Based on an interview with Kavita Bhavan, MD, Chief Innovation Officer and Associate Vice Chair, Clinical Innovation and High Value Care at UT Southwestern Medical Center, for the AMA STEPS Forward® podcast. Quotes and interview transcript edited and reformatted for clarity.
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Learn how the University of Texas Southwestern Medical Center's Parkland Health (Parkland) reached out to local high school students to build trust and overcome vaccine hesitancy in their communities.
“To work through the trust issues, we engaged these really smart young people who want to go into healthcare and empowered them with knowledge so they could help dispel misinformation and co-create the messaging around the importance of getting vaccinated.”
—Kavita Bhavan, MD
Parkland provides care to a medically vulnerable, primarily Hispanic and Black population in North Texas. A community health needs assessment revealed that the areas around Parkland in South Dallas have an almost two times higher death rate from influenza and pneumonia than more affluent areas of North Dallas. Distrust of the health care system within these communities, which are also largely underinsured or uninsured, and higher rates of vaccine hesitancy, contribute to the observed health disparity. Dr Kavita Bhavan and her team at Parkland recognized that overcoming vaccine hesitancy and improving outcomes would require community-level approaches to restore trust.
“We need to be going into the communities, particularly those with disparities, to figure out how we can meet them where they're at and effectively engage them to co-create better clinical outcomes.”
—Kavita Bhavan, MD
Developing the Intervention
Parkland has 8 hired health ambassadors who participate in a work-study program. Additionally, in an ongoing outreach program through UT Southwestern, physicians visited students at Cristo Rey High School in Southeast Dallas to talk about careers in health care. At one of these meetings, Dr Bhavan shared the Parkland community health needs assessment map showing the differences in rates of death from influenza in the Dallas area by zip code. The students were shocked at the clear health disparity and wanted to understand what was driving it.
Dr Bhavan invited the students to go back into their communities and identify barriers to influenza vaccination. These new health ambassadors reported back on misconceptions about vaccines and identified churches and schools as trusted sources of health information in their communities. They then helped co-create and deliver messages about the risks of influenza and the benefits of vaccination, including through Spanish-language interviews on local radio stations. They also worked with Parkland and community leaders to plan and lead community vaccination events; up to 20 highschoolers volunteered their time at these events. Figure 1 shows some of the approaches that helped establish the health ambassador program.
Though the initial vaccination event was held in January 2020, at the very end of flu season, it exceeded all expectations. Parkland Health and Dallas County Health and Human Services (DCHHS) were joint organizers of the first event, with DCHHS providing the vaccines to be administered. At the first vaccination event, more than 400 flu shots were administered. The next challenge was to sustain the program's momentum while navigating the new social distancing and precautions of the COVID-19 pandemic. The student health ambassadors continued to work directly with their communities, building trust as well as a “culture of health” by sharing information—and dispelling misinformation—about influenza vaccination. Parkland Health independently organized four subsequent community vaccination events held in the fall of 2020 that vaccinated more than 1600 people in under 16 hours; for many, it was the first vaccination they had ever received.
The success of the student health ambassador model caught the attention of the Harvard Medical School Center for Health System Transformation. The Center invited Dr Bhavan and ambassador Jasmine Ramirez to share their experiences and discuss the importance of community engagement for building trust, sharing knowledge, and achieving vaccine equity. The same community-focused approach is now being applied to overcoming COVID-19 vaccine hesitancy in underserved communities. Parkland continues to work with high school student health ambassadors to identify barriers to health equity and serve as a source of trusted information about vaccines and vaccination for their parents, grandparents, peers, and communities.
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Bhavan K. COVID-19 vaccine hesitancy: how to overcome the culture of mistrust. February 21, 2021. Accessed April 28, 2022. https://utswmed.org/medblog/covid-19-vaccine-hesitancy-mistrust/
Long A, Mathew S, Alvarez KS, Smartt J, Shah M, Madden C, Perl TM, Cerise FP, Bhavan KP. Co-created messaging for influenza vaccination in a high-risk Hispanic community provides groundwork for COVID-19 vaccine. Health Equity. 2021;5(1):345-52. doi:10.1089/heq.2020.0132
North Texas doctors concerned about 'twindemic' getting flu shots to teens in underserved communities. CBS DFW. October 26, 2020. Accessed April 28, 2022. https://www.cbsnews.com/dfw/news/texas-doctors-twindemic-flu-shots-teens-underserved-communities/
Cerise FP. How Parkland plans to deliver COVID-19 vaccines to the full diversity of Dallas. The Dallas Morning News. January 31, 2021. Accessed April 28, 2022. https://www.dallasnews.com/opinion/commentary/2021/01/31/how-parkland-intends-to-vaccinate-the-full-diversity-of-dallas/