Evaluating a peer-to-peer health education program in Australian public housing communities during the COVID-19 pandemic.

COVID-19 Community health worker Health services Pandemic

Journal

BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677

Informations de publication

Date de publication:
27 Feb 2024
Historique:
received: 20 09 2023
accepted: 23 01 2024
medline: 28 2 2024
pubmed: 28 2 2024
entrez: 27 2 2024
Statut: epublish

Résumé

The cohealth Health Concierge program operated in Melbourne, Australia from July 2020 to 30 June 2022. It provided peer-to-peer support to culturally and linguistically diverse residents of high-rise public housing. During this time, the COVID-19 public health response changed frequently and included movement restriction, testing and vaccination. We conducted a mixed-methods evaluation to determine the Health Concierge program's impact on residents' engagement with health services and public health activities. The evaluation, informed by a Project Reference Group, used the RE-AIM framework. We analysed data from 20,901 routinely collected forms describing interactions between Concierges and residents from August 2021 to May 2022. Additional evaluation-specific data were collected between March and May 2022 in four housing estates; we surveyed 301 residents and conducted 32 interviews with residents, Concierges and program stakeholders. Concierges promoted COVID-safe behaviours; linked residents with support, testing and vaccination services; and disseminated up-to-date information. Of the 20,901 recorded interactions, 8,872 (42%) included Concierges providing support around COVID-19 vaccination. Most surveyed residents (191/301, 63%) reported speaking with a Concierge in the previous six months. The self-reported two-dose COVID-19 vaccine uptake was 94% (283/301). Some residents described having meaningful, appreciated conversations with Concierges, and some described superficial interactions. While residents initially welcomed the program, many felt it failed to evolve. Poorly defined management and hiring criteria led to variable program implementation. A need for bicultural workers to continue linking residents with services was discussed. Concierges' impact on residents may have contributed to high community uptake of COVID-19 testing and vaccination, and had benefits beyond the COVID-19 remit. We recommend the program be revised and continued to inform further preparedness planning and support service access generally. Program models such as this have potential to inform and reassure high-risk communities during a pandemic. In addition, such programs can help overcome vaccine hesitancy and promote protective health behaviours, regardless of whether a pandemic is currently occurring. Ensuring these programs remain responsive to the changing needs of end-users needs over time is imperative.

Sections du résumé

BACKGROUND BACKGROUND
The cohealth Health Concierge program operated in Melbourne, Australia from July 2020 to 30 June 2022. It provided peer-to-peer support to culturally and linguistically diverse residents of high-rise public housing. During this time, the COVID-19 public health response changed frequently and included movement restriction, testing and vaccination. We conducted a mixed-methods evaluation to determine the Health Concierge program's impact on residents' engagement with health services and public health activities.
METHODS METHODS
The evaluation, informed by a Project Reference Group, used the RE-AIM framework. We analysed data from 20,901 routinely collected forms describing interactions between Concierges and residents from August 2021 to May 2022. Additional evaluation-specific data were collected between March and May 2022 in four housing estates; we surveyed 301 residents and conducted 32 interviews with residents, Concierges and program stakeholders.
RESULTS RESULTS
Concierges promoted COVID-safe behaviours; linked residents with support, testing and vaccination services; and disseminated up-to-date information. Of the 20,901 recorded interactions, 8,872 (42%) included Concierges providing support around COVID-19 vaccination. Most surveyed residents (191/301, 63%) reported speaking with a Concierge in the previous six months. The self-reported two-dose COVID-19 vaccine uptake was 94% (283/301). Some residents described having meaningful, appreciated conversations with Concierges, and some described superficial interactions. While residents initially welcomed the program, many felt it failed to evolve. Poorly defined management and hiring criteria led to variable program implementation. A need for bicultural workers to continue linking residents with services was discussed.
CONCLUSIONS CONCLUSIONS
Concierges' impact on residents may have contributed to high community uptake of COVID-19 testing and vaccination, and had benefits beyond the COVID-19 remit. We recommend the program be revised and continued to inform further preparedness planning and support service access generally. Program models such as this have potential to inform and reassure high-risk communities during a pandemic. In addition, such programs can help overcome vaccine hesitancy and promote protective health behaviours, regardless of whether a pandemic is currently occurring. Ensuring these programs remain responsive to the changing needs of end-users needs over time is imperative.

Identifiants

pubmed: 38413968
doi: 10.1186/s12913-024-10627-7
pii: 10.1186/s12913-024-10627-7
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

250

Informations de copyright

© 2024. The Author(s).

Références

Webel AR, Okonsky J, Trompeta J, Holzemer WL. A systematic review of the effectiveness of peer-based interventions on health-related behaviors in adults. Am J Public Health. 2010;100(2):247–53.
doi: 10.2105/AJPH.2008.149419 pubmed: 20019321 pmcid: 2804647
Ballard M, Bancroft E, Nesbit J, Johnson A, Holeman I, Foth J et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020;5(6).
McGowan VJ, Buckner S, Mead R, McGill E, Ronzi S, Beyer F, et al. Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review. BMC Public Health. 2021;21(1):1888.
doi: 10.1186/s12889-021-11852-z pubmed: 34666742 pmcid: 8524206
Shiner M. Defining peer education. J Adolesc. 1999;22(4):555–66.
doi: 10.1006/jado.1999.0248 pubmed: 10469518
cohealth. Public housing residents recruited as. ‘health concierges’ at high-rise towers. Melbourne, Australia. 2020 [updated 15 Nov]. Available from: https://www.cohealth.org.au/media-releases/public-housing-residents-recruited-as-health-concierges-at-high-rise-towers/
cohealth. Resident-to-resident communication key to vaccine uptake in public housing Melbourne, Australia. 2021 [updated 26 Mar]. Available from: https://www.cohealth.org.au/media-releases/resident-to-resident-communication-key-to-vaccine-uptake-in-public-housing/
Wikipedia. Housing Commission of Victoria. 2021 [updated 5 Oct]. Available from: https://en.wikipedia.org/wiki/Housing_Commission_of_Victoria#1960s_high_rises
Button J, Szego J. ‘A completely different world’: the rich and resilient communities inside Melbourne’s towers. The Guardian. 2020, 9 Jul 2020.
Victorian Ombudsman. Investigation into the detention and treatment of public housing residents arising from a COVID-19. ‘hard lockdown’ in July 2020 Melbourne, Australia. 2020. Available from: https://www.ombudsman.vic.gov.au/our-impact/investigation-reports/investigation-into-the-detention-and-treatment-of-public-housing-residents-arising-from-a-covid-19-hard-lockdown-in-july-2020/
Victorian Government Department of Health. Coronavirus update for Victoria– 4 July 2020 Melbourne, Australia. 2020 [updated 4 Jul]. Available from: https://www.dhhs.vic.gov.au/coronavirus-update-victoria-4-july-2020
Premier of Victoria The Hon Daniel Andrews. STATEMENT FROM THE PREMIER 2020 [updated 4 July]. Available from: https://www.premier.vic.gov.au/statement-premier-73
Victorian State Government Deparment of Families Fairness and Housing. High-risk accommodation response extension (HRAR extension). Melbourne, Australia. 2022 [updated 14 Jan]. Available from: https://www.dffh.vic.gov.au/community-services-sector-covid-19
Elmer S, Osborne R, Cheng C, Nadarajah RG. Actions to address health literacy and equity in social housing, Victoria. Swinburne University of Technology. 2022 [updated Aug]. Available from: https://researchbank.swinburne.edu.au/items/ce0d0144-8179 4dee-988d-b1d514977cd7/1/.
Victorian Government Department of Health. High-risk accommodation response extension (HRAR extension): service specifications. Melbourne, Australia. 2021 [updated 16 Apr]. Available from: https://www.dhhs.vic.gov.au/high-risk-accommodation-response-extension-hrar-extension-service-specifications
Victorian Health Association. Funding to support vulnerable Victorians cut, despite program success. Melbourne, Australia. 2022 [updated 10 May]. Available from: https://vha.org.au/news/funding-to-support-vulnerable-victorians-cut-despite-program-success/
Victorian Government Department of Families, Fairness and Housing. High-risk accommodation response extension (HRAR extension): service Specifications January 2022. Melbourme, Australia. 2022 [updated 14 Jan]. Available from: https://www.dffh.vic.gov.au/high-risk-accommodation-response-extension-service-specifications-january-2022-word
cohealth. Lessons from COVID. Slides from presentation at meeting with department of health. Melbourne, Australia; 2020; 30 Nov.
cohealth. Submission to the public affairs and estimates’ committee inquiry in the Victorian Government’s response to the COVID-19 pandemic. Melbourne, Australia. 2020. Available from: https://www.parliament.vic.gov.au/images/stories/committees/paec/COVID-19_Inquiry/Submissions/104._Cohealth.pdf
Hope Z. The unheralded workers helping keep Melbourne COVID-free. The Age. 2020; 14 Nov.
Eddie R. The shot messengers: public housing residents trained to advise on vaccines. The Age. 2021; 4 Apr.
cohealth. Covid-19 community information. Melbourne, Australia. 2021. Available from: https://www.cohealth.org.au/covid-19-community-information/
Blakkarly J. Residents of Melbourne’s public housing towers are now delivering in-language coronavirus advice. SBS News. 2020 15 Nov.
Crudden D. The community leaders fighting the COVID-19 pandemic one vaccine myth at a time. Eminetra. 2021 21 Aug.
Victorian Healthcare Association. Proposed model to embed the HRAR program. Resilient communities program. Melbourne, Australia. 2022 [updated 15 Mar]. Available from: https://vha.org.au/wp-content/uploads/2022/03/Proposed-model-to-embed-HRAR-Resilient-communities-program-March-2022.pdf
Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7.
doi: 10.2105/AJPH.89.9.1322 pubmed: 10474547 pmcid: 1508772
Booth A, Hannes K, Harden A, Noyes J, Harris J, Tong A. COREQ (consolidated criteria for reporting qualitative studies). Guidelines for reporting health research: a user’s manual. 2014:214– 26.
Sripad P, McClair TL, Casseus A, Hossain S, Abuya T, Gottert A. Measuring client trust in community health workers: a multi-country validation study. J Glob Health. 2021;11:07009.
doi: 10.7189/jogh.11.07009 pubmed: 33763223 pmcid: 7956104
Eisenman DP, Williams MV, Glik D, Long A, Plough AL, Ong M. The public health disaster trust scale: validation of a brief measure. J Public Health Manag Pract. 2012;18(4):E11–8.
doi: 10.1097/PHH.0b013e31823991e8 pubmed: 22635199
QSR International Pty Ltd. NVivo 12 plus (released in March 2020), https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home
Forman J, Heisler M, Damschroder L, Kaselitz E, Kerr E. Development and application of the RE-AIM QuEST mixed methods framework for program evaluation. Prev Med Rep. 2017;6.
Anustralian Government, Operation COVID, Shield. COVID-19 vaccine roll-out. Canberra, Australia. 2022 [updated 17 Mar]. Available from: https://www.health.gov.au/sites/default/files/documents/2022/03/covid-19-vaccine-rollout-update-17-march-2022.pdf
Sullivan SG, Brotherton JM, Lynch BM, Cheung A, Lydeamore M, Stevenson M et al. Population-based analysis of the epidemiological features of COVID-19 epidemics in Victoria, Australia, January 2020-March 2021, and their suppression through comprehensive control strategies. Lancet Reg Health-W Pac. 2021;17.
Pienaar K, Murphy D, Keaney J, Bennett C, Kelaita P, Bogatyreva K et al. All in this together? COVID-19 responses, diverse communities and practices of care. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine COVID-19 Conference; 21–22 Jul 2022; Sydney, Australia. 2022.
cohealth. HRAR 3.0 Survey. Results of analyses by AIPCA (La Trobe University) April 2022. Australia: Melbourne; 2022.
newsGP. ‘Shocking’: Migrants more than twice as likely to die of COVID-19: The Royal Australian College of General Practitioners; 2022 [updated 6 Jul]. Available from: https://www1.racgp.org.au/newsgp/clinical/shocking-migrants-more-than-twice-as-likely-to-die
newsGP. Addressing vaccine hesitancy in CALD communities: Royal Australian College of General Practitioners; 2021 [updated 21 Feb]. Available from: https://www1.racgp.org.au/newsgp/clinical/addressing-vaccine-hesitancy-in-cald-communities
Kaufman J, Bagot K, Tuckerman J, Hoq M, Suryawijaya Ong D, Jos C et al. COVID vaccine key cohort preparedness and communication strategies. A report for the Victorian Government. Melbourne, Australia; 2021 14 May.
Wiah S, Subah M, Varpilah B, Waters A, Ly J, Ballard M et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020.
Peretz PJ, Islam N, Matiz LA. Community health workers and covid-19 - addressing social determinants of health in times of crisis and beyond. N Engl J Med. 2020;383(19):e108.
doi: 10.1056/NEJMp2022641 pubmed: 32966715
Tejativaddhana P, Suriyawongpaisal W, Kasemsup V, Suksaroj T. The roles of village health volunteers: COVID-19 prevention and control in Thailand. Asia Pac J Health Manage. 2020;15(3):18–22.
Niyati S, Nelson Mandela S. Impact of the pandemic on accredited social health activists (ASHA) in India. Rev Agrarian Stud. 2020;10(2369-2020-1851).
Chaudhuri S, Addepalli A, Musominali S, Mulongo I, Uragiwe V, Modesta A, et al. With the radio blaring, can information from community-health-worker home talks be heard? Evaluation of a COVID-19 home-talk programme in Kisoro, Uganda. The Lancet Global Health. 2021;9(Supplement 1):28.
doi: 10.1016/S2214-109X(21)00136-4
Choi K, Romero R, Guha P, Sixx G, Rosen AD, Frederes A et al. Community Health worker perspectives on engaging unhoused peer ambassadors for COVID-19 Vaccine Outreach in Homeless encampments and shelters. J Gen Intern Med. 7.
Lee Rosenthal E, Menking P, Begay M-G. Fighting the COVID-19 merciless monster: lives on the line–community health representatives’ roles in the pandemic battle on the Navajo Nation. J Ambul Care Manage. 2020;43(4):301–5.
doi: 10.1097/JAC.0000000000000354 pubmed: 32858729
Sham L, Ciccone O, Patel AA. The COVID-19 pandemic and community health workers: an opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J. 2020;10(2).
Singh SS, Singh LB. Training community health workers for the COVID-19 response, India. Bull World Health Organ. 2022;100(2):108–14.
doi: 10.2471/BLT.21.286902 pubmed: 35125535
Wong RCW, Lee MKP, Siu GKH, Lee LK, Leung JSL, Leung ECM, et al. Healthcare workers acquired COVID-19 disease from patients? An investigation by phylogenomics. J Hosp Infect. 2021;115:59–63.
doi: 10.1016/j.jhin.2021.05.017 pubmed: 34098050 pmcid: 8289439
Jha N. India’s first line of defense against the coronavirus is an army of 900,000 women without masks or hand sanitizer. BuzzFeed News. 2020; 21 Mar.
Rahman AT, Iffath Yeasmine I. Refugee health workers lead COVID-19 battle in Bangladesh camps. United Nations Human Rights Council. 2020; 24 Jul.
Singh L. BMC’s community health volunteers: in the frontline of covid fight, but poorly paid, exposed to risk. The Indian Express. 2020; 28 Apr.
Cohen A. Tales of Unsung Heroes. How Thailand’s Village Health Volunteers helped combat the COVID-19 pandemic. The University of Sydney Sydney Southeast Asia Centre News; 2021. 29 Apr.
Narkvichien M. Thailand’s 1 million village health volunteers - unsung heroes - are helping guard communities nationwide from COVID-19. World Health Organization. 2020; 28 Aug.
Community volunteers visit. Thousands of homes in Myanmar slums with COVID-19 information. UN Habitat. 2020; 18 Jun.
Changoiwala P. The million women working on India’s Covid-19 frontlines. Direct Relief. 2020; 23 May.
Harigovind A. COVID-19 fight brings out the best in ASHA workers. The Hindu. 2020; 29 Mar.
Australia National University - National Centre for Epidemiology and Population Health. Empowering aboriginal health workers key in battle against COVID-19. Canberra, Australia. 2020 [updated 11 May]. Available from: https://nceph.anu.edu.au/news-events/news/empowering-aboriginal-health-workers-key-battle-against-covid-19
Ballard M, Johnson A, Mwanza I, Ngwira H, Schechter J, Odera M et al. Community health workers in pandemics: evidence and investment implications. Global Health: Science and Practice. 2022;10(2).
Colomina C, Margalef HS, Youngs R, Jones K. The impact of disinformation on democratic processes and human rights in the world. Brussels: European Parliament; 2021.
Pym A, Hu B, Karidakis M, Hajek J, Woodward-Kron R. In: Blumczynski P, Wilson S, editors. R A. Community trust in translations of official COVID-19 communications in Australia: an ethical dilemma between academics and news media. Routledge; 2023.
Rees B. High-rise public housing residents welcome new community health program. North West City News. 2022 13 Jul 2022.
World Health Organization. Behavioural considerations for acceptance and uptake of COVID-19 vaccines: WHO technical advisory group on behavioural insights and sciences for health, meeting report, 15 October 2020.

Auteurs

Jane Oliver (J)

Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, VIC, 3000, Australia. jane.oliver@unimelb.edu.au.
Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia. jane.oliver@unimelb.edu.au.

Angeline Ferdinand (A)

Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3000, Australia.

Awil Hussein (A)

North Melbourne Resident Action Group, Melbourne, VIC, 3052, Australia.

Ruqiyo Hussein (R)

Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, VIC, 3000, Australia.

Jessica Kaufman (J)

Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia.

Peta Edler (P)

Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, VIC, 3000, Australia.

Nicole Allard (N)

Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, VIC, 3000, Australia.
cohealth, Melbourne, VIC, 3066, Australia.

Margie Danchin (M)

Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3000, Australia.
Department of General Medicine, The Royal Childrens Hospital Melbourne, Melbourne, VIC, 3052, Australia.

Katherine B Gibney (KB)

Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, VIC, 3000, Australia.

Classifications MeSH