A Community-Engaged Social Marketing Campaign to Promote Equitable Access to COVID-19 Services Among Latino Immigrants

Abstract

To address disparities in COVID-19 outcomes among Latinos with limited English proficiency in Maryland, our team developed a culturally congruent intervention that coupled a statewide social marketing campaign with community-based COVID-19 services. In the first year, we reached 305 122 people through social media advertisements and had 9607 visitors to the Web site. Social marketing campaigns represent an opportunity to promote COVID-19 testing and vaccine uptake among Latino populations, especially when they are paired with community services that simultaneously address structural barriers to care. (Am J Public Health. 2023;113(3):263–266. https://doi.org/10.2105/10.2105/AJPH.2022.307191)

The COVID-19 pandemic has disproportionately affected Latino populations in the United States, with Latinos accounting for 18% of the US population but 27% of all COVID-19 cases in 2020.¹ A number of factors (e.g., occupational exposures, higher household occupancy, lack of insurance, limited English proficiency) have led to Latino immigrant communities experiencing a disproportionate burden of COVID-19 infections and mortality.^2,3 Social marketing interventions have been shown to be effective in reaching populations with barriers to accessing traditional health care settings, including Latino populations.^4,5 We sought to address disparities in COVID-19 testing and vaccination by coupling a social marketing campaign with accessible community-based COVID-19 services in Maryland.

INTERVENTION AND IMPLEMENTATION

Our team developed the Mejor Vive Sin Duda (Better to Live Without Doubt) social marketing intervention (hereafter referred to as Sin Duda) through community-based participatory research.⁶ The Sin Duda campaign was coupled with community health worker (CHW) navigation and community-based COVID-19 services to simultaneously address structural barriers to care. The campaign evolved with the COVID-19 pandemic in three main iterations focused on COVID-19 testing, COVID-19 vaccination, and COVID-19 home tests and treatment.

Our team began by developing accessible COVID-19 testing and vaccination services in partnership with local community-based organizations (CBOs).^7,8 Services included free community-based events conducted twice a week as well as a COVID-19 hotline for Latinos, each staffed by a team of bilingual CHWs. We then developed and implemented the Sin Duda campaign, guided by a community advisory board at each stage. The campaign name was developed through a crowdsourcing open contest to incorporate community input.⁹

The campaign’s “call to action” was to visit the project Web site (www.sinduda.org), which included COVID-19 information in English and Spanish and options to request CHW navigation to COVID-19 services via a Qualtrics form or the hotline. The campaign content was designed to have not only linguistic concordance but also cultural congruence, incorporating cultural beliefs from diverse countries of origin guided by input from Latino community members and team members (e.g., the community advisory board, CHWs, media designers).

Advertisements were distributed through Facebook and Instagram (Figure A, available as a supplement to the online version of this article at http://www.ajph.org) as well as Facebook and WhatsApp CBO groups. The campaign’s testing and vaccination phases each consisted of two social media pushes six to eight weeks in duration that featured four to six new advertisements to capture users’ attention and prevent advertisement fatigue. Finally, we included offline advertisements (e.g., radio, billboards) for two- to three-month periods to build campaign recognition and reach those without social media access.

PLACE, TIME, AND PERSONS

The Sin Duda campaign launched across Maryland on March 1, 2021, and remains active. Here we present the first year of data (through March 1, 2022), which included the COVID-19 testing and COVID-19 vaccination iterations. Services are designed to meet the needs of Latino adults and children in Maryland, with a focus on those with limited English proficiency.

PURPOSE

The Sin Duda campaign seeks to improve COVID-19 outcomes among Latino populations with barriers to accessing traditional health care settings by (1) promoting awareness and uptake of community-based COVID-19 services, (2) disseminating timely, evidence-based COVID-19 information to combat misinformation, and (3) empowering community members through community-based participatory research and partnerships with CBOs.

EVALUATION AND ADVERSE EFFECTS

Reach was evaluated via online metrics and surveys conducted at 30 different community-based venues (e.g., churches, consulates, parks) from March to July 2022. Participants were asked to provide information on demographic characteristics and were asked whether and how they had seen or heard of Sin Duda. We report descriptive statistics from the first year of the campaign and the survey period.

From March 1, 2021, to March 1, 2022, the Sin Duda campaign reached 305 122 people through paid advertisements on Facebook and Instagram (as measured by these platforms). Further organic (unpaid) reach was achieved via posts on CBO WhatsApp groups and social media pages. For context, the Latino adult population in Maryland is estimated at 492 262 residents; of these individuals, 274 298 are estimated to be foreign born.¹⁰ Figure A displays examples of advertisements with high performance as defined by social media industry benchmarks (e.g., reach, click-through rates).

During the first year, we had 9607 unique visitors to the project Web site (Table 1). After the addition of a vaccination-focused page in May 2021, there were 1075 Web site requests for COVID-19 vaccinations. Requests via telephone calls were more common than requests via Qualtrics forms.

TABLE 1—

Characteristics of Mejor Vive Sin Duda Web Site Users: Maryland, March 1, 2021–March 1, 2022

	No. (%)
Referral source
Social media advertisement	7321 (76)
Direct URL entry	1830 (19)
Google or other Web site	456 (5)
Language
Spanish	5283 (55)
English	4324 (45)
Method of access
Mobile phone	7686 (80)
Desktop computer	1825 (19)
Tablet computer	96 (1)
Location
Maryland	6965 (73)
Outside of Maryland	2642 (27)
Means of request for COVID-19 vaccine servicesa
Call to Baltimore Esperanza Center hotline	408 (38)
Call to Maryland vaccine hotline	260 (24)
Qualtrics form	407 (38)

Note. The sample size was 9607.

^a May 20, 2021, to March 1, 2022 (n = 1075).

Among the 424 survey respondents, 29% (n = 121) indicated they had seen or heard of the Sin Duda campaign. Facebook was the most common means of exposure (n = 102; 84% of those exposed), followed by WhatsApp (n = 64; 53%). Of the respondents exposed to the campaign, 61% (n = 74) reported that it influenced their decision to get vaccinated, 32% (n = 39) reported that it helped them understand how to obtain vaccination or testing, 12% (n = 14) reported that it influenced their decision to undergo COVID-19 testing, and 16% (n = 19) reported that it did not influence them.

There were no known adverse effects stemming from this intervention.

SUSTAINABILITY

We adapted the Sin Duda campaign to focus on home-based testing and linkage to COVID-19 treatment. As a result of improved testing and vaccine availability via state and local agencies, CHW navigation has shifted to include these services. After the current funding period, the Web site will remain a resource to Maryland communities as long as it is relevant in terms of the COVID-19 pandemic.

PUBLIC HEALTH SIGNIFICANCE

The Sin Duda campaign is one of the first social marketing interventions to promote COVID-19 services in Latino communities that are home to residents with limited English proficiency. Community engagement at each project stage was key to ensuring relevant and effective content. In its first year, the campaign reached 305 122 Latino individuals across Maryland, and survey data demonstrated comparable reach to previous interventions.⁵ The majority of survey respondents exposed to the campaign reported that it influenced their decision to get vaccinated or helped them understand how to obtain services. However, 71% of survey respondents did not report campaign exposure, highlighting the need for further efforts to more effectively reach underserved populations.

By coupling the reach of social marketing with community-based services to address systemic barriers to care, we were able to serve Latino populations in Maryland in multiple ways. First, the campaign increased awareness of local COVID-19 services, thereby expanding the potential client base for COVID-19 testing and vaccination. Second, social marketing provided a nimble medium to disseminate timely, evidence-based COVID-19 information. Third, Sin Duda provided culturally congruent avenues of communication for Latino individuals outside of traditional health care settings.

Our experience may inform future social marketing interventions seeking to reach underserved populations. Although Instagram and Tiktok have eclipsed platforms such as Facebook and WhatsApp among younger and English-speaking populations, CBO Facebook and WhatsApp groups have proven key in reaching Latino immigrant adults.^5,11 This represents an ongoing opportunity to financially support local CBOs while distributing information through trusted community channels.

In terms of content, the highest performing advertisements featured themes of self-efficacy and collective efficacy.⁹ Media coverage of COVID-19 in Latino populations has often focused on vaccine hesitancy.¹² Our team has found that, in addition to addressing intersectional factors that contribute to vaccine hesitancy, strength-based messaging can be more effective than deficit-based messaging. Future social marketing interventions can tailor lessons learned from the Sin Duda campaign to local communities and should incorporate access to culturally congruent services to address systemic barriers to care.