BC School of Social Work participation is led by Donahue and DiFelice Professor Kirsten Davison, left, and Associate Professor Rocio Calvo. (Lee Pellegrini)
The COVID-19 pandemic in the United States laid bare the health-related systematic disparities faced by some racial and ethnic groups, especially Latinx populations. As various researchers and advocates have noted, Latinxs have consistently borne the brunt of COVID’s impact: They are more likely to become infected with the virus, more likely to be hospitalized, and more likely to die from COVID.
While the numbers are even higher for Latinxs with mental illnesses such as depression, anxiety, and addiction, their vaccination rates—for COVID as well as influenza—lag behind other groups. But a project to be launched in coming months by the Boston College School of Social Work and Harvard T.H. Chan School of Public Health aims to address this vaccine hesitancy by working with health care professionals at the community level.
BCSSW’s participation is led by Donahue and DiFelice Professor Kirsten Davison, the school’s associate dean for research, and Associate Professor Rocio Calvo, assistant dean for diversity, equity, and inclusion. Also working with the team are Connell School of Nursing Associate Professor Nadia Abuelezam and Assistant Professor Brittney van de Water; and Kimberly O’Brien, clinical social worker and research scientist at Boston Children’s Hospital and Harvard Medical School. Sebastien Haneuse, a professor and expert in biostatics, is coordinating the Chan School’s role and serves as principal investigator. The project has received a five-year, $2.8 million grant from the National Institutes of Health.
“ Rather than presuming we know what to do and how to do it, we are responding to the distinctive needs of the community. We spoke with people who are served by EBNHC, we heard their stories, and we also spoke with the staff at the center to get their perspectives because they are the ones who serve this community day in and day out.”
At the core of this study is a longstanding partnership between BCSSW’s nationally acclaimed Latinx Leadership Initiative directed by Calvo and the East Boston Neighborhood Health Center, which serves more than 20,000 registered behavioral health patients with a mental health diagnosis, more than 70 percent of them Latinx. EBNHC has served as a field practice placement site for LLI students since 2016 and LLI alumni have been part of its core BH staff. The project with EBNHC seeks to ameliorate the effect of structural racism and intersectional trauma on Latinxs with mental illness—particularly in their efforts to seek health care—by testing a BH intervention that is culturally and linguistically appropriate and, it is hoped, will reduce vaccine hesitancy.
“Rather than presuming we know what to do and how to do it,” said Calvo, “we are responding to the distinctive needs of the community. We spoke with people who are served by EBNHC, we heard their stories, and we also spoke with the staff at the center to get their perspectives because they are the ones who serve this community day in and day out.”
Davison said, “The frequency with which vaccination came up in these discussions, both with patients and staff, was striking. On vaccine hesitancy, the center’s social workers told us, ‘They trust us enough to bring up the issue. But we don’t want to be seen as “persuaders.”’ So, what we are trying to do here is to create a safe space for the patients to talk about vaccines in a way that is helpful and enlightening for them.”
The intervention to be utilized involves motivational interviewing (MI), in which the clinician uses discrete, accommodating language to discuss a patient’s vaccination status, views, and concerns, such as:
“If it is OK, I’d like to shift our conversation to talk about vaccination.”
“I’m not here to try and make you get the COVID vaccine; I want to try my best to understand your situation and help you consider if you want to be vaccinated. I can help you with that. But that’s up to you.”
“What would be the not-so-good things about getting the COVID vaccine? What worries you about it? What would be the good things? What do you think would happen if you don’t get it?”
The clinician also uses MI to assess and enhance patients’ readiness to be vaccinated, asking him or her to rate from 0 to 100 percent how ready they are to get the vaccine and then discuss their response (“What would it take for you get a 100 percent rating?”). Depending on a patient’s response, the clinician can provide information on walk-in or scheduled appointments, offer to give vaccine information, services, or resources at a later date, or help the patient consult a nurse for medical questions.
Calvo and Davison emphasized, however, that for the MI to be successful, clinicians must build a rapport and trust with Latinx patients, who often have negative health care-related experiences because of professionals’ lack of appreciation for cultural and language variations. Grasping the diversity within the Latinx population is vital to develop individualized therapeutic relationships, they said.
The MI intervention states the importance of identifying and respecting cultural values: “respeto”—how the patient would like to be addressed (Don? Señor? Doña? Señora?); “personalismo”—whether the patient seeks to maintain harmonious relationships by not expressing disagreement directly; “confianza”—essentially the cross-cultural construct of trust.
A strong fluency in Spanish, and an awareness of its subtleties, affords the best opportunity for a BH professional to connect with a Latinx patient, Davison and Calvo said: Common words used in Spanish to express emotional distress do not have equivalent meaning in English, and Latinx also use Spanish “dichos” (sayings) to describe feelings and symptoms embedded with cultural meaning.
“My grandmother had a dicho that translates to ‘Now peace and then glory,’” explained Calvo. “When you say that in Spanish instead of English, though, it has much more of an impact. Of course, there are certain words and phrases in English that don’t precisely translate into other languages. These may seem like little things, but they’re very important to how a clinician can effectively communicate with a Latinx client.”
Sean Smith | University Communications | October 2022