Innovating a Teach-Back Model for Community Health Workers Led Health Literacy Practice to Improve COVID-19 Health Equity.

Abstract

Background: From 2021 to 2023, the City of Albuquerque, the University of New Mexico (UNM) Office for Community Health, the UNM Hospital Health Literacy Office (UNMH HLO), and partners in Albuquerque, New Mexico, implemented the Albuquerque COVID-19 Health Literacy Project (AHLP). The goal of the program was to develop a network of Community Health Workers (CHWs) and community agency partners able to use health literacy (HL) best practices to reduce coronavirus disease 2019 (COVID-19)-related health disparities in Albuquerque, New Mexico.

Brief description of activity: AHLP created a training and support infrastructure to provide CHWs with the knowledge, skills and tools for using HL strategies and approaches for COVID-19 health promotion. The UNMH HLO guided integration of HL practices into the work. We collected and visualized data to identify geographies of need, map project outreach activities, and monitor population health indicators of the project's coordinated service efforts.

Implementation: Trainings, a core feature of the AHLP, were primarily conducted via video conference and included a project launch training, weekly check-ins, monthly workshops, and a series of on-site open house events at the facilities of agency partners. We conducted 10 trainings at which Teach Back and plain language strategies were taught and practiced with CHWs for this project. CHWs conducted outreach through events, phone calls, individual in-person meetings, group meetings, spur-of the moment conversations, and shorter and less structured CHW conversations.

Results: The AHLP reached 44,690 people-2.5 times our goal. Seventy two percent of clients indicated they were likely to get the COVID-19 vaccine. The COVID-19 booster gap closed for those living in high versus low Social Vulnerability Index geographies, reducing this disparity nearly 3-fold in 6 months. CHWs implemented this work using HL best practices that have primarily been developed for use in clinical settings and in the process, they innovated ways to adapt these practices to be appropriate for community contexts.

Lessons learned: HL practices were seen as valuable by AHLP CHWs. They reframed plain language as a path to empowerment. But for Teach Back to be used by CHWs in nonclinical settings, there needed to be changes to the way that Teach Back is taught, conceptualized, and implemented. CHWs in the AHLP refocused these tools and brought them into the CHW work they are already doing. [HLRP: Health Literacy Research and Practice. 2025;9(2):e56-e63.].