Understanding Vaccine Acceptance among Indigenous Populations in Guatemala
A collaborative, mixed methods study exploring the nuances of vaccine acceptance and evaluating the use of localized educational content to improve vaccine uptake among Indigenous Guatemalans.
Indigenous Maya peoples make up over 40% of Guatemala’s overall population. They have faced substantial barriers to COVID-19 vaccine access and acceptance. Consequently, vaccination rates among Indigenous Guatemalans remained concerningly low in the months following the introduction of the vaccine.
We worked with Wuqu’ Kawoq | Maya Health Alliance and the University of California San Francisco to understand the factors contributing to vaccine hesitancy in these populations and to explore a community-centric approach to vaccine outreach. As part of our multi-phase study, we created and disseminated culturally and linguistically appropriate educational video content to target populations via social media, and evaluated its impact on vaccine perceptions.
Barriers to COVID-19 vaccine uptake among Indigenous Guatemalans included lack of guidance in local languages, confusion around availability and eligibility, and myths and misinformation about side effects. Our teams recognized that in order to overcome these challenges, it was necessary to better understand vaccine perceptions in these communities and to identify ways to reach them with localized and understandable vaccine information.
Wuqu’ Kawoq is an established and trusted community health organization that works directly with local Indigenous communities. In collaboration with the Wuqu’ Kawoq team and research partners at UCSF’s Institute for Global Health Sciences, we designed a multi-part study aiming to:
1. Understand how the COVID-19 vaccine is perceived by the Indigenous Maya population in the Central Highlands of Guatemala
2. Determine which myths and misinformation exist within the community
3. Develop an understanding of where Indigenous Maya populations seek vaccine information
4. Identify trusted sources of messaging for Indigenous community members
5. Understand how Indigenous community members prefer to receive health information, including considerations such as language, format, and platform.
PHASE I: Qualitative study
The initial phase involved focus group discussions with community members and in-depth interviews with local community health workers, nurses, and physicians in Guatemala’s Central Highlands. Respondents noted a lack of information available in local languages and confusion around vaccine availability and eligibility, increasing mistrust in the vaccine and opening the door to myths and misinformation. It also became evident that increasing vaccine acceptance would require integrating local understanding, cultural contexts, and Indigenous languages such as K’iche’ and Kaqchikel into vaccine messaging.
PHASE II: Content Development
With our collaborators, we co-developed two sets of culturally appropriate educational videos covering COVID-19 vaccine side effects and myths and misinformation about the vaccine. The content was adapted from videos in our COVID-19 toolkit, using a community-based, human-centered design approach. All of the new videos were translated into Spanish, K'iche’, and Kaqchikel .
PHASE III: Social media dissemination and evaluation
The final phase of the study involved leveraging social media to test the effectiveness of vaccine education content in local Mayan languages compared to Spanish. Our team found Facebook to be the most relevant and accessible social media platform for the target community, so we ran a Facebook Ads campaign and conducted a Facebook Brand Lift study targeting users geographically.
This phase also entailed conducting in-person surveys before and after the social media promotion. The surveys aimed to determine whether the campaign effectively reached the target populations and influenced their vaccine understanding and acceptance.
Initial results suggest that localized health education content that is disseminated through trusted sources can successfully improve vaccine knowledge and uptake. The full analysis is currently underway and will be published upon completion.
All videos are available in Spanish, K’iche’, and Kaqchikel on YouTube:
Sample Project Videos
¿Cómo funcionan las vacunas COVID-19?
¿Jas qas ube’el uchak ri vacuna rech Covid-19?
¿Achike ruma ri vacunas k’o q’axon nkiya’ chawe?
¿Es cierto que las vacunas contra el COVID-19 contienen microchips?
Le ukojik le toqo’j kunanik q’ateb’al uwach le Covid-19, la kuq’atej uwach le alk’walanem?
Ri vacunas richin COVID-19 yat kikamsaj?
COVID-19 and Intimate Partner Violence
Globally, 1 in 3 women will experience intimate partner violence in their lifetime.
Now, in the shadow of COVID-19 and its pandemic, communities, researchers, advocates, and survivors are seeing and experiencing a worsening of intimate partner violence (IPV).
We worked with Stanford University’s Department of Emergency Medicine and the community based organization Next Door Solutions to Domestic Violence to create a video series that aims to better inform health workers, community members, and survivors about the complexities of IPV, while navigating the challenges the pandemic has created in seeking help.
The COVID-19 crisis has exacerbated existing difficulties for IPV survivors to access resources, new and existing. Risk factors known to be correlated with IPV have increased, such as financial, medical, and emotional stressors, disproportionately impacting communities of color. Resources and help systems that were once reliable and consistent closed down, migrated to online services, or were confusing for survivors and their friends and families. Many IPV hotlines and shelters experienced a decrease in call volumes, and judicial proceedings paused entirely or moved to online platforms. Many IPV victims now lack safe and reliable access to resources.
Amid these entangled issues, community health workers (CHWs) and educators can serve a vital role in supporting survivors through education, empowerment, and connection to resources. We know CHWs are trusted and knowledgeable aides for people experiencing IPV, and are key players in bridging the gap between survivors and access to help. However, lack of health worker training around IPV paired with reduced in-person or otherwise private medical encounters during COVID-19 have made it harder for people to securely reach out to CHWs, and for CHWs to reach out to survivors who could possibly be isolated.
We collaborated with the Department of Emergency Medicine at Stanford’s School of Medicine and Next Door Solutions to Domestic Violence, a nonprofit organization located in San Jose, CA, to create an educational video series on COVID-19, IPV, and the impact of the pandemic on survivors. The video series serves as a source of information to help CHWs and community members better understand what IPV looks like, ways to support survivors, and additional resources for those interested in reaching out, all while navigating the parallel challenges of the COVID-19 pandemic.
All videos are freely available in both English and Spanish on our YouTube channel, as well as in the Digital Medic mobile app for iOS and Android.
Sample Project Videos
Impact on Intimate Partner Violence
Healthy vs Unhealthy Relationships
Supporting Family and Friends
COVID-19: Science of the Virus
Self-isolation and Self-quarantine
Advocacy Training for Community Health Workers
A mobile training to elevate the voices of frontline community health workers.
For too long, community health workers (CHWs) have been excluded from discussions that influence their work and their communities. That’s why “Advocacy Training for Community Health Workers” is a critical course to share with CHWs around the world. This free mobile training equips CHWs with the skills to effectively share their personal stories and promote the health issues most important to their communities.
Community health workers are the most proximal and trusted care providers for millions of people around the world. Despite their demonstrated impact, CHWs have historically been excluded from conversations and decision-making that influence their work and communities.
We worked with the Community Health Impact Coalition and an advisory group of CHWs from around the world (Kenya, Uganda, Liberia, South Africa, Sierra Leone, Malawi, and Guatemala) to ensure that all content is action-oriented and reflective of the realities of CHWs’ work and the challenges they face.
Learners will have the ability to access and download videos, reading materials, and reflection exercises on the following topics:
1. The history and background of CHW programs
2. How to advocate for improved health care and working conditions
3. How to tell personal stories to advocate for change
4. How to use technology tools to participate in global conversations
The full course is freely available in the Digital Medic app for iOS and Android. Learners have the ability to download materials for offline access.
We have also created a free Facilitator Guide to assist with in-person and hybrid group learning sessions. The guide is recommended for CHW trainers and supervisors, and is designed to align with your existing schedule.
All materials are available in English, French, and Spanish through the course website.
Our evaluation team will be measuring learner engagement with the course as well as how virtual training impacts knowledge, attitudes, and practices of CHWs. Check out our findings as of July 2021 in the Progress Report linked below.
Foundations of Maternal and Child Health
Around the world, more than 800 women die every day from preventable causes related to pregnancy and childbirth. Both new mothers and their infants face an even greater risk of experiencing poor health outcomes if they live in an under-resourced part of the world.
The great majority of maternal and infant deaths occurring in low-resource setting can be prevented. Improvements in maternal knowledge, leading to health-promoting behaviors, are often an important part of the solution.
In collaboration with the Philani Maternal Child Health and Nutrition Trust, we created a collection of foundational health education videos addressing key topics in maternal child health. The series was first narrated in isiXhosa, then translated into Hindi and Dioula. It is currently being used in South Africa, India and Burkina Faso.
By partnering with community health workers, who are trained in delivering health education messaging, we work to disseminate our content via mobile technology to families who would otherwise lack access to this information. Armed with tablets and smartphones, and using our offline app, we empower these frontline healthcare providers with accessible teaching tools which empower them in the field. The maternal child health content is also freely available on our DM YouTube Channel.
In 2017, we began conducted focus groups with community health workers who had experience using our video health promotion content during their home visits. Recent research suggests that tablet-based, digital teaching tools were an acceptable, feasible and empowering resource for community health workers.
Trauma-informed Interviewing Techniques
Training Attorneys Working with Children
Under the United States’ Zero Tolerance Policy, thousands of children were separated from their loving caregivers upon arrival at the US border. News agencies, legal and medical professionals estimate that thousands more families were separated prior to the implementation of the policy. Forced separation from a primary caregiver, at any age, is considered a major trauma with lasting negative health effects for children and their families.
Hundreds of lawyers and physicians have volunteered their services to the victims of family separation but the resources available to support these professionals are scarce and often inaccessible to busy professionals in need of practical advice and emotional support.
Through a series of short video interviews with lawyers and physicians who have years of experience working with separated families, we are creating a compact “toolkit” to offer these professionals efficiently delivered, just-in-time support that will leave them with the strategies and coping skills they need to do this heroic humanitarian work.
The toolkit is openly available below for lawyers and physicians who may be considering volunteer work of this nature. It will also be disseminated through multiple professional and charitable organizations working with these professional volunteers.
We are committed to understanding the effectiveness of all our health education interventions. We will collect survey feedback and conduct in-depth focus group sessions with learners to examine how our trauma-informed training content can better prepare those on the front lines working to protect vulnerable children.