Public health information communication preferences among residents in six (6) King County homeless shelters between March 2020 and October 2021; Lessons from the COVID -19 pandemic

Introduction: An unforeseen outcome of the COVID-19 pandemic was the unprecedented proliferation of misinformation, commonly termed as an 'infodemic.' This had extensive repercussions, including a reduced ability for homeless shelters to effectively convey accurate information to their residents, who have specific needs as persons experiencing homelessness. We sought to better understand approaches used by shelters to inform residents(people experiencing homelessness) about COVID-19, how the information was perceived, and how to improve communication strategies. Methods We conducted semi-structured interviews and focus group discussions across six homeless shelters in King County, Washington between July and October 2021. We systematically selected residents and staff aged ≥ 18 years for interviews and recruited a convenience sample of residents aged ≥ 18 years who had not participated in the interviews for focus group discussions. We used a conceptual model informed by the Health Belief Model and the Confidence, Complacency, Convenience Model of Vaccine Hesitancy to understand factors influencing shelter residents’ COVID-19 information choices, perceptions, and experiences with shelter-specific communication. Thematic analysis was conducted using Dedoose. Results We conducted interviews with 25 shelter residents, six shelter staff, and eight focus groups with 43 residents. Residents reported that they received COVID-19 information from internal homeless shelter sources and external sources. Internal sources included shelter staff and residents; external sources included family, friends, healthcare providers, and other physical and online resources. Participants selected information sources based on perceived usefulness, objectivity, and trustworthiness, and if the sources were viewed as authorities on COVID-19. Shelter management was instrumental in disseminating COVID-19 information by providing staff with up-to-date COVID-19 information during meetings and sharing online and printed resources. Staff then utilized established channels to share the information with residents, including through individual and group verbal communication, posters, and flyers that were distributed to residents. While some of the shelter-provided information was perceived as well-informed, consistent, and visible, some residents reported that information was not well delivered, lacked compassion, and did not reach all residents. Shelter residents preferred communication that was simple, clear, and compassionate, and which included explanations for various recommendations. They also reported the need for tailored messages, multimodal communication, communication from trusted health professionals, and inclusion of people experiencing homelessness in message development. Conclusion Participants expressed a preference for person-centred communication approaches and underscored the importance of effective pathways for disseminating health information within homeless shelters. Utilizing clear, concise, and specific public health messaging and channels tailored to individuals experiencing homelessness can significantly improve communication between shelters and their residents. Utilizing the right channels through trusted messengers can help deliver health messaging to effectively reach people experiencing homelessness.