Evaluating the Implementation of Public Health Strategies to Address COVID-19 Disparities in a Community Setting: A Qualitative Study Using the RE-AIM Framework.

Background: Health disparities, particularly among racial and ethnic minority populations, were exacerbated by the COVID-19 pandemic due to factors like social determinants of health, vaccine hesitancy, and pre-existing health conditions. Local government leaders within an urban city received federal funds to address these disparities by improving health literacy and engaging in culturally responsive outreach and education among Black and Latinx communities within a mid-sized city in the southeastern United States.

Objective: To identify facilitators and barriers to implementing public health strategies aimed at addressing COVID-19 health disparities in a community guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework.

Design: The research team conducted qualitative, semi-structured interviews via telephone, Zoom, or in person between March 20th and April 12th, 2024.

Participants/setting: Fifteen participants, including local governmental health office staff (e.g., nurse navigators, administrative staff) and employees from community center partner sites, were included in the study.

Analysis: Two coders applied both a priori codes guided by the RE-AIM framework and data-driven inductive codes to transcripts in NVivo 14. A final interrater reliability measurement, Cohen's kappa coefficient (k = 0.74), was calculated, indicating a moderate level of agreement between coders. NVivo 14 data visualization tools (e.g., coding matrices) were used to inform thematic content analysis.

Results: Themes were identified within each RE-AIM dimension, highlighting various facilitators and barriers to implementing the selected public health strategies. Working in synergy with community center staff and other community partners to create tailored services and resources was vital for successful implementation. Transparency and timely communication, additional full-time program implementers (i.e., nurse navigators), and sustainable funding sources were identified as key elements to enhance effective implementation.

Conclusions: Insights from the local governmental health office and community center staff's experiences in this study highlight recommendations for effective implementation of locally tailored public health strategies to address COVID-19 health disparities in similar community-based settings. Future research should capture the perceptions and experiences of community members to better understand acceptability, accessibility, and utilization in similar initiatives.