As COVID Surged, Health Communication Research Laboratory Broke New Ground in Rapid Research

Faculty; Public Health; Research; Social Work

The COVID-19 pandemic created challenges that spanned the boundaries of public health, social needs, and communication while magnifying already-existing health disparities in St. Louis and across the nation. The Health Communication Research Laboratory (HCRL), based at the Brown School, has taken quick action on all those fronts, partnering with local organizations to secure millions of dollars in federal grants to address immediate issues like vaccination and community impact while conducting longer-term research that can make a difference when the next pandemic hits.

The lab’s team began soon after COVID arrived in the U.S. by publishing reports correlating the pandemic’s progress with growing social-needs across the nation, using information the lab was already collecting from 2-1-1 helplines in 43 states. Twelve COVID-related projects followed with missions that included addressing vaccine hesitancy and disparities in St. Louis, boosting COVID testing in underserved communities, and understanding how the pandemic was affecting the nation’s most vulnerable. The surge in work increased the lab’s team from 23 to 64 faculty, staff and students, the largest workforce in the HCRL’s 26-year history, involved in 18 active projects.

“Our team was already deeply involved in health disparities and social needs research when the pandemic hit, and we were well-positioned,” said Matthew W. Kreuter, the Kahn Family Professor of Public Health at the Brown School, the founder and senior scientist of the HCRL, and a leading expert in health communication. “If you’re going to be in our field and you have a pandemic like this, you have to rise to the occasion,” he said.

As federal resources became available, the HCRL joined three national networks funded by the National Institutes of Health and the Centers for Disease Control and Prevention to address COVID-related disparities. “We worked with community partners to act and evaluate solutions,” Kreuter said, including hundreds of meetings with leading organizations to increase vaccination and testing in vulnerable populations, especially African Americans. The studies provided a wealth of opportunities for Brown School students, who played key roles in the lab’s work.

Vaccines, Testing, and Underserved Communities

The bulk of the HCRL’s COVID work was part of the three networks:

  • Community Engagement Alliance (CEAL), addresses disparities in vaccination by race and ethnicity. The HCRL focused on St. Louis and St. Louis County. Its work included recruiting Vaccine Ambassadors, newly vaccinated St. Louisans to talk to the unvaccinated using “conversation cards” that suggested ways to talk about vaccination. Cards were distributed to 5,000 area residents as they received a vaccination. Another project supports efforts to vaccinate homebound seniors and providing home test kits. A misinformation monitoring system surveys a panel of 200 community members about misinformation they’ve heard and develops responses for frontline workers. Finally, a COVID research information hub is a one-stop website to learn about COVID studies in St. Louis and encourage participation in the research by diverse segments of the community.
  • RADxUP research encourages COVID testing in underserved populations. One study looks at why people are calling 2-1-1 about COVID; a second study interviews 2-1-1 staff about the calls they’ve received during the COVID pandemic, while a just-completed third study interviewed 150 2-1-1 callers in Connecticut and North Carolina about their COVID experiences. The lab will also evaluate an online illustrated learning tool on COVID testing and vaccination knowledge, beliefs, and intended behaviors. The lab is currently conducting a message-testing study to see what approaches are most effective at increasing interest in vaccination and testing, with a particular focus on those experiencing housing instability and seeking rent relief.
  • The Vaccine Confidence Network is aimed at increasing confidence in the COVID vaccines among vulnerable populations. The HCRL team has attended 184 vaccine events at health clinics, libraries, churches, schools and other settings in the St. Louis area to determine ingredients for success, including incentives; conducts in-depth interviews about the life impact of COVID; and examines life during COVID for low-income women with children. “It’s given us unprecedented insights into how their lives have been affected,” Kreuter said.

“Over the last 18 months we’ve captured really good information on action-oriented community responses that we’re evaluating in real time so we can share lessons learned with the larger community,” he said, particularly with the misinformation-monitoring response system. “We’re getting accurate information into the hands of trusted local messengers,” he added.

Kreuter said the lab’s work has broken new ground in rapid research in public health.

“It’s illustrated a new way that academic research centers like ours can work with community partners to address urgent needs of the community in a faster and more rigorous way than could be conducted without a partnership,” he said. The HCRL also partnered with the Sam Fox School to create the Health Communication Design Studio, led by Penina Laker, to contribute design expertise to messaging and communication. “It’s another big and lasting product of this work,” Kreuter said.

Community partners say the lab’s expertise has had an immediate impact.

“The St. Louis County Department of Public Health is pleased with the support from the HCRL that helps ensure racial equity in COVID-19 vaccination across the St. Louis region,” said Damon Broadus, a member of the regional response team to the pandemic. “Early in the project we worked hard to address challenges to vaccination, including reluctance, especially among African Americans. The survey results shared by the HCRL team helped us adjust our strategies to reach residents exactly where they are in the community. This was invaluable given the limited resources available during the height of a pandemic.” Broadus also praised the weekly misinformation monitoring, which he called “a creative strategy to build knowledge and trust about COVID-19 vaccinations.”

The HCRL also created simple instruction booklets for using COVID-19 self-tests for homebound seniors. The city liked the approach and asked the HCRL to print more in order to expand distribution through the St. Louis public schools.

Surge in rapid research creates challenges, opportunities

Founded in 1996, the Health Communication Research Laboratory seeks to eliminate health disparities by increasing the reach and effectiveness of health information to low-income and minority populations. Past projects have investigated ways to encourage immunization, cancer prevention, and healthy schools. Aside from COVID-related research, current projects include efforts to find ways to help more people stop smoking and control diabetes, led by HCRL co-director Amy McQueen, associate professor of medicine.

Charlene Caburnay, HCRL co-director and research assistant professor at the Brown School, said the expansion that these projects brought to the HCRL has more than doubled the lab’s staff and students. “All the hiring and training, space, computers, working remotely and managing field work in the community during a pandemic required a great deal of effort,” she said. “It was exciting but really required a lot of coordination and flexibility as well.”

Jennifer Wolff, the HCRL’s research director, said the short turnaround time required to make a fast impact presented obstacles unusual for the typical academic research timeline. Establishing relationships and planning with community partners added even more moving parts.

“It’s really changed how I think about research,” said Wolff, who came to the lab from the University of North Florida, where she was an assistant professor of psychology. “We’ve had to work quickly, and change as the pandemic changed. When I step back, it’s kind of amazing what we’ve been able to accomplish.”

McQueen noted that the lab also kept other big grant projects going despite COVID challenges. Those included working with multiple 211 and state tobacco quitlines to provide support for smokers interested in quitting or creating a smoke-free home; a project with a Medicaid health plan partner in Louisiana to address unmet needs among a sample of adults with type 2 diabetes; and wrapping up the main analyses and report for another project that tested novel intervention strategies for smokers who called 211 for help with unmet needs.

“Even as we added COVID projects, we still had three major trials in various stages of data collection and analysis to maintain,” McQueen said. “COVID caused some delays and declines in recruitment, as well as influenced the basic needs expressed by our participants. It has been essential to have great project managers on our study teams, as investigators get spread thin over multiple projects.”

Students gain valuable experience

Those accomplishments wouldn’t be happening were it not for the myriad of accomplished Brown School students who have played key roles.

Rachel Garg, MPH ’18, is a fifth-year doctoral student in the Brown School’s public health sciences program. The COVID project she worked on most was Focus-19, in which she led a team of grad students to analyze data from 2-1-1 help lines to find stories about the pandemic’s social and economic impact, like one report that linked an increase in requests for help with rent in Milwaukee to the upcoming lifting of a ban on evictions during the pandemic.

“Focus-19 was really intense when we started,” Garg said. “I loved it, it felt really meaningful. Sometimes research takes so long, but this didn’t, and it felt really impactful.”

For her dissertation, she’s using data from the lab’s Life During COVID study, which tracks 60 low-income women with children, and surveys their needs via mobile phone every three days for more than a year. All are current or former smokers, and Garg is analyzing data to examine the relationship between social needs, stress, sleep, depression and smoking behavior.

Now in her sixth year at the HCRL, Garg said her experience there has altered her career path. “I chose the MPH because I thought it would be very practical and that I would find a job rather than start a PhD program,” she said. “But once I started at the HCRL, I got so engaged in the research process it completely changed my mind. I feel lucky I’ve been able to stay in the lab and see these research project through from start to finish.”

Mikayla Johnson, MSW/MPH ’22, worked on COVID projects including the Vaccine Ambassadors project; another getting feedback from youth about COVID; and message testing to share with St. Louis city and county public health departments. She especially enjoyed interviewing people about their COVID experiences. “It was really exciting to be able to see the process of planning projects and attacking COVID health disparities in different ways,” she said. “I really enjoyed being out in the community and hearing first hand how they were dealing with the pandemic and the different ways they think about it. It continues to be a really traumatic experience for a lot of people, and it’s valuable to hear from them so policymakers can know and do things differently in the future.”

“When I started, I had never interviewed people before. I thought it would be really hard to get them to open up. But a lot of people came with a story they wanted to share, and felt it was an important perspective for others to hear, like the recently married woman who talked about losing her husband to COVID and what that was like.”

As she applies for jobs, Johnson said she wants to build a career that would align with her values in social justice and eliminating health disparities. The HCRL was a perfect place for that. “I’ve been really grateful for my experience, where I’ve been given opportunities to contribute and use my skills.”

Like Garg, Victoria De La Vega, MPH ’22, hadn’t considered going into research before working at the HCRL. A former Peace Corps volunteer in Albania, she was attracted to the Brown School by its focus on diversity and health equity, and to the HCRL for its emphasis on the practical impact of research. “I think it’s super important to have skills and knowledge to turn data into useful information,” she said. “The HCRL does a great job at that.”

“Working for the HCRL exceeded my expectations,” she added. “The staff is great, and they gave me the flexibility to work on different projects.” One of her first projects as a research assistant was interviewing 211 staff and callers about the impact of COVID. “It was my first time conducting research interviews,” she said. “It was challenging but also extremely interesting. People got emotional, and that could be really hard. I had to be an empathetic listener while making sure we were getting relevant responses. Giving people a chance to share what they’ve been through has been hard but very rewarding, a very important learning experience for me.”