Project Abstract Community health workers (CHWs) played an essential role in addressing multi-level, community barriers to accessing COVID-19 information, testing, risk mitigation, and vaccination; however, little is known about how CHWs managed their roles in light of enormous social, community, and political challenges. In May 2020 the Orange County Health Equity COVID-19 Community- Academic Partnership formed with community-based health equity leaders and health equity academic partners to elevate the need for and guide local COVID-19 equity response and recovery initiatives. Equitable recovery must address larger civic engagement needs, and CHWs were essential to navigating rising anti-immigrant attitudes, and promoting civic engagement for census complete count and elections turnout in addition to COVID-19 education and chronic disease management. In this study, we aim to: (1) Examine from the perspective of CHWs and community members the facilitators, barriers, and processes of change of delivering COVID-19 response and chronic disease management CHW intervention during the COVID-19 pandemic. In partnership with five community-based organizations, we will conduct focus groups in the areas with the highest social vulnerability to COVID-19 in Orange County, CA; (2) Assess the systemic factors that enhance inequities in COVID-19 testing, cases, and vaccines in Orange County areas with the highest social vulnerability to COVID-19. Through interviews with community leaders and policy stakeholders, we will identify the multilevel contextual factors that contribute to successes and challenges of CHWs and community members to access COVID-19 education, testing, and vaccinations; and (3) analyze how advocacy efforts implemented by CHWs and community-based organizations shape the COVID-19 response. We will recruit and interview CHWs from across California to identify the degree to which Orange County’s community responses and resiliencies are generalizable to diverse populations across the state. Strengths of this study include our responsiveness to community-driven COVID-19 interventions; the integration of chronic disease management into the study of COVID-19 responses; a focus on CHW efforts to ensure access to COVID-19 resources and to build consciousness among community members and transform local COVID-19 responses; strong community and university leadership; and multilevel assessments of COVID-19 interventions. We will advance knowledge about processes of change in COVID-19 CHW interventions in communities with highest social vulnerability to COVID-19. The results of this study will inform policy recommendations to strengthen equitable COVID-19 recovery and prepare for future public health crises and serve as a model of CBPR nationwide.

Project Narrative This study will build upon an existing robust relationship between community-based organizations and the University of California, Irvine and use a community-based participatory research (CBPR) process and ethnographic methods to identify the multilevel factors associated with COVID-19 response and recovery among community health workers (CHWs) and community members in vulnerable ethnic/racial communities of Orange County, CA and across California. The results of this study will inform policy recommendations to strengthen equitable COVID-19 recovery and prepare for future public health crises and serve as a model of CBPR nationwide.