Health Confianza is a multi-sector, collaborative program in Bexar County, Texas that aims to increase the availability, accessibility and use of preventive health information and services amongst Hispanics and African Americans in 22 zip codes with the highest health disparities in Bexar County’s population of 2 million. Built on the foundation of the 300-member COVID Community Response and Equity Coalition, Health Confianza is the product of a triad partnership between the City of San Antonio Metropolitan Health District, UT Health San Antonio, and the University of Texas at San Antonio. Health Confianza developed evidence-informed strategies to target multiple levels of the Socio-Ecological Model. Such strategies include Extension of Community Healthcare Outcomes (ECHO) at the interpersonal level, natural leader training at the community level, and a health literacy pledge program at the organizational level. 

During the COVID-19 pandemic, Health Confianza aimed to improve access to information, vaccine uptake, patient-provider communications, and organizational adoption of Culturally and Linguistically Appropriate Standards. Additionally, the Health Confianza curriculum equipped participants to validate health information through mis- and dis-information identification training. Since the pandemic, the curricula and goals have expanded to include the “Wellness Cultura” campaign, focused on wellness and preventive health information and resources.

The San Antonio Metropolitan Health District served as the primary recipient and administrative partner on this grant, while the UT Health San Antonio developed all programming and implementation, and the University of Texas at San Antonio served as the evaluating partner. In the end, implementation had about 18 months to yield results for the purpose of the grant period reporting. Despite the limited time, amidst acute phases of the COVID-19 pandemic, the demonstration project yielded promising practices and results that are being innovatively continued today.

Community Health Clubs identified and recruited community health workers and community leaders to train with knowledge, curriculum, and facilitation techniques to form Community Health Clubs that share knowledge and improve health literacy in the local community. Initial evidence shows that Club participants demonstrated improved COVID preventive behavior knowledge, health literacy, and self-efficacy to share COVID information.

Ambassador Trainings recruited community leaders for a series of trainings to equip ambassadors with knowledge, skills, and confidence to talk with their community about health issues, including COVID-19. Evidence demonstrates that Ambassador trainings can be effective at improving health literacy, preventive behaviors, and information dissemination.

ECHO (Extension for Community Healthcare Outcomes) Trainings leveraged the virtual tele-mentoring program with providers and healthcare workers to increase their knowledge in a specific healthcare area; thus, increasing patient health literacy and patient-provider communications. Two ECHO series were for healthcare providers, while another was tailored for Community Health Workers, and a fourth was open to all community members. The project provided evidence that the ECHO model is positively associated with changes in healthcare provider confidence for patient-provider communication and sharing COVID-19 information. Providers and community health workers reported engaging in discussions about COVID more after the ECHO trainings.

Seed Grant projects consisted of community-campus collaboration for health profession students to partner with community-based organizations to implement innovative health literacy projects that address COVID-19 inequities within San Antonio. Evaluators asked seed grant leads to collect basic demographic data on their participants and outcome data based on their selection of 10 potential indicator(s) aligned with their project. This data was captured via online surveys and recipient uploading of data at the end of projects. This project provides limited evidence that the seed grants were effective in improving health literacy and COVID-19 behaviors or outcomes. That said, there is evidence that this program strengthened multi-sector, community-based partnerships between community-based organizations, academics, health professional students, community members, and the local health department.  

The Organizational Pledge Program facilitated the first-ever nonclinical organization health literacy program through an eight-month cohort learning series to train and support local health and social service organizations interested in evolving into health literate organizations.  The pilot pledge program learning collaborative included eight monthly sessions from September 2022 to April 2023, lasting 1.5 hours each for 2-3 staff from each of the 10 participating organizations. This cohort was the first to use the HLE-2 assessment tool in nonclinical settings. Due to OMH timeline, organizations received training and developed a plan, but did not have time to implement their health literacy changes. Therefore, the evaluation focused on gathering feedback and quality improvement data rather than measuring impact. Data did demonstrate that participants rated the training program and learning collaborative favorably. Feedback suggested that participants were engaged in the learning collaborative, excited to learn how to apply the CLAS standards to their organization’s health literacy plan, and enthusiastic about making changes in their organization’s health literacy.

The social and mass media strategies resulted in 4.4 million impacts in one year through organic social channels, paid social media, peer influencer campaigns, radio spots, print ads, emails, website, and earned and paid media coverage. These various strategies disseminated scientifically correct and culturally appropriate COVID-19 preventive messages and informational, localized resources.

The founding partners are proud of Health Confianza’s innovative sustainability plan. At the end of the demonstration grant from the Office of Minority Health, San Antonio Metropolitan Health District developed an MOU to transition Health Confianza’s intellectual property and brand to UT Health San Antonio, where they continue to develop and grow trust and partnerships to strive for positive, equitable health outcomes across San Antonio.

POPULATION OF FOCUS

Bexar County, Texas is a majority-minority metropolitan county with a population of 2 million inhabitants. Latinos account for three-fifths of the county’s population with people of color—nonwhites—overall making up nearly three-fourths of the overall population.

The population of focus consists of all persons living in the 22 target zip codes, clustered in the Bexar County’s western, southern, and eastern areas and in the top 25 in at least two of three of the following COVID-19 rates: positive cases, active cases, and deaths. According to the 2019 American Community Survey, the 22 zip codes contain an aggregate population of 651,062. The target area represents one-third of the Bexar County population, but as of April 2021, it accounted for 52% of deaths, 43% of positive cases, and 40% of active cases in the county. Moreover, the 22 target zip codes are in the top quartile of the CDC’s Social Vulnerability Index, experiencing disparities in socioeconomic status, language isolation, transportation needs, household composition/disability, access to broadband, and are in the lowest quartile for health literacy. As of May 2021, five of the 22 zip codes were classified as having high COVID-19 case rates and low vaccination rates (78211, 78219, 78220, 78227, 78242). Three of these five zip codes range from 48.1% to 94.4% in the percentage share of residents who are Latino and where very low percentages of Latinos have at least a bachelor’s degree (78242, 5.7%; 78227, 6.5%; 78220, 7.2%; 78211, 7.3%; and 78219, 9.0%).

Overall, the target area is disproportionately Latino with this group accounting for 83% of the zone’s total population with whites making up 11%, Blacks 5%, and all other racial groups 1% of the remainder of the population. The fact that the 22 zip codes are areas of the county that have been particularly hard hit by the pandemic reflects the overrepresentation of Latinos among persons contracting and dying from COVID-19 in the county.

Within the 22 targeted zip codes, we identified two disparate populations: non-Hispanic Blacks and Latinos. These two groups exhibit a variety of determinants that have particularly predisposed them to the wrath of COVID-19 and for the long road of difficulty in the recovery from the pandemic when it is over. Indeed, across a dozen demographic and socioeconomic indicators for residents of the target area, Latinos and Blacks fare much worse than do whites. Below are some illustrations of the significant disparities that exist between these group.

·         Black and Latino households are approximately twice as likely to be headed by a single female.

·         Whites 25 and older are nearly twice as likely as Blacks and three times as likely as Latinos to have at least a bachelor’s degree.

·         For every $1 of white households, Black and Latino households earn 61 cents and 80 cents, respectively.

·         Latino and Black families are 1.7 times more likely to be in poverty compared to white families.

·         Latinos and Blacks 19 to 64 years of age are 1.7 times and 1.2 times more likely, respectively, to lack health insurance compared to whites.

·         Latino households are 2.6 times more likely than white households to have more than 1.01 persons per room.

·         Black and Latino households are about 1.3 times more likely than white households to not have broadband access.

Comparison Group: The comparison group is the non-Hispanic white population. Overall, in the aggregate, whites represent approximately 11% of the population of the 22 targeted zip codes. Whites account for less than 2.5% of residents of nine target zip codes (78152, 78203, 78211, 78220, 78224, 78225, 78226, 78237, and 78264) and make up more than 8% of the population in three zip codes (78201, 78212, and 78223).

INNOVATIVE MODEL PRACTICE

Health Confianza’s model of culturally and linguistically appropriate sequential engagement strategies at multiple levels of the socio-ecological model is innovative. While each strategy alone is worth of its individual merits, together they have a multiplicative effect to comprehensively address health inequities throughout San Antonio.

As such, the innovative milestones and lessons learned for each strategy are as follows:

Community Health Clubs:  Not only is the Community Health Club model nascent to the United States, Health Confianza’s Club strategy is the first time that the club model was introduced to elementary and high schools in the United States. There was participant affinity for the curriculum and over 100 community leaders trained to lead clubs. Of high note, multiple Memorandums of Understanding have been developed with local school districts and Health Confianza – to continue and grow partnerships with local health entities (including the health department) and school stakeholders (faculty, nurses, parents, students, and more).

Ambassador Trainings: This was the primary strategy used to engage and support partners in the hard-to-reach far Southside of the county. Ambassador Trainings serve as approachable entry points for partner engagement and initial trust building with local public health-related organizations.

ECHO: The ECHO programs had large attendances (regularly over 100 in attendance) and were able to activate and launch quickly for fast impact, due to strong partnerships already in place. The fourth ECHO series was innovative by featuring community member voices (not case studies on paper) and providing direct engagement for CHWs and providers to best understand patient experiences in and out of clinics.

Seed Grants: The Seed Grants engaged diverse partners and implementation strategies – and engaged health professional students in health literacy, a topic that they may only learn limited amounts of in the classroom. This demonstrated investment in the community – and therefore trust for future partnerships.

Organizational Pledge Program: This program is full of innovation, starting by being the first program for nonclinical organizations to achieve health literacy programming through participation of local organizations serving other social determinants of health (i.e. housing). This program was also the first to adapt and use the HLE-2 health literacy assessment in nonclinical settings. Its strategies yielded high enthusiasm and motivation from current participants, as well as high demand from other organizations who want to participate in future cohorts.

Mass and Social Media: The “Boost Community. Boost Health.” Campaign is part of multiple strategies that attracted national attention and local success in brand recognition – and more importantly, it grew local trust in the “Health Confianza” brand. The media strategies cultivated and grew trust with partners through reciprocal support by innovatively co-marketing and grouping partners’ events in marketing information, producing a “win-win” relationship and outcomes. The campaign also attracted regular, significant unpaid, earned media features in radio, television, and written modalities – ultimately leading to over 4.4 million impacts in just a year.

MODEL PRACTICE RECOMMENDATIONS

The key elements that led to Confianza’s innovative, model practices are summarized through the following notes.

Efficient Initiation: This project highlighted the need to swiftly develop and vet plans at the project’s outset, to hit the ground running quickly and engage community partners for buy-in as early as possible, as community trust is the key to success.

Comprehensive Training: It’s important to extend training durations for health professionals and non-healthcare individuals, as well as offer non-cohort (ad hoc, single session availability) for busy health professionals and non-healthcare individuals to maximize information offerings, participation, and support. Incorporating interactive exercises and tailored content in training modules localizes the content and maximizes impact of the efforts.

High School Engagement: To engage with high schools (organizationally and at the student-level), one must prioritize trust-building through listening sessions. After that initial trust is build, it’s key to promote informed decision-making over coercion, as well as to focus on dialogue around priority health issues for the audience, not the health-promoting organization.

Tailored Engagement: Emphasizing personalized conversations is key to effective buy-in from community partners. Although this isn’t the fastest route, it’s the most sustainable and impactful on community health outcomes.

Organizational Health Literacy & CLAS Standards: Integrating these concepts into training programs Is key to addressing gaps in understanding, improving health literacy, and maintaining high levels of engagement. This information is harder for organizations to seek and adapt without structured, tailored programs.

Strategic Outreach & Timing: Recognizing the impact of timing and considering community rhythms is essential when planning implementation of programming. Optimizing outreach around periods of higher community engagement yields the most (and easiest) success.

Content Accuracy & Review: Thorough reviews of content for most recent updates and accuracy is crucial before hosting engagement sessions.

Partnership Concentration: Prioritizing targeting partnerships and concentrating efforts on Memorandums of Understanding earlier in engagement is important for programmatic sustainability and demonstrating commitment to partners.

Trust-Building & Collaboration: Investing substantial time and effort in trust-building is crucial for successful partnerships. Most of Confianza’s partnerships took at least a year to earn steady trust. This trust development requires ongoing collaboration and dedication at all hours on all days.

Data Collection & Participation: To enhance community involvement in data collection, it’s important to closely collaborate and develop a strong working relationship with the evaluation partner.

PROMISING PRACTICES

The Organizational Health Literacy Pledge Program is regarded as the most promising practice from this demonstration grant. A suggestion for future implementation is to start with this program and use it to engage organizations who have their employees and staff later engage in other strategies, such as ambassador training. The Pledge Program might also consider increasing the stipends to participating organizations. to cover the effort of the organizations’ staff to attend meetings, work with their mentor, develop the plan and implement the efforts.

Reflecting on the entirety, sequential engagement proved to be the most successful method for sustained program participation – and organizational partnerships proved to be a strong gateway to sequential engagements. The team is proud of its partnership with the San Antonio Independent School District through its youth ambassadors; youth community health club; and significant school nurse training, support, response, and resources. Four of the 10 pledge participants engaged in multiple Confianza strategies. The ambassador trainings proved to be an approachable entry strategy for initial engagement.

Community Health Worker engagement through flipped classroom-ECHOs (participants sharing case studies), interprofessional ECHOs, and the ambassador and club trainings show promise for improving access to health information throughout San Antonio.

San Antonio Metropolitan Health District is the backbone and founding facilitator of Health Confianza and it’s partnerships. In July 2021, Metro Health received the US Health and Human Services Office of Minority Health’s Advancing Health Literacy Grant (OMH AHL) to launch Health Confianza, a multidisciplinary, community-wide health literacy effort, and appointed the CREC as the advisory committee. Inspired by the Equity Atlas and COVID-19 Equity Index, Health Confianza will focus on twenty-two zip codes within Bexar County identified as high risk for COVID-19 based on unfavorable outcomes related to COVID-19 positive case rate, active case rate, and death rate.

The HHS AHL initiative developed strategies to enhance health literacy among socially vulnerable populations. Strategies were created with culturally and linguistically appropriate services' (CLAS) standards for healthcare settings. These strategies were expanded creatively through innovative adaptations to share among varying levels of healthcare providers, community leaders, school-based ambassadors, and community health workers. Through tailored public health measures and improved media communications, Health Confianza serves as an empowerment campaign for providers and community members. It enables populations living within the target zip codes to develop the tools needed to identify misleading health information related to COVID-19 and enable them to make more informed healthcare decisions for themselves and their families.

Health Confianza's innovative approach to combatting misinformation and building trust is a collaboration among Metro Health, UT Health San Antonio, and the University of Texas at San Antonio. Dr. Jason Rosenfeld, Assistant Professor at UT Health San Antonio, leads the program delivery and Dr. Erica Sosa, Associate Dean for Research at UTSA, oversees the evaluation component. Health Confianza lays the foundation for improved health and well-being beyond COVID-19 by increasing the availability, acceptability, and use of COVID-19 health information and services among Hispanics and African Americans living in 22 zip codes in Bexar County, Texas.

The Metro Health-facilitated (and NACCHO Innovative Practice Gold Awardee) COVID-19 Community Response and Equity Coalition, of 300 members from 150 multi-sector organizations, kick-started and served as the advisory body to Health Confianza. 

HEALTHY PEOPLE 2030 HEALTH LITERACY INDICATORS EVALUATION

The evaluation related to Healthy People 2030 health literacy indicators was conducted through a community resident survey. The evaluation focused on Hispanic/Latino and Black/African American residents living in the 22 Bexar County zip codes identified as disparate populations. The evaluation had two layers of outcome evaluation: (1) overall outcome evaluation across the entire project, and (2) strategy-specific outcome evaluations to measure the impacts of each strategy.

Outcome data for the entire project was collected at baseline, quarterly throughout implementation, and post implementation, and included a serial cross-sectional survey across residents in the 22 zip codes, regardless of direct project engagement since it was anticipated the mass media would reach most residents over the two-year period. The resident survey outreach was conducted via phone calls, online, and the CREC. The only two required data points were zip code and race/ethnicity. The survey collected basic demographic information, COVID-19 preventive behaviors, and attitudes towards COVID-19, and vaccine hesitancy – all to assess progress towards Healthy People 2030 health literacy and patient-provider communication objectives. Participants were compensated for survey completion. Back-translation was performed to provide surveys in English and Spanish. Prior to collecting data, the survey was piloted with a sample of residents.

The team analyzed data to assess differences from baseline to follow-up, comparing community members in target zip codes who identify as Hispanic/Latino and/or Black/African American with those who identify as non-Hispanic whites. Changes in vaccination rates and self-reported COVID-19 preventive behaviors were examined. Overall, outcome data was analyzed using larger aggregate data for comparisons using linear and generalized linear mixed models, with fixed and random effects.

The health indicators showed mixed results from baseline (n=1,200) through follow-up (n=1,465). There was no significant increase in the number of residents who reported accessing healthcare. The proportion of adults who reported their healthcare provider checked their understanding declined but then increased, ending with a slight, non-significant decrease from baseline (-4%). The proportion of residents who reported poor communication had a non-significant increase (+2%) by the end of the project. Finally, the proportion of adults whose healthcare provider involved them in decision-making decreased slightly from baseline (-4%).

Vaccinations started with a higher proportion of black/African American residents reporting receiving their initial series of the vaccines (31%) at baseline, compared to both non-Hispanic white (16%) and Hispanic/Latino residents (12%). By the end of the project, a lower proportion of Black and African American residents reported receiving their vaccines (34%), compared to non-Hispanic white (39%) and Hispanic/Latinos (35%).

A lower proportion of non-Hispanic white residents initially reported COVID-19 testing and preventive behaviors but by project end, a similar proportion engaged in testing and preventive behaviors (45%) as Hispanic/Latinos (46%) and Black/African American residents (49%).

COMMUNITY HEALTH CLUB EVALUATION

This project provides partial evidence that the Club curriculum impacts health literacy and COVID-19 behaviors. Data showed small improvements in COVID preventive behavior knowledge. The CHW group showed improvements in COVID health literacy and self-efficacy to share COVID information. The older adults did not show improvements. However, possibly the CHWs were motivated to learn and saw a direct connection of the COVID curriculum to their professional goals. There is some evidence that the COVID curriculum can improve health literacy and COVID knowledge among highly motivated individuals.

This project does not provide evidence that the Community Health Club model is effective to improve health literacy or COVID-19 behaviors. Deviations of club design versus reality underlie this lack of evidence. First, UTH staff led all sessions instead of trained community members. Though this approach was deemed necessary. it also restricts the ability to understand if trained leaders can implement clubs and to what extent. Second, club activities were integrated into existing programs, and as such, it is challenging to assess dose (most participants were confused on which activities were club activities) and attendance (participants did not necessarily attend a club but instead attended their usual activity). Third, the clubs did not have a consistent cohort. In defining a community health club, Waterkeyn and Waterkeyn (2013) describe clubs as critical to developing community cohesion and suggest 20 sessions with the same people for six months or more to collectively increase understanding and behavior change.  The lack of a cohort model and discussion points diminish ‘club’ characteristics of the training provided. Nevertheless, future research might examine how the community health club model that has shown success in developing countries might be effectively translated to urban communities and explore further explore ways to support trained club leaders in facilitating their own clubs.

AMBASSADOR EVALUATION

This project does provide some evidence that the Ambassador Trainings can be effective to improve health literacy or COVID-19 behaviors. Ambassadors improved their self-reported knowledge and behaviors related to COVID-19. Ambassadors who received training also reported sharing messages with their networks and communication systems. Implementing ambassador training through workplaces and organizations who already serve much of the community have established communications systems might be one key to success.  Future research might explore barriers to message sharing barriers and ways to better support ambassadors in disseminating messages.

ECHO EVALUATION

The project does provide evidence that the ECHO model is positively associated with small changes in provider confidence for communication and sharing COVID-19 information. Providers and CHWs reported engaging in discussions about COVID more after the ECHO training. The change from a cohort model to an open model most likely affected attendance. High attrition contributed to a very small dose of ECHO training per participant. Future research might examine how design may produce knowledge, attitudes, and behavior impacts that are more robust.

ORGANIZATIONAL PLEDGE PROGRAM EVALUATION

This project did not capture impact data for the Pledge Program but shows participants rated the training program and overall learning collaborative favorably. Feedback suggested that participants were engaged in the learning collaborative, excited to learn how to apply the CLAS standards to their organization’s health literacy plan, and enthusiastic about making changes in their organization’s health literacy. The participants provided suggestions for improving the content with more practical application, increasing interaction among participants, modifying the length of the program/frequency of meetings, and adjusting the location and modality (ex: hybrid). They expressed optimism for organizational health literacy changes. Team leads echoed many participant suggestions and wanted clearer guidelines for how to work with their mentors. Mentors also wanted clarity on roles and preferred meeting with mentees through modality (online or face-to-face). Overall, participants, team leads, and mentors were excited about the program and optimistic about future iterations.

SEED GRANT EVALUATION

This project provides limited evidence that the seed grants were effective in improving health literacy and COVID-19 behaviors or outcomes. Recipients seemed to have challenges collecting and tracking data to provide evidence of impact. There are several reasons this might have occurred, including that a few grants were awarded before the initial webinar to provide guidance for evaluation. Though evaluators volunteered technical assistance, few recipients reached out to schedule consultation. When consultations did occur, it was usually before the recipients had developed their surveys, so only initial input was received from evaluators without follow-up. Due to different and sometimes delayed start times, recipients completed their projects and submitted their data at the end of the project, when it was too late for evaluators to adjust methods to improve the data. Future iterations of the seed grant might provide evaluation webinars prior to submitting the proposal. The team might consider including the evaluation team in reviewing grant applications so guidance can be provided earlier to the scholars. Finally, if possible, asking for outcome data periodically throughout the project can allow for modifications, when needed.

HEALTH CONFIANZA’S IMPACT ON HEALTH EQUITY

The evaluation team created the Health Disparity Impact Statement to assist in identifying geographic and racial/ethnic groups experiencing disparities related to COVID, as well as communities facing obstacles related to non-medical factors influencing health. From baseline to follow-up, the target zip codes had inconsistent impacts on the patient-provider communication. The targeted zip codes did not decrease the disparities in COVID-19 vaccines or COVID prevention behaviors, nor increase the proportion of adults who accessed and utilized healthcare or reported reduced communication issues. Though there was no evidence of impact on these health indicators during the less-than-two-year program period, a longer-term evaluation could possibly identify impacts in 5 or 10 years. The community health clubs aimed to train leaders from each community; however, mapping the potential leaders’ zip codes geographically shows that many participants were not from the 22 target zip codes. That said, due to the nature of the pandemic and myriad efforts across the city serving to address the virus and social determinants of health, it is difficult to specify the direct impact of Health Confianza on health equity in San Antonio, especially during a short and chaotic project period.

The largest number of participants throughout the project were in the ECHO training, which targeted healthcare professionals and activities with the lowest number of participants were the community health clubs and ambassador training, which targeted community members residing in the target zip codes. It is unclear, based on our data, if community members did not have access to the project activities or if they did have access but chose not to participate. Most activities were offered online, which reduced transportation barriers but potentially increased internet access barriers. Longer-term evaluation might be able to uncover potential impacts of strategies that would take longer to show results due to the short grant period. Some strategies’ proposed changes will occur after this project’s end and therefore are not included in this evaluation report. However, changes to policies and practices could potentially impact community members in the future. Further research is needed to identify opportunities for considering health equity in the strategies and approaches to improve impact.

SUSTAINABLE PARTNERSHIP WITH LOCAL HEALTH DEPARTMENT

The founding partners are proud of Health Confianza’s innovative sustainability plan. At the end of the demonstration grant from the Office of Minority Health, San Antonio Metropolitan Health District developed an MOU to transition Health Confianza’s intellectual property and brand to UT Health San Antonio, where they continue to develop and grow trust and partnerships to strive for positive, equitable health outcomes across San Antonio.

SUSTAINABLE EVALUATION

The evaluation team is open to providing ongoing technical assistance to our partner community-based organizations to continue their efforts towards increasing health literacy and outreach to local communities. The UTSA Center for Community-Based and Applied Health Research has committed internal resources to this effort.

SUSTAINABLE IMPLEMENTATION

The primary plan for sustaining this initiative was to build the capacity of Confianza partners to continue their work beyond the grant period. This was integrated into our training activities (ambassadors and clubs) and our organizational strategy (pledge program). For the Confianza Scholar grants, each project included UT Health San Antonio faculty and students, and, where promising projects were initiated, Health Confianza will continue to support through the Cheever Center for Medical Humanities and Ethics Community Service Learning program (mini and midi-grant program). The only strategy where this sustainability plan was not feasible was our workforce training via the ECHO telementoring modality, as this requires human and financial resources to support the ECHO SuperHub program at the UT Health San Antonio ReACH Center. With that said, one grant is under review with AHRQ to continue developing ECHO series for healthcare workers focused on Long COVID, and a second grant is under development for submission to Pfizer.

Additionally, the Health Confianza initiative is expanding its curriculum, resources, and focus beyond COVID, to the Wellness Cultura. Wellness Cultura is a bilingual preventive health and wellness online resource with a list of local clinics and culturally and linguistically appropriate information.

Strategies to be Sustained:

Community Health Clubs: in collaboration with the San Antonio Metropolitan Health District, and with funding from the CDC, Health Confianza continues to train and mentor community partners and CHWs to form and sustain Community Health Clubs. To date, over 20 clubs have been formed and supported by Health Confianza and we expect to double that number in the coming 6 months. The final version of the Confianza Health Literacy Curriculum for Clubs will be provided to all individuals who participated in our Club training strategy and posted on the website.

Ambassadors: Health Confianza will continue to support trained Ambassadors, providing health promotion materials (including the Confianza Health Literacy curriculum), additional training, and mentorship as requested. Some Ambassadors have requested Community Health Club training and will be invited to training workshops in the coming year.

Workforce Training and ECHO: Confianza is already planning to continue developing and implementing workforce training on Long COVID via grants that are currently under review.

Pledge Program and Organizational Training: Without funding, Health Confianza will remain in touch with the 10 organizations that completed the pledge program, to provide mentorship and support as they implement organizational changes identified during the 8-month learning collaborative. Grants are under development to sustain this strategy, including ongoing support/mentorship for these 10 organizations and the formation of new pledge program cohorts.

Marketing & Communications: The Health Confianza website will remain available, which will be complimented by a soon to be launched preventive health microsite. Our social media presence will continue beyond the grant period as we have secured funding to sustain our marketing and communications specialist. This individual will continue to write and tell stories about our strategies and partners, helping to encourage our partners to sustain their initiatives and strategies in alignment with our sustainability plan. Please view our website for resources for community members, schools, healthcare providers, and organizations. Additionally, please view our social media: Facebook, X (Twitter), Instagram, and YouTube.  

SUSTAINED COMMUNITY PARTNERSHIPS

The following is a list of partnerships being sustained, as supported by UT Health’s MOU with the San Antonio Metropolitan Health District.

San Antonio Independent School District: Health Confianza has an MoU with the school district to train campus leaders as Ambassadors (nurses, social workers, teachers, parents, students) and to facilitate formation of Community Health Clubs for students and parents. Confianza has already met with all school nurses for the District to introduce the Club model and will begin campus meetings and implementation plans in September/October 2023. Confianza also plans to continue supporting school nurses by restarting our K-12 nurses webinar series and by providing health promotion materials (e.g. poster, flyers) using health literate strategies.

Monster Moms: The Executive Director of Monster Moms was recently trained to form Clubs and with mentorship from a Confianza CHW, she plans to initiate her first Community Health Club in September 2023. In addition, Monster Moms will be working closely with Confianza to form and sustain Clubs on SAISD campuses, and to deliver curriculum on trauma informed care and youth empowerment.

San Antonio Metropolitan Health District’s Health Neighborhoods Program: The entire Healthy Neighborhoods CHW team has been trained in the Club methodology and received training on our nutrition and physical activity curriculum. 20 CHWs will begin forming clubs and delivering this curriculum in September 2023. Three Clubs have already been formed in collaboration with the Healthy Neighborhoods team.

Alamo Community Group: The Alamo Community Group sent three members of their team for Club training and are currently working with the Confianza CHW/outreach team to develop a strategy and timeline for creation of Clubs.

Ascension DePaul Services and Southside Independent School District: Ascension DePaul, with support from a Confianza CHW, has launched a Club with Southside ISD as of the new school year. This program will be sustained by the Ascension DePaul leadership team, and those CHWs trained in the model.

Good Samaritan Community Center: With funding from the National Council on Aging, Good Samaritan Community Center, has established a Community Health Club in August 2023. This Club will focus on vaccine promotion and preventive health education.

Prospera Housing: With funding from the National Council on Aging, Prospera Housing will train over 12 of their CHWS in the Club model. These CHWs, with support from a Confianza CHW will establish a virtual Club for training and mentorship, and then will establish Clubs at each of their apartment complexes.  These Clubs will focus on vaccine promotion and preventive health education.

ReACH Center & UT Health San Antonio Post COVID-19 Recovery Clinic: A soon to be funded grant from AHRQ will see Health Confianza continuing to collaborate with the ReACH Center ECHO Super Hub and the Post-Covid-19 Recovery Clinic to design and delivery Long COVID and health literacy-oriented ECHO sessions, as well as community outreach and education strategies leveraging our ambassador, Club and marketing strategies.

Harlandale Independent School District: This coming year our Confianza CHW team will deliver a month-long ambassador style training for parents and teachers at Harlandale HS with a focus on mental wellness and resiliency. We plan to leverage this partnership to promote Clubs and ongoing campus engagement.