# Combating Disparities in a Pandemic: Increasing Dissemination of Coronavirus Disease 2019 Resources in Spanish

## TL;DR

This paper describes efforts to reduce the disparity in online traffic between English and Spanish coronavirus information on a public website during the pandemic.

## Contribution

The study implemented and evaluated interventions to increase dissemination of Spanish-language COVID-19 resources.

## Key findings

- Spanish webpage views increased significantly during high-demand periods like pediatric vaccine roll-out.
- There was a 55.4% reduction in the mean monthly difference in webpage views between English and Spanish by June 2021.
- A 71.8% reduction in the mean monthly difference in unique visits was observed by February 2021.

## Abstract

Disparities exist in access to coronavirus disease 2019 (COVID-19)-related health information. We aimed to close a gap in online traffic between English and Spanish COVID-19-related health information on our institution’s publicly-facing website by 50% within ten months.

We used A3 improvement methodology. Outcome measures were the mean monthly difference between English and Spanish COVID-19 online traffic vis-a-vis (1) total webpage views and (2) unique webpage visits. Process measures were stratification of outcome measures by language. Plan-Do-Study-Act cycles included: Recurring advertisements on a local Spanish television station disseminating up-to-date COVID-19 information, including our institution’s Spanish COVID-19 online resources, incorporation of QR codes into clinic discharge paperwork linking to institutional Spanish COVID-19 resources, and leveraging social media to expand reach. Control charts assessed impact over time.

There were 1,226,196 total webpage views (369,983 Spanish; 856,213 English) and 1,065,536 unique webpage visits (350,518 Spanish; 715,018 English). Both outcome measures displayed sustained, special cause improvement from a mean monthly difference of 25,397 to 11,321 webpage views (55.4% reduction, June 2021) and 25,066 to 7080 unique webpage visits (71.8% reduction, February 2021) corresponding to special cause improvements in process measures. Improvements were not temporally associated with an intervention but coincided with emergency use approval of the COVID-19 vaccine for children aged 12–15 years (May 2021).

Although our interventions did not directly show improvements in our measures, we noted increased page views of Spanish COVID-19-related health information on our institution’s publicly-facing website in times of high demand for linguistically appropriate services, including pediatric vaccine roll-out.