What Matters to Us: Bridging Research and Accurate Information through Dialogue (BRAID) to Build Community Trust and Cultivate Vaccine Confidence

"By leveraging the expertise of community experts and subject matter experts, the BRAID Model offers a promising approach to build trust and increase vaccine confidence in communities of color, ultimately contributing to more equitable vaccine uptake and better health outcomes."

Disparities in COVID-19 vaccine uptake in the United States have persisted in many communities of colour, such as the Bronx, New York (NY), where over 80% of the population is Black and Latino. Historical distrust in healthcare systems and the continued legacy of medical injustice and racial and ethnic discrimination have contributed to COVID-19 vaccine distrust in the US. In response, a group of NY-based researchers used the Bridging Research, Accurate Information, and Dialogue (BRAID) model to elicit community members' COVID-19-vaccine-related perspectives and informational needs and inform strategies to improve vaccine acceptance. This paper describes the use of that model and gleans lessons learned for others.

Developed in 2020 by researchers at the Albert Einstein College of Medicine, the BRAID model is centred on community engagement and is informed by evidence-based approaches such as motivational interviewing. BRAID provides space for bilateral, dynamic dialogues ("conversation circles") with (i) community members who are "experts" in what matters most to their community and (ii) researchers that elicit community perspectives, concerns, and questions related to a variety of public health topics, such as COVID-19 vaccines. Based on community expert input, (iii) clinical, scientific, and public health experts (subject matter experts) are invited to join the circles to learn about what matters to the community and to share accurate health information tailored to community concerns. Circles re-convene over time, with the goals of: building trust between community and subject matter experts, addressing emerging health information needs in real time, and collaborating with community experts to co-produce health messages that are acceptable to the community.

The researchers conducted a longitudinal qualitative study over 13 months (May 2021-June 2022) with 25 community experts from the Bronx, including community health workers (CHWs) and representatives from community-based organisations. Each expert participated in 1-5 of the 12 conversation circles conducted via Zoom. Clinicians and scientists attended circles to provide additional information in content areas identified by the experts. Inductive thematic analysis was used to analyse the conversations.

Five overarching themes, related to trust, emerged:

1. Disparate and unjust treatment from institutions: Knowledge of historical racial injustices added to participants' vaccine concerns. The legacy of historical structural racism in Black communities and of being "experimented on" contributed to distrust of the vaccine. Community members shared how health professionals often communicated and behaved in ways that conveyed elitism and disinterest in partnering with patients. These personal experiences of healthcare communication and delivery, including the rapid pace of office visits, contributed to their distrust of providers and the care delivered by them.
2. The impact of rapidly changing and confusing COVID-19 messages in the lay press (a different story every day), which added to participants' mistrust of the vaccine and healthcare messages: Figure 2 in the paper depicts evolving attitudes and perspectives of BRAID community participants over time as mapped to a COVID-19 media story and data timeline.
3. Influencers of vaccine intention: BRAID participants shared that family influenced vaccine intentions, either positively or negatively. Some participants also expressed concerns about inequitable and unethical vaccine distribution. Surprisingly, participants shared that deaths of loved ones did not motivate their communities to get the vaccine and, in some cases, increased vaccine mistrust.
4. Strategies to build community trust: Participants described BRAID circles as effective conduits for building community and individual trust of clinicians, the health system, and the vaccine. Multiple participants also emphasised the power of authentic stories shared by trusted messengers outside the health system as an effective vaccine promotion strategy. A CHW explained that, having convinced one Muslim faith leader to share his vaccine experience, he was able to get most of the mosque's members vaccinated.
5. What matters to community experts: Participants reported feeling respected and free to express their true concerns and opinions at the circles, which also left them empowered to take action for themselves and their communities. They valued being able to facilitate the flow of information from knowledgeable health experts to the marginalised communities they serve. One of them said, "I am going to share this through my social media." Many participants also requested information that would help them and their communities make informed vaccination decisions.

In short, the findings highlighted the influence of factors such as health communication on trust (or lack thereof) and vaccine intention. They also reinforce that creating safe spaces for dialogue and listening and responding to community concerns in real time are effective trust-building strategies. The BRAID model fostered open discussion about the factors that influence vaccine uptake and empowered participants to share accurate information with their community.

By the conclusion of the conversation circle series, all participants said they and some of their previously unvaccinated family members had obtained the vaccine. Recipients included individuals who had previously expressed strong objections to the vaccine. While a variety of factors (incentives, mandates, and changes in infection rates) likely contributed to this behaviour change, multiple participants directly attributed their participation in BRAID as the deciding factor that moved them and their families toward vaccination.

The researchers note that, at the individual provider level, insight gained through the experience may encourage providers to reflect on their own practices and to open up spaces for honest dialogue. At the health system level, findings can inform trust-building strategies for medical centres in underserved communities.

In conclusion: "The BRAID model can also be easily adopted to explore and impact drivers of other disparate health conditions."