The Be REAL Framework: Enhancing Relationship-Building Skills for Community Health Workers.

Trust plays an integral part in the effective functioning of public health systems. During the COVID-19 pandemic, distrust of public health fueled vaccine hesitancy and created additional barriers to immunization. Although most Americans have received at least one COVID-19 vaccine, the percentage of fully immunized adults remains suboptimal. To reach vaccine-hesitant communities, it is vital that public health be worthy of trust. As trusted members of their communities, community health workers (CHWs) can serve as ideal messengers and conversation partners for vaccination decision-making. We developed the Be REAL framework and training materials to prepare CHWs to work with vaccine-hesitant communities nationwide. Through the four steps of "Relate," "Explore," "Assist," and "Leave (the door open)," CHWs were taught to prioritize relationship building as a primary goal. In this shift from focusing on adherence to public health recommendations (e.g., get vaccinated) to building relationships, the value of vaccine uptake is secondary to the quality of the relationship being formed. The Be REAL framework facilitates CHWs harnessing the power they already possess. The goal of the Be REAL framework is to foster true partnership between CHWs and community members, which in turn can help increase trust in the broader public health system beyond adherence to a specific recommendation.