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October 3, 2022

Becoming Beacons of Trust

Strategies for Building Public Health Outreach

Lenora E. Johnson, DrPH, MPH

By Lenora E. Johnson, DrPH, MPH, Director of the Office of Science Policy, Engagement, Education and Communications in NIH’s National Heart, Lung, and Blood Institute (NHLBI)

When I was a kid, I’d have little debates with my grandmother about whether something was true or not. She’d say one thing, and if I suspected she was wrong, I’d challenge her. “How do you know that?” I’d ask. And without as much as a blink—call it a version of the modern-day clapback—she’d straighten up, look me in the eyes, and say, “I know what I know because I know what I know.”

Over time, I realized that what my grandma knew was based on her lived experiences – at home, around town, at church. She’d been through enough, seen enough—good and bad—to come to conclusions on her own about what was right or wrong, silly or smart, real or fake.  And as an elder in the community, she took seriously her job to pay this hard-earned knowledge forward.

She had become a beacon of trust.  

I thought often of my grandmother at the height of the pandemic, when misinformation about COVID-19-related clinical trials and vaccines ran rampant among the very communities—mostly Black and Brown—that needed accurate information most. They were experiencing disproportionately high rates of severe disease and deaths from COVID-19, and their long and familiar history of underlying chronic health conditions only underscored how deeply entrenched the disparities already were.

At NIH, we knew we had to get evidence-based facts and resources to these communities so they would hear truths, consider them against alternative information swirling about, and make informed decisions about mitigation strategies, vaccines and more. But how? As a federal entity, �����ƽ��already seemed removed, suspect. And because of a nationwide dearth of scientists and researchers of color—a problem we continue to address—few of the people standing centerstage to offer guidance looked like the people they were eagerly hoping to enroll in trials and vaccinate. Needless to say, this chasm between community and institution was problematic. Finding a successful way to bridge the divide required something special, something new. And in my mind, it had to start with humility.

What does that look like? I often think of it as entering the home of somebody you don’t know. You don’t just run up to the door, barge in and say, “Guess what I’ve got for you! You need this!” You knock first, then kindly introduce yourself. If you’re in the South, you’d probably even need to sit on the porch and drink tea for a while. And even then, you may not immediately get invited in because of a wariness, unspoken and not, that says, “What are you doing here really? Why are you coming to me?”

With patience, though, something eventually happens, as my work over the years has borne out. When you begin to show genuine interest or concern about how people are doing in that house, in that neighborhood, in that community, the ones who live there warm up to what you have to offer. But here’s the key: you can’t just “speak” your interest; you have to show it. You go to meet-and-greets, attend health fairs, church services, schools. You sit, talk, listen, pray.

The point: “entering in” takes time.

For us, it also took the help of a vast cadre of people—namely, our community partners, the people and organizations we knew had already won the trust of those they served. These were the elders (think my grandma), ministers, teachers, and community workers who could help us translate information into a language, style and format that would be understood, even welcomed.

It also took other people of color whose varied jobs put them along what we call “the scientific pathway.” These were the funders, researchers, clinicians, and safety monitors—all of whom brought to the mix another level of insight, credibility, and assurance. And their voices resonated. When you hear someone say, “Look, I’m a researcher. I work in this lab. I trust it” —and they have a similar lived experience or cultural tradition as you—it matters.  

Finally, it took neighbors and friends who could do some old-school, pound-the-pavement kind of outreach, using door knockers, pamphlets on windshields, and basic canvassing—all in good spirit. We call it “transcreating,” focusing on meaning in cultures and communities, or “co-creating,” working with communities to realize goals. Suddenly what was old became new again, and in an age of digital overload and confusion, that helped, too.

I guess you could say trust got “distributed;” we connected to people with whom we had long-held relationships, and they in turn connected with people who trusted them.

The challenge now is to figure out how to “enter in” more often, preferably when a crisis is not at our backs, when all anybody wants to do is to sit together on a big porch, drink tea, listen, and learn.