Skip to main content

Contact tracing programs have to work with local communities to be successful

Contact tracing programs have to work with local communities to be successful

/

People won’t pick up the phone if they don’t trust the person on the other end

Share this story

Coronavirus Pandemic Causes Climate Of Anxiety And Changing Routines In America
Photo by Justin Sullivan / Getty Images

Tracking the spread of COVID-19 could help fight the pandemic — but a lot of people aren’t answering the phone when contact tracers call. To gain the public’s trust, experts say officials should work with community members when they develop contact tracing programs. That’s especially important for poor communities and communities of color, which may be suspicious of the health care system in general, even as they’re facing high rates of coronavirus infection.

“You’re building a new system on top of historic mistrust. You may be trying to reach people who have never accessed primary care, people who are worried about anything related to the government, or who may have mixed citizenship families,” says Denise Smith, executive director at the National Association of Community Health Workers.

Every piece of a contact tracing program has to be scrutinized to make sure it won’t exacerbate those worries — including word choice. When global health organization Partners In Health started working with the state of Massachusetts to develop a COVID-19 contact tracing program, it quickly figured out a key word to avoid: agent.

The organization helped write the scripts for calls with people diagnosed with COVID-19. To successfully gather the information they need, a contact tracer making that call has to have the trust of the person they’re calling. That person has to agree to tell the contract tracer about their living situation, job, and the people they interact with. For some communities, the word “agent” was a surefire way to eliminate that trust.

For some communities, the word “agent” was a surefire way to eliminate that trust

“If they said, ‘I’m a contact tracing agent, or something that used agent — that’s a trigger word for undocumented people, or people of color,” says Joia Mukherjee, chief medical officer at Partners In Health.

A contact tracing program may ask all of the right medical questions, but if it isn’t designed in a way that’s culturally informed, it won’t be successful. Mobilizing nursing and public health students to make contact tracing calls or creating an app to automate the process, may only work for privileged communities, says Shreya Kangovi, a health policy researcher and associate professor of medicine at the University of Pennsylvania.

“Those things are always going to be expedient, and they’re going to be top of mind to the people who are designing these solutions,” Kangovi says. “But if we’re serious about addressing COVID-19 in the hardest hit communities, that’s not going to work.”

Think about, for example, a 40-year-old woman living in West Philadelphia who works in retail and lives with and cares for her aging mother and teenage son. She’s lost work hours, is struggling to make rent, and doesn’t have internet access or a smartphone. If she gets a call from a contact tracer telling her she’s been exposed to the coronavirus and needs to stay home, she may be suspicious, Kangovi says. But if someone from the community calls and starts by asking what she might be struggling with or what help she may need if she were to stay home, that could be more effective.

 “That’s what it means to do culturally competent contact tracing, to have it be baked-in,” Kangovi says.

At minimum, that means asking members of marginalized communities to review the plans for the program and the script contact tracers use to make sure there isn’t language that would make people suspicious. To be most successful, it means hiring people with local experience, like community health workers, to make the contact tracing calls themselves.

Mukherjee saw the importance of local contact tracers internationally during the Ebola crisis. People from the community were accepted as contact tracers, but representatives from international organizations were not. “When foreigners came in to try to do the work without local people involved, they were attacked,” she says. In Massachusetts, Partners In Health is working to hire contact tracers from a diverse set of backgrounds, regardless of public health experience. “For example, we’ve worked with unions to say, okay, these custodial workers are going to be heavily affected, and we need people from those walks of life.”

“We’ve worked with unions to say, okay, these custodial workers are going to be heavily affected, and we need people from those walks of life.”

Some public health departments around the country that initially built contact tracing programs without community involvement had to rethink their approach. Bernice Rumala, a health equity expert and community health worker, says she’s heard from three health departments that have asked for help making changes. One had initially only involved senior-level health department employees in the contact tracing program, which excluded community health workers. They started running into problems in their engagement — which community health workers had already started seeing on the ground.

“They’re now starting a community health worker pilot program, to expand the role of community health workers in terms of contact tracing,” Rumala says.

Public health departments and officials probably already know the importance of outreach to marginalized communities and recognize that people in those communities may be less likely to respond to contact tracers, Mukherjee says. She worries, though, that the focus on equity gets lost somewhere on the path from program development to its final implementation. Funding may not be targeted to those issues. “You have to put your money where your mouth is,” she says.

Violence from public institutions like police, which erodes trust in public health in communities of color, is currently a focus of national conversation. That makes intentionally building programs that can establish trust with those communities even more important.

“And I think that a lot of people are mistrustful because they should be mistrustful,” Kangovi says. Contact tracing programs that include community members can reconnect those people with institutions focused on their health. “Those will not only be the great ingredients to stemming with public health pandemic, but they’ll also go a long way to repairing our social fabric right now.”

Today’s Storystream

Feed refreshed Sep 24 Striking out

E
External Link
Emma RothSep 24
California Governor Gavin Newsom vetoes the state’s “BitLicense” law.

The bill, called the Digital Financial Assets Law, would establish a regulatory framework for companies that transact with cryptocurrency in the state, similar to New York’s BitLicense system. In a statement, Newsom says it’s “premature to lock a licensing structure” and that implementing such a program is a “costly undertaking:”

A more flexible approach is needed to ensure regulatory oversight can keep up with rapidly evolving technology and use cases, and is tailored with the proper tools to address trends and mitigate consumer harm.


A
Youtube
Andrew WebsterSep 24
Look at this Thing.

At its Tudum event today, Netflix showed off a new clip from the Tim Burton series Wednesday, which focused on a very important character: the sentient hand known as Thing. The full series starts streaming on November 23rd.


A
The Verge
Andrew WebsterSep 24
Get ready for some Netflix news.

At 1PM ET today Netflix is streaming its second annual Tudum event, where you can expect to hear news about and see trailers from its biggest franchises, including The Witcher and Bridgerton. I’ll be covering the event live alongside my colleague Charles Pulliam-Moore, and you can also watch along at the link below. There will be lots of expected names during the stream, but I have my fingers crossed for a new season of Hemlock Grove.


A
Andrew WebsterSep 24
Looking for something to do this weekend?

Why not hang out on the couch playing video games and watching TV. It’s a good time for it, with intriguing recent releases like Return to Monkey Island, Session: Skate Sim, and the Star Wars spinoff Andor. Or you could check out some of the new anime on Netflix, including Thermae Romae Novae (pictured below), which is my personal favorite time-traveling story about bathing.


A screenshot from the Netflix anime Thermae Romae Novae.
Thermae Romae Novae.
Image: Netflix
J
Twitter
Jay PetersSep 23
Twitch’s creators SVP is leaving the company.

Constance Knight, Twitch’s senior vice president of global creators, is leaving for a new opportunity, according to Bloomberg’s Cecilia D’Anastasio. Knight shared her departure with staff on the same day Twitch announced impending cuts to how much its biggest streamers will earn from subscriptions.


T
Twitter
Tom WarrenSep 23
Has the Windows 11 2022 Update made your gaming PC stutter?

Nvidia GPU owners have been complaining of stuttering and poor frame rates with the latest Windows 11 update, but thankfully there’s a fix. Nvidia has identified an issue with its GeForce Experience overlay and the Windows 11 2022 Update (22H2). A fix is available in beta from Nvidia’s website.


A
External Link
If you’re using crash detection on the iPhone 14, invest in a really good phone mount.

Motorcycle owner Douglas Sonders has a cautionary tale in Jalopnik today about the iPhone 14’s new crash detection feature. He was riding his LiveWire One motorcycle down the West Side Highway at about 60 mph when he hit a bump, causing his iPhone 14 Pro Max to fly off its handlebar mount. Soon after, his girlfriend and parents received text messages that he had been in a horrible accident, causing several hours of panic. The phone even called the police, all because it fell off the handlebars. All thanks to crash detection.

Riding a motorcycle is very dangerous, and the last thing anyone needs is to think their loved one was in a horrible crash when they weren’t. This is obviously an edge case, but it makes me wonder what other sort of false positives we see as more phones adopt this technology.


A
External Link
Ford is running out of its own Blue Oval badges.

Running out of semiconductors is one thing, but running out of your own iconic nameplates is just downright brutal. The Wall Street Journal reports badge and nameplate shortages are impacting the automaker's popular F-series pickup lineup, delaying deliveries and causing general chaos.

Some executives are even proposing a 3D printing workaround, but they didn’t feel like the substitutes would clear the bar. All in all, it's been a dreadful summer of supply chain setbacks for Ford, leading the company to reorganize its org chart to bring some sort of relief.