Puerto Rico Community Action Research and Engagement (PR-CARE) to Eliminate Disparities in Diagnostic of COVID-19 among Rural Underserved and Vulnerable Populations.

波多黎各社区行动研究和参与 (PR-CARE) 旨在消除农村服务不足和弱势群体中 COVID-19 诊断的差异。

• 批准号: 10447427
• 负责人: EDNA ACOSTA-PEREZ
• 金额: $ 107.05万
• 依托单位: UNIVERSITY OF PUERTO RICO MED SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10447427
• 关键词: Action Research; Address; Adopted; Attitude; Behavioral; Behavioral Model; Belief; COVID-19; COVID-19 diagnostic; COVID-19 disparity; COVID-19 impact; COVID-19 testing; COVID-19 vaccination; COVID-19 vaccine; Caribbean Hispanic; Caring; Cessation of life; Chronic Disease; Clinical Research; Collaborations; Communities; Community Actions; Computer Assisted; Data; Disadvantaged; Discrimination; Elderly; Environmental Risk Factor; Ethics; Family member; Funding; Future; Gender; Generations; Geography; Goals; Government; Health; Health Policy; Health Services Accessibility; Health behavior; Hispanic; Homelessness; Income; Individual; Intervention; Interview; Knowledge; Language; Low income; Methods; Modeling; National Institute of General Medical Sciences; Outcome; Pathway interactions; Perception; Phase; Policies; Population; Populations at Risk; Poverty; Public Health; Puerto Rican; Puerto Rico; RADx Underserved Populations; Reduce health disparities; Reporting; Research; Research Methodology; Resources; Rural; SARS-CoV-2 infection; Services; Sexual and Gender Minorities; Shapes; Social Work; Structure; Surveys; Symptoms; Testing; Thick; Translational Research; Trauma; Underserved Population; Vaccination; Validation; Vulnerable Populations; Work; base; community engaged research; community engagement; community partnership; coronavirus disease; disparity elimination; disparity reduction; gender diversity; geographic barrier; health care service utilization; health disparity; health equity promotion; human old age (65+); improved; infection risk; informant; intersectionality; lens; medical vulnerability; migration; policy implication; population health; programs; rural area; rural underserved; social; social health determinants; social vulnerability; testing access; uptake; vaccine acceptance; vaccine access; vulnerable community

In Puerto Rico, the COVID-19 burden in the elderly population is significant as 23% of the confirmed COVID-19 cases and 75% of the deaths have been reported in this group with a low testing rate (3.4 per 100,000) in those > 65 years. The knowledge, beliefs, attitudes, and practices about the risk of infection from COVID-19, symptoms, testing and vaccination, remain a public health concern in Puerto Rico. In 2019, 21.3% of the population living in PR were elderly (> 65 years) with 43.3% living in poverty, were isolated, and medically vulnerable due to their chronic diseases. Isolation for elders has been exacerbated due to the high rate of migration of their family members that culturally cared and lookout for them. The Puerto Rico Community Action Research and Engagement (PR-CARE) initiative aims to focus on the elderly communities in PR who are disadvantaged by geography, sexual and/or gender identification, homelessness and/or income to identify how multiple factors serve to disadvantage this at-risk population in COVID-19 testing and vaccine uptake. Our well-established community partner network, using a mixed methods research strategy, has the goal of examining how social determinants of health, in addition to critical policy and environmental factors, address testing and vaccine access and uptake in elderly (> 65 years old) populations in Puerto Rico who suffer from high levels of social vulnerability (i.e., homeless), who are geographically isolated (i.e., living in isolated or rural areas), living in poverty, and gender or sexual diverse (i.e., L.G.B.T.T.Q.I.A.+). Our strategies are guided by four theoretical frameworks: Community Engagement Continuum, Intersectionality-Informed Approach, Anderson’s Behavioral Model of Health, and Historical Trauma. These models will enable us to portray a critical array of multi-domain determinants of health to understand health disparities and healthcare utilization, specifically COVID-19 testing, and vaccinations, in vulnerable elderly communities. Our aims are to: 1) assess federal and Puerto Rico Commonwealth policy implications on COVID-19 testing in low-resourced and socially vulnerable elderly in Puerto Rico; 2) examine individual and social determinants of health that influence the uptake of the COVID-19 diagnostics among low-resourced and socially vulnerable elderly in Puerto Rico and 3) combine results from the systematic policy review and key informants (Aim 1: qualitative) and elderly individuals (Aim 2: quantitative and qualitative) to identify challenges, barriers and effective strategies and language to support and improve COVID-19 testing and other related health outcomes in this vulnerable population. The community engagement research that comprises PR-CARE will work to expand the scope, reach, access to and uptake of COVID-19 testing for vulnerable elderly populations in Puerto Rico. Concurrently, it will identify and create permanent pathways in health policy that increase the availability of health services for vulnerable populations, promoting health equity using the lens of social, ethical, and behavioral implications.

在波多黎各，老年人口的 COVID-19 负担很重，占确诊的 COVID-19 病例的 23%， 75% 的死亡报告显示，检测率较低（每 100,000 人中有 3.4 人）发生在 65 岁以上的人群中。 关于感染 COVID-19 的风险、症状、检测和实践的知识、信念、态度和做法 疫苗接种仍然是波多黎各的一个公共卫生问题。2019 年，居住在波多黎各的人口中有 21.3% 是老年人（> 65 岁），其中 43.3% 生活在贫困中，被孤立，并且由于慢性病而在医疗上处于弱势。 由于文化关怀和关注的家庭成员的高迁移率，老年人的处境更加恶化 波多黎各社区行动研究和参与 (PR-CARE) 倡议旨在重点关注 波罗的海地区因地理、性和/或性别认同、无家可归而处于不利地位的老年社区 和/或收入，以确定多种因素如何使这一高危人群在 COVID-19 检测中处于不利地位， 我们完善的社区合作伙伴网络采用混合方法研究策略，具有以下特点： 目标是研究健康的社会决定因素以及关键的政策和环境因素如何解决 波多黎各高水平老年人口（> 65 岁）的检测、疫苗获取和接种情况 社会弱势群体（即无家可归者）、地理位置偏僻（即生活在偏远地区或农村地区）、居住在 贫困、性别或性别多元化（即 L.G.B.T.T.Q.I.A.+）。我们的战略以四个理论框架为指导： 社区参与连续体、交叉性知情方法、安德森健康行为模型，以及 历史创伤。这些模型将使我们能够描绘一系列关键的多领域健康决定因素。 了解弱势群体的健康差异和医疗保健利用，特别是 COVID-19 检测和疫苗接种 我们的目标是：1) 评估联邦和波多黎各联邦政策对 COVID-19 的影响。 对波多黎各资源匮乏和社会弱势的老年人进行测试；2) 检查个人和社会决定因素 影响资源匮乏和社会弱势老年人接受 COVID-19 诊断的健康状况 波多黎各和 3) 将系统政策审查的结果与关键信息提供者（目标 1：定性）和老年人结合起来 个人（目标 2：定量和定性）来识别挑战、障碍以及有效的策略和语言 支持并改善该弱势群体的 COVID-19 检测和其他相关健康结果。 包括 PR-CARE 在内的参与研究将致力于扩大 COVID-19 的范围、影响范围、获取和吸收 同时，它将为波多黎各的弱势老年人口进行测试，并建立永久性的途径。 提高弱势群体获得卫生服务的机会、促进健康公平的卫生政策 社会、道德和行为影响的镜头。