Project Abstract
Community health workers (CHWs) played an essential role in addressing multi-level, community
barriers to accessing COVID-19 information, testing, risk mitigation, and vaccination; however,
little is known about how CHWs managed their roles in light of enormous social, community, and
political challenges. In May 2020 the Orange County Health Equity COVID-19 Community-
Academic Partnership formed with community-based health equity leaders and health equity
academic partners to elevate the need for and guide local COVID-19 equity response and
recovery initiatives. Equitable recovery must address larger civic engagement needs, and CHWs
were essential to navigating rising anti-immigrant attitudes, and promoting civic engagement for
census complete count and elections turnout in addition to COVID-19 education and chronic
disease management. In this study, we aim to: (1) Examine from the perspective of CHWs and
community members the facilitators, barriers, and processes of change of delivering COVID-19
response and chronic disease management CHW intervention during the COVID-19 pandemic.
In partnership with five community-based organizations, we will conduct focus groups in the areas
with the highest social vulnerability to COVID-19 in Orange County, CA; (2) Assess the systemic
factors that enhance inequities in COVID-19 testing, cases, and vaccines in Orange County areas
with the highest social vulnerability to COVID-19. Through interviews with community leaders and
policy stakeholders, we will identify the multilevel contextual factors that contribute to successes
and challenges of CHWs and community members to access COVID-19 education, testing, and
vaccinations; and (3) analyze how advocacy efforts implemented by CHWs and community-based
organizations shape the COVID-19 response. We will recruit and interview CHWs from across
California to identify the degree to which Orange County’s community responses and resiliencies
are generalizable to diverse populations across the state. Strengths of this study include our
responsiveness to community-driven COVID-19 interventions; the integration of chronic disease
management into the study of COVID-19 responses; a focus on CHW efforts to ensure access to
COVID-19 resources and to build consciousness among community members and transform local
COVID-19 responses; strong community and university leadership; and multilevel assessments
of COVID-19 interventions. We will advance knowledge about processes of change in COVID-19
CHW interventions in communities with highest social vulnerability to COVID-19. The results of
this study will inform policy recommendations to strengthen equitable COVID-19 recovery and
prepare for future public health crises and serve as a model of CBPR nationwide.