Advancing Inclusive Communication During COVID-19

Understanding individual COVID-19 risk and prevention is critical to prevent the spread of the virus. Millions of people require some form of accessible information that is clear, actionable, and appropriate for their needs. However, few such COVID-19 resources existed in 2020, particularly for those with disabilities. To address this gap, CDC funded the development of COVID-19 information in inclusive and accessible formats. 

One in four American adults reports having at least one physical, intellectual, or developmental disability. The COVID-19 pandemic disproportionately impacted people with disabilities and widened existing health disparities and inequities. For many people with intellectual and developmental disabilities (IDD), these disparities were compounded by literacy limitations, such as extreme low literacy (ELL), that made it challenging to access, understand, and act on critical COVID-19 prevention information. For Spanish-speaking people with IDD and people who communicate using American Sign Language (ASL) or braille, finding accessible and appropriate COVID-19 resources was even more challenging.

Using our substantial experience in engaging people with disabilities and/or literacy limitations and creating award-winning materials, RTI researchers and our partners at CommunicateHealth developed a multifaceted approach to increase inclusivity in health communication about COVID-19.

Formative Research

RTI researchers began by defining three priority audiences:

1. People with IDD and ELL. People with IDD are a diverse audience with a vast array of communication needs and challenges. Our team focused on those with ELL, which includes a spectrum of individuals with literacy limitations, from those who understand common signs and images to those who can read basic books with pictures.
2. People who use ASL. This includes people who are deaf, hard of hearing, or unable to speak and their families.
3. People who use braille. This includes people who are blind or who have low vision.

To identify best practices for communicating with these three audiences, we conducted a literature review and environmental scan and interviewed individuals with accessible communication needs, their caregivers, and staff from key organizations that serve these audiences. 

Material Development 

The RTI and CommunicateHealth team developed a suite of new COVID-19 materials that were culturally and linguistically appropriate and met the diverse communication needs of our target audiences. For those with IDD and ELL, we created easy-to-read content, including webpage text, social stories, interactive materials, and animated videos in English and Spanish. For those who communicate using ASL, we created an ASL video series covering important COVID-19 topics. For those who use braille, we translated COVID-19 vaccine guidance and communication products into digital and printed braille. To ensure that materials resonated with and represented a range of audiences, we considered a variety of intersecting barriers to COVID-19 vaccination and education, such as cost, immigration status, health care delivery modes, and more.

In 2020, very few COVID-19 resources existed in accessible formats, and hardly any had been tested with people with accessible communication needs. Working with CDC, we developed and disseminated 64 Easy to Read webpages, social stories, and animated videos in English and Spanish; 10 ASL videos; and 5 braille resources.

Using a mix of traditional and innovative dissemination techniques to promote materials to people who need them, we generated more than 2 million impressions targeting people with IDD and their caregivers, people who use ASL, people who use braille, and the organizations and health care providers that serve these audiences.

Throughout the formative research and dissemination process, we developed key partnerships with individuals and organizations that support people with accessible communication needs, including the following:

• Sign1News, a digital network that delivers news for the deaf and hard-of-hearing community
• The Daily Moth, a digital network that delivers news in video using ASL
• NFB-NEWSLINE, a free audio news service for anyone who is blind, low-vision, deafblind, or print disabled
• National Library Service for the Blind and Print Disabled, a free braille and talking book library service for anyone who is blind, low-vision, or print disabled

Our research also informed the development of an evidence-based Product Development Tool to help researchers, clinicians, and public health professionals create communication products for adults who have IDD/ELL (Squiers et al., 2023). In spring 2023, our team delivered four trainings to more than 400 communicators and visual designers at CDC on clear communication for people with IDD, people who use ASL, and people who use braille. As a result, CDC now has staff who are trained to develop materials rapidly for this audience in the event of future emergencies. 

Through this project, we learned valuable lessons about developing and disseminating materials in accessible and inclusive formats that can be leveraged for future emergencies:

• We learned that ASL media outlet partners were willing and excited to partner with CDC to share and promote the COVID-19 ASL videos. One of our partners, Sign1News, created a Public Health page for its audience, and the media outlet cited our partnership as the inspiration to build this page. The page will be used to share important public health information with the deaf and hard-of-hearing community. 
• We learned that limited published information is available about best practices for disseminating health information to people who use braille. It is still unclear which material format or channel is best for reaching this audience, as people who use braille may also use digital braille, audio, and other assistive technologies.

In future research on inclusive and clear communication best practices, we hope to identify the most effective dissemination strategies to ensure that materials get into the hands of people who need them, particularly during emergencies. Building a robust dissemination system will help ensure that people with disabilities have access to the information they need.

 To take advantage of the resources developed during this project, visit the following links:

• How to Develop Products for Adults with Intellectual Developmental Disabilities and Extreme Low Literacy: A Product Development Tool 
• COVID-19 Materials for People with Intellectual and Developmental Disabilities and Care Providers
• COVID-19 ASL Playlist