The Peoples and Places Framework, which is based on ecological models of health, provides an approach for combining communication and marketing principles for the purpose of achieving public health objectives[1],[2]. The playbook leverages this framework for analyzing vulnerable populations by understanding  the attributes of “people and “places” that influence both individual health behavior as well as the health of the larger community. For the purpose of this playbook, the focus will be on People and Places attributes for vulnerable populations, specifically at the community level. When conducting an analysis of a vulnerable population, it’s important to remember that “one size does not fit all.” A vulnerable population in one geographical area of the country will not be the same in all areas of the country. For example, Native American tribes, which differ in attributes of people and place depending on the tribe. An analysis of each community must be conducted in order to design effective, customized health communication interventions.


Oftentimes, health communication strategies are planned based on a larger level analysis of a population at a national or state level. This may result in overlooking the uniqueness of vulnerable populations within those larger geographic areas. In this section, we will address understanding the attributes of a community such as their social norms, values, beliefs, cultures, fears, social networks, vaccine intention, income disparities, which contribute to COVID-19 vaccine adoption and health messaging to promote behavior change.

Social Norms, Values and Health Beliefs

Community and individual social norms, values, and health beliefs will influence COVID-19 vaccine adoption and how receptive they will be to vaccine health messaging[1]. For example, is the social norm for a specific population to put the greater good of their community or people over the individual need? What do they value – is it health for the community, family, or self; the desire to get back to life the way it was; the ability to get together with family and friends; the choice of whether or not to take the vaccine versus having it be mandated by work or school;  the safety of the vaccines? Understand how religious beliefs may affect their decision to adopt the COVID-19 vaccine. For example, are there ingredients in the vaccine that may be counter to their religious beliefs?

Barriers to Vaccine Adoption

There are many communication barriers that can prevent vaccine adoption such as health literacy levels, digital literacy levels, access to certain communication channels, and language barriers.[1] Lower health literacy levels in vulnerable populations have been associated with greater medical mistrust and have lower quality communication with healthcare providers.[2] Vulnerable populations with low health literacy levels may also experience disparities related to digital health literacy.[3] Greater attention to the disparities in digital health should be considered as more health information is delivered in an online format.

Socioeconomic factors, race and ethnicity can also play a role in the adoption of health behaviors. Vulnerable populations., who were born outside of the U.S. and with lower socioeconomic status, have been found to have limited resources for health information; Blacks are more likely to seek health information from healthcare providers, while Hispanic are more likely to get health information from broadcast media[4]. Additionally, age and health literacy levels should also be considered during analysis. Older adults have unique health literacy challenges that need to be considered such as the need of assistance with signing up for the COVID-19 vaccine online, and assistance with understanding both online and print instructions due to cognitive, visual and auditory limitations.[5] As part of the analysis, health communication scientists must consider all of these factors prior to designing communication strategies.

  • Ensure that messaging is at the appropriate health literacy level for the target population and is written in plain language.
  • If using digital communications, ensure that the target audience has access to the content and is at the appropriate literacy level to understand the content provided
  • Understand the communication channels and sources most used by the target audience for health information.
  • Understand the specific socioeconomic barriers that may prevent a target audience from vaccine adoption.
  • Select the native language of the target audience when develop health messaging.
  • Ensure that the health messaging is culturally appropriate.
  • Understand cognitive, visual and auditory limitations/barriers that can impact the ability of the older adults to get vaccinated.

Message Delivery

Choose the Right Messenger

Barriers: Lack of Trust in Health Information

Trust plays a major role in effective communication with a community. Oftentimes, health communication campaigns use government leaders as the spokesperson. For communities that are distrustful of the government, elected officials may not be the best choice to communicate health messages.


Community Opinion Leaders
Choose leaders within the community, who have already established trusting relationships with its members such as faith leaders, community healthcare providers, and small business owners.

Frontline Workers
Consider frontline workers, who interact with community members everyday and have developed trusted relationships, deliver the messages. They are in the places where community members most frequent such as health centers, barbershops, beauty salons, community centers, senior centers, local pharmacies, bingo halls, and small community grocery stores. These can also be groups consisting of trusted lay community members who can share health information directly with their community. Because they are from the community, they understand local culture, beliefs, norms and values and can break through communication barriers such as language.

Identify who the gatekeepers are in the community. These respected community members control information that flows to the people that you want to reach. An example is a familial gatekeeper. In different cultures a particular family member such as the abuela in the Latino community decides what information and health services should be accessed by the rest of the family, and even, whether or not family members should get a COVID-19 vaccine. Health communication efforts can focus on educating them on the COVID-19 vaccine. Health campaigns can also leverage these familial gatekeepers to assist in the formative evaluation of health messaging and communication strategies.

Use communication vehicles that resonate with specific communities

Barriers: Preferences for Receiving Communication Messages

In all geographic areas, whether it be a county, city or town, there are diverse communities consisting of different race and ethnicities with their own cultural beliefs, values, social norms, and language. Not only is the right message important but also how that message is delivered. 


We have already discussed the importance of identifying the messenger.  But of equal importance is understanding where a particular community goes for health information such as local news, online social networks, word of mouth, community newspapers radio stations, information sheets, etc. Consider digital literacy levels before focusing on a predominantly online campaign.