COVID-19 Vaccination Among Environmental Service Workers Using Agents of Change

Vaccine hesitancy remains a barrier to community immunity against SARS-CoV-2 infection. Health care workers are at risk both of infection and for nosocomial transmission, but have low rates of vaccine uptake due to hesitancy. This project sought to improve the SARS-CoV-2 vaccine uptake among environmental services (EVS) workers at a large academic regional medical center using a community-based participatory approach (CBPA).

The CBPA engaged environmental service workers from January 2021 to March 2021. Public health experts and environmental services department leaders developed a 1-hour training for peer lay health educators (N=29), referred to as agents of change (AOC). AOC were trained on COVID-19 infection, benefits of SARS-CoV-2 vaccination, and techniques to address vaccine misinformation among their peers. Following the program, we conducted semistructured interviews with the AOC to document their experiences.

Analysis of the semistructured interviews shows that 89.6% of participants (N=26) felt the training was informative; 79.3% of participants (N=23) reported using personal testimony while engaging in discussions about vaccination with their peers, and the majority of participants (N=26, 89.6%) discussed vaccination outside of the workplace in other community settings. During the 2-month time span of the program, mRNA COVID-19 vaccination rates among the EVS staff increased by 21% (N=126 to N=189).

Our CBPA program demonstrated an increase in mRNA COVID-19 vaccine uptake through using an AOC lay health educator model. As the need for COVID-19 vaccination continues, we must continue to investigate barriers and sources of hesitancy in order to address these through tailored interventions.