From Selma to the Bronx: How Local Health Centers Built Trust to Reach Patients

From the expanse of rural Alabama to the dense streets of the Bronx, health providers spoke Tuesday about a common thread needed to reach patients in both places: Trust.

Two health centers facing shared challenges in very different environments were at the heart of a panel discussion this week, sharing how they addressed gaps in patient knowledge and access to prevent disease and improve health.

Meneka Johnson Nicholson, PhD, COO of the Rural Health Medical Program in Selma, Alabama, and Dr. Viju Jacob, Vice President of Medical Affairs at Urban Health Plan in the Bronx, New York, spoke about their work to reach people with immunizations and health services.

Both health centers were part of the Innovation in Care Awards, funded by the Pfizer Foundation and administered by Direct Relief.

Over the past five years, the program has reached more than 700,000 people and delivered over 141,000 vaccinations targeting Covid-19, influenza, Hepatitis A, B, and C, HPV, HIV and STIs, pneumococcal disease and tuberculosis. The program, which has provided funding to 46 safety-net health providers, has increased vaccinations while addressing hesitancy and misinformation through trusted, culturally responsive engagement in 20 states and Washington, D.C.

Jacobs and Johnson Nicholson shared their learnings with other clinicians at the CHI Community Health Conference put on by the National Association of Community Health Centers, which gathered thousands of health centers and partner organizations from across the U.S. in Las Vegas.

Community-Led Healthcare and Outreach Strategies

Community health centers have built the critical trust needed to reach underserved populations, and both panelists discussed vaccine hesitancy and fatigue, supporting the infectious disease workforce, building strong partnerships, reducing barriers to care, and conducting culturally responsive outreach. They also highlighted creative modes of bringing care to the community through mobile units and effective management of vaccine and treatment supplies.

At the Urban Health Center, which has sites in the Bronx, Queens, and Manhattan, about 91,000 patients a year receive care, according to Jacob. The health center offers a full suite of primary care services, and also operates an extensive workforce training program.

"We are the largest employers in our own zip code," he said, and the vast majority of staff are local."

Those local relationships and approach were key to earning trust and reaching patients with information, he said, and the support of the infectious disease prevention program came at the right time.

"It was a very timely project that Direct Relief brought to us," he said. The program brought in a dedicated vaccine coordinator, who worked with patients to provide trustworthy information, and nurses educated more than 32,000 patients about immunization and the benefits.

Meneka Johnson Nicholson, PhD, COO of the Rural Health Medical Program in Selma, Alabama, also spoke. Though the communities of urban New York and rural Selma couldn't be more different, "many of the challenges are the same," she said.

Overcoming Rural Health Disparities and Historical Hesitancy

The health center operates across six counties in Alabama's Black Belt region, and patients often have to travel long distances to reach care; transportation is challenging for many.

"Some of our communities are the poorest in Alabama," she said. "Distance matters… That rural context shaped everything we did."

Reaching the community was the first step. Earning trust was the next, and one that is ongoing. Historical injustices, including the Tuskegee syphilis study, which occurred in Alabama, contribute to valid reasons for members of the Black community to question vaccination, she said.

"We can't ignore that type of history," she said. Educating people with information, and also acknowledging valid concerns, was all part of the approach.

Expanding partnerships, like working with public health departments, an approach for both health centers, as well as connecting with faith communities, schools, and local organizations, were key to gaining trust.

The program ultimately reached more than 32,000 people with outreach and community engagement, and also expanded health care services beyond immunization. "This partnership has improved access to healthcare while restoring hope that rural communities are not being forgotten," one local leader said of the program.

Bringing care to the community, instead of expecting them to always come to a clinic, was also key. "That's what equitable access looks like in practice," she said.

In addition to expanding vaccination rates and health services, more than 600 health workers have also been trained as part of the initiative. "This is something that takes time, and it takes investment… to make sure that we are preventing disease and creating healthy communities," said Katie Lewis, Direct Relief's Director of U.S. Programs. Health centers step up any time there are health needs in the community, including during major outbreaks.

Anna Lopez-Carr, PhD, Direct Relief's Evaluation Manager, spoke about the data collected over the past five years. The Pfizer program launched in 2020, and then three months later, Covid-19 lockdowns happened, and health centers launched into action.

"We had this privilege to support clinics and staff" as they adapted to supporting patients during the pandemic, she said, adding that health centers were "extremely innovative in the way they delivered this care" from mobile units to peer ambassadors and more, she said.

The program currently has 16 new awardees from Alaska's remote Tribal villages to Appalachia and the Deep South.