Feedback and Lessons Learned from CBO Program Award Recipients

TAB B: Focus Group Guide

Introduction

Background: Facilitator will provide a high-level overview about the CBO Program evaluation.

HRSA’s Community-Based Workforce to Increase COVID-19 Vaccine Outreach Program (CBO) Program directly supports a community outreach workforce to serve as trusted messengers in their community, building vaccine confidence and addressing barriers to vaccination. Focused on serving the most vulnerable and medically underserved communities, this program builds upon national vaccine education, outreach, and vaccination efforts to tailor approaches to meet unique and diverse community needs.

To further evaluate the CBO Program’s progress toward its goals, the CBO Program Team is hosting guided discussions to complement and contextualize the quantitative data that was collected via Survey Monkey. The feedback you share today will help tell the story of the CBO Program, strengthen our understanding of the overall outcomes of the CBO program, and inform future HRSA programs.

Purpose: Facilitator will share the theme and purpose of the specific Focus Group event.

Informed Consent: Facilitator will review the following statements and cue participants to verbally consent prior to the start of the Focus Group.

• Facilitator will note that the virtual session will be recorded to ensure we accurately capture experiences and ideas shared.

• Facilitator will explain that conversations had during the event should not be shared with anyone outside of the Focus Group, and that the confidentiality of anything they choose to say during the session cannot be guaranteed.

• Facilitator will instruct participants to maintain the privacy and confidentiality of people they speak about.

• Facilitator confirms that no information shared during the event will be attributed to any specific personally identifiable information.

• Facilitator will explain that we have HRSA staff observing.

To obtain consent, facilitator will ask each participant to share their name and state yes/no as to whether they agree to participate in the recorded Focus Group. This will allow participants who do not consent to participate and/or to the recording of the session to disconnect prior to starting the event.

Ground Rules: Facilitator will provide the following list of ground rules prior to starting the event:

• First, there are no right or wrong answers. We are interested in your opinions and perspectives on the needs of your organizations.

• Second, you do not have to agree with everyone else in this room if that is not how you really feel. We expect people will have different views on these questions.

• Third, we want you to feel comfortable saying good things as well as critical things. We are not here to promote a particular way of thinking. We just want to understand your viewpoints.

• Fourth, we ask that you talk one at a time.

• Fifth, we ask that you mute yourself when not speaking and remain fully engaged during the session.

Platform: Zoom; All Focus Groups will be virtual.

Length: All Focus Groups will be one hour.

Theme 1 - Community-Based Workforce

Participants: CBO Awardee Community Outreach Workers

Purpose: To understand the perspectives of Community Outreach Workers and their direct experience with the communities that they served to gain insight on how HRSA can support community-based organization (CBO) and workforce needs.

Note:

• Protocol questions may be translated into Spanish or other languages as needed to conduct non-English-language Focus Groups.

• Facilitator will explain that we use the term Community Outreach Workers to describe the many community-based workforce titles like community health worker, health navigator, promotores, etc.

Focus Group Guided Discussion Questions

1. Please introduce yourself, where you’re located, and your favorite part about doing community outreach work.

2. Do you live in the same community that you served for this program?

   1. If so, do you feel this was helpful for your work?

   2. If not, how did that impact your outreach work, if at all?

3. What strategies were utilized to conduct outreach in underserved communities?

   1. What specific strategies did you use to overcome mistrust? (Including mistrust of government, vaccines in general, etc.)

   2. What challenges did you encounter when using specific outreach strategies?

   3. What specific engagement strategies worked well?

4. How did you adjust outreach strategies to engage different populations, including communities who speak different languages or have different cultural norms, etc.?

1. Based on your experience, what strategies worked best for that population/community?

5. What were community members’ needs? How did they change over time (i.e., new waves, booster authorizations, authorizations for new age groups, etc.)?

   1. How did outreach and education strategies change in response to COVID-19 developments (i.e., new waves, booster authorizations, authorizations for new age groups, etc.)?

6. In your work, how did you help connect or integrate parts of the public health system, e.g., connecting siloed health care providers?

7. Did you feel you had the training and skills you needed to do your job well?

   1. What else could have made your job more successful (e.g., additional supplies, training, staff/capacity, etc.)?

8. If HRSA or another federal agency funded a similar program for community outreach workers, what would you recommend we do differently (from your/the worker perspective)?

   1. Would you be interested in doing work like this again? Why or why not?

   2. What advice or lessons-learned would you share with Federal funders for next time?

Theme Two – Community-Based Outreach Programming

Participants: CBO Awardee Leadership: Project Directors, Program Managers, other Program Staff (Administrative, Evaluation, Fiscal, etc.)

Purpose: To understand the perspectives of HRSA-funded Project Directors and other leaders so HRSA can more clearly understand specific community-based organization (CBO), programmatic, and workforce needs.

Protocol questions will be tailored to incorporate more specific language based on the target population determined for each Focus Group. Some populations of Focus might include:

• First-time HRSA Awardees - Cooperative agreements and local awardees

• Experienced HRSA Awardees - Cooperative agreements and local awardees

Focus Group Guided Discussion Questions

1. Please introduce yourself and share where your organization works and the population that it serves, as well as your role (e.g. as Project Director or other role).

2. How did programs engage community outreach workers (COWs)?

   1. How did programs engage COWs who live in the same community that they serve?

   2. How did programs plan to sustain their COW workforce and/or support COW transition after this award?

3. What successes did your program achieve?

   1. How could these successes be replicated in future programs that establish and expand a COW workforce?

   2. How do you feel your CBO project activities will impact work like this moving forward (e.g., building trust with community, using CHWs for other community health topics, etc.)?

4. What barriers did your program experience (to inform future replications of establishing and expanding a COW workforce)?

   1. How could future programs that establish and expand a COW workforce address these barriers?

   2. What were ‘lessons learned’ in encountering these barriers?

   3. How did organizational capacity affect the program’s outcomes?

5. What specific outreach strategies did you find successful in reaching underserved communities?

   1. What strategies were successful for outreach about COVID-19 vaccination

   2. What strategies were successful for outreach about broader health needs (e.g., chronic disease management, behavioral health, SDOH, etc.)

   3. How did your program adjust your initial outreach strategies to meet the needs of these communities over time?

6. How did outreach and education strategies change in response to COVID-19 developments (i.e., new waves, booster authorizations, authorizations for new age Groups, etc.)?

   1. New waves (e.g., Omicron)

   2. Booster authorizations

   3. Authorizations for new age groups

   4. Other developments

7. How has the CBO Program’s outreach model affected community perceptions of COVID-19 vaccines/boosters?

8. What can we learn about the role of outreach workers in connecting/integrating the public health infrastructure?

   1. Connecting existing siloed health care providers

   2. Other areas of public health infrastructure

9. If HRSA or another federal agency funded a similar program for community outreach workers, what would you recommend we do differently?

   1. Would you be interested in applying for another program like this? Why or why not?

   2. What advice or lessons-learned would you share with Federal funders for next time?

Theme Three – Special Populations

Participants: CBO Awardee Project Directors, Program Managers, other Program Staff (Administrative, Evaluation, Fiscal, etc.), and Community Outreach workers.

Purpose: To understand tailored programming and outreach strategies utilized with different populations of Focus to gain insight on how HRSA can better understand specific community needs.

Protocol questions will be tailored to incorporate more specific language based on the target population determined for each Focus Group. Populations of focus might include:

• Pediatric, adolescent, and young adult populations,

• Rural populations

• Immigrant, undocumented, farmworker populations

• Faith-based based interventions or settings

• Other at-risk populations (people with disabilities, homeless, justice-involved, etc.)

Focus Group Guided Discussion Questions

1. Can you introduce yourself and provide a little background on your work or experience with population/s of focus?

2. How did your organization and Community Outreach Workers tailor outreach and education strategies to best reach population/s of focus?

   1. What were some new/innovative strategies your organization developed that worked well in reaching this population? How did you come up with them?

   2. Are there strategies you tried that didn’t work particularly well with this population?

3. Based on your experience, what would you say were the biggest challenges in reaching population/s of focus?

   1. What are some barriers CHWs needed to overcome to reach this population?

   2. What are some barriers this population faces regarding accessing health care/public health systems?

   3. What were some major factors influencing vaccine hesitancy for your population of focus?

4. How did outreach and education strategies change/evolve overtime in response to COVID-19 developments?

   1. For example: New waves, booster authorizations, authorizations for new age groups, etc.

   2. What was your process for creating/developing new strategies as the pandemic evolved?

5. What do you feel your impact has been in the community?

   1. How do you think the CBO Program’s community-based outreach model affected the community’s perceptions of COVID-19 vaccines/boosters?

   2. How do you feel your CBO Program activities will impact work like this moving forward (e.g., trust building with community, using CHWs for other community health topics, etc.)?

6. Based on your experience, how did outreach workers connect your community/community members to local health care and public health systems?

7. If HRSA or another federal agency funded a similar program for community outreach workers, what would you recommend we do differently?

   1. Would you be interested in applying for/working on another program like this? Why or why not?

   2. What advice or lessons-learned would you share with Federal funders for next time?

Closing

To close, Facilitator will thank the participants for sharing their experiences and perspectives and provide an opportunity for participants to ask questions of HRSA staff, time permitting.

Facilitator will also read the following burden statement:

The purpose of this collection is to obtain feedback and lessons learned from HRSA's Community-Based Workforce for COVID-19 Vaccine Outreach (CBO) Program award recipients to inform the CBO Program outcomes summary and future HRSA programs. The results of this collection will inform lessons-learned from the program and any future funding opportunities for community-based workforce programs. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection is 0915-0212, and it is valid until 04/30/2024. This information collection is voluntary. All information obtained will be used by HRSA and will not be shared with the public. Public reporting burden for this collection of information is estimated to average 1.25 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or paperwork@hrsa.gov.