February 02, 2021

Engaging Underserved Communities

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When the pandemic began, the UAB Minority Health & Health Disparities Research Center (MHRC) quickly pivoted its focus to COVID-19. Because minority race/ethnicity, obesity, and chronic health conditions are risk factors for severe COVID-19 illness, the MHRC was uniquely qualified to address health disparities in the context of the pandemic. Also critical was MHRC’s ability to leverage its robust community engagement partnership network and Building Healthy Communities Coalitions across Alabama.

The MHRC identified key concerns via a series of virtual focus groups with five underserved communities across the state, including confusion about who was impacted and at risk for infection; worry over basic needs (food, shelter, paying bills, childcare, job loss); and overeating, lack of exercise, increased alcohol consumption, and other risky behaviors. In addition, the center identified barriers related to social determinants of health common in low-resource communities, including lack of transportation, lack of health insurance, and uncertainty about risk, testing processes, and eligibility requirements.

In essence, the MHRC found that COVID-19 was making marginalized communities even more marginalized. The center developed an intervention model around COVID-19 in vulnerable communities—the Community Mobile Testing Model (CMTM)—with three essential components:

  • COVID-19 community engagement and education
  • Mobile testing units serving walk- and drive-through services located in vulnerable communities
  • Patient navigators to guide individual participants through the testing process and follow-up

The CMTM was piloted in June and July. The MHRC held 33 testing sites in 18 communities and tested 1,434 people. COVID-positive rates in this initial expansion were 5% for whites, 9% for Black/African Americans, and 29% for Hispanics. Following the success of this community initiative, the MHRC applied for and received Jefferson County CARES (Coronavirus Aid, Relief, and Economic Security) Act funding which allowed the center to expand the model in Jefferson County. The expanded program involves preventing COVID-19 through better adherence to prevention guidelines; testing for COVID-19 in underserved communities and hotspots; and preparing for future waves through improved health (better nutrition, more physical activity, and improved wellness).

Based on this work, the MHRC was well-positioned when the NIH sought to launch the Community Engagement Alliance Against COVID-19 Disparities (CEAL) program, which focuses on Blacks/African Americans, Hispanics/Latinos, and American Indians—populations that account for over half of all reported cases in the U.S.

CEAL is funded by a $12 million award to teams in 11 high-risk states: Alabama, Arizona, California, Florida, Georgia, Louisiana, Michigan, Mississippi, North Carolina, Tennessee, and Texas. The CEAL teams promote and facilitate the inclusion and participation of underrepresented communities in vaccine and therapeutic clinical trials to prevent and treat the disease.

“Building on existing partnerships within UAB, the goal of Alabama CEAL is to establish a research and community engagement infrastructure to identify contributing factors to the disproportionate burden of COVID-19 in vulnerable communities and establish effective, community-engaged strategies to enhance education, address misinformation, improve access, and increase inclusion of underserved populations in COVID-19 research,” says MHRC Director Mona Fouad, M.D., lead principal investigator of UAB’s CEAL award. 

The UAB CEAL investigators are leveraging the infrastructure and community partnerships of the MHRC, the UAB Center for Clinical and Translational Science, and the UAB Schools of Medicine, Public Health, and Health Professions. – Jane Longshore and Bob Shepard