Socially oppressed groups are not only at heightened risk of COVID-19 morbidity and mortality, but are also less likely to receive a COVID-19 vaccine. In Westchester County, NY, the sociodemographic characteristics that are correlated with high case rate at the zip code level are race, ethnicity, English language proficiency, and household crowding. These high-risk zip codes also have lower COVID-19 vaccine uptake than the rest of the county. Improving health literacy may address health disparities among the socially oppressed. For instance, lack of culturally and linguistically appropriate health communication can thwart future contact with the healthcare system and muddy discernment of reliable health information. Race, ethnicity, and language are also linked with vaccine skepticism and reduced patient-provider interaction, often due to past experiences of medical discrimination. As such, the Westchester County Department of Health (WCDH) proposes a program that applies a train-the-trainer framework and delivers community-directed health education to neighborhoods with high social vulnerability and that experience high levels of COVID-19-related risk. Our objective is to work with community leaders to co-develop an educational program that aims to: (1) improve knowledge and attitudes about COVID-19 prevention, protocols, and vaccines; (2) expand patients? roles in healthcare decision-making and their understanding of the healthcare system; and (3) increase adherence to COVID-19 public health protocols and vaccine uptake. To achieve these outcomes, WCDH will take a two-pronged approach to a train-the-trainer program: one branch is community-based and engages community- and faith-based organizations (CBFOs); the other involves a partnership with the Westchester County Department of Corrections (DOC) to address health literacy among DOC staff and incarcerated and formerly-incarcerated populations.We will train 160 community members to reach 16,00
0 individuals in the geographic area of focus, and 12 corrections staff members to educate 400 jail residents and 600 DOC staff members during the grant period. Curriculum will be designed to fill 1-hour educational sessions and will be tailored to meet particular community needs, including language translation/interpretation and addressing concerns specific to some faith-based communities. Mercy College, a Minority Serving Institution, will lead process evaluation and make quality improvement recommendations to WCDH, DOC, and CBFOs, ensuring target populations are reached and proposed outcomes are being adequately measured. Focus groups selected from priority populations will provide feedback on cultural and linguistic appropriateness in accordance with National CLAS standards.To evaluate program outcomes, recipients of the educational program will complete a pre-survey before the educational presentation. Community-based and DOC staff participants will complete a post-survey after 6 months, while jail residents will receive a post-survey 3 months after the education date. Surveys before and after the intervention will aim to assess: (1) knowledge and attitudes about COVID-19, public health protocols and vaccines; (2) patients' roles in healthcare decision-making and their understanding of the healthcare system; and (3) adherence to COVID-19 protocols and vaccine uptake. Investigators will employ t-tests and chi-square analyses for pre-post changes and a multivariable regression analysis to adjust for covariates such as race, ethnicity, age, gender, and English language proficiency. In addition, we will select a demographically-matched control group to complete pre-post surveys 6 months apart to evaluate changes in COVID-19 behaviors, attitudes, and knowledge independent of the intervention.