Community Input Helps Tennessee Address COVID-19 Disparities

Two African American doctors stand at an intake table at a COVID-19 vaccine site in Tennessee. The table reads ‘GET VACCINE READY!’
Left to right: Drs. Neely Williams and Dr. Arthur Lee at a Tennessee CEAL Get Vaccine Ready! intake table at a COVID-19 vaccine site in state. Photo credit: Tennessee CEAL Team

In September 2020, NIH announced a $12 million award to help communities that have been disproportionately affected by the COVID-19 pandemic. The award supports 11 research teams in states across the U.S. through the NIH Community Engagement Alliance (CEAL) Against COVID-19 Disparities, with the goal of supporting and facilitating community-engaged research and outreach for communities highly impacted by COVID-19 infections, hospitalizations and death.

In April, NIH funded 10 additional research teams. Tennessee is one of the initially funded research teams. “Throughout most of the pandemic, Tennessee has been one of the states most severely affected by COVID-19,” said Paul Juarez, Ph.D., a professor, and the director of the Health Disparities Research Center of Excellence at Meharry Medical College in Nashville. The diversity of the state—from low-income African American communities in and around Memphis to the tech and entertainment boom in Nashville, to large, sparsely populated rural areas in the Appalachians—has made it difficult to get accurate information about COVID-19, testing, and vaccines to many communities, said Dr. Juarez. He is the principal investigator (PI) of the Tennessee CEAL team. “The strategies we’ve had to develop are really regional strategies. In addition, our strategies are continually being modified in response to the ever-changing nature of the pandemic and our understanding of it.”

Dr. Juarez has spent decades conducting research that engages local communities. In addition to his work at Meharry, Dr. Juarez and his wife, Patricia Matthews-Juarez, Ph.D., established the University of Tennessee Health Science Center’s Research Center on Health Disparities, Equity, and the Exposome in Memphis in 2014. He and other Meharry-based researchers involved with Tennessee CEAL have long-standing relationships with community members and health departments. And to address the importance of tailoring information to different areas of the state, the group has western, central, and eastern regional research councils and has connections with academic and community partners across the state, all of which Dr. Juarez oversees. When the Tennessee CEAL team received the grant to address COVID-19 outreach, he said, they “were able to hit the ground running.”

The Tennessee CEAL team’s initial goals were to provide information about COVID-19 and testing to the community and to recruit diverse participants for four COVID-19 clinical trials. To pursue these goals, the team leveraged long-standing community ties and social media to target affected communities. The connection to community is at the center of these efforts, said Stephania Miller-Hughes, Ph.D., M.S., M.S.C.I., one of the co-PIs for the central Tennessee region and an associate professor at Meharry. “What’s most important is getting community stakeholders involved in this work and having them as the ambassadors,” she said.

Gathering Input to Share Information

One important role for stakeholders is helping the CEAL team understand what their communities need—and the best ways to get it to them. With the CEAL funding, Dr. Miller-Hughes and the central Tennessee CEAL team convened stakeholder groups in various forums, including a joint town hall with faith leaders, to determine their needs and get their input about COVID-19 in their communities. She is also collaborating on a Tennessee CEAL research project to investigate the value of intensive community health worker support to address structural inequities underlying COVID-19 disparities. The project will test whether people who receive culturally tailored education and support from community health workers will experience greater understanding of and comfort with COVID-19 and vaccination than those who receive health education only.

Tennessee CEAL is using other avenues to disseminate COVID-19 information, too. The team is providing information in English and Spanish on the Meharry website. It has also turned to youth ambassadors to amplify accurate COVID-19 information and, more recently, increase trust in the vaccine. The ambassadors include high school, college, and graduate students interested in health care careers, many of whom are members of diverse communities that have been historically underrepresented in health care. By sharing information about COVID-19 with family, friends, neighbors, and their communities, Dr. Juarez said, “youth ambassadors can help really create a culture where people are more accepting of getting the vaccine.”

Personal connections with family and community have also influenced several Tennessee CEAL researchers. When Dr. Miller-Hughes was in graduate school, her maternal grandmother died of diabetes. This spurred Dr. Miller-Hughes to conduct independent research on the disease, which disproportionately affects African Americans, and led to her current work in health care disparities, which now includes COVID-19.

Meeting Evolving Needs

Another important part of Tennessee CEAL’s work is establishing safe, community-based spaces for people to get information and receive COVID-19 testing. Meharry runs several public testing sites, including one on its campus and another at Nashville’s Nissan Stadium, but these sites may not be accessible to the people most at risk. Lack of transportation and mistrust of large, anonymous testing operations can prevent people from at-risk communities from getting tested.

To overcome these barriers, the CEAL team has worked with the School of Dentistry to deploy its mobile van at small sites with trusted partners, such as local community organizations, churches, and schools. With the van, the team has been able to test between 200 and 300 people in a single afternoon. Dr. Juarez said that the Tennessee CEAL team is planning a similar strategy working with its community health center partners and the Tennessee Department of Health to ensure everyone has access to accurate, culturally and linguistically, trusted information to make an informed decision and to coordinate the delivery of vaccines to vulnerable communities in the coming months. Priority populations include non-English speaking persons, persons who live in rural areas, and parents of school age children.

Rev. Neely Williams, M.Div., Ed.D., the Tennessee CEAL team’s director of community engagement, has been essential to this work. Rev. Williams has a foot in both worlds: She has worked with researchers as a patient co-investigator on Patient-Centered Outcomes Research Institute research projects, and she has developed deep ties to her community in Nashville through years of working as a pastor. Connections like these, both in Nashville and through community partners elsewhere in the state, have helped the TN CEAL team respond to communities’ changing needs during the pandemic, from information to testing to vaccine availability.

In her own community, the recent loss of a deacon to COVID-19 inspired Rev. Williams to redouble her work to help people make informed choices about safety precautions, testing, and vaccines. When it comes to supporting local communities through Tennessee CEAL and other partnerships, she said, “I don’t look at what I do as my job. It’s my mission.”

Page updated August 13, 2021