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Specific COVID-19 messaging targeting ethnic minority communities

2021; Elsevier BV; Volume: 35; Linguagem: Inglês

10.1016/j.eclinm.2021.100862

2589-5370

Aftab Ala, Chantal Edge, Alimuddin Zumla, Shuja Shafi,

COVID-19 Clinical Research Studies

Over a year into the COVID-19 pandemic, ethnic minority communities in the UK and elsewhere continue to be affected by a disproportionate burden of COVID-19 associated morbidity and mortality [[1]Keys C. Nanayakkara G. Onyejekwe C. Sah R.K. Wright T. Health inequalities and ethnic vulnerabilities during COVID-19 in the UK: a reflection on the PHE Reports.Fem Leg Stud. 2021; 14 (Jan): 1-12Google Scholar]. Increased COVID-19 risk has been attributed to a wide range of factors [[2]Pareek M. Bangash M.N. Pareek N. Pan D. Sze S. Minhas J.S. Hanif W. Khunti K. Ethnicity and COVID-19: an urgent public health research priority. 395. The Lancet, 2020: 1421-1422Google Scholar,[3]Sze S. Pan D. Nevill C.R. Gray L.J. Martin C.A. Nazareth J. Minhas J.S. Divall P. Khunti K. Abrams K.R. Nellums L.B. Ethnicity and clinical outcomes in COVID-19: a systematic review and meta-analysis. EClinicalMedicine, 2020Google Scholar]. Whilst developing and implementing culturally appropriate, targeted interventions to mitigate the impact of COVID-19 on ethnic minority communities, are considered important, they have not been forthcoming. The low COVID-19 vaccine uptake among 'BAME' communities remains a priority for the government [[4]Sky news, 7th February 2021: https://news.sky.com/story/covid-19-government-very-concerned-about-low-vaccine-uptake-among-bame-communities-12211460 - accessed 8th February 2021Google Scholar]. The proportion of ethnic minority groups accepting vaccines will remain low, unless the underlying issues are addressed urgently. Recent video messaging by ethnic minority Members of Parliament [[5]BBC news: Coronavirus: black MPs unite in video to encourage vaccine take-up https://www.bbc.co.uk/news/uk-politics-55839493 - accessed 8th February 2021Google Scholar] may not be optimally effective due to several factors including scepticism, complacency and mistrust of messaging by scientists and politicians as compared to other local community leaders. It is recognised that the impact of COVID-19 may not be uniform across ethnic groups and thus no one specific intervention may be effective within the community to modulate behavioural change. There are several dimensions of vaccine hesitancy including safety, preference of natural immunity, commercial profiteering and mistrust of vaccine including socio-demographic subgroups among ethnic minorities subgroups that remain. Concerns regarding vaccine safety, mistruths promoted by anti-vaccers and conspiracy theorists also need to be addressed [[6]Iacobucci G. Covid-19: NHS must tackle vaccine lies to improve uptake among ethnic minorities, says Stevens.BMJ. 2021; 372 (Jan 27doi: 10.1136/bmj.n242. PMID: 33504495): n242Crossref PubMed Scopus (2) Google Scholar] and trust improved [[7]Agley J. Xiao Y. Misinformation about COVID-19: evidence for differential latent profiles and a strong association with trust in science.BMC Public Health. 2021; 21 (Jan 7PMID: 33413219): 89https://doi.org/10.1186/s12889-020-10103-xCrossref PubMed Scopus (125) Google Scholar]. A culturally appropriate COVID-19 information and messaging platform is urgently required (Fig. 1). The messaging should be clear, in both style and content conveying simple, easy to understand, visual, consistent, and generic to all communities, ethnic groups, cultures, and faiths. Trust between healthcare staff and communities is essential for the success of any COVID-19 intervention. Harnessing the wide range of experience of multiple faith groups, prominent community leaders, and NHS staff regarding community engagement, for development and dissemination of culturally appropriate COVID-19 materials and interventions, and engaging proactively with communities to re-assure them, and dispel misconceptions and anxieties arising from anti-vaccine propaganda. Messages should avoid being judgemental. Colloquial terms can potentially increase a sense of discrimination and social isolation within ethnic groups, and the commonly used acronym 'BAME' should be avoided. Alternative phrases may include 'ethnic communities', representing cohesion and trust. However, the phrase 'social distancing' is not easily interpreted within cultures [[8]Sørensen K. Okan O. Kondilis B. Levin-Zamir D. Rebranding social distancing to physical distancing: calling for a change in the health promotion vocabulary to enhance clear communication during a pandemic. Glob Health Promot, 2021https://doi.org/10.1177/1757975920986126Crossref Scopus (18) Google Scholar] and needs to be replaced by 'physical distancing' to highlight alternative forms of socializing, alongside further consideration of messaging integrity after translation. The involvement of religious leaders [[9]World health Organization 2020. Practical considerations and recommendations for religious leaders and faith-based communities in the context of COVID-19 file:///C:/Users/Prof%20Zumla/Desktop/WHO-2019-nCoV-Religious_Leaders-2020.1-eng.pdf -accessed 8th February 2021Google Scholar] and faith based communities and engaging those who have recovered from COVID-19 will bring invaluable experiences critical to positive messaging. Local radio, TV, and social media which operate actively during religious events and festivals such as Christmas, Hanukah, Diwali, Eid, Ramadan Holy, Shivaratri, Baisakhi, may prove particularly useful. Communities propagate messages effectively internally, so it would be beneficial if restrictions are announced in a timely fashion prior to festivals or events. Social media platforms are accessed frequently by all generations within households and should be used to disseminate surveys to seek real time feedback on behavioural change and address social media scaremongering. There may be merits in developing the school curriculum to convey messages to young children and young adults who can then promote them within families. Using community champions as advocates to promote key guidance documents, will require training to understand local community needs and deliver consistent and relevant messages. This will require appropriate funding for capacity building within relevant Voluntary, Community and Social Enterprise (VCSE) Health and Wellbeing Alliance and other stakeholder groups. Additionally the use of community pharmacies and primary care facilities to target ethnic minority communities should display messaging videos, films and key COVID-19 guidance documents. Vaccine related concerns need to be approached with empathy and humility. Empathy in relation to conveying vaccine safety, the mechanisms of actions and their roles. Humility, in supporting faith group and knowledge champions to support vaccine roll out and improving uptake within the community groups. If COVID-19 is 'gods plan' then so is the vaccine. Places of worship such as churches, mosques, temples are being set up as COVID-19 vaccination centres, we advocate for wider use of this approach, across a diverse range of faith groups. In parallel, we recommend further emphasis that the NHS is here for everyone. A key consideration should be given to dissemination of targeted messaging with vaccine invitations and at the time of the vaccination itself, reminding individuals that even when vaccinated, preventative measures such as physical distancing, face covering and hand washing are important. Additionally, recognizing that there might well be access issues and not only vaccine distrust as well as the opportunity to ask health care workers about possible concerns, are critical. The need for evaluating the recommended targeted interventions remain paramount, as these will influence the success and future iterative modifications of these successive interventions and therefore subsequent vaccine uptake. The COVID-19 pandemic rhetoric focused on 'BAME' communities has sometimes led to stigmatization and is seen as a 'problem'. Ethnic communities are not the problem, they are the solution. Where positive engagement has been achieved, we need to learn from and highlight local initiatives and approaches for the betterment of the nation. The development of a coordinated messaging toolkit for nationwide community engagement, to build capacity and resilience across the country is critical. Certainly, NHS and Public Health England messaging must be jointly co-designed and co-produced, to ensure all communities feel ownership. Joint engagement and partnership with local communities is key to understanding how to make messages relevant and culturally competent. All authors have an interest in issues surrounding ethnic minority health. Authors acknowledge receipt of an National Institute for Health Research grant (DHSC/UKRI COVID-19 Rapid Response Initiative, Developing and Delivering targeted SARS-CoV-2(COVID-19) health interventions to Black, Asian and Minority Ethnic (BAME) communities living in the UK, COV0143). The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. Sir Zumla is a co-PI of the Pan-African-European Network for Pandemic Preparedness, Research and capacity development for Emerging and Re-Emerging Infections (PANDORA-ID-NET; https://www.pandora-id.net/) funded by the European and Developing Countries Clinical Trials Partnership (EDCTP). Sir Zumla is also in receipt of an National Institutes of Health Research senior investigator award.