Community-Driven Advocacy: Addressing COVID-19 Health Inequities and Increased Institutional Mistrust in Historically Oppressed Communities in the United States Público
Ranson, Hannah (Spring 2021)
Abstract
Introduction: Communities of color have experienced centuries of historical and modern-day experiences with structural racism, health inequities, and lack of government accountability which has led to an innate institutional mistrust. There is considerable concern around people of color’s COVID-19 vaccine uptake, which may be influenced by both personal hesitations related to mistrust, as well as inequitable social and environmental barriers to access.
Objectives: The goal for this project was to create an advocacy tool to leverage the voices and knowledge of experienced faith and community leaders around the United States in order to inform action that could mitigate COVID-19 health inequities and institutional mistrust in historically oppressed communities of color.
Methods: An advocacy interview guide, which was crafted from literature on community mobilization, was used to gather the insights and perspectives of faith and community leaders with experience in building trust in communities of color and increasing access to influenza prevention services. Interviews were conducted that helped shape six Community Leadership Voices Action Briefs that provide key insights to cultivating community trust, along with necessary action steps to reduce COVID-19 related health disparities.
Results: The findings that emerged from this project center around the content provided by community leaders in the Community Leadership Voices Action Briefs. Two categories from the briefs were examined for common themes across participants, they include Capacity & Successes: Cultivating Trust and Essential Principle-Based Actions. The main findings around cultivating trust included the following themes: authentic partnerships, provision of resources and services, leadership development and training, community engagement and collaboration, and cultural responsivity. Common action recommendations made by community leaders focused on centering the community, ensuring equitable access, prioritizing community and public health, addressing systemic racism, and engaging in a collective dialogue.
Implications & Recommendations: Foundational practices in public health continue to harm communities of color. Thus, in order to effectively address health inequities, we must adopt community-driven approaches and anti-racists frameworks that truly engage and build authentic relationships with communities that value equity and social justice.
Table of Contents
Chapter 1: Introduction…………………………………………………………………………1
Introduction & Rationale……...…………………………………………………………..1
Problem Statement………………………………………………………………………...4
Purpose Statement………………………………………………………………………...5
Objectives………………………………………………………………………………....5
Significance Statement……………………………………………………………………6
Chapter 2: Review of the Literature…………………………………………………………....8
2.0: Introduction…………………………………………………………………………..8
2.1: COVID-19 Disparities and Underlying SDOH………………………………………9
2.2: Vaccine Hesitancy and Expanding Mistrust………………………………………...25
2.3: Essential Public Health Practices…………………………………………………...35
2.4: Community-Driven Advocacy……………………………………………………...48
2.5: Summary of Current Issues and Project Relevance…………………………………52
Chapter 3: Methodology……………………….……………………………………………….55
Introduction………………………………………………………………………………55
Population & Sample…………………………………………………………………….55
Procedures………………………………………………………………………………..56
Instruments……………………………………………………………………………….61
Ethical Considerations…………………………………………………………………...61
Limitations……………………………………………………………………………….61
Chapter 4: Results………………………………………………………………………………62
Introduction………………………………………………………………………………62
Summary…………………………………………………………………………………69
Chapter 5: Discussion and Implications………………………………………………………71
Introduction……………………………………………………………………………....71
Results Analysis………………………………………………………………………….72
Application of Results……………………………………………………………………78
Implications………………………………………………………………………………81
Conclusion……………………………………………………………………………….83
References……………………………………………………………………………………….85
Appendices……………………………………………………………………………………...A1
Appendix 1: AdvocateAurora Healthcare System & The Center for Faith &
Community Health Transformation Brief……………………………………………….A2
Appendix 2: Buddhist Tzu Chi Medical Foundation Brief…………………………...…A5
Appendix 3: Appendix 3: Detroit United Health Organization Brief …………………..A9
Appendix 4: Lowell Community Health Center Brief…………………………………A13
Appendix 5: Methodist Le Bonheur Healthcare & the Congregational Health
Network Brief………………………………………………………………………….A17
Appendix 6: Centura Health & Penrose St. Francis Health Services
Mission Outreach Brief………………………………………………………………...A20
Appendix 7: Advocacy Tool In-depth Interview Guide……………………………….A23
Appendix 8: Shifting the Conversation: Vaccine Hesitancy to Vaccine Access…..…..A26
About this Master's Thesis
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