How trusted messengers in eastern North Carolina are building faith in public health

Public health depends on science. But science alone doesn’t build trust.

In rural eastern North Carolina, trust is shaped by lived experience — by whether systems have shown up, whether care is accessible, and whether people feel heard.

This week on Rural Narratives, we look at trusted messengers: the neighbors, providers, community health workers, and local leaders who help people make sense of health information because they understand both the facts and the realities of the communities they serve.

Guests: 

Erin Storie, COO at Care Share Health Alliance

Alice Richman, professor at ECU and director of the Rural Health Disparities Lab

Rural Narratives is a project of Narrative Arts, a nonprofit media and storytelling organization working alongside communities to share stories that deepen connection, expand understanding, and strengthen public life in rural America. Learn more at www.narrativearts.org.

Transcript

SPEAKER_04 0:00

Public health depends on science, but science alone doesn't build trust. Sometimes we need to hear the information from someone we feel like just gets it. Someone who understands our experiences and concerns. And in communities in rural eastern North Carolina, that someone makes all the difference. I'm Lena Hong. Welcome to Rural Narratives. This week's episode is all about trusted messengers and the importance of how information is delivered and by who. Our guests are two North Carolinians who think deeply about how trust is built in rural health work. Erin Story grew up in rural northeastern North Carolina and now serves as chief operating officer at CareShare Health Alliance. They partner with organizations across the state to expand health access and equity. Then we'll hear from Dr. Alice Richman, a professor at Eastern Carolina University. She's the director of the Rural Health Disparities Lab. Her work focuses on vaccine hesitancy and community-engaged public health. For transparency, Dr. Richman advises narrative arts on our rural health programming. She was not involved in the making of this episode of Rural Narratives. When people are unsure about public health guidance, the problem is not always a lack of facts. Of course, the science matters, but people also pay attention to who is telling them the information. We do it all the time in our everyday lives. If your longtime neighbor told you that there was a huge sale coming up at the store down the street, that feels a lot more trustworthy than if a stranger stopped you and told you the exact same thing. That perspective matters in northeastern North Carolina, where Aaron's story grew up.

SPEAKER_03 1:57

I lived in like eastern North Carolina. I want to say maybe like close to 30 years.

SPEAKER_04 2:02

She grew up in Gates County, near the Virginia border.

SPEAKER_03 2:05

One of the most rural counties in North Carolina is Gates County. We have, or at the time that I was living there, we have one stoplight for the entire county.

SPEAKER_04 2:14

Now she runs CareShare Health Alliance, which partners with organizations all over the state to address health issues for the most vulnerable North Carolinians. She has a lot of experience in rural health communications. Erin used to work at a health center serving the community she grew up in.

SPEAKER_03 2:30

One of the really great things about that job was that I really got to help people who either I knew or very easy to relate with them with the situations that they were in. And I like to think that that maybe helped me be a better communicator to those people.

SPEAKER_04 2:47

Where Erin grew up is part of a cluster of counties that are consistently ranked bottom in health outcomes in the state. Many of these counties have large black populations and higher poverty rates. Erin says these outcomes are not about individual failure. Rather, it reflects deeper barriers like limited funding and fewer local services and resources.

SPEAKER_03 3:07

It's never because the people in eastern North Carolina don't want to help, like, you know, teachers don't want to help their students, providers don't want to help their patients. It's because they are working with very little to provide to a lot of people. Because there's just not other resources there that can like mitigate the fact that they're not funded well enough from the federal state level.

SPEAKER_04 3:30

Over time, these conditions shape how people experience public health systems and whether they believe those systems are working for them.

SPEAKER_03 3:37

Feeling screwed over is a very consistent feeling. I think most rural communities in North Carolina feel like that, but I feel like it's pretty intense in the eastern part of the state.

SPEAKER_04 3:49

One example of how these feelings showed up was in 2020, when the COVID-19 vaccine was first rolled out to the public just nine months after the start of the pandemic. And there was resistance to getting the shot everywhere in the country. I was in Chapel Hill at the time, and the way that I grew up, I always got all my vaccines without question. So here I was, surrounded by some of the best healthcare facilities in the state and equipped with all the right information that assured me that it was safe. And yet, it still took me three months to get the first shot, and only after I saw multiple people in my community do it as well. And Erin says that she was in a pretty similar situation.

SPEAKER_03 4:29

Even I had concerns about it too, which is unlike me. But you know, I felt like enough people around me were taking the vaccine and vouch for its safety that I would feel comfortable doing it too.

SPEAKER_04 4:44

For many people, questions about the COVID-19 vaccine were tied to deeper concerns. Does the government have my best interests at heart? Can I trust public health institutions? In Eastern North Carolina, that feeling was heightened. At this point, it wasn't enough to reassure people with statistics on how safe vaccines are, or telling them that vaccines need to go through long processes before they're rolled out to regular people.

SPEAKER_03 5:10

You have to start with somebody who is part of the community, is a trusted member of the community, and is willing to make a one-on-one connection and take time with people who might have concerns about things that could potentially really help them.

SPEAKER_04 5:25

At the time, Erin worked on a social media campaign for the health clinic to help ease some of these concerns. Instead of relying only on official public health messages, she asked familiar faces in the community to share why they chose to get vaccinated. Aaron says the posts from the campaign were very popular on social media.

SPEAKER_03 6:11

You know, anything. Anything where we put a staff member on, like our Facebook or social media, like it that it would just blow up, like it would go viral in Hartford County, you know?

SPEAKER_04 6:24

At the end of the day, these trusted individuals were following what all the health organizations were recommending, but it mattered that they were the ones delivering that message to their community.

SPEAKER_03 6:35

That was kind of where we were coming from with that. Is it's like we just really wanted people to know that they're people that they trusted, people that were in their community, believed in the vaccine, believed in it to keep people safe and to keep them safe as well.

SPEAKER_04 6:50

Aaron calls them trusted messengers, people who are already known, respected, and believed in a community. That same idea is central to Dr. Alice Richmond's work at Eastern Carolina University, where she researches rural health disparities and vaccine hesitancy.

SPEAKER_02 7:07

The location of ECU, we're really located in a rural part of the state. And so we have a lot of counties out here that are deeply in need.

SPEAKER_04 7:15

ECU is in Greenville, which is in northeastern Pitt County. A lot of Dr. Richmond's research has focused on the HPV vaccine. HPV is a commonly sexually transmitted infection. Most cases go away on their own, but some can lead to several types of cancer. The HPV shots are typically given from a young age. That particular vaccine has had a lot of hesitancy around it. She says some of the hesitancy came from misinformation about side effects and stigma around HPV being sexually transmitted. Dr. Richmond started looking more specifically into messaging around vaccines because of the uncertainty people felt about the COVID-19 shots.

SPEAKER_02 7:54

I really wanted to work with communities to understand what messages they were getting from the messengers, so the from the government, from people they trusted, and how did they perceive those messages? And also having the community develop messages by them for them.

SPEAKER_04 8:12

She partners with communities to come up with long-term solutions.

SPEAKER_02 8:15

What that really means at the core is that involving the community from the needs assessment, like what are the needs affecting your community? What are things that are problematic here? How would you think that we should address that? And sort of coming up with a collaborative approach to addressing that and then delivering that community engaged program or intervention collaboratively and evaluating it and then giving that back to the community in a reciprocal way.

SPEAKER_04 8:41

Her work centers around identifying and supporting trusted messengers in the community.

SPEAKER_02 8:46

We know that provider recommendation is the number one reason why people get the vaccine and complete the series. And so a lot of the research has been focused on provider recommendation.

SPEAKER_04 8:56

She says providers and other trusted messengers need information and the confidence to make a strong recommendation.

SPEAKER_02 9:03

And not just telling someone, but really explaining what that prevents and what that means. So me as a parent, if someone says this can prevent cancer for your child, I'm more likely to listen than if they just say, Do you want to get this vaccine for your child? It's recommended. Like I want to know the reason of why I want to protect the health of my child.

SPEAKER_04 9:22

And it's not just primary care providers. Dr. Richmond also works with community health workers who share vaccine information and supports people in getting care.

SPEAKER_02 9:32

We equip community health workers with pertinent information and they go and educate and navigate to age-appropriate screening doing that intervention, looking to see can this community health worker delivered intervention both increase knowledge about vaccine, but also access to care? Can it actually change some behavior?

SPEAKER_04 9:50

These approaches also help address the barriers to care, like transportation time and navigating the health system.

SPEAKER_02 9:58

So someone might not have transportation to get to a place to get a vaccine. Someone might have other structural barriers. They might work a few jobs and not be able to go when the place is open. They might need help making an appointment, understanding how that process is, showing up to an appointment, navigating that process at the point of care. Some of that can be scary. Some of that can be not well known to someone, setting up a telehealth appointment if they're not mobile.

SPEAKER_04 10:23

She says involving communities from the start can build trust. And that can then lead to stronger support for policies that shape their health. In both conversations with Dr. Richmond and Aaron, I asked what it feels like to do this work at a time when public health has become so politicized and trust has been strained. Dr. Richmond says the way COVID-19 was handled still shapes how people respond to public health messages today.

SPEAKER_02 10:56

We've had a lot of misinformation. We have a lot of uncoordinated events that haven't looked good and that have been politicized. And then since the COVID-19 pandemic, vaccine hesitancy has really come to light even more for not just HPV vaccine, but a lot of other pertinent vaccines that we have that against vaccine preventable diseases that people need to stay healthy.

SPEAKER_04 11:19

Ongoing policy debates and shifts in public health funding and messaging have left many people unsure of what they can trust and who.

SPEAKER_02 11:28

But despite all the challenges, we're still here and we still want to continue to work in this area, even in these hard times when it's there's not a lot of funding.

SPEAKER_04 11:38

Erin sees it similarly. She says rural Eastern North Carolina is vulnerable, but people there know what is happening to their communities.

SPEAKER_03 11:46

There is a lot going on in Eastern North Carolina, but the people that live and work there who are trying to do work to assist their communities and to support their communities, they're doing a really good job. And there's a lot of people there who truly believe in what they're doing and they're doing their absolute best to help the situations that unfortunately are being thrust on Eastern North Carolina.

SPEAKER_04 12:12

Just because you have the credentials or the authority, it doesn't guarantee that people trust you. In rural Eastern North Carolina, trust often starts with someone people already know, the person who listens, who understands, and helps them get what they need.

SPEAKER_03 12:29

Those trusted community voices, there's always somebody in the community who absolutely knows what's going on and is sharing it with their community members. I'm Lena Hong. Thanks for listening to Role Narratives.