Impact of a Community Care Intervention to Address Inequities in COVID-19 and Influenza Vaccination Among Adults Suffering from Disproportionate Chronic Disease

社区护理干预措施对解决患有不成比例慢性病的成年人中 COVID-19 和流感疫苗接种不公平问题的影响

• 批准号: 10419818
• 负责人: Marielena Lara
• 金额: $ 76.69万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-18 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10419818
• 关键词: Address; Adult; Affect; Anxiety Disorders; Asthma; Attitude; Awareness; Behavior; Behavior Therapy; Behavioral; Behavioral Model; COVID-19; COVID-19 vaccination; COVID-19 vaccine; Caring; Case Management; Characteristics; Chronic; Chronic Disease; Clinical; Color; Communicable Diseases; Communities; Community Health Aides; Conscious; Data; Decision Making; Diabetes Mellitus; Education; Educational Materials; Effectiveness of Interventions; Emotional; Equilibrium; Ethnic Origin; Ethnic group; Exhibits; Federally Qualified Health Center; Goals; Habits; Health; Health Services Accessibility; Hypertension; Individual; Influenza; Influenza vaccination; Information Dissemination; Intention; Intervention; Interview; Knowledge; Language; Link; Measures; Mediating; Mediator of activation protein; Medical; Mental Depression; Mental disorders; Methods; Modeling; Modification; Motivation; New Jersey; New York City; Not Hispanic or Latino; Obesity; Participant; Patient Representative; Patient-Focused Outcomes; Patients; Physical Capacity; Physical environment; Population; Population Heterogeneity; Post-Traumatic Stress Disorders; Poverty; Primary Health Care; Psyche structure; Race; Randomized; Randomized Controlled Trials; Research; Resources; Risk; Risk Assessment; Role; Social Environment; Structural Racism; System; Techniques; Telephone; Time; Treatment Efficacy; Treatment outcome; Trust; Uninsured; Vaccinated; Vaccination; Vulnerable Populations; World Health Organization; base; behavior change; bilingualism; community based participatory research; community engagement; community organizations; comparison intervention; contextual factors; design; effective intervention; efficacy testing; ethnic minority; ethnic minority population; evidence base; experience; follow-up; formative assessment; health care service; healthcare community; improved; intervention effect; literacy; meetings; multi-component intervention; poor communities; population based; primary outcome; psychoeducational; psychologic; racial and ethnic; racial minority; response; risk perception; secondary outcome; skills; social; social health determinants; social norm; transmission process; treatment as usual; uptake; vaccine acceptance; vaccine access; vaccine hesitancy

Racial and ethnic minorities with chronic illness suffer disproportionately from infectious diseases. Analysis of COVID-19 and influenza data suggest multiple determinants of vaccination inequities among non-Hispanic whites and other racial/ethnic groups. These include manifestations of structural racism such as poor access to care and lack of cultural, language, and literacy-appropriate factual information to promote awareness of and motivation to partake in protective vaccination behaviors. Integrated within health and community systems alike, community health worker (CHW) interventions are an effective strategy to simultaneously address structural and social determinants of health in multiple settings. Building on a long-standing partnership between RAND, Clinical Directors Network (CDN), and local community groups and leaders, we propose a study to tailor, implement and evaluate a community health worker (CHW intervention) to increase vaccination acceptance and vaccination rates for COVID-19 (primary outcome) and influenza (secondary outcome) among individuals with chronic illness who receive their primary care in Federally Qualified Health Centers (FQHCs). Tailoring of the CHW intervention will be grounded on the Capability, Opportunity, Motivation, Behavior (COM-B) theoretical behavioral model and in partnership with a Community Advisory Board (CAB) composed of patients and representatives from local community organizations. We propose a randomized controlled trial (RCT) to determine the efficacy of the CHW-VB (Community Health Worker Intervention to enhance Vaccination Behaviors) intervention to improve vaccine acceptance, uptake, and implementation among racial/ethnic minority adults with any of 7 chronic conditions (asthma, diabetes, hypertension, obesity, depression, anxiety disorder, or PTSD). The study has 4 aims over 5 years: 1) tailor the CHW intervention based on formative research (Aim 1: Year 1); 2) conduct the RCT to test the efficacy of CHW-VB (Aim 2: Years 2-4); 3) understand the effects of CHW-VB and examine measures of capability, motivation, and opportunity as mediators and demographic characteristics and chronic medical/mental conditions as moderators (Aim 3: Years 3-4); and, 5) assess contextual factors affecting implementation and sustainability (Aim 4: Year 5). Our community-based participatory research approach is anchored in partnership with the CAB in all stages of the research, through regular meetings for the formative assessment, co-designing the adaptation of the intervention, troubleshooting any implementation hurdles, and actively participating in the interpretation and dissemination of the results. FHQCs employ CHWs as part of the lifeline of health care services delivered to mostly non-white and under/uninsured patients with chronic illnesses. Community engagement is also a core value for FQHCs who are governed by individuals and community-based agencies from the impoverished communities they serve. The CHW-VB intervention, if efficacious, has a high potential for scalability and sustainability in this setting.

患有慢性病的少数种族和族裔尤其容易患传染病。分析 COVID-19 和流感数据表明非西班牙裔疫苗接种不平等的多个决定因素 白人和其他种族/族裔群体。其中包括结构性种族主义的表现，例如难以获得 关心和缺乏与文化、语言和识字能力相适应的事实信息，以提高人们的认识和 参与保护性疫苗接种行为的动机。融入卫生和社区系统 同样，社区卫生工作者 (CHW) 干预措施是同时解决问题的有效策略 多种环境下健康的结构和社会决定因素。 建立在兰德、临床主任网络 (CDN) 和当地之间的长期合作伙伴关系的基础上 社区团体和领导人，我们提出一项研究来定制、实施和评估社区健康 工作人员（CHW 干预）提高 COVID-19 疫苗接种接受度和疫苗接种率（初级 接受主要治疗的慢性病患者中的流感（次要结果）和流感（次要结果） 联邦合格健康中心 (FQHC) 的护理。社区卫生工作者干预措施的定制将基于 能力、机会、动机、行为 (COM-B) 理论行为模型并与 社区咨询委员会 (CAB) 由患者和当地社区代表组成 组织。我们提出一项随机对照试验 (RCT) 来确定 CHW-VB 的功效 （社区卫生工作者干预以增强疫苗接种行为）干预以改善 患有 7 种慢性病中任何一种的少数种族/族裔成年人对疫苗的接受、采用和实施 疾病（哮喘、糖尿病、高血压、肥胖、抑郁、焦虑症或创伤后应激障碍）。 该研究在 5 年内有 4 个目标：1）根据形成性研究定制社区卫生工作者干预措施（目标 1： 第一年）； 2) 进行随机对照试验以测试 CHW-VB 的功效（目标 2：第 2-4 年）； 3）了解影响 CHW-VB 并检查作为中介者和人口统计的能力、动机和机会的衡量标准 特征和慢性医疗/精神状况作为调节因素（目标 3：3-4 年）；以及，5) 评估 影响实施和可持续性的背景因素（目标 4：第 5 年）。我们以社区为基础 参与式研究方法在研究的各个阶段都与 CAB 合作，通过 定期举行形成性评估会议、共同设计干预措施的调整、故障排除 任何实施障碍，并积极参与结果的解释和传播。 FHQC 使用 CHW 作为向大多数非白人和白人提供医疗保健服务的生命线的一部分 患有慢性疾病的未投保/未投保的患者。社区参与也是 FQHC 的核心价值， 由来自其所服务的贫困社区的个人和社区机构进行管理。 CHW-VB 干预如果有效，则在这种情况下具有很大的可扩展性和可持续性潜力。