Improving uptake of COVID-19 testing and vaccination in a homeless population: mixed-methods evaluation of community health worker-led education in a shelter

Objectives Access to healthcare and accurate health information is a persistent issue for people experiencing homelessness (PEH), one heightened by the COVID-19 pandemic and exacerbated by issues of health literacy and mistrust. Strategies involving community health workers (CHWs) have the potential to improve education and service delivery for PEH. The objective of this study is to assess PEH knowledge, attitudes and barriers to COVID-19 testing and vaccination, and the impact of CHW-led education within a homeless shelter in Indiana. Design/setting Between November 2021 and April 2022, 15 sessions were held at a homeless shelter that combined focus group discussions with COVID-19-related education. Pre-/post-tests measured knowledge gains and attitude shifts among PEH. Guided by the socioecological model, thematic analysis of focus group transcripts identified key motivators and barriers to COVID-19 vaccination and testing. Participants 78 PEH (73% male, 74% white, mean age=48). Outcome measures COVID-19-related knowledge gains and willingness to receive testing and vaccination among PEH. Results Completion of an educational session was associated with a significant increase in knowledge scores (mean pre-test score=10.76/15, SD=2.16; mean post-test score=13.58/15, SD=1.72; p<0.001), with most participants (91%) improving by up to 10 points. The proportion of unvaccinated participants (42%) willing to be vaccinated increased from 21% to 39%. Participants willing to get tested for COVID-19 after a known exposure increased from 83% to 92%. Qualitative findings from the sessions provided insights into key knowledge gaps and revealed participant preferences towards health education format and topics. Conclusion CHW-led COVID-19 education increased knowledge gains and positively influenced attitudes towards vaccination and testing among PEH. Findings highlight the importance of tailored, community-driven interventions for pandemic response and emphasise the crucial role of education in building trust and promoting health literacy to improve health outcomes for vulnerable populations.