Dime la Verdad (Tell me the truth) will evaluate the use of storytelling by community health workers as a communication strategy to disseminate reliable health information on social media and encourage informed decision-making in favor of recommended immunizations in communities with high morbidity and mortality due to respiratory virus infections.

Dime La Verdad is an innovative social media capacity-building program based on theoretical frameworks related to health communication that empowers community health workers to disseminate reliable information about respiratory virus protection strategies through the use of personal narratives on social media. The proposed work will use a rigorous stepped wedge design to 1) deliver a scalable program of science communicators using an adapted curriculum grounded in principles of health communication, 2) evaluate how diffusion of health messaging is perceived on social media, and 3) discern how use of personal narratives to enhance science communication can encourage informed decision-making to promote evidence-based immunization practices and improve health outcomes.

Public understanding of respiratory virus transmission and prevention is shaped by a wide range of information sources, including social media. As social media platforms play an increasingly central role in shaping health communication, it is critically important to define best practices to disseminate reliable information online. This is especially important when considering the lives of susceptible groups who may not have easy access to culturally relevant and language-concordant reputable sources. Although access to health care remains a significant barrier, access to reliable health messaging is a significant predictor of immunization against respiratory viruses. Yet, little is known about community-level differences in how narratives about respiratory virus protection emerge, how they are shared, and how they ultimately affect decision-making in favor of proven infection prevention strategies.

Social media posts that include personal narratives are effective at reliably communicating health recommendations, especially those that come from a trusted peer. Therefore, communication strategies that leverage neighborhood and interpersonal relationships can prove extremely effective at health communication. Community health workers are trusted community members who serve as links between health/social services and a defined region to improve access to health services and quality of service delivery. Community health workers can diffuse reliable information in the neighborhoods they serve and can be essential to address concerns about health recommendations, increase trust, and improve health outcomes; they have been at the forefront of addressing lower rates of testing for respiratory viruses and inform decision-making to promote evidence-based immunization practices in communities with unmet health and social needs. Community health workers are uniquely positioned as trusted messengers to disseminate reliable information through strategic use of social media and principles of health communication.

Employing a place-based approach (i.e., engaging with local neighborhood strengths and members) to enhance public communication was an effective strategy to diffuse reliable information during the most recent pandemic. Partnerships between multidisciplinary healthcare professionals and lay community health workers improved health communication on the ground and on social media. Reach has been particularly successful in communities with previously unmet needs for reliable, language-concordant information thanks to the co-creation of multi-lingual, easy-to-digest infographics.

Because community health workers are trusted community members who can improve the quality of health/social services delivery, they are uniquely positioned to provide place-based, reliable health communication on social media. To date, there has been no evaluation of whether training community health workers to improve science communication on social media can increase knowledge about respiratory virus prevention and improve decision-making in favor of recommended immunizations. Dime La Verdad (Tell me the truth) will create a scalable program of science communicators. We plan to do the following:

1. Identify and evaluate use of social media by community health workers to communicate health information in neighborhoods with low rates of immunization against respiratory viruses and high rates of influenza-like illness. We will interview community health workers that service areas with obstacles to reliable health communication in order to understand existing information sources, perceptions of safety of recommended immunizations, and personal plans to get immunized.
2. Engage community health workers as neighborhood champions in an adapted science communication curriculum where they can learn to diffuse reliable information. Participants will learn how to make their own infographics as well as incorporate personal narratives into their posts. Participants will share posts with their social media circles to test their effectiveness.
3. Test effectiveness of personal-narrative posts versus resharing of standardized content shared by community health workers with their social networks. Using a stepped-wedge approach, members of participants' social media circles will be surveyed to measure the reach and effectiveness of social media posts. We hypothesize that community health workers will be viewed as trusted messengers and that personal narrative posts designed using principles from the training program will be shared, viewed, and recalled more often as compared to standard informational posts, ultimately leading to improved decision-making in favor of recommended immunizations.

This work will test a model of community capacity-building while providing greater knowledge of how a place-based approach to dissemination of credible scientific information can effect health behavior change.

Inclusion Criteria:

1. 18 years or older
2. Fluent in English or Spanish
3. Provide services as a community health worker or similar designation in at least one of the seven communities with high morbidity and mortality due to respiratory virus infections
4. Have a social media presence (personal or work related)

Exclusion Criteria:

1. Plan to stop working as a community health worker or similar designation before spring of 2028 (end of data collection planned)
2. Do not wish to participate in a social media campaign

De-identified information to data analysis.The list that links the study code to each participant's personal information will be kept completely separate from the de-identified database.