Strengthening the organizational health literacy capacity of community-based organizations to support COVID-19 precautionary behaviors in marginalized communities.

In March 2021, the Biden administration announced the Advancing Health Literacy to Enhance Equitable Community Responses to COVID-19 initiative that encouraged local and state governments, as well as other public entities to apply for funding to improve COVID-19 prevention behaviors and vaccination among underserved populations in the United States. The initiative specifically called for projects to adopt an approach that included health literacy as described in Healthy People 2030 and the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (NCLAS). The City University of New York Graduate School of Public Health (CUNY SPH) and New York City Department of Health and Mental Hygiene (NYC Health Department) worked together to identify the approach most suitable for improving COVID-19 prevention behaviors in communities in NYC that were disproportionately impacted by COVID-19. Given the role of community-based organizations (CBOs) in COVID-19 information dissemination, personal protective equipment distribution, and filling social services gaps such as food distribution, the approach included augmenting community-based organizations' skills for doing this work primarily via improving their organizational health literacy and their NCLAS practices. This paper describes the implementation of the Community-based Initiative for Health Literacy and Action (CIHLA). From March 2022 to June 2024, CUNY SPH and NYC Health Department worked with four community-based organizations that served four Black, Indigenous, and people of color neighborhoods disproportionately impacted by COVID-19 in NYC to build their organizational health literacy and NCLAS practices to improve their capacity to meet the needs of their communities. The approach included the development of a health literacy plan, didactics such as workshops and communities of practices, and a quality improvement process using the Plan-Do-Study-Act model where plans for improvement were introduced and changes were tested at rapid rates. This paper describes the implementation of CIHLA and lessons learned that may be helpful to other researchers and practitioners applying organizational health literacy principles and interventions in community settings to address health inequities.