Using Health Communication to Increase COVID-19 Testing and Vaccination in Underserved Populations

Many low-income Americans, racial and ethnic minorities, and other marginalized groups live in information-poor environments, disproportionately exposed to misinformation about COVID-19, and distrusting medical, government, and scientific institutions and leaders. These and other social, cultural, and behavioral factors pose significant obstacles to public health efforts to increase population testing and vaccination in a pandemic. Testing and vaccination efforts must be paired with an understanding of the needs and cultures of different communities, and the contexts in which people live must be considered, especially among groups hit hardest by the COVID-19 pandemic. The study approach was built on strong evidence from the team's decades-long program of health communication research to eliminate disparities, especially proven message tactics such as cultural values, disparity framing, and narratives, that was applied to the COVID-19 context. Specifically, a multi-method content analysis of 43,000+ COVID-19 testing inquiries to 2-1-1 callers was conducted with the following aims: Aim 1) Survey and interview over 500 2-1-1 callers and phone operators; Aim 2) Develop and evaluate in randomized A-B testing new COVID-19 testing messages among 300 2-1-1 callers; and Aim 3) Taken together, these activities identified essential contexts and content for communicating about COVID-19 testing to vulnerable populations, and Aim 3 integrated this knowledge into proven message tactics and determined their impact on interest in, and intention to be tested, and other key outcomes. The existing partnership with 2-1-1 was central to this research. Of the 24 priority populations identified in the NOSI, 2-1-1s serve a higher proportion of callers from nearly every group compared to their proportion of the U.S. population, including 60-80% racial or ethnic minorities, 40-55% with household income below $10,000, and 1 in 4 who have not completed high school. During COVID-19, 2-1-1s in 36 states have fielded 964,286 COVID-19 requests. These first-hand accounts from underserved Americans concerned about, or affected by, COVID-19 must inform communication efforts, and the infrastructure of 2-1-1 was well suited to support rapid testing of promising approaches.