Infectious disease researcher puts her bilingual skills to good use

Engagement with the Latinx community helps COVID-19 vaccine acceptance

When it comes to encounters with health care providers and institutions, nothing is more important than trust to Cristina Solis Mendiola, part of the Cincinnati Latinx community.

That’s why it was so critical to her when she made her first phone call after being accepted into the University of Cincinnati/UC Health Moderna COVID-19 vaccine trial that the person on the other end of the line spoke fluent Spanish.

“The important part for her was that she felt comfortable and safe around the place that she was going to go to,” says her bilingual daughter Cristina Morgan, who is also enrolled in the study along with her father, Jose Octavio Aleman Ruiz. “My mom had some not so great experiences in some other health care settings, so this was great.”

Video link: https://www.youtube.com/embed/XXgJ_Xhv5uk?rel=0

The person on the other end of the line on that initial phone call was Shaina Horner, a clinical research professional in the Division of Infectious Diseases at the UC College of Medicine. She played a critical role in reaching out to the local Latinx community to educate them about the vaccine and the vaccine trial. Her connections in the community date back more than a decade.

“The success of this effort was built on work that started in 2006, when several social service and health care providers, dedicated to serving the Latinx community, were struggling to find resources. We were looking for ways to work together and network to provide help for that community,” UC’s Horner says. “Over the course of the last decade through [the organizations] Apoyo Latino and the Latino Health Collaborative, we’ve been able to grow a robust network of resources to support the Latinx community. We’ve figured out how we as providers in the community create that safety net and make sure that we are educating each other about what’s available.”

Cristina Solis Mendiola, left, Cristina Morgan, Jose Octavio Aleman Ruiz, and Shaina Horner, MD in an examination room at Holmes Hospital

Cristina Solis Mendiola, left, Cristina Morgan, Jose Octavio Aleman Ruiz, and Shaina Horner, MD. Photo credit/Colleen Kelley/UC Creative + Brand

Early influences

Horner’s passion for improving the lives of the people in the Latinx community in Cincinnati goes back to her days in high school.

“In high school, I had a really amazing Spanish teacher, Teresa Tolentino,” Horner says. “She really impressed upon us the importance of service learning. As a high school student, I started working at our church food pantry filling out forms for Spanish speakers. Eventually with support from my teacher, I started an English as a second language class in my neighborhood. It really stuck with me when Teresa expressed how we had this responsibility if we spoke another language to use it to help others.”

Horner says since those days in high school, she has attempted to live up to that responsibility. She studied Spanish in college, worked with bilingual after-school programs and worked with migrant workers in a family support center on the west coast north of Seattle.

Shaina Horner, MD, of the UC Division of Infectious Diseases

Shaina Horner of the UC Division of Infectious Diseases/Photo provided

In 2010 after returning to Cincinnati, she worked at the Healing Center, a social services agency in a northern Cincinnati suburb, helping to support and educate the Latinx community. She built connections with other providers to increase access to resources. Her work at the Healing Center and her advocacy to reduce health disparities in the Latinx community led her into community health research. In 2017 she worked with UC College of Medicine students to develop the Student Run Free Clinic, housed at the Healing Center.

Those connections with the Latinx community would come into play a month or so into the COVID-19 pandemic when Amy Rule, MD, a newborn nursery pediatrician with the perinatal institute at Cincinnati Children’s Hospital Medical Center, noticed a pattern.

“We cover all the area hospitals, including University of Cincinnati Medical Center and UC West Chester Hospital and we started noticing in the early part of the pandemic that Latina moms made up 4% of deliveries but 60% of the maternal COVID-19 positives in area delivery hospitals,” Rule says. “My colleague Dr. Keith Martin and I got contacted by Dr. Carl Fichtenbaum, Dr. Maggie Powers-Fletcher and Dr. Kristin Hudock at the UC College of Medicine. They were doing a biorepository study and they noted they kept having to [get] consent [from] people in Spanish and so we were all seeing this trend that there were a lot of Latinx folks who were getting COVID. We were very concerned because we were worried that a lot of these families didn’t have what they needed to isolate.”

Putting passion to work

a woman gets her blood pressure checked by a female doctor in an exam room

Cristina Morgan, left, with Shaina Horner at the UC Infectious Disease Clinic at Holmes Hospital. Photo credit/Colleen Kelley/UC Creative + Brand

Rule and Martin received a Community Engagement Grant through the Center for Clinical and Translational Science and Training (CCTST) for a study involving Latinx community outreach to better understand the facilitators and barriers to care and prevention of COVID-19 infection. In the process of putting that team together, Christine O’Dea, MD, from the Department of Family and Community Medicine recommended Horner because of her deep involvement in the Latinx community.

“Shaina was the first community health worker research assistant who joined our team,” says Rule. “She was amazing, she really carried that first part of our project. She did the majority of our interviews and a ton of our surveys. She really helped us make connections with other partners.”

Around the same time, Rule and Martin were brought on as study collaborators by Fichtenbaum and Powers-Fletcher who wanted as diverse a population as possible for the Moderna COVID-19 vaccine trial. Having already worked with Rule and Martin on the CCTST grant, for Horner it was a natural transition to tap into her connections in the Latinx community to achieve that diversity goal for the trial.

“With the Moderna trial, I was trying to increase participation from within the Latinx community and make sure there was awareness about both the trial and vaccines in that community,” Horner says. “One of the strategies that I used that was really effective was social media. I did interviews on three different social media pages to raise awareness in the Latinx community. The Latinx community is very relational, and it takes a long time to build that trust with people. So when they build relationships with agencies or people that they follow for trusted information, if you can connect with them, it’s a great opportunity to share trusted information through trusted sources. The majority of people who were primarily Spanish speakers who got involved in the study happened as the result of those connections.”

people dancing in colorful costumes at an outdoor festival

Dancers at a Latinx festival. Photo/Apoyo Latino: The Greater Cincinnati Latino Coalition

Martin, a doctor of osteopathic medicine and a clinical fellow and attending pediatrician at Cincinnati Children’s, says the CCTST project and the work that Horner has done with the vaccine trial recruitment was built out of advocacy and partnership building with Cincinnati Latinx organizations including Apoyo Latino: The Greater Cincinnati Latino Coalition, the Latino Health Collaborative, Santa Maria Community Services, Su Casa Hispanic Center and others.

“In collaboration with community members and trainees, we created a large number of videos and infographics, many of which are hosted on the Apoyo Latino website, a big information repository of the Latinx community that was built by Shaina and others,” says Martin. “Although COVID-19 has been this terrible challenge for everyone in many different ways, it has applied a microscope to a community which has often been ignored when examining complex problems such as fear and insecurities about food, jobs, housing and immigration.”

I’m really grateful to do this work. I think it’s amazing in a pandemic to be able to do work that feels really meaningful, and I feel like we’re working toward a solution.

Shaina Horner

Horner says the key to getting the desired diverse enrollment numbers comes down to education and conversations, and it certainly helps to have the skills to talk to that population in their native language. She says in those conversations during the process of getting consent for the vaccines, she can see the relief on their faces as they start to understand that some of their fears about the vaccines are unfounded.

“I’m really grateful to do this work,” Horner says. “I think it’s amazing in a pandemic to be able to do work that feels really meaningful, and I feel like we’re working toward a solution. I’m really grateful to all of the people who are willing to participate. It’s really incredible that these people are stepping up and we couldn’t do this without them. Dr. Fichtenbaum refers to them as ‘heroes’ and it’s true. There is a pandemic and we need a solution and we can’t do it without the people who are stepping up to volunteer.”

Gaining a sense of purpose

Volunteering for the trial gave participant Cristina Morgan a sense of purpose and fulfillment.

“I was literally doing nothing but working and staying home, so, at least helping with the vaccine makes me feel like I’m doing something for someone,” she says. “I’m not a front-line worker and I don’t have one of those types of jobs so, at least with this, I feel better.”

Morgan says her mom felt better having Horner speaking her language as she guided her through the process of the vaccine trial.

“She loved it because every single question that she asked Shaina, whether it was a small question or a silly question or anything like that, Shaina was always super respectful, she never felt like she was asking a stupid question,” Morgan says. “Shaina was just so good at explaining things and telling her everything and reassuring her that everything was fine.”

Lead photo/Colleen Kelley/UC Creative + Brand

Providing education

Research shows Latinos have the highest rates of people who say they won't take the COVID-19 vaccine or that they will only take it if it's required. In addition, many Latinos have language barriers and are being exposed to unregulated campaigns of misinformation. For those reasons, UC published two educational videos (one in English and one in Spanish) about the COVID-19 vaccine. The videos feature Maria Espinola, PsyD, assistant professor in the Department of Psychiatry and Behavioral Neurosciences, and Moises Huaman, MD, and Horner, both with the Division of Infectious Diseases. 

Watch the video in Spanish.

Watch the version in English

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