Vaccine Confidence: Identifying Trusted Messengers

At the Core of Care

Published: June 1, 2021

 

SARAH: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families, and communities.

I'm Sarah Hexem Hubbard, Executive Director of the Pennsylvania Action Coalition and the National Nurse Led Care Consortium.

As part of our special COVID-19 vaccine confidence efforts, we're creating a series of podcast episodes that can be helpful to nurses at this time, and the communities they serve. Nurses from around the country have been sharing their insights with us.

And on this episode, Dr. Meriam Caboral-Stevens is joining us to discuss what it means to be a trusted messenger. She'll also share what her vaccination rollout experience has been like so far in developing outreach efforts within Michigan's Asian and Arab American communities.

Dr. Caboral-Stevens is a nurse practitioner, researcher, and faculty member at Eastern Michigan University in the School of Nursing.

She's also on the faculty at the university's Center for Health Disparities innovations and studies. As part of her involvement on a CDC reach COVID-19 vaccination initiative, she and her team at the center are working to educate trusted messengers and increase awareness and vaccination among Asian and Arab American communities and the important role community organizations can play in this process.

Dr. Caboral-Stevens is also a member of the Philippine Nurses Association of Michigan, and we'll be hearing at the end of this episode from one of her colleagues, Reglita Laput, who's the current president of that organization.

We'll also hear from Opeyemi Ogunniyi. Opeyemi will talk to us about how she's addressed vaccine hesitancy at her hospital outside Houston, Texas, and what she's hearing from friends and family in Lagos, Nigeria, where she's from.

But right now, let's turn to Meriam Caboral-Stevens.

Dr. Caboral-Stevens, thank you so much for joining us on At the Core of Care.

MERIAM: Thank you for having me. It's a pleasure.

SARAH: So first, can you share what drew you to nursing how you got into your current role at Eastern Michigan School of Nursing and at the Center for Health Disparities, Innovations, and Studies?

MERIAM: I grew up in the Philippines and being a nurse was not actually my first career choice. It was never actually in my radar at all. To me, nursing, then was not as famous or it's not a fashionable or one of those high paying jobs, especially in the country. So but when I was growing up, I'm always torn. I'm always focused on graduating from one University in the Philippines. And that's the University of Santo Tomas. So when, when it was time to go register, the only two courses that were available was accounting and nursing. I wasn't going to go into accounting. I hated math. I mean, lo and behold, now I'm all I'm doing research, I had to learn statistics and start loving or liking statistics. I mean, how ironic, is that? Right? But the other the other program was nursing. So I got stuck in nursing.

I mean, looking back at what happened, I don't know what if it was fate that actually, all those courses, all those programs were packed, or I couldn't transfer. Because right now, I don't think I would have liked any other career choice besides being a nurse.

I do love being a nurse. And I am proud to be a nurse where I am right now.

So how did I end up in my current role with our Center for Health Disparities, innovations and studies at Eastern Michigan?

Well, I'm moved actually to Michigan in 2015. I worked and lived in New York and Brooklyn, New York for 30 years. I actually loved New York. But my husband Job had to be in Michigan. So against my, you know, my decision, we have to move because I got up, stay with him and follow him and you know, be with him. I don't want that travel. Because we did it actually for a couple of years. And it was actually a disaster for both of us. So I was like, Okay, I had to make a decision. If you're going to stay in Michigan, I got to go to Michigan and find work in there. And for some reason, there was something about Eastern Michigan University that was calling me.

And it's been five years now since I've been at Eastern Michigan. I love it there. And how I ended up with the Center for Health Disparity is that Dr. Tsu-Yin Wu, who is the center director actually received a five-year CDC REACH in a collaborative agreement, and REACH standing for racial and ethnic approaches to community health in 2017. So when she received a grant, she needed a program manager and communication lead for that REACH collaborative agreement. So she asked me if I'm interested? And we're actually in our third year now with the CDC REACH project.

And the CDC REACH initiative has been very eye-opening for me about what the community is all about. I wasn't involved with the Asian American groups in New York. I was involved mostly with black African minority groups in Brooklyn. But now it's, it's totally an eye-opener for me, even from me being an Asian. It's like, Oh, my gosh, I really need to learn a lot about the Asian culture. So it's been very fruitful. And it's been very good for me.

SARAH: So as part of the vaccination rollout, can you tell us a bit about what your work has been like, for you and obviously, as part of your role with the CDC REACH COVID-19 initiative?

MERIAM: We rolled out our COVID-19 vaccine in Aprll. And at first it was actually a little bit difficult, because people actually were all trying to get vaccinated during the initial rollout. And everybody was trying to go wherever or register wherever they can register even I had to register into three different registry in order to for me to be on the schedule to get vaccinated.

But the vaccination initiative by the CDC is actually about three or two or three things.

It's about equipping trusted messengers in order to increase Asian Americans and Arab Americans’ confidence and uptake of the COVID-19 vaccination, as well as for us to facilitate partnership between the community and the vaccine providers so that communities that are underserved will get the vaccine that they needed. And also, it's about communication. In order for us to increase confidence about COVID-19 vaccine, we got to increase the confidence of the community, not just the general public, but particularly within the underserved in the Asian and Arab Americans community. So we have so far, we have rolled out or facilitated 10 mass vaccine clinics since we started in April.

Also a lot of the Asian Americans communities have worked with us and have collaborated and accepted us in setting up mass clinics in their community.

The rollout I believe has been successful. And also the Arab Americans community. They do have what they call ACCESS, which is Arab Community Center for Economics and Social Services. It is a specific service that's focused on Arab Americans. And they've been very much engaged and in vaccinating their community. I've heard a couple of my students actually volunteered to give vaccination at a couple of their mass vaccine sites for that.

SARAH: So, you are this trusted messenger, right? You're building this for the Asian and Arab American community in Michigan. What previous knowledge are you drawing from? What best practices and are there ways that you're also innovating at this time and working with these partners?

MERIAM: When we talk about like vaccine confidence, we also have to look at why are they hesitant to take the vaccine? So in getting their confidence, we got to address some of their concerns about why are they vaccine-hesitant? I think it's not just the Asian and Arab American communities, but also other minority groups that have concerns about the current COVID-19 vaccine. It's mostly like they're worried because the vaccine trial is too quick. I mean, it's done within a one-year period. I mean, is it effective? Is it efficient? Is it even safe?

Now, it there's also a lot of distrust about the government's involvement with how the clinical trials have been conducted, or whether there was a government involvement, or how much involvement, the government was a part of in developing the vaccine.

But there's also like, individuals who say, is this vaccine appropriate for them?

I mean, those are the general concerns, but there's also other barriers that goes with it.

But there's a lot of language barriers.

I mean, a lot of people, older individuals have access problems, they don't have transportations and access to technology. I mean, in order for you to register to get in an appointment, you have to go online and really put in your name in there. And a lot of older individuals are not tech-savvy. And that's a big thing, and also religious belief.

Now, one of the things that we always practice is, we have to, like I said, address the concerns, but also debunking the myths, as well as the misconceptions and presenting them with the facts. So if we do that, but we have to do it from what is it that the community is more worried about, the certain communities may not be worried about one thing, whereas the others is more worried about something than the other.

So the debunking of myths and misconceptions has also to be specific to individuals. The next thing is we develop or translate messages.

A lot of the messages out there are in English. There's very few Asian Americans, and much less sometimes it's non-existent, actually, in Arab Americans. And we found that about, there's not enough translated materials for Arab Americans.

Going back to our experience with the flu, we actually translated messages into 13 different languages. And that was helpful. And we're starting to work on that with the COVID-19.

And one of the best practices that I always tell my students like, you have to present the data in order for me to trust the information you're giving me. So if we can get the community to understand that vaccine works. I mean, I think they have more confidence in receiving it. And we do have data, that vaccine works. With COVID-19, it may not be a longitudinal data, but we've had data with other vaccines like smallpox, like measles.

SARAH: And it is, it's helpful that we have data. Every day we have more real-time data of how this is working. But then it also comes to the messenger, so you have the information, and then who's sharing the message. So we'd love to hear about your work engaging individuals. I know in the Muslim community, you have some examples of that work, engaging spiritual leaders, such as an Imam, what does that type of relationship-building involve?

MERIAM: We're lucky because the CDIS director, Dr. Tsu Yin Wu, she's had established relationships with the Muslim community, because of her previous project, which is called healthy Asian American project.

But I mean, it is a little bit different with me, I had to establish my relationship with the Muslim community, because I'm the new person, and they don't know me. So they had to trust me, and from my perspective, I got to learn the culture. I'm Catholic, and it's actually we're sort of like in the opposite spectrum. So I have to learn to respect their beliefs, I have to learn to respect their culture. And I have to learn that in order for any activities, or in order for any events to be successful, we have to go through the Imams because they are actually the communal decision-makers. They are sort of like the gatekeepers of the Muslim community. I cannot be a spokesperson for a Muslim community, because I'm a female. Mostly it's a male-dominated community and the males are the ones that makes the decision and going back again, that the Imam had to be involved in making a in making any of the community decision.

SARAH: Has that been a productive relationship. up with the mom, in terms of talking about the vaccine? I wonder if there are aspects of being able to gather in the mosque that, could be sort of a motivation point to be able to be able to worship together at some point in the future?

MERIAM: Yeah, because when I, when we had the last mass vaccine, it was actually in a mosque. And the Imams were there. They were the ones that came, and they welcomed us. And they were having, we had individuals that were registered during the session. And they have prayer time. So what happened was there are certain rooms in there there's rooming there were members pray. And it's interesting that after they pray, they actually had their vaccine because the Imams tell them to go and get their vaccine, which actually was very successful in that sense.

And they were the ones that told us, well, maybe we need more sites because everybody was so happy that they got the vaccine.I think being in a mosque and following the culture, there was actually I had to ask permission, because when I went inside the mosque because my group went inside the mosque. And every were all of us were wearing our shoes. And when we realized that the people, even the women, and men were removing their shoes, entering the mosque. So I had to ask them, like, Should I remove my shoes, because I don't want to be disrespectful if this is your place of worship.

And they did say that you are okay. Because we are giving the vaccine and we are there for service.  But they do appreciate me asking them that I can take off my shoes if you want. I mean, it's carpeted. So it wasn't a problem for me. But that actually helped the relationship a little bit more.

SARAH: Cultural humility, right. We want to we want to ask not to not assume.

And wondering about the Asian American community. Are there any successes that you've seen or obstacles that you that you had to overcome?

MERIAM: The Asian American communities have been very successful in receiving the vaccine. I mean, I don't know if I should be surprised or not. Because I mean, Asian Americans, particularly the older Asian Americans are usually hesitant to get the vaccine. But I mean, I've been to several Asian mass clinics, because they were part of our partnership. And I've seen the Chinese American organizations, they've been doing mass vaccines continuously for their community. They're very much engaged in vaccinating their community, and also the Filipino communities. We've had three vaccine sites for the Filipino community. And we've had mass vaccines with combined Thai community and Filipino community together so that we can accommodate both schedules and also the numbers so we can make sure that the numbers are there. Now, were there any obstacles in the Asian community?

Our first lessons learned you got to confirm who's coming and who isn't. And we realized that maybe a third of the registrants already had their vaccine, because when we call them said, Oh, yeah, I already had the shot. We’re like, oh, okay, lesson number one, we had to confirm who's coming and who's not and who had received the vaccine.

SARAH: So what are some efforts underway to address the gap in Vaccine Education materials? You had mentioned? You know, language acts as being a barrier. What are some efforts currently in the works to address that that gap?

MERIAM: We wanted a lot of the younger generations to really get vaccinated. And a lot of them are on social media. So we use social media a lot. We're looking into actually using social media influencers, as one of our messengers. There's actually one study that I Know of the utilize social media influencer in health promotion. And this, the study said, using social media influencers reach a lot of people. So if one social media influencers let's say if I locate a Filipino social media influencers, they reach 90 people or be 900 people, that's a lot more than us going, having a training or having an educational, face-to-face session.

So if we develop, if we identify right now, we're actually scheduled to train trusted messengers. So we're training them in a sense that we're providing them the knowledge of how to relay messages to their community. And it's more about specifics for their community, rather than a general information. And we do help them decide what message would you like your community to receive? So even though we translate the message or we ask someone to translate the message, we give it back to the community and say, when would this translation? Or would this message be okay

SARAH: We know from what we've heard and seen through the COVID-19 pandemic, the Filipino nurses community has been especially hard hit both as frontline providers as well as experiencing disproportionate rates of COVID-19. How do you see that impacting Filipinos interested in entering the nursing profession related to recruitment or retention? How are Filipino nurses handling stress at this time?

MERIAM: The Filipino community actually realized that what you mentioned, we were hard hit with COVID. And there's actually an initiative or there's a study that's being conducted by the Philippine Nurses Association, looking at Filipino nurses experience with COVID. And four of my Filipino colleagues are going to be embarking on a new research study in the summer about pandemic fatigue, and also about experience with discrimination. And I think the Filipino community, I mean, we're a tight knit community. And also, we're sort of like very religious and spiritual and a lot of the Filipino communities rely mostly on spirituality and religion and their faith in order to keep them like positive to stay positive. And I think because have that background. I mean, we've actually helped each other a lot. We've had a few conversations, there's some listening sessions, with several organizations, just to see how everybody else is doing around the country. And there's still a lot of things that needed to be done. I mean, I don't think that just with the Filipino, but with all the nurses.

Does COVID-19 deter us from becoming a nurse? I think it's the opposite. I think a lot of people now wanted to become nurses. The frontliners, doctors, paramedics, because of how the front liners, the nurses, the doctors, everybody in the hospital worked during the pandemic. And however, people say that nursing is a dirty job, because you take care of the bedpans, you take care of everything. But at the end of the day, it's very fulfilling, that you've helped people get better, or that you've helped someone die with dignity, especially with COVID-19. So I think the respect for nurses and other frontline workers has changed tremendously.

SARAH: As you look back on the past year, how do you think that these experiences are going to shape your approach to healthcare, your practice, as well as healthcare delivery more broadly in the future?

MERIAM: I don't think I'm going to change the way I practice because of this. It's just becoming more cognizant of what's going on. And I've always followed one of my favorite theorists Roy, is the adaptation model. And I always have that propensity to be able to adapt in a situation. And it's ironic that actually one of my students, at the evaluation, she actually sent me a note or evaluated and said, I wish more faculty will be as proactive as you in switching our class into online. Because when when I actually switched the class online after spring break, because I realized that okay, this is from my knowledge of epidemiology, and how infectious disease is. I made that decision. So I told him like, Well, you know, I don't know how safe it is. For us to be in a classroom and I had like 30 students, and the room is tight. So I said, Well, I'm going to switch you guys into online. And from that time, I mean, after a week or two, we switched to online. So I, and based on that, I don't think I'm going to change my practice, I'm just going to be probably a lot more cognizant of what's going on around me.

Now, how will this pandemic shape the healthcare system? Well, I think it's an eye-opener to the healthcare system. I mean, I don't think anybody was prepared for a pandemic. So this is going to be a lessons learned for, for all, or most, if not all, of the healthcare systems around the world. I mean, its disaster preparedness, this may not be what we technically call a disaster, but it is a pandemic, we were not prepared, nobody was prepared for a pandemic. I mean, technically it is a disaster. So they will have to go back and see what worked and what didn't work. And they need to prepare themselves for situations like this. It may not be a pandemic, next time, but it could be bioterrorism in the state that we are in, it could be other forms of disaster, we really may not be hit by a pandemic in the next 100 years. But there are other disasters that may come around. So everybody has to be prepared, there has to be of disaster preparedness amongst them. And one of the other things that is going to be there, or it's going to probably change is telehealth.

Before COVID-19 telehealth was kind of like a buzzword. A lot of the institution is like Yep, telehealth is good. We'll start doing telehealth. But the majority of the health institutions did not have infrastructures for telemedicine or telehealth.

So I think it will be one of the things that health care systems and healthcare providers will have to embrace. It's not going to go away. And patients actually said they prefer sometimes to see their doctors using telehealth, because they don't need to go to the hospital to the office, especially if they don't have any symptoms for follow-up. I mean, if you don't have any symptoms that is pressing, just a general follow-up or for a refill of medication. You could just meet with your doctor via telehealth. So I think telehealth is here to stay.

I just wanted to tell everybody that while COVID-19 is still here. I mean, let's do our job, let's do our part, get vaccinated. It helps. It saves lives.

SARAH: Thank you so much for joining us on At the Core of Care.

MERIAM:  Thank you for inviting me to this podcast.

SARAH: And finally, we're going to hear from two nurses who are building vaccine confidence in their communities. Opeyemi Ogunniyi will share her experience navigating vaccine hesitancy with patients at her hospital outside Houston, Texas, and what she's hearing from friends and family in Lagos, Nigeria, where she's from.

And then we'll hear from Reglita Laput, a community health nurse in Michigan. She's a Director of Clinical Services for a homecare program. And in her spare time, Reglita is the current president of the Philippine Nurses Association in Michigan and has been active in helping organize community-based vaccination events.

Opeyemi Ogunniyi: My name is Opeyemi Ogunniyi. I'm a registered nurse in Houston, Texas. I work in a local hospital. Right now, I'm in the medical-surgical unit. I'm from Nigeria, I've been in the US for, this will be my – I came in into the country in 2010, so this will be my 11th year.

Where I came from, is, is a big community, which is Lagos, the western part of Nigeria.

Before even going into nursing, I have a degree. I finished my bachelor's in biochemistry while I was out of states. So getting in here I was planning on Okay, since I have my bachelor's in biochemistry, why don't I do like some masters in biochemistry. So basically, I stayed with my uncle who also was a nurse. So seeing him impact lives day to day made me to maybe to change my career apart from biochemistry into nursing.

COVID is something that has affected not just me, but my family. We're trying to create awareness for the vaccination because where I where I come from Nigeria, most people did not believe that COVID existed, they thought it was all a lie. Not until later last year to this year, when people were passing away and they found out that some of the symptoms were related to COVID because most of the symptoms of COVID, they believed there was malaria. So they'd never believed that it was COVID, they thought it was just like a made up term from the US.

One of my aunt, she was hit by COVID. This person is very vibrant. She does things for herself. She didn't have any issue of COPD or something. But she had to depend on oxygen. So it was really really bad. We thought, “Oh, we're going to lose her, but we thank God that never happened that way. So that's, that's got me really worried about COVID. She noticed that he was just coughing, day in, day out and just wondering, I've always maybe just an ordinary cough, she went to the doctor. The first doctor she went to, he said, Oh, he's just malaria that he gave her like anti-malaria medication. And still, that never made it better. So, it wasn't until she went to the second doctor, which is a teaching hospital. And that's when they found out that it was COVID. So, right now she is seeming more, getting like she's precautious, more than even we within the healthcare field. But right now, she's doing much better. She told me because I speak to my aunt everyday. She told me right now she's off the oxygen. So, she's pretty much in a good state, she’s back to work, too.

I work in a unit, which is designated as COVID. So basically, you educate them, you keep on educating them and their family. Because some people think that after they get COVID, they can’t receive the vaccination, which is not true.

It's just for them not to just to prevent them going to get into the stage of the hospital. And it also prevents reinfection too, which they found they understood. And went through the route of getting vaccinated.

After experiencing this pandemic firsthand and also being a patient, I just had a baby too. So I think it's pretty much going to change the face of healthcare in the future. There's going to be pretty much more of the tele visits in terms of primary care. It was occurring before, but this pandemic made it more pronounced.

Especially with nurses, the community look up to us. In terms of what we put out there, we're almost like, like a guide. So that says a lot on the role of a nurse in the eyes of a patient. So we need to be more knowledgeable, we need to keep more aware of our surroundings aware of what's going on in the news in the community in society in the world, the world at large.

REGLITA LAPUT: My name is Reglita Laput. I am the president of the Philippine Nurses Association of Michigan. I am also working as a Director of Clinical Services in homecare.

I love to care for people. So I decided to take up nursing. When I was a student, I really love my experience in community health nursing. So I thought that I might as well focus on being a community health nurse or a public health nurse.

I feel that life is fulfilling when you have helped others. So I am very willing to do one extra mile just to be of help to others. It is very fulfilling that you have shown your love, you have shown your service to the community and to the world in general.

As a community health nurse working in-home care, I try as much as possible to educate our patients to be vaccinated. And also our therapists, our nurses. But I also work with communities. And I really try to show to them the magnitude of the problem.

First, I will ask, how are you now? How do you feel about this situation now? Something like that, and I touch the heart. And I will also show to them the implications of the pandemic. It's our families are affected. We cannot show our relationships, even to our friends and our families. We cannot hug anymore. But this is not normal. So what I do is I try to do a heart-to-heart talk, in a voice that shows really that you are concerned and explain to them that this is how it is. If we're not going to put an end to this, many of our, even our families will be affected, many will die. We have to wear a mask, we have to observe social distancing. And all of this combined together, we will be able to stop this virus. But most importantly, we have to get ourselves be vaccinated. Because the vaccine gives us a security blanket, although it's not 100% is a very slim chance. But you are protecting yourself and you are protecting your family, you are protecting others. So let's get ourselves vaccinated.

Of course, there are some people who are quite reluctant to be vaccinated. But when I talk to them, I would say you are concerned that it will have side effects on your body. But think of the benefits it will give to your body rather than the side effects. The benefits outweighs your fear about side effects. Even with your first dose, you feel something it means that the vaccine is working your antibody is giving a light oh this is something power into my body. So that is good is, that is good. Means the vaccine is working. Your body is reacting producing the antibodies.

We have to work together for this common goal. Our goal is to really to have herd immunity. What I would like to let our communities even for the world to know is that we can all together stop this virus. If we will work all together. We are going to stop this pandemic

 

CREDITS

SARAH: This project was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention. The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services. The contents of this resource do not necessarily represent the policy of CDC or HHS and should not be considered an endorsement by the federal government. For more information about related upcoming webinars and where to find COVID-19 resources, log on to nurseledcare.org. And in case you missed any of our previous episodes, you can always go back and find them wherever you listen to podcasts. In the meantime, definitely continue to stay up to date with us on social media at @NurseLedCare At The Core of Care is produced by Stephanie Marudas and Emily Previti of Kouvenda Media and mixed by Brad Linder. I'm Sarah Hexem Hubbard of the Pennsylvania Action Coalition. Thanks for joining us. 

This project was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number NU50CK000580). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The contents of this resource center do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government. 

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