Developing and evaluating the living better @home with COVID-19 model : a co-designed home-based management model for people from Arabic-speaking communities

Rationale: home-based management model for people with COVID-19 is rarely adopted by ethnic minorities, resulting in challenges to provide equitable health services to diverse communities. This study conducted in Greater Sydney, where 37.4% of the population identify as ethnic minorities, aimed to co-design a culturally appropriate home-based COVID-19 management model for people from Arabic-speaking backgrounds. Method: This study occurs in two phases. In phase 1, an experience-based co-design methodology was used. End-users and health professionals were selectively recruited from local Arabic community groups, university and one metropolitan health service to participate in workshops, discussing COVID-19 self-management during the pandemic. Findings from workshops were thematically analysed to identify key elements needed for successful self-management. The model was then implemented and evaluated in phase 2 for reach, feasibility and impact using a study-specific survey and analysis of pre-post COVID Knowledge, Beliefs and Attitudes questionnaire. Results: Seven end-users and six health professionals were recruited for phase 1. Key themes were founded in emotional responses to lived experiences from 2020 to 2021, when mandatory public health orders were enforced by government. The themes included i) fear and anger towards the government for stigmatising the Arabic-speaking communities ii) right to make personal health decisions robbed by health authorities, iii) lack of preparedness for managing COVID-19 at home as they were in disbelief of the government’s COVID-19 management plans, and iv) challenge balancing family and financial pressures alongside implementing COVID-19 safe practices. It was also determined that any program needs to be community-based and supported by varied media and resources in both Arabic and English languages. The model uses a reflective practice approach that builds self-awareness of COVID-19 knowledge, behaviours and beliefs to motivate people to plan for COVID-19. Participants were empowered to develop their individualised COVID-19 plan-on-a-page, adapting the prevention, preparedness, response, and recovery risk management model to be for self-management of COVID-19. A train-the-trainer model was also created to support implementation. Within a month of implementing phase 2, 117 Arabic speaking participants completed the program. All were satisfied with the program, with 92 participants (78%) strongly recommending the program to others. COVID Knowledge, Beliefs and Attitudes scores all significantly improved after the program (Table 1). Conclusion: A community based approach, using reflective practice principles to empower people to create their own management plan improved people’s knowledge, beliefs and attitudes towards COVID-19. Beyond COVID, similar models may be adapted for chronic disease management for ethnic minorities.