Avery, Mitchell, and Yancey counties in Western North Carolina have been home to a growing Latinx population for decades. Few resources, and no local agencies, are geared specifically toward the needs of Latinx residents in this area. Like other Latinx communities across North Carolina, they have been disproportionately impacted by the COVID-19 pandemic, illuminating substantial underlying inequities.
To address local Latinx community needs related to the pandemic, a partnership of community health, legal, and educational organizations recruited 12 bilingual, bicultural Latinx residents of Mitchell and Yancey counties in the fall of 2020 to serve as community ambassadors and to develop and disseminate COVID-19 prevention messages. This partnership included Mountain Community Health Partnership (MCHP), a local federally qualified health center; Partners Aligned Toward Health (PATH), a nonprofit that convenes groups and agencies to identify and address community health issues; and faculty and students from the University of North Carolina Gillings School of Global Public Health’s place-based health program in Asheville. Professionals from Mountain Area Health Education Center (MAHEC), Yancey County Emergency Management, Pisgah Legal Services, and WNC Health Network provided training and relevant resources to the ambassadors.
Named Community Ambassador Real Equality (CARE) by participants, the CARE program uses the Boot Camp Translation process, an evidence-based community-engagement model that brings community members and professionals together to create and share culturally responsive and relevant health messaging [1, 2]. CARE adapted the Boot Camp Translation model to keep pace with a rapidly evolving pandemic: meetings are held online, and medical information and community messages are updated regularly. Early in the process, it became clear that personal interactions and one-on-one conversations between ambassadors and their networks are a highly impactful way to share information, influence behavior, and keep up to date with ever-evolving health recommendations. The cohort approach has created multiple channels of communication to share information and resources broadly within the community while building the capacity of emerging leaders and strengthening relationships between community members and agency professionals. It ensures that community feedback is not siloed or reduced to a single voice. Additionally, by building a team, this program fosters a culture of collaboration and reaches a wide range of community members from a variety of social circles and backgrounds.
CARE ambassadors were recruited from the three counties through outreach to people and agencies working with Latinx community members. Initial CARE ambassadors were then invited to identify and recruit additional bilingual, bicultural community members who had the ability to attend remote meetings and were willing to share information within their networks. Ambassadors are paid a monthly stipend, which addresses equity considerations and bolsters income for families in a hard-hit demographic. Ambassadors meet twice-monthly with staff from PATH, MCHP, and UNC Gillings, and are trained in the health impacts and prevalence of COVID-19. They also learn the legal rights of undocumented people and recipients of Deferred Action for Childhood Arrivals (DACA) seeking COVID-19 testing and vaccination, effective public health messaging strategies, motivational interviewing, and local access to resources, testing, and vaccinations. In turn, the ambassadors educate agency partners about local Latinx community values, methods of communication, barriers to access, and perceptions of COVID-19. Time and care have been taken to cultivate relationships of open communication, listening, and respect for the ambassadors’ cultural knowledge and experiences. The ambassadors’ campaign is targeted to specifically meet the needs of the local Latinx community, while simultaneously sharing relevant information with the broader local population. The ambassadors have also supported the My Reason WNC campaign led by WNC Health Network, which features community members sharing their motivations for practicing the “3Ws” campaign communicated by the North Carolina Department of Health and Human Services and/or receiving the COVID-19 vaccine [3].
The CARE campaign includes Spanish-language and bilingual videos; social media infographics; radio spots; distribution of masks, hand sanitizer, and bilingual workplace safety materials; and one-on-one conversations within ambassadors’ networks. Even in the early stages of the campaign, ambassadors reported changes in their own COVID-19 prevention behaviors and beliefs, and in those of their families and coworkers. One ambassador successfully encouraged her manager to enforce precautionary measures in the workplace, and her manager now consults with her about new COVID-19 information. Several ambassadors began with vaccine uncertainty, and have since chosen to get vaccinated due to the trust they built with local health professionals. As vaccine availability has increased, ambassadors are also taking an active role in helping friends, family members, and coworkers access vaccine appointments.
As the CARE ambassadors have elevated community needs and concerns, health centers and emergency management professionals in the region have become better equipped to serve the Latinx community. Interpretation and translation have been more heavily prioritized, and health care providers have a new awareness of intersecting concerns—around insurance coverage, immigration status, and proof of identification—that influence Latinx community members’ utilization of COVID-19 care and prevention services.
The CARE program would not be possible without strong collaboration. As in most places—and especially in rural communities—relationships, trust, compromise, and follow-through are key to success. Local knowledge of agencies and systems, alongside known issues and points of friction, has led to a thoughtful and strategic approach to working together for the good of the community. Together, CARE ambassadors and agency representatives are cultivating a network of advocates that will enhance the services available to Latinx residents in the current public health crisis and beyond.
Acknowledgments
The CARE initiative is funded with a grant from the AMY Wellness Foundation.
Disclosure of interests. As the CARE Project launched, LaCosta Tipton was an employee of Mountain Community Health Partnership and an MPH student at the UNC Gillings School of Global Public Health. As part of her academic work, she designed an evaluation of the CARE project. Hannah Robinson was an employee of Partners Aligned Toward Health and a UNC Gillings MPH student. She wrote a case study of the CARE Project as part of her academic work. Neither activity was related to their employment status or promotion.
- ©2021 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.
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