Leeds: The importance of the messenger, not just the message

One of the key challenges of the COVID-19 pandemic response has been ensuring that all communities have equitable access to guidance as well as addressing the issue of misinformation and myths. Public Health relies on effective communication methods to engage with communities and the COVID-19 pandemic shone a light on the different communities and groups that were excluded. There was therefore a concern in public health that these existing inequalities would be exacerbated by the upcoming campaigns and promotion of the COVID-19 vaccinations.

A cross-directorate working group was established to address two issues:

• The high prevalence of misinformation and myths about the vaccine circulating within Leeds communities
• A known gap in the wider public health workforce’s knowledge about COVID-19 and the vaccine.

Local insight, taken before the first wave of the vaccine rollout, showed that misinformation and mistrust in messages would be two significant barriers to the COVID-19-19 vaccine uptake. By examining the insight from different partners in the city, including Healthwatch and local third sector organisations, Public Health was able to understand the barriers, the gaps in information and the main concerns that were voiced by diverse communities about the vaccine. This helped us identify some of the key challenges before the rollout and helped inform practise by understanding the particular communication requirements of different communities. The local insight highlighted that national messages were not relevant for all the diverse communities across Leeds and certain barriers, such as health and digital literacy were significant in affecting access to relevant and timely information. The insight also highlighted the need to reach a large number of community members, from diverse neighbourhoods, in a short amount of time, which required an effective solution in order to achieve this.

A key partner in this solution was the wider public health workforce, as they told us that their knowledge and confidence was a significant barrier to them talking about vaccinations with the members of the community they worked with. Therefore, the work programme aimed to ensure that they had the skills, knowledge, and confidence to have meaningful conversations with community members, to help them come to the right decision for them about the vaccine, based on factual information and after talking through any concerns with an informed and trusted source.

A training session was developed as part of a wider work programme called Leaving No One Behind, a local multiagency response to reducing vaccine inequalities. Through a range of different vaccine offers and alternative models, this has increased uptake in the communities where uptake has been lowest.

The development of a cascade training model, delivered to key influential and trusted local stakeholders who in turn could impart the information within local communities, became the preferred solution to addressing these interwoven issues. This would also compliment other strands of work being developed or delivered to tackle the impact of COVID-19-19 in Leeds. The target was to ensure anyone working with communities at ground level would have access to the latest intelligence and research on the vaccine. 

Want to Know More session on COVID-19

The ‘Want to Know More’ sessions (WTKM) are a familiar brief training offer typically provided by public health specialists and accessed by the wider public health workforce across the city. Networks are in place to distribute the offer city-wide, however, targeted advertising of the COVID-19 training session was promoted among key community stakeholders. 

The training covered scientific information about COVID-19, associated health inequalities and the latest research and information on the vaccines and a brief guide to using the Making Every Contact Count (MECC) principles for initiating conversations. An Infection, Prevention and Control nurse from Leeds Community Healthcare Trust delivered the section about the COVID-19 vaccine. Bringing not only expertise, but additional credibility to the training. The section covered elements which were identified in the insight sessions that people wanted to know about and included what’s in the vaccine, how it was developed, vaccine effectiveness and potential side effects. They were also there to answer any questions raised by participants.

Training distribution

Community based stakeholders are typically part of the Leeds vibrant and proactive voluntary and community sector and are very familiar and trusted in the diverse communities of Leeds. There was implicit understanding of the importance the messenger, not just the message as an underpinning principle to this strand of work. Explicitly the crucial difference of having a familiar and trusted person sharing impartial and factual information, sometimes translated into a community language as opposed to national government messages and information.  

Initial targeting sought those working with people and communities most at risk in the city – those areas of high poverty (defined as the 10 per cent most deprived in the country), older people and communities with large proportions of Black and minority ethnic groups. As this work developed and promotion through word of mouth increased the demand for the training session, a distribution list was developed to track delivery and identify gaps in training provision. This matrix included all known COVID-19 vulnerabilities - ethnic groups, age, poverty, locality, faith groups and the extremely clinically vulnerable.      

The training was part of the development of a foundation for clear information about the vaccine that could then be disseminated across the city to support the wider public health workforce to have informed conversations about the vaccine.

39 participants dialed in to the webinar, representing a range of organisations including third sector, Leeds NHS Clinical Commissioning Group (CCG), education settings, pharmacies, and GP practices.

The WTKMA training was recorded for it to be shared as a workforce resource and viewed across a wider audience. Since the video of the training was uploaded to the Leeds Public Health Resource Centre YouTube channel, there have been 200 views. This video has one of the highest viewing figures out of all the Public Health webinars published on the channel, suggesting a positive reach. The viewership combines both returning and new viewers.

The master slides from the WTKM training have been adapted to develop further training for the COVID-19 Vaccine local Community Champions, specifically recruited for COVID-19 work, to support them with their interactions with members of the community using door-knocking approaches and having informed conversations about the vaccine. The slides were also used and tailored to meet the needs when training a range of other audiences in the dissemination plan. This included delivery to Local Care Partnerships (LCPs), Active Leeds, the Family Inclusion team, and Housing staff.

Feedback from the COVID-19 training session indicated a need for supporting material. However, this material would need to be easily portable, wind and rain proof. A digital resource, accessible as a download and online, was developed using the WTKM content including FAQs about the vaccine and tips for having opportunistic and meaningful conversations using the MECC principles. This provided an aide-memoir for those attending the training. As new information was released, the digital resource was updated, and an email alert was sent to all training attendees. This resource continues to be a reliable source of information and is updated as required.  

Developing a cascade training model, with a health inequalities approach, at pace, to build wider public health workforce confidence and skills to have COVID-19 vaccine conversations has raised valuable learning to share and feed into ongoing COVID-19 vaccine work.

Key reflections and learning

• Information relating to who, how, when, and where to get your vaccine has continued to change, often rapidly, both nationally and locally and this makes the shelf life of any training developed that tries to include this information, time limited. Being able to signpost to the Leeds CCG webpage as the place for the latest trusted information helped with this. It also met the request from the insight to have one place for accessing trusted information
• Developing a digital resource to support the training had multiple benefits:
  • It could be easily updated, removing the shelf-life limitations
  • It enabled us to update emerging concerns e.g. fertility
  • After the training people could go back to it to help maintain confidence
  • It could be dipped in and out of and used to support training
  • It was reminder of where to access trusted information and additional resources, including accessible formats, this was important as the training and the digital resource were only in English
• The training was developed with a master slide set; however, we encouraged this to be adapted to the audience as it was cascaded, this helped to address the ‘one size doesn’t fit all’
• Taking a flexible approach, with support offered where needed enabled us reach into different communities in different ways
• The COVID-19 hesitancy training group worked closely with and supported the COVID-19 Vaccine Community Champions project, this meant we could use insight from the community champions to inform later versions of the training and our training could be shared with the champions and supported with Q&A sessions from the Public Health.
• The speed at which information changes has meant that future training for the champions will be recorded and focus on core, static messages not likely to change
• The training was one part of a multi-faceted approach and supported the work of the other workstreams looking to address vaccine health inequalities, such as door knocking, roving bus and community settings for vaccines. These have been supported by a wide range of staff and volunteers where being able to have positive and informed vaccine conversations is really important

The work brought together many different partners to enable a training package to be developed which drew on individuals’ areas of expertise and local insight. This meant that what was produced was responsive to the needs of the wider public health workforce within the limitations of delivering online training.

What would we do differently now

• We only had Skype available for the WTKM session which was very limited. Since then, Microsoft Teams has been made available which offers a more interactive platform
• Make available key fixed messages, in a range of different languages and formats e.g., audio as well as written to increase accessibility
• Expansion of the digital offer e.g. Audio translation via QR codes
• Share work widely within PH, the Council as a whole and partners
• Use key messages in community engagement events including opportunities to discuss any concerns with health professionals