Orange County (OC), California, is the sixth most populous county in the US, with Latinos and Asian Americans and Pacific Islanders (AAPIs) comprising 55% of the 3.2 million inhabitants. In a geographic area composed of Santa Ana and other North OC cities reside 588,000 people in 92 census tracts who are considered of greatest need. Residents of these high-need areas face barriers to accessing COVID-19 resources and to meeting Healthy People 2030 (HP2030) objectives for health literacy. For instance, they make up 18% of OC's total population, but 41% of its confirmed COVID-cases and 43% of COVID deaths. In health care settings, they face language and access barriers that impede understanding, communication and shared decision-making. With COVID-19, inequities have grown as these communities face increased discrimination and violence, myths spread through ethnic media and social networks, and language and technical barriers with vaccine registration apps.The goal of the Health Equity and Literacy in OC (HEAL-OC) initiative is to reduce COVD-19 inequities through four objectives: 1) increase collaborative capacity of the City of Santa Ana and an established partnership, the Orange County Health Equity COVID-19 Community-Academic Partnership (OCHEC-CAP); 2) develop a Disparities Impact Statement (Outcome 1) as a framework for designing, implementing and evaluating interventions; 3) implement a sustainable Health Literacy Plan incorporating National CLAS Standards; and 4) engage with a Minority Serving Institution (University of California, Irvine) to conduct rigorous evaluation with periodic reporting and quality improvement recommendations to all partners. The OCHEC-CAP will undertake two major strategies to achieve planned outcomes. With guidance from the Community Stewardship Board, the Population Health (PH) track will implement a Population Health Literacy Plan in community settings to improve access and use of COVID-19 health resources (
Outcome 2) and reduce gaps in COVID-19 testing and vaccination (Outcome 3). The Community Health Center (CHC) track will target HP2030 Health Literacy objectives (Outcome 6) in health care settings in high-need areas. We will establish a Health Literacy Working Group consisting of four CHCs to develop and implement a Health Literacy Surveillance and Intervention Plan (Outcomes 4 & 5). Planned evaluation activities rely on multiple and mixed methods to assess process, reach, and outcomes. A Technical Advisory Group includes academic and clinical experts in infectious disease, public health, community engagement and primary care. For the PH track, data will track COVID-19 testing and vaccination rates and documentation (IID-D02) at the zip code or census tract level from State/County datasets weekly, and gap reductions between high and lower SVI areas will be assessed. For the CHC Track, appropriate measures of HP2030 objectives HC/HIT-01, HC/HIT-02 and HC/HIT-03 will be identified and collected, and gap reductions between baseline and HP2030 target values for CHCs will be analyzed. HEAL-OC will follow iterative, rapid cycle quality improvement strategies, and will engage initiative stakeholders including community and clinic representatives, leaders, and county and elected officials to improve planned efforts, train and coordinate with other service providers, and inform broader health equity efforts to ultimately reduce inequities among our diverse and underserved populations. ESTIMATED NUMBER OF PEOPLE TO BE SERVED AS RESULT OF THE AWARD OF THIS GRANT: 90,000