Evaluating the Peel Community Health Ambassador Program: Building trusting, equitable, and responsive healthcare during the COVID-19 pandemic

Peel has seen the highest positivity rates of COVID-19 across the province and country. While many people who identify from Peel’s diverse communities have experienced negative impacts to their overall health and well-being, data collected throughout the pandemic show that certain communities have been disproportionately impacted by COVID-19 based on race, immigration, gender, housing, and employment. In response to these structural inequalities including racism and discrimination that have impacted COVID-19 testing and vaccination rates in Peel, the Community Health Ambassador program was developed and implemented through the High Priority Community Strategy (HPCS) at 6 community agencies. The purpose of the program was to provide culturally specific community outreach, education, and support during Wave 3 of the COVID-19 Pandemic in Peel. While the six community agencies were required to collect data on key performance indicators and report to Ontario’s Ministry of Health, a summative evaluation of the program has not been completed which creates an important research gap regarding the effectiveness of this type of community-driven response to address structural inequalities during the COVID-19 Pandemic.

The goal of this one-year project is to accelerate the availability of high-quality and real-time evidence regarding the impact of a community-driven solution, the Community Health Ambassador Program, on structural inequalities, including systemic racism, that continue to hamper the response and recovery from COVID-19.  In direct response to locally identified needs and research gaps, the specific objectives of this project are to: 1) Explore how the Community Health Ambassador Program has addressed structural inequalities and discrimination such as systemic racism during COVID-19 response with individual’s that identify from South Asian, Black and racialized communities in Peel; and 2) Conduct a program evaluation to assess the overall impact of the Community Health Ambassador Program.

A Community-Based Participatory Research (CBPR) approach will be used throughout this study with equitable collaboration and partnership between community leaders, service providers, CHAs, community members, and researchers. This project will use the mixed methods PRISM framework to evaluate the CHA Program in the areas of Reach, Effectiveness, Adoption, Implementation, and Maintenance as well as contextual factors such as multi-level organizational and recipient characteristics and perspectives, implementation and sustainability infrastructure, and external policies or guidelines. Quantitative data will be abstracted from the monthly reports that include key performance indicators submitted by the community agencies to Ontario’s Ministry of Health. Qualitative data will be collected through virtual semi-structured interviews and focus groups with community agency leaders, Community Health Ambassadors, and service users of the Community Health Ambassador Program                                                                                                                

The proposed project will yield high-quality, rapid cycle, relevant evidence with our diverse communities across Peel, filling a critical research gap by evaluating an innovative community-driven solution. Our project offers a coherent and integrated response from community service providers, healthcare workers, public health authorities, policymakers, and decision-makers in a region that has been disproportionately impacted by the COVID-19 Pandemic. The findings will help Ontario and Canada respond effectively to the ongoing pandemic and minimize the direct and indirect impacts on people who identify from racialized communities experiencing structural inequalities within and across Canadian and global jurisdictions. The model can likely be used to address other chronic diseases such as diabetes, heart disease, cancer, and mental health.

PARTNERHSHIPS: Canadian Mental Health Association, Peel Dufferin School Board, Dixie Bloor Neighbourhood Centre, Indus Community Services, Peel Public Health, Punjabi Community Health Services Roots Community Services, WellFort Community Health Services

FUNDER: Canadian Institutes of Health Research