination rates requires a coordinated, multifaceted approach. The healthcare community should put our collective efforts toward enhancing and utilizing specific technologies as well as employing culturally sensitive and targeted modalities and programs that can increase knowledge on the importance of adult vaccinations. We know that the use of technology to deliver culturally targeted health information greatly improves health communication and outcomes by addressing factors that contribute to health disparities such as health literacy, language proficiency, health system navigation, and knowledge and beliefs. By doing so, we can successfully educate, fight misinformation, and achieve better results in addressing inequities for diverse and underserved individuals and communities.
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ABXOGM230004 December 2023