Background and objective:
In August 2021, Melbourne (Australia) entered another period of lockdown and restrictions in response to the COVID-19 pandemic. Messages about vaccinations and other COVID-safe behaviours were not reaching everyone because people’s particular health literacy needs were not considered. People experiencing vulnerability and disadvantage, such as those living in social and public housing were most at risk. This research aimed to develop a granular understanding of the experiences and health literacy needs of people residing in these settings to optimise communication and engagement for COVID-19 prevention and safety.

Methods:
The Ophelia (Optimising Health Literacy and Access) process, a participatory community-based method, was chosen for this research project to accelerate the generation and deployment of fit-for-purpose interventions. Community engagement processes included approaches through trusted local entities, incentives, and repeat targeting (with incremental trust development). Postcards were disseminated to recruit people for an online or phone survey. Doorknocking occurred in tandem with service providers to conduct the survey face-to-face. The research team also attended community events such as pop-up vaccination hubs. Sixteen workshops were held with 4 teams of health workers and weekly sense-making meetings were held over 9 months with executives from 5 health services.

Results:
865 people participated from public and community housing, rooming houses, caravan parks, supported residential services, disability services and homeless hotels. Overall, their health literacy was much lower than national average. Fifty vignettes of typical residents were developed, and these then elicited >400 rapid practice solutions for health workers and managers to implement.

Conclusion:
The combination of COVID-19 related and other variables provided insights into the mechanisms required to inform and generate context-specific interventions. This is important, because it is this diversity that helps us understand why public health messages and engagement strategies, designed to reach the average person, can leave so many behind.