Dr. Susan Mayfield Johnson, associate professor in the School of Health Professions at The University of Southern Mississippi (USM), realizes better than most the importance of training community health advisors (CHAs) in underserved areas of Mississippi.

Johnson has helped train CHAs for more than 20 years and is currently leading a cohort of higher-education professionals as part of an initiative titled: “The Community Engagement Alliance (CEAL) Against COVID-19 Disparities.”

CEAL is an initiative funded by the National Institutes of Health that seeks to accomplish the following objectives:

1. Conduct urgent community-engaged research and outreach focused on COVID-19 awareness and education to address widespread misinformation about COVID-19 and promote an evidence-based response to the disease.
2. Promote and facilitate inclusion of diverse racial and ethnic populations in COVID-19 clinical trials, reflective of the populations disproportionately affected by the pandemic.

Mississippi is one of 11 states participating in the CEAL initiative, and the Mississippi CEAL team includes researchers from USM, University of Mississippi Medical Center, the Mississippi State Department of Health and Tougaloo College. In order to effectively address health disparities surrounding COVID-19 in Mississippi and engage priority populations from across the state, project teams are conducting five research projects that engage community partners in COVID-19 awareness and education, especially among African American, Latinx, and American Indian communities.

Johnson’s team has developed a CEAL project titled: “Engage Community Health Advisors (CHAs) to address issues of COVID-19 in vulnerable Mississippi communities.” She emphasizes that CHAs are an important health workforce in the United States who are defined by their trusting relationships with communities, especially those considered vulnerable or facing other economic or social disadvantages.

“Community health advisors are particularly well-known for their contributions to promoting health equity, including addressing social determinants of health and improving health outcomes for chronic diseases,” said Johnson. “Racial disparities in rates of COVID-19 infection and deaths have brought new attention to glaring health inequities in the U.S., with calls for disaggregation of COVID-19 data to identify different impacts of the virus on varies populations.”

She notes that this revelation has inspired calls to involve CHAs in addressing these disparities through a range of roles, including contact tracing, resource coordination and leadership roles in nonpharmaceutical interventions.

Community health advisors often work hand-in-hand with community health workers (CHWs) in promoting awareness and education for underserved populations. Most CHWs are paid professionals with academic degrees who hold leadership positions in organizations and provide reimbursable services.

“At the other end of the continuum are volunteers CHAs who work within their own social networks through person-centered webs of relationships that connect individuals to other individuals or groups,” said Johnson. “CHAs incorporate health promotion activities into daily routines, and are often sought-after for advice and assistance. Their helping abilities are seen as a natural extension of their personalities.”

Members of Johnson’s research team include the following:

Professors Tanya Funchess and Charkarra Anderson-Lewis in USM’s School of Health Professions, plus CHW Samaria Lowe.

Dr. Sandra Melvin, CEO/Founder of the Institute for Advancement of Minority Health, plus CHW Kierra Melvin.

Dr. Erica Thompson, Executive Director of Magnolia Medical Foundation, plus CHW Mireya Alexander.

Thus far, the team has trained 45 African-American CHAs who are working primarily in Forrest and Hinds counties. At the time of the project’s inception, these counties were experiencing the highest rates of COVID-19 infection and deaths.

“This type of training process builds linkages with local service providers, ensures accurate presentation of information and fosters development of individual and community capacity,” said Johnson. “After training, CHAs provide informal counseling, advice and assistance through referrals to appropriate services and resources based on their COVID-19 training within their own neighborhoods, churches, work and other social networks.”

CHAs Mayra Ranshur and Iveth Diaz note that the training has helped them gain a better understanding of COVID-19’s effects on their communities.

Said Diaz: “I learned about the great emotional and mental impact that this pandemic has caused. I was unaware of the high rate of suicide, anxiety and depression.”

Said Ranshur: “I have become more aware of the different ways in which COVID has affected us. Also, the community’s denial about vaccination, and how we can work together to improve our community with vaccinations.”

Johnson says focus groups were conducted during the beginning of the pandemic last year to assess the community’s awareness and needs. She says that from those groups minority community members reported that pervasive myths existed about the sources of COVID-19. These included, lack of inclusion of racial/ethnic minority members in clinical trials, conflicts with media on the safety of vaccines, a political climate that did not support and model the seriousness of the pandemic, repeated historical atrocities of medical harm to people of color and lack of representation of people of color getting vaccines.

“To date, some of the aforementioned myths are reasons people have cited for low vaccination rates,” said Johnson. “However, we have seen a difference in the politics surrounding COVID-19 and more representation among African-Americans supporting vaccines, so there has been an uptake in vaccination rates.”

Over the past several months, Magnolia Medical Foundation has taken the lead role in training Latino communities along the Gulf Coast, with one notable difference: the program is conducted entirely in Spanish.

“It is facilitated in Spanish, sessions by health and social service professionals are conducted in Spanish and all curriculum and assessments are in Spanish,” said Johnson. “This is done to ensure cultural adaptation and competency as Spanish is the primary language of the participants”

Johnson further explains that because Spanish-speaking trainers, with subject matter expertise in COVID-related areas, are needed for the sessions. Since few are available in Mississippi, Johnson has reached out to other CHWs and community partners across the nation for assistance. The response has been overwhelmingly positive.

She notes that the Latino CHAs being trained along the Gulf Coast have communicated that working with national advisors has given them a global perspective of how COVID-19 is affecting Hispanic community members.

“It has really expanded their worldview of COVID and the needed actions by local community members,” said Johnson. “For example, one CHA was not going to get the vaccination, but she has changed her mind. She said that the education and information provided by healthcare workers from across the country in her language has helped change her mind. She has signed up for a vaccination event with Magnolia Medical Foundation and will soon be vaccinated. Her adult daughter is also getting vaccinated after hearing her mother’s decision.”

The CEAL project is set to conclude in September, but the CHAs have developed groups that may continue to work beyond that time. The Latino CHA group is planning an event for the end of July. Two Forrest County CHA groups are planning community events in August: a health fair/education event in Lumberton on Aug. 7 and a COVID19 vaccine Block Party on Aug. 14 at Dewitt Sullivan Park in the Palmer’s Crossing community in Hattiesburg.

To learn more about the CEAL initiative, visit: https://covid19community.nih.gov/