Episode 7: REACHing for Vaccine Equity Innovative Strategies to Build Vaccine Confidence in a Hispanic/Latino Community – Penn State College of Medicine

Yabo Beysolow 00:48

Hello. My name is Dr. Yabo Beysolow. At the top of each episode, we really like to explore how individuals can continue to thrive with the preventive power of getting vaccinated and adopting healthy behaviors. Today, we’ll be talking about how vaccination can protect individuals in communities surrounding the Pennsylvania State College of Medicine area. I’m delighted today to welcome our guests, Andrea Murray, who is the Project Director for the Penn State REACH Project, and also Dr. William Calo, Associate Professor of Penn State College of Medicine. I’ve had the pleasure of working with their organization over the past two and a half years through the REACH Project and I’m so excited to hear from them today as they share all of the great work that they’ve been doing to promote flu and COVID-19 vaccination in their communities. So, Andrea and Dr. Calo welcome. We’re so glad to have you on the show.

Andrea Murray 01:44

Thank you so much for having us.

I just wanted to share a little bit about the communities that we’ve been working with here through the Penn State College of Medicine REACH Project. We’re located right here in central Pennsylvania, close to Pennsylvania’s capital of Harrisburg, but work directly in Lebanon and Berks counties and their county seats, which are Reading and the city of Reading and the city of Lebanon, working with our communities, especially our priority population, the Hispanic and Latino communities has really given us the opportunity to meet some great community partners with those community partners and uplifting their voices. With the resources we have from the REACH project, we’ve been able to reach our community members about the COVID-19 and flu vaccines in partnership and working very close with those that know the communities the best.

Yabo Beysolow 02:34

Excellent. Thank you. Thank you for that great introduction. And Dr. William, would you like to add anything more about perhaps the unique cultural aspects of community?

William Calo 02:44

Thank you again for the invitation to participate in this podcast. I would like to add some information in terms of the two communities that we were with in Lebanon. We’re talking about a little bit over 26,000 people. And in Reading, we’re talking about 95-96,000 people. So this is what we consider small to midsize towns or cities.

And these are very unique places in our region because the majority of this population are Hispanics, not only from one single geographic area but for multiple areas, including Puerto Ricans, people from Cuba, Mexican Americans, people from Dominican Republic and many other Central American countries. So this is a melting pot for Latinos in this area, which is pretty unique again because we’re not talking about the usual large or big cities. We’re talking about small, midsize places in central Pennsylvania.

Yabo Beysolow 03:37

That is a great representation of your community, as you mentioned, a melting pot there of various Latino communities, so thank you for sharing that. So, with that as the background, could you tell us a little bit, either one of you, how the cultural aspects of the community might affect your work? And also, if there are any health inequities that face your community?

Andrea Murray 04:00

Yeah, so culturally, our communities are very tight-knit. We see that family is very important to our community members as a lot of them have immigrated to the area to meet up with family that have might’ve been here for a few years now. Moving into the smaller communities provides an opportunity for a lower rent, a better chance of receiving benefits, and then also great opportunities for agricultural work here in central Pennsylvania.

And so having those close-knit families who are all together, it’s really important to understand how their decisions are made up amongst their family and their community as well. So they rely on each other a lot. It’s not only, you know, your mom is your mom, but your neighbor is also your mom, or your neighbor’s grandma is your grandma. And so there’s a lot of community within families and then within their communities in themselves.

Yabo Beysolow 04:56

Yes, that, community bonding and family connections. So very important. Dr. Calo, anything you’d like to add about perhaps some health inequities that may face the community that you serve?

William Calo 05:08

Yeah. In particular, I will add that…I want to put in context where we’re located. We’re Penn State Health, and we are a large healthcare system. We have multiple hospitals in our region. So the communities that we serve they’re not sure in terms of access to health services, not only from Penn State Health, but we also have some other competitors.

I would not name them, but we have so many options for accessing health services from health systems and FQHCs, and independent clinics; regardless, that’s large access to health systems. There’s a…there’s a problem in our communities, and it’s connected to cultural aspects and language, you know…so that is a benefit of working with the REACH project, that allows us to integrate and get knowledge about those cultural backgrounds to try to develop interventions and programs that are more accessible for these people, not access in terms of the place where the systems are located, but access in terms of knowledge.

In terms of language, in terms of me as a Hispanic, I feel comfortable to go to a place that I know I will receive the care that I need, you know, care that respects diversity, equity, who I am as a person and as a community. So I want to put that in context because that’s some of the best things that we’re doing as part of the REACH project here in our central region.

Yabo Beysolow 06:46

Thank you for bringing that distinction to light. Again, not access as regards when we think of access systemically but in terms of access to knowledge, being comfortable accessing care, and the quality of care. That is culturally tailored. So, thank you for bringing light to that. So, you know, in working with your organization, I’ve really been inspired by the work that you have accomplished.

Can you start by telling us a little bit about how you built those relationships or fostered partnerships in your community to promote flu and COVID-19 vaccination? Talk about the strategy and framework.

Andrea Murray 07:25

Sure. I think what really helped is that we had started making these relationships…are building relationships with our community partners. Even before we saw the pandemic of COVID-19 affect our, our nation and the world. And so making those strong relationships amongst those community partners beforehand was really important.

And we were doing that through nutrition programs, assessing different opportunities to increase physical activity in our communities, and also really working closely with the other health care providers and federally qualified health centers in our communities to try to help those folks that might be at risk for diabetes as well. And so making those connections while working in the other aspects of the REACH project really helped as we embarked on, you know, thinking about flu and COVID-19 vaccine hesitancy. And so the creation of one, joining with partners through organizations but also joining with community partners that were well known in the communities.

And so I said community champions before. It was really important to find out who was trusted. Also, you know, a trusted messenger. Who was the person that when someone came into the communities of Lebanon and Reading? Who was that person that everybody got sent to to figure out where to live, how to get their kids enrolled to school?

Who are the best places to buy groceries that were familiar to them from their home countries? And so making those relationships and really solidifying those relationships with those trusted messengers and community members in the community were just as important as working with community organizations as well. And so, really building those relationships, I think, was, is how we set the foundation for our work in the COVID-19 and flu hesitancy work that we, we did with our project.

Yabo Beysolow 09:31

Very important. Those trusted leaders and messengers. Was there anything in particular that may have surprised you about working with your trusted messengers?

William Calo 09:41

Let me, let me add something here. As, as I was mentioning the trusted messenger and I want to start saying that we’re, we’re doing this work about COVID-19 and flu vaccination with these communities, but we are not new in these communities. We have been working for many, many years in different topics.

Andrea mentioned some of them and including other aspects, including mental health issues and social services, and other work. So that is quite important because as we have been working to identify those trusted messengers or people, organizations, those communities. It’s equally important that these people recognize us as a trusted organization as a trusted person, and I think that is a bidirectional thing that we have to work and it’s something that will not happen in a day or a week, or a month. This requires sometimes multiple years and we have been so grateful of having Andrea with us for many years.

So she has been able to develop some of these relationships from scratch, you know, and I think that that’s something that is very important about…not only find who these people are, but also show them that we are trusted as well to work with us.

Yabo Beysolow 10:57

Thank you, both of you. Just some great insight there. The importance, as you mentioned, of that bidirectional trust, to the community and vice versa. So, let’s turn a little bit to the community itself. How have flu and COVID-19 vaccines been accepted in your community?

And then the second part to that question, what were some of the challenges that you overcame in your community with regard to flu and COVID vaccination?

Andrea Murray 11:25

I love this question. You know, as, as we started our work in flu and COVID-19 vaccine hesitancy, I learned a lot of cultural behaviors and norms behind vaccination within the Hispanic and Latino communities that I wasn’t aware of. You know, this isn’t something that we always talked about, was vaccines with the work that we were doing before.

And so as we learned, we learned that sometimes they are really hesitant. These vaccines aren’t as widely talked about or encouraged in their home countries where they’re coming to…to live here in the United States, where we do talk more about vaccination. The hesitancy was already there when it…when we talked about the flu vaccine, we frequently heard, you know: “Oh, I don’t get that.” “It’s going to make me sick.” “Oh, I didn’t need to have that where I lived before. Why do I need to have it now?” And so it was really important for us to provide the education. It wasn’t necessarily talking to them and saying, “Hey, you got to get this” right? It was, “let’s talk to you about what you might not know,” like how I just learned something that I may not have known, learning the importance of the voices of the community and, like I said before, the voices of family members as well. So it was really important to make sure that we were educating all generations of the Hispanic and Latino community about the importance of the vaccines to as a generational culture, you know, whatever grandma says is probably what you should probably do.

And so it was really important for us to talk to everybody and be able to share information. So the education was, was the most important. And I think that it was really great that we had the opportunity to educate the community and the way that we did.

Yabo Beysolow 13:17

Great. Thank you, Andrea and Dr. William, anything to add on that and the question again-just how have flu and COVID-19 vaccines been accepted in the community, and what were some of the challenges that you had to overcome?

William Calo 13:31

been working in the vaccine communication space for many years, mostly around HPV vaccination. With patterns of adolescence vaccine hesitancy and distrust, something that we have seen for many years or decades, this is not something new. I think COVID just exacerbated some of, some of those distrust and misinformation, especially in this age of social media.

What is important here is that because the attitudes or the question that people may have about vaccines are so different. A one-size-fits-all intervention would not fit the unique preferences and information needs of people. So we in the REACH project, we know that. So we have been able to develop a series of interventions that are capable to reach diverse community members and sectors, but at the same time, at different levels of knowledge and different levels of readiness to get vaccinated.

For some people, they’re willing to get the vaccine, but they don’t know where to get the vaccine for free or low cost or at what time of the day, you know, so, so we have been developing interventions that distribute that information, make that information accessible. With other people that we know, there’s some distrust or some questions that need to be addressed.

We have been developing other information that are tailored to that, so we have been able to deploy interventions that are able to address all these different levels of vaccine willingness in the community that we serve.

Yabo Beysolow 14:59

It’s an excellent description there of tailoring to the needs of the community based on what you have learned from the community. So again just really appreciative of all the work that you both are doing. I would like to ask you both to comment on a specific project that you may have conducted with regards to health promotion and vaccine promotion.

Andrea Murray 15:18

You know, we did a lot of work in this space, but I think my favorite was being able to ask people that had been vaccinated why they got vaccinated and giving them the opportunity to tell their community why they did that. And so, not overusing trusted messengers, but our trusted messengers in our community, they came together, and we were able to take some still photography, some video.

We were also be, we’re able to make some life-size cardboard cutouts of these folks. And it was nice being able to share their reason why. You know, it’s nice to see a celebrity here and there saying why they got vaccinated, but we really wanted to make our own community members and those that were trusted the celebrities.

It was easier for somebody to see, you know, Guadalupe, who owns the Mexican restaurant and store in Lebanon, on a billboard saying, “I got my COVID-19 vaccine. I got my flu shot because I wanted to open up my store or because I want to be able to see my neighbors.” And, I think it was easier to share with them, with the community, their stories because then the community could then stop in right and see Guadalupe and ask Guadalupe about her experience receiving the vaccinations and be able to have a good conversation and being able to educate Guadalupe on how to answer those questions was even, you know, a next step as well.

I think when people saw that these folks were coming and stepping up and saying, “I have been vaccinated,” it really helped in being able to have those folks be able to answer the questions of the community members and educating them about what the importance of getting vaccinated.

Yabo Beysolow 17:05

So Andrea, so this was like a video campaign or promotional strategy that you conducted?

Andrea Murray 17:12

Yeah. Yep. It included, like I said, photography and billboards, yard signs videos, social media posts. So it was, it was a huge marketing campaign. We did all of our materials in both English and Spanish, including some infographics too. The infographics the topics were gathered through stakeholder boards of those that were both trusted messengers and community organizational leaders to let us know what was happening and what was being talked about in our communities.

We then took that information back and created these great infographics that were shared with our community partners and our health services communities to be able to share with our communities.

Yabo Beysolow 17:57

Wonderful, wonderful. And Dr. William, could you share, and please feel to share some of your research, some of your work as well in the community of a particular project?

William Calo 18:07

I would like to highlight one project that is a new population and a new setting for me in the last two years, We have learned a lot about, you know, specific groups and specific characteristics that, that make some people a little bit more hesitant or unwilling to get the vaccine, but a population that we learned has been very hesitant is pregnant woman.

And and we have been working in the last four or five years with some WIC offices, specifically the one in the city of Lebanon, to deliver breastfeeding counseling to some of these moms in both English and Spanish. And we learned about vaccine hesitancy in this particular place looking at the research happening nationwide.

We also learned that this is one of the hardest groups to get the COVID-19 vaccine: pregnant and postpartum women. And we took advantage of this partnership with this WIC site and our other WIC site in, in Reading in Berks County. So we developed a short campaign where we identify some women who receiving WIC benefits and got the vaccine and would like to share their experiences with other WIC mothers about how important it is to get the COVID-19 vaccine to protect themselves and the future baby.

So we developed that campaign a year ago, we’ve reached into WIC sites. It was a total success that the REACH team apply for new statewide funding, and we received funding to expand our project from two WIC locations to 18 locations in 17 counties. And in the last three months, we have been doing that work, and we have reached over 1,400 WIC families in these 18 sites. So, it’s one of the projects that I really care a lot because for me, you mentioned what research I’m doing. Of course, we always try to innovate. And I never worked with pregnant and postpartum mothers in a WIC office. So, that was completely new to me. Andrea was a WIC staff many years ago. So she helped us to make those connections. And I think it’s a population that we should continue working with. Andrea mentioned how important family is for Latinos. So when we’re able to impact that mom, you know, that mother is going to be just when they have that baby. And it’s only the mother getting the COVID-19 vaccine during pregnancy or postpartum, but also we’ll understand how important it is to get that baby getting all those vaccines, you know.

So we’re having an impact not only on those adults but also in families in the future. And that is what really made me happy about this project.

Yabo Beysolow 20:47

Thank you. That’s just such a wonderful example of a project that intersects not only the vaccine work but also health promotion in your community and reaching people where they are, specifically the WIC population, women, infant, and child. So thank you. Are there any other projects? I know, Andrea, you mentioned at the beginning diabetes.

Are there other projects that intersected both, you know, work in both areas?

Andrea Murray 21:12

We were really lucky to work with some community-based organizations that were doing some fantastic vaccination work out in our communities that turned to us and said, “Hey, REACH team. Would you be able to come, and would you be able to help out at our vaccination sites and be able to provide information?”

And so we were able to do this by actually going and and we realized that 15 minutes after you got your vaccine, especially your COVID-19 vaccine, and you sat and you waited to, be assured that there was no side effects from the vaccine, was a great opportunity for us to do some screening for diabetes prevention.

And so our community health workers and our REACH staff had the opportunity to sit down with those folks while they were waiting for that 15 minutes and be able to utilize the CDC’s diabetes prevention screening tool.

And then be able to share with those folks where they can go if they screened at risk for diabetes, where they can go in the community and, and share that information with our community partners.

Yabo Beysolow 22:19

Another great example there of working together for health promotion. Thank you. So I guess, you know, as we move along now, we’re three years away from the onset of the pandemic. How is your organization planning to sustain the vaccine equity work that you’ve done thus far and keep that focus on the importance of vaccinations?

Andrea Murray 22:43

Another great question, but what we’ve realized is that sustainability is really important. It’s important to be able to provide our community organizations with tools and materials that can continue to be used in the future to encourage vaccination amongst our priority population. We found a lot of folks not being able to translate materials into Spanish at such a fast pace with the information that our communities needed. We were able to do that for them, and now going through the materials and making sure that everything is up to date with the latest information about both the flu and COVID-19 vaccines and being able to have a repository of that information where folks can go and utilize and pull that information and use as needed in their community organizations or healthcare services is what’s really important for us. We feel like people actually might know who we are as REACH now, right? And through this work, seeing the REACH logo and the communities that we’ve been working with alongside the logos of our community partners. I think it, it gives us the opportunity to be able to provide this information and have people trust that information as well.

Yabo Beysolow 23:56

Thank you, Andrea and Dr. Calo anything? Thank you.

William Calo 23:59

Yeah, I’ll let, I’ll let you add the, an important thing is when we develop interventions, materials, or resources, it’s quite important to develop those materials with sustainability in mind from the very beginning. You know, it’s something that you can deploy quickly as part of your REACH project, but at the same time, thinking about and what happened after that, you know, so going back to the example about this project that we have with this 18 WIC sites, we’re not only going to educate these these families during in-person events.

[We have also developed our intervention to be web-based. So, we developed the stories of this woman, and we have developed these two-minute video clips that this WIC sites will be running in their websites or on the TVs that they have in the waiting rooms. We’re also transitioning that to 20 second social media clips and now they can put in Twitter and Facebook accounts. So even if the project ends or the particular funding, our activities end, they can continue run that because we have developed in these packages that are easy to implement, not only in the size that we’re working with. But hopefully other WIC sites across the state or nationwide can just take our social media clips or our short videos and use them.

So I think it’s quite important that you develop interventions with sustainability in mind from day one.

Yabo Beysolow 25:37

Very, very good examples there of sustainable work and reaching outside of even your community to communities nationwide. Well, you know, I really wanted to just hear from you. This is what we call our inspiration section of the podcast. What is one message, a story that has inspired your own confidence in vaccines, or something that keeps you returning to this work daily?

Andrea Murray 26:04

I just really enjoyed being out in the community at a time where we were told to stay apart stay safe. I had the opportunity to be able to be out in the community and providing folks with the information needed to make the best decisions for themselves and their families regarding the flu and COVID-19 vaccine and being able to share that with our community leaders and community partners. It was a time of coming together. It was a time that we got to learn a lot more about each other and, you know, a time where it wasn’t work anymore, it was being there to help everybody stay safe and learn about these vaccines.

William Calo 26:50

In my case, I would like to say that sometimes you are not able to convince a person to get a vaccine. It, it’s flu, it’s COVID, it’s HPV, it’s shingles, it’s any other vaccine. So, and sometimes that hurts. I have been working in this space for more than ten years, and you, you develop your signs and your products, and you believe that they will convince anybody to get the vaccine, but sometimes it is not that case – that is the thing that motivates me to continue working.

Because that tells me that there’s something that I miss or something where we should do a better program evaluation to get the information correct or something like that. But at the same time, it tells me sometimes that maybe it’s not my information, it’s our science that is that is not there…is that maybe we need to be a little bit more engaged with that community, with that person.

So how we can continue building that trust, how we can continue building those collaborations? And sometimes something that the, the REACH project here at Penn State we do pretty well is that we are not only present in the vaccine events or other events that are particularly for the REACH project, we are present in any health or social event that we can, and we make ourselves available. And when the community starts seeing you more consistently and more consistently that, that really opens so, so many doors. Maybe I cannot convince you to get the vaccine today, but as Andrea mentioned, maybe I can convince you to get the DPP screener.

Or maybe I can convince you to check your food insecurity score or your BMI or something. So we have to make ourselves open that sometimes we have wins or losses, but I think how we make ourselves more available and accessible to those community people at the very end, you know, we’ll make our work easier.

Yabo Beysolow 28:51

Well, this has just been really amazing. I’ve really enjoyed hearing about all of the incredible work that you and your organization are doing in the community to build trust, improve health. I just want to say a big thank you to both of you, Andrea and Dr. William. And it’s just been wonderful chatting with you both today, and I’m sure our listeners will enjoy this podcast as well.

So, thank you.

Andrea Murray 29:15

Thank you so much for having us.

William Calo 29:18

Thanks so much.

Yabo Beysolow 29:19 You’re welcome.