Public understanding of respiratory virus transmission and prevention is shaped by a wide
range of information sources, including social media. As social media platforms play an
increasingly central role in shaping health communication, it is critically important to
define best practices to disseminate reliable information online. This is especially
important when considering the lives of susceptible groups who may not have easy access
to culturally relevant and language-concordant reputable sources. Although access to
health care remains a significant barrier, access to reliable health messaging is a
significant predictor of immunization against respiratory viruses. Yet, little is known
about community-level differences in how narratives about respiratory virus protection
emerge, how they are shared, and how they ultimately affect decision-making in favor of
proven infection prevention strategies.

Social media posts that include personal narratives are effective at reliably
communicating health recommendations, especially those that come from a trusted peer.
Therefore, communication strategies that leverage neighborhood and interpersonal
relationships can prove extremely effective at health communication. Community health
workers are trusted community members who serve as links between health/social services
and a defined region to improve access to health services and quality of service
delivery. Community health workers can diffuse reliable information in the neighborhoods
they serve and can be essential to address concerns about health recommendations,
increase trust, and improve health outcomes; they have been at the forefront of
addressing lower rates of testing for respiratory viruses and inform decision-making to
promote evidence-based immunization practices in communities with unmet health and social
needs. Community health workers are uniquely positioned as trusted messengers to
disseminate reliable information through strategic use of social media and principles of
health communication.

Employing a place-based approach (i.e., engaging with local neighborhood strengths and
members) to enhance public communication was an effective strategy to diffuse reliable
information during the most recent pandemic. Partnerships between multidisciplinary
healthcare professionals and lay community health workers improved health communication
on the ground and on social media. Reach has been particularly successful in communities
with previously unmet needs for reliable, language-concordant information thanks to the
co-creation of multi-lingual, easy-to-digest infographics.

Because community health workers are trusted community members who can improve the
quality of health/social services delivery, they are uniquely positioned to provide
place-based, reliable health communication on social media. To date, there has been no
evaluation of whether training community health workers to improve science communication
on social media can increase knowledge about respiratory virus prevention and improve
decision-making in favor of recommended immunizations. Dime La Verdad (Tell me the truth)
will create a scalable program of science communicators. We plan to do the following:

1. Identify and evaluate use of social media by community health workers to communicate
health information in neighborhoods with low rates of immunization against
respiratory viruses and high rates of influenza-like illness. We will interview
community health workers that service areas with obstacles to reliable health
communication in order to understand existing information sources, perceptions of
safety of recommended immunizations, and personal plans to get immunized.

2. Engage community health workers as neighborhood champions in an adapted science
communication curriculum where they can learn to diffuse reliable information.
Participants will learn how to make their own infographics as well as incorporate
personal narratives into their posts. Participants will share posts with their
social media circles to test their effectiveness.

3. Test effectiveness of personal-narrative posts versus resharing of standardized
content shared by community health workers with their social networks. Using a
stepped-wedge approach, members of participants' social media circles will be
surveyed to measure the reach and effectiveness of social media posts. We
hypothesize that community health workers will be viewed as trusted messengers and
that personal narrative posts designed using principles from the training program
will be shared, viewed, and recalled more often as compared to standard
informational posts, ultimately leading to improved decision-making in favor of
recommended immunizations.

This work will test a model of community capacity-building while providing greater
knowledge of how a place-based approach to dissemination of credible scientific
information can effect health behavior change.