The HERO (Healthcare Workers Exposure Response and Outcomes) research program recruited more than 55,000 healthcare workers and members of their communities to participate in the HERO Registry, where participants shared what it is like to work and live during the COVID-19 pandemic.

HERO used a variety of strategies to recruit healthcare workers with diverse professional backgrounds, including nurses, therapists, physicians, emergency responders, food service workers, environmental services workers, interpreters, and transporters. Anyone who worked in a setting where people receive health care, and their family members, close contacts and community members, was eligible.

A healthcare worker (HCW) Subcommittee was formed early on to guide study conduct through the lived experiences of frontline health care workers. Subcommittee members included an environmental service worker, a respiratory therapist, nurses, clinicians, a paramedic, a hospital administrator, and a medical technician. The HCW Subcommittee co-chairs were also members of the HERO Steering and Executive Committee team, to ensure adoption of HCW-focused priorities.

The recruitment plan prioritized authentic engagement of HCWs and HCW groups to enhance inclusive study recruitment, inform retention strategies, implement multifaceted engagement tools and leverage the participant portal to return value to HERO Registry members.

The HERO team also engaged with community members to provide recommendations and best practices to improve inclusion. Community engagement methods included two virtual Community Engagement Studios with racially and ethnically diverse members of underrepresented healthcare worker groups and nine semi-structured interviews with HERO Healthcare Worker Subcommittee members.

Specific approaches used to enhance diversity in HERO included encouraging healthcare workers to be champions, video testimonials from members, social media campaigns, earned media, and digital media targeted campaigns in cities with a high prevalence healthcare workers from diverse backgrounds. The team developed a toolkit for community partners to help spread awareness about the HERO Registry. The kit included promotional materials, messaging options, and the opportunity to request printed materials. The team also partnered with influencers, nursing homes, community partners, and professional associations such as the American Dental Association and EMS World, to raise awareness of the program and broaden the diversity of the program by role, race, and ethnicity.

The most successful strategy for enhancing enrollment and diversity in the HERO Registry was a pharmacy referral campaign that included an email invitation to people who were recently vaccinated to join HERO-TOGETHER and participate in a post-vaccine observational research. With this campaign, the team reached the enrollment goal of 20,000 participants early and achieved broader representation in the study population. Enrollment of people identifying as Black increased from 5.2% pre-campaign to 9.4% post-campaign and inclusion of people identifying as Hispanic, Latino/a increased from 8% to 12%.

The HERO team highlights the importance of:

• Involving the community throughout the project to guide and influences the registry’s plan, design, development, and future direction to reach diversity goals
• Setting early, measurable enrollment goals for Registry representativeness
• Enhancing inclusive registry enrollment by using diverse photo and video representation; sharing exciting, frequent social media posts; partnering with racial and ethnic minority groups within large organizations; using existing participants as registry ambassadors; developing ways for participants to engage with each other; and listing examples of healthcare worker roles being recruited.
• Developing communications and outreach efforts that consider diversity and appeal to broad audiences, and tracking and measuring the impact of these efforts.